Abstract
Objectives
Little is known about emergency department (ED) utilization among the nearly 1 million
older adults residing in assisted living (AL) settings. Unlike federally regulated
nursing homes, states create and enforce AL regulations with great variability, which
may affect the quality of care provided. The objective of this study was to examine
state variability in all-cause and injury-related ED use among residents in AL.
Design
Observational retrospective cohort study.
Setting and Participants
We identified a cohort of 293,336 traditional Medicare beneficiaries residing in larger
AL communities (25+ beds).
Methods
With Medicare enrollment and claims data, we identified ED visits and classified those
because of injury. We present rates of all-cause and injury-related ED use per 100
person-years in AL, by state, adjusting for age, sex, race, dual-eligibility, and
chronic conditions.
Results
Risk-adjusted state rates of all-cause ED visits ranged from 100.9 visits/100 AL person-years
[95% confidence interval (CI) 92.8, 109.9] in New Mexico to 162.3 visits/100 AL person-years
(95% CI 154.0, 174.7) in Rhode Island. The risk-adjusted rate of injury-related ED
visits ranged from 18.7 visits/100 AL person-years (95% CI 17.2, 20.3) in New Mexico
to 35.7 visits/100 AL person-years (95% CI 34.7, 36.8) in North Carolina.
Conclusions and Implications
We observed significant variability among states in all-cause and injury-related ED
use among AL residents. There is an urgent need to better understand why this variability
is occurring to prevent avoidable visits to the ED.
Keywords
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Article info
Publication history
Published online: July 06, 2020
Footnotes
This work was supported by research awards from the National Institute on Aging (R01 AG057746), the Veterans Health Administration (CDA 14-422) and the AHRQ T32 training grant (T32HS000011).
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Institutes of Health, or the United States government.
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