Department of Public Health Sciences and Pediatrics, Università di Torino, Via Santena 5 bis, 10126, Torino, Italy.
Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy.
BMC Geriatr. 2022 May 12;22(1):418. doi: 10.1186/s12877-022-03078-4.
Emergency department (ED) use among nursing home (NH) residents is an internationally-shared issue that is understudied in Italy. The long term care in Italy is part of the health system. This study aimed to assess trajectories of ED use among NH residents and determinants between demographic, health supply, clinical/functional factors.
A pooled, cross-sectional, time series analysis was performed in an Italian region in 2012/2019. The analysis measured the trend of ED user percentages associated with chronic conditions identified at NH admission. A GLM multivariate model was used to evaluate determinants of ED use. The variables collected were sex, age, assistance intensity, destination after discharge from NH, chronic conditions at NH admission, need for daily life assistance, degree of mobility, cognitive impairments, behavioural disturbances and were taken from two databases of the official Italian National Information System (FAR and C2 registries) that were combined to create a unique and anonymous code for each patient.
A total of 37,311 residents were enrolled; 55.75% (20,800 residents) had at least one ED visit. The majority of the residents had cardiovascular (25.99%) or mental diseases (24.37%). In all pathologies, the percentage of ED users decreased and the decrease accelerated over time. These results were confirmed in the fixed effects regression model (coefficient for linear term (b = - 3.6177, p = 0, 95% CI = [- 5.124, - 2.1114]); coefficient for quadratic term = - 0.7691, p = 0.0046, 95% CI = [- 1.2953, - 0.2429]). Analysis showed an increased odds of ED visits involving males (OR = 1.27, 95% CI 1.24;1.30) and patients affected by urogenital diseases (OR = 1.16, 95% CI [1.031-1.314]). The lowest odds of ED visits were observed among subjects aged > 90 years (OR = 0.64, 95% CI [0.60-0.67]), who required assistance for their daily life activities (OR = 0.86; 95% CI = [0.82, 0.91]), or with serious cognitive disturbances (OR = 0.86; 95% CI = [0.84, 0.89]), immobile (OR = 0.93; 95% CI = [0.89, 0.96]), or without behavioural disturbances (OR = 0.92; 95% CI = [0.90, 0.94]).
The percentage of ED users has decreased, through support from the Italian disciplinary long-term care system. The demographic, clinical/functional variables associated with ED visits in this study will be helpful to develop targeted and tailored interventions to avoid unnecessary ED use.
养老院（NH）居民在急诊部（ED）的使用是一个国际上共同存在的问题，在意大利研究较少。意大利的长期护理是卫生系统的一部分。本研究旨在评估 NH 居民 ED 使用的轨迹及其在人口统计学、卫生供应、临床/功能因素方面的决定因素。
在 2012/2019 年，对意大利一个地区进行了一项 pooled、cross-sectional、time series 分析。该分析测量了与 NH 入院时确定的慢性疾病相关的 ED 用户百分比的趋势。使用多变量 GLM 模型评估 ED 使用的决定因素。收集的变量包括性别、年龄、辅助强度、NH 出院后的去向、NH 入院时的慢性疾病、日常生活辅助需求、移动程度、认知障碍、行为障碍，这些变量来自意大利官方国家信息系统（FAR 和 C2 登记处）的两个数据库，这些数据库被合并为每个患者的唯一和匿名代码。
共纳入 37311 名居民；55.75%（20800 名居民）至少有一次 ED 就诊。大多数居民患有心血管疾病（25.99%）或精神疾病（24.37%）。在所有疾病中，ED 用户的比例下降，且随着时间的推移下降速度加快。这些结果在固定效应回归模型中得到了证实（线性项系数（b=-3.6177，p=0，95%CI=-5.124，-2.1114）；二次项系数=-0.7691，p=0.0046，95%CI=-1.2953，-0.2429）。分析表明，男性（OR=1.27，95%CI 1.24；1.30）和患有泌尿生殖系统疾病的患者（OR=1.16，95%CI [1.031-1.314]）ED 就诊的可能性增加。年龄>90 岁（OR=0.64，95%CI [0.60-0.67]）、需要日常生活活动辅助（OR=0.86；95%CI [0.82，0.91]）、认知严重障碍（OR=0.86；95%CI [0.84，0.89]）、行动不便（OR=0.93；95%CI [0.89，0.96]）或无行为障碍（OR=0.92；95%CI [0.90，0.94]）的患者 ED 就诊的可能性最低。
通过意大利专科长期护理系统的支持，ED 用户的比例有所下降。本研究中与 ED 就诊相关的人口统计学、临床/功能变量将有助于制定有针对性和定制的干预措施，以避免不必要的 ED 使用。
