Glober Nancy, LaShell Alexandra, Montelauro Nicholas, Troyer Lindsay, Supples Michael, Unroe Kathleen, Tainter Christopher, Faris Greg, Fuchita Mikita, Boustani Malaz
Indiana University School of Medicine Indianapolis Indiana USA.
Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem North Carolina USA.
Alzheimers Dement (Amst). 2023 Sep 7;15(3):e12469. doi: 10.1002/dad2.12469. eCollection 2023 Jul-Sep.
Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer's disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics ( < 0.001) or palliative care consult ( = 0.038). They were less likely to be full code at admission ( < 0.001) or to be discharged home ( < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22-2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient-centered outcomes.
老年人经常从一个急诊科(ED)转至另一家医院接受专科护理,但对于这些转院是否对患者,尤其是患有阿尔茨海默病和其他相关痴呆症(ADRD)的患者产生积极影响,人们知之甚少。在本研究中,我们旨在描述院际转院对患有和未患有ADRD的老年人的影响。在对电子病历的回顾性研究中,我们收集了老年人(年龄≥65岁)的人口统计学、保险类型、初始代码状态、重症监护、住院时间、专科会诊、48小时内的手术以及出院处置等数据。我们纳入了至少有一次急诊就诊且被转至三级医院的老年人。通过逻辑回归分析,我们估计了根据ADRD诊断得出的死亡、重症监护住院或48小时内手术的几率。患有ADRD的患者更常接受老年病学(P<0.001)或姑息治疗会诊(P = 0.038)。他们入院时为完全代码状态(P<0.001)或出院回家(P<0.001)的可能性较小。患有ADRD的患者在转院后48小时内接受重症监护或手术的情况较少(优势比[OR]为1.87,95%置信区间[CI]为1.22 - 2.88)。患有ADRD的患者在转院后接受重症监护病房入院或专科手术的可能性较小。需要进一步研究以全面了解以患者为中心的结局。