Nursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers |
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| Institution: | 1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;2. ICES, Toronto, Ontario, Canada;3. Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada;4. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada;5. Trillium Health Partners, Toronto, Ontario, Canada;6. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada;7. Bruyère Research Institute, Ottawa, Ontario, Canada;8. Departments of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada;1. School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia;2. Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia;3. Medical School, The University of Western Australia, Crawley, Western Australia, Australia;4. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia;5. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia;6. Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia;1. Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA;2. Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA;4. Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA;5. Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA;1. Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland;2. Balgrist University Hospital, Department of Neurology and Neurophysiology, Zurich, and University of Zurich, Zurich, Switzerland;3. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA;4. Department of Gastroenterology, University Hospital Zurich and University of Zurich, Zurich, Switzerland;5. Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland;6. University of Zurich, University Hospital Zurich, Center of Clinical Nursing Science, Switzerland;7. Marcus Institute of Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, MA, USA;1. Department of Emergency Medicine, Washington University in St Louis School of Medicine, Emergency Care Research Core, St Louis, MO, USA;2. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;3. BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA;4. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA;1. Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia;2. Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia |
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| Abstract: | ObjectivesTo determine which nursing home (NH) resident-level admission characteristics are associated with potentially preventable emergency department (PPED) transfers.DesignWe conducted a population-level retrospective cohort study on NH resident data collected using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and linked to the National Ambulatory Care Reporting System for ED transfers.SettingWe used all NH resident admission assessments from January 1, 2017, to December 31, 2018, in Ontario.ParticipantsThe cohort included the admission assessment of 56,433 NH residents.MethodsPPED transfers were defined based on the International Classification of Disease, Version 10 (Canadian) We used logistic regression with 10-fold cross-validation and computed average marginal effects to identify the association between resident characteristics at NH admission and PPED transfers within 92 days after admission.ResultsOverall, 6.2% of residents had at least 1 PPED transfer within 92 days of NH admission. After adjustment, variables that had a prevalence of 10% or more that were associated with a 1% or more absolute increase in the risk of a PPED transfer included polypharmacy of cohort (OC) 84.4%, risk difference (RD) 2.0%], congestive heart failure (OC 29.0%, RD 3.0%), and renal failure (OC 11.6%, RD 1.2%). Female sex (OC 63.2%, RD -1.3%), a do not hospitalize directive (OC 24.4%, RD -2.6%), change in mood (OC 66.9%, RD -1.2%), and Alzheimer's or dementia (OC 62.1%, RD -1.2%) were more than 10% prevalent and associated with a 1% or more absolute decrease in the risk of a PPED.Conclusions and ImplicationsThough many routinely collected resident characteristics were associated with a PPED transfer, the absence of sufficiently discriminating characteristics suggests that emergency department visits by NH residents are multifactorial and difficult to predict. Future studies should assess the clinical utility of risk factor identification to prevent transfers. |
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| Keywords: | Long-term care nursing home older adults emergency department cohort study |
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