Gérontopôle, Toulouse University Hospital, Toulouse, France; INSERM, UMR 1027, Toulouse, France.
Gérontopôle, Toulouse University Hospital, Toulouse, France; CREAI-ORS Occitanie, Toulouse, France.
J Am Med Dir Assoc. 2021 Dec;22(12):2579-2586.e7. doi: 10.1016/j.jamda.2021.04.002. Epub 2021 May 5.
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.
Multicenter, observational, case-control study.
17 hospitals in France, 1037 NH residents.
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.
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.
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.
clinicaltrials.gov, NCT02677272.
确定与养老院（NH）居民潜在不适当转移至急诊部（ED）相关的因素，并比较经不适当和适当处理的个体转移前后的住院费用。
多中心、观察性、病例对照研究。
法国 17 家医院，1037 名 NH 居民。
法国南部 17 家公立医院 ED 每周系统纳入所有 NH 居民进行 1 周的转移。由家庭医生、急诊医生、老年病学家和药剂师组成的专家小组定义转移是否为潜在不适当。将居民和 NH 的特征和背景因素纳入混合逻辑回归，以确定与潜在不适当转移独立相关的因素。在转移前后的 6 个月内，从国家健康保险索赔数据库中收集医院费用。
共有 1037 名 NH 居民（平均年龄 87.2±7.1 岁，68%为女性）转至 ED；220 例（21%）转移被认为是潜在不适当的。调整后，食欲减退（比值比[OR]2.41，95%置信区间[CI]1.57-3.71）、高残疾程度（OR 0.90，95% CI 0.81-0.99）和无法及时获得医疗建议（OR 1.67，95% CI 1.20-2.32）与潜在不适当转移的可能性增加显著相关。NH 中存在老年痴呆症特殊护理病房（OR 0.66，95% CI 0.48-0.92）、NH 工作人员接受过预先指示培训（OR 0.61，95% CI 0.41-0.89）和呼叫 SAMU（移动急救医疗单位）（OR 0.47，95% CI 0.34-0.66）与潜在不适当转移的可能性降低显著相关。尽管与适当转移相比，潜在不适当转移的 6 个月住院费用更高（分别为€6694 和€4894），但转移适当性与住院费用无显著相关性。
NH 向医院 ED 的转移通常是适当的。转移的适当性取决于 NH 工作人员的培训、获得专家医疗建议的机会以及在做出转移决定前呼叫 SAMU。
clinicaltrials.gov，NCT02677272。
