Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
BMJ Open. 2019 Apr 24;9(4):e026881. doi: 10.1136/bmjopen-2018-026881.
This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.
Population-based prospective cohort study.
ED of a large university hospital.
All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).
Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.
A total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71-85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.
Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.
本研究旨在描述在急诊（ED）就诊前使用市立医疗服务与死亡率、再次住院和机构化之间的关系。
基于人群的前瞻性队列研究。
一家大型大学医院的 ED。
在一年内（2013 年 11 月至 2014 年 11 月）首次前往 ED 的来自单一市的所有≥65 岁的医学患者。
根据 ED 就诊前的市立医疗服务情况，将患者分为独立于家庭护理、依赖于家庭护理或居住在护理院。患者在出院后随访 360 天。结果是出院后死亡率、再次住院和机构化。
共纳入 3775 名患者（55%为女性），年龄（中位数（IQR）为 78 岁（71-85））。在基线时，48.9%为独立，34.9%接受家庭护理，16.2%居住在护理院。接受家庭护理或居住在护理院是死亡率、再次住院和机构化的强预测因素。在独立的患者中，64.3%在出院后 360 天内继续保持独立。即使在≥85 岁的患者中，也有 35.4%在 ED 接触后 1 年内独立居住在自己的家中。
在急诊老年患者中，院前市立医疗信息与患者结局密切相关。它有可能被用于对接受 ED 就诊的老年急性病患者进行风险分层和需求规划。
