Abstract
Objective
To determine if nursing home (NH) resident characteristics associated with potentially
preventable emergency department transfers (PPEDs) are similarly associated with non–potentially
preventable emergency department transfers (non-PPEDs).
Design
We conducted a population-level retrospective cohort study using linked administrative
data reported using the Resident Assessment Instrument–Minimum Data Set Version 2.0
and the National Ambulatory Care Reporting System for emergency department transfers.
Setting and Participants
We assessed all NH residents transferred to the emergency department within 92 days
after admission. The cohort included 56,433 NH resident admissions assessment of which
3498 NH residents experienced PPEDs, and 9331 residents experienced non-PPEDs.
Methods
We assessed Ontario NH residents admission assessments collected between January 1,
2017, and December 31, 2018. We used cumulative incidence functions and Cox regression
to compare resident characteristics between residents experiencing PPEDs and non-PPEDs.
PPEDs were defined based on the International Classification of Diseases, 10th Revision.
Results
Approximately 23% of residents experienced an emergency department transfer within
92 days of NH admission. The cumulative incidence of PPEDs was 6.3% and non-PPEDs
was 16.8%. After adjusting for clinically relevant features, 14 of 18 resident admission
characteristics were associated with both types of transfers. Resident admission characteristics
associated with a greater risk of PPEDs solely were pneumonia [hazard ratio (HR) 1.48;
CI 1.25–1.70] and oxygen therapy (HR 1.88; CI 1.69–2.10). Resident admission characteristics
associated with a greater risk of non-PPEDs solely are experiencing a change in mood
(HR 1.09; CI 1.01–1.18) and delirium (HR 1.08; CI 1.04–1.13).
Conclusions and Implications
PPEDs were associated with a similar cluster of NH resident characteristics as those
transferred for non-ambulatory reasons, suggesting that the clinical distinction between
PPEDs vs non-PPEDs within the NH might be unclear. These findings highlight that the
PPED indicator could be revised to improve specificity.
Keywords
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Article Info
Publication History
Published online: November 12, 2022
Publication stage
In Press Corrected ProofFootnotes
This research was supported by the Schlegel Chair in Clinical Epidemiology and Aging at McMaster University .
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
