Nothelle Stephanie K, Slade Eric P, Magidson Phillip D, Prichett Laura, Finney Amanda, Chotrani Tanya, Amjad Halima, Szanton Sarah, Boyd Cynthia M, Wolff Jennifer L
Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Center for Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
BMC Emerg Med. 2025 Sep 26;25(1):193. doi: 10.1186/s12873-025-01353-2.
Persons living with dementia (PLWD) have longer lengths of stay (LOS) in the Emergency Department (ED), which increases risk of delirium, falls and medication errors. Care of PLWD in the ED is complex and presence of dementia care specialists (geriatrics, neurology, psychiatry) may streamline care. We sought to understand the contribution of health system factors, including presence of dementia care specialists, to LOS among PLWD.
We linked statewide ED visit data on patients discharged from the ED for Arkansas, Arizona, Florida and Massachusetts from the 2018 Healthcare Cost and Utilization Project State Emergency Department Database to the American Hospital Association Annual Survey and Healthcare Information Technology supplement. We included ED visit records for persons ≥ 65 years with ICD-10 dementia diagnoses. Median LOS was estimated at the hospital level and then used as a dependent measure in hospital-level Poisson multivariable models that conditioned on system characteristics.
We included 72,083 ED visits resulting in discharge at 225 health systems. Most EDs were in non-governmental, not-for-profit community hospitals (n = 159, 71%). Median patient age was 83 years (IQR 67, 92), females comprised a mean of 64% of visits. Median LOS was 4 h (IQR 3-7), mean LOS was 9.3 h (SD 16.3). Neurology was the most commonly available dementia care service (n = 180, 80%), followed by psychiatric services (n = 139 EDs, 62%) and geriatric services (n = 132, 59%). In Poisson models adjusting for a parsimonious set of co-variates, the presence of geriatric services was associated with a 16% lower mean LOS (IRR 0.84, 95% CI 0.73-0.97), however, this association lost significance in fully adjusted models (IRR 0.87, 95% CI 0.76-1.01).
Availability of geriatric specialty services may offer hospitals an advantage in streamlining ED care for PLWD and in reducing visit length for this complex patient group. These findings reinforce the potential value of the Geriatrics Emergency Department Accreditation programs.
痴呆症患者（PLWD）在急诊科（ED）的住院时间更长，这增加了谵妄、跌倒和用药错误的风险。急诊科对痴呆症患者的护理很复杂，痴呆症护理专家（老年医学、神经学、精神病学）的存在可能会简化护理流程。我们试图了解包括痴呆症护理专家的存在在内的卫生系统因素对痴呆症患者住院时间的影响。
我们将阿肯色州、亚利桑那州、佛罗里达州和马萨诸塞州2018年医疗成本和利用项目州急诊科数据库中从急诊科出院患者的全州急诊科就诊数据与美国医院协会年度调查和医疗信息技术补充数据相链接。我们纳入了年龄≥65岁且有国际疾病分类第十版（ICD - 10）痴呆症诊断的急诊科就诊记录。在医院层面估计中位住院时间，然后将其用作基于系统特征的医院层面泊松多变量模型中的因变量。
我们纳入了225个卫生系统中72,083次导致出院的急诊科就诊记录。大多数急诊科位于非政府非营利性社区医院（n = 159，71%）。患者中位年龄为83岁（四分位间距67，92），女性就诊次数平均占64%。中位住院时间为4小时（四分位间距3 - 7），平均住院时间为9.3小时（标准差16.3）。神经科是最常见的痴呆症护理服务科室（n = 180，80%），其次是精神科服务科室（n = 139个急诊科，62%）和老年医学服务科室（n = 132, 59%）。在调整了一组简约协变量的泊松模型中，老年医学服务的存在与平均住院时间降低16%相关（发病率比值比[IRR] 0.84，95%置信区间[CI] 0.73 - 0.97），然而，在完全调整的模型中这种关联失去了显著性（IRR 0.87，95% CI 0.76 - 1.01）。
老年医学专科服务的可及性可能使医院在简化对痴呆症患者的急诊科护理以及缩短这一复杂患者群体的就诊时间方面具有优势。这些发现强化了老年医学急诊科认证项目的潜在价值。
