Seidenfeld Justine, Stechuchak Karen M, Smith Valerie A, Stanwyck Catherine, Perfect Chelsea, Van Houtven Courtney, Nicole Hastings Susan
Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA.
Department of Emergency Medicine, Durham VA Health Care System, Durham, NC, USA.
J Geriatr Emerg Med. 2024 Jul 29;5(3). doi: 10.17294/2694-4715.1080.
Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty.
Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before.
Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups.
Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.
在新冠疫情期间，老年人极易受到医疗保健中断的影响，但尚不清楚急诊就诊率的变化是否因患者特征而异。我们以一组老年退伍军人为研究对象，根据四个感兴趣的特征（年龄、种族、地区贫困指数和虚弱程度）研究了急诊就诊率的变化。
参与者年龄≥65岁，在2018年2月2日至2019年5月7日期间在初级或老年诊所就诊≥2次。针对每个特征构建了调整后的负二项回归模型。我们分别报告各亚组按季度划分的所有急诊就诊的平均次数，并报告率比，以比较新冠疫情第一年与前一年的急诊就诊情况。
具有完整病例数据的患者有38871人。在前两个季度，所有亚组的急诊就诊次数均有所减少，第三和第四季度的变化更大。极度虚弱的患者在新冠疫情之前和期间的人均急诊就诊估计次数均值最高，在疫情的多个季度中，其急诊就诊次数也显著减少，且减少幅度大于其他虚弱亚组。
根据虚弱程度对老年人进行分层，确定了在新冠疫情期间急诊就诊变化最大的患者亚组。极度虚弱的患者需要特别关注，以了解急诊就诊的变化如何影响患者的治疗结果。
