Emergency Department Utilization by Noninstitutionalized Elders

Shah, Manish N.; Rathouz, Paul J.; Chin, Mph Marshall H.

doi:10.1111/j.1553-2712.2001.tb01303.x

Cited by 56 publications

(63 citation statements)

References 33 publications

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“…Die Inanspruchnahme stationärer Versorgungsleistungen durch ältere multimorbide Patienten wurde größtenteils anhand folgender Endpunkte untersucht: Zahl der Krankenhauseinweisungen [17,20,21,22,23,24,25], der Tage oder Näch-te im Krankenhaus [16,21,22] und der Notaufnahmen [26,27,28,29] innerhalb eines Jahres sowie der ungeplanten Wiedereinweisungen innerhalb eines Monats oder Jahres [30,31,32]. Die gesamte Evidenz entstammt der ausländischen Literatur.…”

Section: Stationäre Versorgungunclassified

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Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten

Lehnert

König

2012

Bundesgesundheitsbl.

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Multiple chronic conditions (multimorbidity) are common among elderly patients; however, little is known about the specific effects of multimorbidity on health care utilization and health care costs. This article reviews empirical studies from the international literature that investigated the relationship between multiple chronic conditions and health care utilization (e.g. ambulatory care, stationary care, pharmacotherapy) and/or health care costs in elderly general populations. Although synthesis of studies was complicated, especially because of ambiguous definitions and measurements of multimorbidity, almost all studies observed a positive association of multimorbidity and utilization and costs. Many studies found that utilization and costs significantly increased with each additional chronic condition. In light of these findings coupled with the fear that current care arrangements may be inappropriate for many multimorbid patients, important implications for research and policy are presented and discussed.

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Section: Stationäre Versorgungunclassified

“…2). In einer ebenfalls mit administrativen Daten durchgeführten schwedischen Studie [23] hatten Patienten mit drei oder mehr Krankenhauseinweisungen signifikant mehr chronische Erkrankungen (3,45) [30,31,32] oder Notaufnahmen im Allgemeinen [26,27,28,29] betrachtet haben, diesbezüglich einen signifikanten positiven Zusammenhang.…”

Section: Stationäre Versorgungunclassified

Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten

Lehnert

König

2012

Bundesgesundheitsbl.

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“…Although studies in emergency medicine have only occasionally used the Andersen and Newman model, it provides an excellent conceptual model to frame analyses of health services utilization. [11][12][13] This study had two major aims: 1) to characterize the reasons for EMS use by non-institutionalized elder patients who present to an academic urban hospital ED, and 2) to identify predictors, particularly potentially modifiable predictors, associated with EMS utilization by non-institutionalized elder patients.…”

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confidence: 99%

Predictors of Emergency Medical Services Utilization by Elders

Shah

2003

Academic Emergency Medicine

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Objective: Elders (age Ն 65 years) frequently use emergency medical services (EMS) for care. Understanding reasons for EMS use by elders may allow better management of EMS demand. To the best of the authors' knowledge, no studies have identified patient characteristics associated with EMS use by elders. This study aimed to identify patient attributes associated with elder EMS users. Methods: This was a prospective cohort study of non-institutionalized elders presenting to an urban university hospital emergency department. Nine hundred thirty elder patients completed the survey. The authors asked patients about access to care, health beliefs, and reasons for requesting EMS assistance. Univariate and logistic regression were used to identify predictors of EMS use. Results: The sample had a mean age of 76 years; 37% were male; 79% were African American. Thirty percent arrived via EMS. Sixty-five percent of those transported and 46% of those not transported by EMS were admitted to the hospital (p < 0.001). Reported reasons for using EMS transport included immobility (33%), illness (22%), request by others (21%), instruction from health care providers (10%), and lack of transportation (10%). Logistic regression identified symptom onset within four hours of seeking care (OR = 3.1), age Ն 85 years (OR = 1.63), increased deficiencies in activities of daily living (OR = 1.40 per deficiency), worse physical functioning (OR = 1.14/10 points), and worse social functioning (OR = 1.06/10 points) as factors associated with EMS use. Conclusions: Elders report using EMS because of immobility, perceived medical needs, or requests by others. Similarly, the presence of acute illness symptoms, older age, and poor social and physical function, rather than health beliefs, predict EMS use among elders. These factors must be considered when managing the demand for EMS services. shown that elders access emergency medical services (EMS) care significantly more frequently than younger individuals, with a rate of approximately 70 incidents/1,000 population for the overall population, approximately 100 incidents/1,000 population for individuals aged 65-74 years, and approximately 200 incidents/1,000 population for individuals more than 85 years old.2-5 The combination of the growing elder population and the higher utilization rates will place EMS services in greater demand in the years to come, thus requiring greater expenditures by communities with limited funds.One approach to the problem of increasing EMS volume is to understand and then intervene upon the reasons elder patients access the EMS system. By intervening upon the modifiable factors that stimulate demand for EMS, clinicians, administrators, and public health planners may be able to better manage the demand for EMS services. However, we have not found any studies that performed detailed evaluations of reasons for elder use of EMS. Previous studies examining EMS use by elders have primarily described the epidemiology of injuries in elder patients, 2,6 compared young EMS

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“…Compared with those of younger ages, older people use hospital EDs at higher rates, 1 are more likely to make a return visit, 2 use more resources during a visit, 3 subsequently experience greater functional decline, 4 and have higher rates of utilization of hospital and community health services. 5,6 Nevertheless, there are deficiencies in the quality and continuity of ED services provided to this high-risk population, including failure to recognize and appropriately manage geriatric syndromes, and failure to communicate to the primary physician the problems identified and interventions implemented at the ED visit.…”

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confidence: 99%

Hospital Characteristics and Emergency Department Care of Older Patients Are Associated with Return Visits

McCusker

Ionescu‐Ittu

Ciampi

et al. 2007

Academic Emergency Medicine

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Objectives: To explore hospital characteristics and indicators of emergency department (ED) care of older patients associated with return visits to the ED.Methods: Provincial databases in the province of Quebec, Canada, and a survey of ED geriatric services were linked at the individual and hospital level, respectively. All general acute care adult hospitals with at least 100 eligible patients who visited an ED during 2001 were included (N = 80). The study population (N = 140,379) comprised community-dwelling individuals aged 65 years and older who made an initial ED visit in 2001 and were discharged home. Characteristics of the hospitals included location, number of ED beds, ED resources, and geriatric services in the hospital and the ED. Indicators of ED care at the initial visit included day of the visit, availability of hospital beds, and relative crowding. The main outcome was time to first return ED visit; the authors also analyzed the type of return visit (with or without hospital admission at return visit, and return visits within seven days).Results: In multilevel multivariate analyses adjusting for patient characteristics (sociodemographic, ED diagnosis, comorbidity, prior health services utilization), the following variables were independently associated (p < 0.05) with a shorter time to first return ED visit: more limited ED resources, fewer than 12 ED beds, no geriatric unit, no social worker in the ED, fewer available hospital beds at the time of the ED visit, and an ED visit on a weekend. use more resources during a visit, 3 subsequently experience greater functional decline, 4 and have higher rates of utilization of hospital and community health services. 5,6 Nevertheless, there are deficiencies in the quality and continuity of ED services provided to this high-risk population, including failure to recognize and appropriately manage geriatric syndromes, and failure to communicate to the primary physician the problems identified and interventions implemented at the ED visit.7-9 These deficiencies in care may contribute to the higher rates of return visits and other adverse outcomes.Descriptive studies indicate that early return visits (variously defined) are more often due to the same unresolved problem than later return visits [7][8][9] and that many

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Emergency Department Utilization by Noninstitutionalized Elders

Cited by 56 publications

References 33 publications

Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten

Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten

Predictors of Emergency Medical Services Utilization by Elders

Hospital Characteristics and Emergency Department Care of Older Patients Are Associated with Return Visits

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