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Original Study| Volume 21, ISSUE 4, P469-475.e1, April 2020

Physician Availability in Long-Term Care and Resident Hospital Transfer: A Retrospective Cohort Study

  • Daniel M. Kobewka
    Correspondence
    Address correspondence to Daniel M. Kobewka, MD, MSc, Department of Medicine, Division of General Internal Medicine, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada.
    Affiliations
    Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada

    The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada

    University of Ottawa, School of Epidemiology & Public Health, Ottawa, Ontario, Canada
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  • Elizabeth Kunkel
    Affiliations
    Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
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  • Amy Hsu
    Affiliations
    Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada

    Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada
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  • Robert Talarico
    Affiliations
    ICES uOttawa, Ottawa, Ontario, Canada
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  • Peter Tanuseputro
    Affiliations
    Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada

    The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada

    University of Ottawa, School of Epidemiology & Public Health, Ottawa, Ontario, Canada

    Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada

    ICES uOttawa, Ottawa, Ontario, Canada
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Published:August 05, 2019DOI:https://doi.org/10.1016/j.jamda.2019.06.004

      Abstract

      Objectives

      To investigate whether same-day physician access in long-term care homes reduces resident emergency department (ED) visits and hospitalizations.

      Design

      Retrospective cohort study.

      Setting and participants

      161 long-term care homes in Ontario, Canada, and 20,624 residents living in those homes.

      Methods

      We administered a survey to Ontario long-term care homes from March to May 2017 to collect their typical wait time for a physician visit. We linked the survey to administrative databases to capture other long-term care home characteristics, resident characteristics, hospitalizations, and ED visits. We defined a cohort of residents living in survey-respondent homes between January and May 2017 and followed each resident for 6 months or until discharge or death.
      We estimated negative binomial regression models on counts of hospitalizations and ED visits with random intercepts for long-term care homes. We controlled for residents' sociodemographic and illness characteristics, long-term care home size, chain status, rurality, and nurse practitioner access.

      Results

      Fifty-two homes (32%) reported same-day physician access. Among residents of homes with same-day physician access, 9% had a hospitalization and 20% had an ED visit during follow-up. In contrast, among residents in homes without same-day access, 12% were hospitalized and 22% visited an ED.
      The adjusted hospitalization and ED rates among residents of homes with same-day physician access were 21% lower (rate ratio = 0.79, P = .02) and 14% lower (rate ratio = 0.86, P = .07), respectively, than residents of other homes. We estimate that nearly 1 in 6 resident hospitalizations could be prevented if all long-term care homes had same-day physician access.

      Conclusions and implications

      Residents of long-term care homes with same-day physician access experience lower hospitalization and ED visit rates than residents in homes that wait longer for physicians, even after adjusting for important resident and home characteristics. Improved on-demand access to physicians has the potential to reduce hospital transfer rates.

      Keywords

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