Abstract
Objectives
To determine the factors associated with the potentially inappropriate transfer of
nursing home (NH) residents to emergency departments (EDs) and to compare hospitalization
costs before and after transfer of individuals addressed inappropriately vs those
addressed appropriately.
Design
Multicenter, observational, case-control study.
Setting and Participants
17 hospitals in France, 1037 NH residents.
Measures
All NH residents transferred to the 17 public hospitals' EDs in southern France were
systematically included for 1 week per season. An expert panel composed of family
physicians, emergency physicians, geriatricians, and pharmacists defined whether the
transfer was potentially inappropriate or appropriate. Residents' and NHs' characteristics
and contextual factors were entered into a mixed logistic regression to determine
factors associated independently with potentially inappropriate transfers. Hospital
costs were collected in the national health insurance claims database for the 6 months
before and after the transfer.
Results
A total of 1037 NH residents (mean age 87.2 ± 7.1, 68% female) were transferred to
the ED; 220 (21%) transfers were considered potentially inappropriate. After adjustment,
anorexia [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.57-3.71], high level
of disability (OR 0.90, 95% CI 0.81-0.99), and inability to receive prompt medical
advice (OR 1.67, 95% CI 1.20-2.32) were significantly associated with increased likelihood
of potentially inappropriate transfers. The existence of an Alzheimer's disease special
care unit in the NH (OR 0.66, 95% CI 0.48-0.92), NH staff trained on advance directives
(OR 0.61, 95% CI 0.41-0.89), and calling the SAMU (mobile emergency medical unit)
(OR 0.47, 95% CI 0.34-0.66) were significantly associated with a lower probability
of potentially inappropriate transfer. Although the 6-month hospitalization costs
prior to transfer were higher among potentially inappropriate transfers compared with
appropriate transfers (€6694 and €4894, respectively), transfer appropriateness was
not significantly associated with hospital costs.
Conclusions and Implications
Transfers from NHs to hospital EDs were frequently appropriate. Transfer appropriateness
was conditioned by NH staff training, access to specialists’ medical advice, and calling
the SAMU before making transfer decisions.
Trial Registration
clinicaltrials.gov, NCT02677272.
Keywords
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Article info
Publication history
Published online: May 05, 2021
Footnotes
Funding: This study was supported by a grant from the French Ministry of Health (Programme de recherche sur la performance du système de soins; PREPS 2014, 14-0185).
Sponsor's role: The Toulouse University Hospital Center is the sponsor of the FINE study (CHU Toulouse; 15 7464 06) and is responsible of regulatory affairs and contracts with study sites.
All authors declare no conflicts of interest.
Identification
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
