Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada.
Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA.
J Am Med Dir Assoc. 2023 Sep;24(9):1341-1348. doi: 10.1016/j.jamda.2023.06.024. Epub 2023 Aug 4.
We examine annual rates of emergency department (ED) visits, hospital admissions, and alternate levels of care (ALC) days (ie, the number of days that an older adult remained in hospital when they could not be safely discharged to an appropriate setting in their community) among older adults.
Repeated cross-sectional study.
Linked, individual-level health system administrative data on community-dwelling persons, home care recipients, residents of assisted living facilities, and residents of nursing homes aged 65 years and older in Ontario, Canada, from January 1, 2013, to December 31, 2019.
We calculated rates of ED visits, hospital admissions, and ALC days per 1000 individuals per older adult population per year. We used a generalized linear model with a gaussian distribution, log link, and year fixed effects to obtain rate ratios.
There were 1,655,656 older adults in the community, 237,574 home care recipients, 42,600 older adults in assisted living facilities, and 94,055 older adults in nursing homes in 2013; there were 2,129,690 older adults in the community, 281,028 home care recipients, 56,975 older adults in assisted living facilities, and 95,925 older adults in nursing homes in 2019. Residents of assisted living facilities had the highest rates of ED visits (1260.69 vs 1174.91), hospital admissions (482.63 vs 480.19), and ALC days (1905.57 vs 1443.03) per 1000 individuals. Residents of assisted living facilities also had significantly higher rates of ED visits [rate ratio (RR) 3.30, 95% CI 3.20, 3.41), hospital admissions (RR 6.24, 95% CI 6.01, 6.47), and ALC days (RR 25.68, 95% CI 23.27, 28.35) relative to community-dwelling older adults.
The disproportionate use of ED visits, hospital admissions, and ALC days among residents of assisted living facilities may be attributed to the characteristics of the population and fragmented licensing and regulation of the sector, including variable models of care. The implementation of interdisciplinary, after-hours, team-based approaches to home and primary care in assisted living facilities may reduce the potentially avoidable use of ED visits, hospital admissions, and ALC days among this population and optimize resource allocation in health care systems.
我们研究了老年人每年急诊就诊、住院和替代护理水平（ALC）天数（即老年人在社区中无法安全出院到适当环境时留在医院的天数）的发生率。
重复横断面研究。
来自加拿大安大略省的社区居住者、家庭护理接受者、辅助生活设施居民和养老院居民的个人层面健康系统行政数据，年龄为 65 岁及以上，链接数据，2013 年 1 月 1 日至 2019 年 12 月 31 日。
我们计算了每 1000 名老年人中急诊就诊、住院和 ALC 天数的发生率。我们使用具有正态分布、对数链接和年份固定效应的广义线性模型来获得比率比。
2013 年社区有 1655656 名老年人、237574 名家庭护理接受者、42600 名辅助生活设施老年人和 94055 名养老院老年人；2019 年社区有 2129690 名老年人、281028 名家庭护理接受者、56975 名辅助生活设施老年人和 95925 名养老院老年人。辅助生活设施的居民急诊就诊率最高（1260.69 比 1174.91）、住院率（482.63 比 480.19）和 ALC 天数（1905.57 比 1443.03）每 1000 人。辅助生活设施的居民急诊就诊率（RR 3.30，95%CI 3.20，3.41）、住院率（RR 6.24，95%CI 6.01，6.47）和 ALC 天数（RR 25.68，95%CI 23.27，28.35）显著高于社区居住的老年人。
辅助生活设施居民急诊就诊、住院和 ALC 天数的不成比例使用可能归因于该人群的特征和该部门分散的许可和监管，包括可变的护理模式。在辅助生活设施中实施家庭和初级保健的跨学科、非工作时间、团队为基础的方法可能会减少该人群中潜在可避免的急诊就诊、住院和 ALC 天数的使用，并优化医疗保健系统中的资源分配。
