Kim Seonji, Ko Sung-Keun, Lee Tae Young, Lee Jin-Hee
Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
National Emergency Medical Center, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, South Korea.
Intern Emerg Med. 2023 Jan;18(1):169-176. doi: 10.1007/s11739-022-03146-y. Epub 2022 Nov 4.
Multiple chronic disorders and disabilities among older patients in long term care hospitals (LTCH) tends to increase the healthcare burden by causing overcrowding, particularly in emergency departments. Therefore, access to timely and adequate healthcare for LTCH patients is an increasingly important issue, and potentially avoidable hospitalizations (PAHs) and hospitalizations during non-office hours can result as indicators of emergency department overcrowding. The study aimed to evaluate PAHs and hospitalizations during non-office hours in emergency departments for older patients transferred from LTCH compared to patients living at home. We performed a cross-sectional study using the National Emergency Department Information System database from January 2018 to December 2019, in South Korea, with older patients (≥ 65 years) who visited nationwide emergency departments. Adjusted odds ratio (aOR) and 95% confidence interval (CI) for indicators of overcrowding as PAHs and hospitalizations during non-office hours were calculated by logistic regression. Among the 2,177,663 older patients who visited the emergency departments, 98,434 patients were living in LTCH and 2,079,229 patients were living at home. The older patients living in LTCH was associated with PAHs (aOR: 1.90, 95% CI 1.87-1.94) and hospitalizations during non-office hours (aOR: 1.76, 95% CI 1.73-1.78). LTCH patients showed more hospital visits, extended stay in the emergency department, greater prevalence of chronic diseases, greater rates of transfer as well as higher admission rates and mortality as compared to the patients living at home. The LTCH older patients were associated with the indicators of emergency department overcrowding, which impacts health care quality in hospitals. Introduction of policy and training programs for LTCH staff are recommended to manage vulnerable groups in advance.
长期护理医院（LTCH）中老年患者的多种慢性疾病和残疾往往会因过度拥挤而增加医疗负担，尤其是在急诊科。因此，为LTCH患者提供及时、充分的医疗服务是一个日益重要的问题，而潜在可避免住院（PAH）和非办公时间住院可作为急诊科过度拥挤的指标。本研究旨在评估与居家患者相比，从LTCH转诊的老年患者在急诊科的PAH和非办公时间住院情况。我们使用韩国2018年1月至2019年12月的国家急诊科信息系统数据库进行了一项横断面研究，研究对象为全国急诊科就诊的老年患者（≥65岁）。通过逻辑回归计算PAH和非办公时间住院等过度拥挤指标的调整优势比（aOR）和95%置信区间（CI）。在2177663名就诊急诊科的老年患者中，98434名患者住在LTCH，2079229名患者居家。住在LTCH的老年患者与PAH（aOR：1.90，95%CI 1.87-1.94）和非办公时间住院（aOR：1.76，95%CI 1.73-1.78）相关。与居家患者相比，LTCH患者就诊次数更多、在急诊科停留时间更长、慢性病患病率更高、转诊率更高以及住院率和死亡率更高。LTCH老年患者与急诊科过度拥挤指标相关，这会影响医院的医疗质量。建议为LTCH工作人员引入政策和培训项目，以便提前管理弱势群体。
