Key result
Hospital inpatient admission within 7 days of ED discharge occurred in 4.6% of visits, with end-stage renal disease (AOR 3.83; 95% CI 2.42-6.08) and heart failure associated with the greatest odds.
Cohort (n=505,315)
Yes
Effect estimate: OR 3.83 (95% CI 2.42-6.08)
In older Medicare beneficiaries discharged from the ED, congestive heart failure and renal disease are strong predictors of hospital admission within 7 days.
HF and ESRD flag high 7-day readmission risk after ED discharge in older adults; hypothesis-generating for targeted follow-up.
OBJECTIVES: To identify predictors of hospital inpatient admission of older Medicare beneficiaries after discharge from the emergency department (ED). DESIGN: Retrospective cohort study. SETTING: Nonfederal California hospitals (n = 284). PARTICIPANTS: Visits of Medicare beneficiaries aged 65 and older discharged from California EDs in 2007 (n = 505,315). MEASUREMENTS: Using the California Office of Statewide Health Planning and Development files, predictors of hospital inpatient admission within 7 days of ED discharge in older adults (≥65) with Medicare were evaluated. RESULTS: Hospital inpatient admissions within 7 days of ED discharge occurred in 23,340 (4.6%) visits and were associated with older age (70-74: adjusted odds ratio (AOR) = 1.12, 95% confidence interval (CI) = 1.07-1.17; 75-79: AOR = 1.18, 95% CI = 1.13-1.23; ≥80: AOR = 1.4, 95% CI = 1.35-1.46), skilled nursing facility use (AOR = 1.82, 95% CI = 1.72-1.94), leaving the ED against medical advice (AOR = 1.82, 95% CI = 1.67-1.98), and the following diagnoses with the highest odds of admission: end-stage renal disease (AOR = 3.83, 95% CI = 2.42-6.08), chronic renal disease (AOR = 3.19, 95% CI = 2.26-4.49), and congestive heart failure (AOR = 3.01, 95% CI = 2.59-3.50). CONCLUSION: Five percent of older Medicare beneficiaries have a hospital inpatient admission after discharge from the ED. Chronic conditions such as renal disease and heart failure were associated with the greatest odds of admission.
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Gabayan et al. (2014) conducted a cohort in Older Medicare beneficiaries discharged from the emergency department (n=505,315). Predictors of admission (e.g., end-stage renal disease, congestive heart failure) was evaluated on Hospital inpatient admission within 7 days of ED discharge (OR 3.83, 95% CI 2.42-6.08). Hospital inpatient admission within 7 days of ED discharge occurred in 4.6% of visits, with end-stage renal disease (AOR 3.83; 95% CI 2.42-6.08) and heart failure associated with the greatest odds.
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