Resumen de Predictors of Admission After Emergency Department Discharge in Older Adults

Gelareh Z. Gabayan, Catherine A. Sarkisian, Li-Jung Liang, Benjamin C. Sun

• Objectives To identify predictors of hospital inpatient admission of older Medicare beneficiaries after discharge from the emergency department (ED).

  Design Retrospective cohort study.

  Setting Nonfederal California hospitals (n = 284).

  Participants Visits of Medicare beneficiaries aged 65 and older discharged from California EDs in 2007 (n = 505,315).

  Measurements Using the California Office of Statewide Health Planning and Development files, predictors of hospital inpatient admission within 7 days of ED discharge in older adults (≥65) with Medicare were evaluated.

  Results Hospital inpatient admissions within 7 days of ED discharge occurred in 23,340 (4.6%) visits and were associated with older age (70–74: adjusted odds ratio (AOR) = 1.12, 95% confidence interval (CI) = 1.07–1.17; 75–79: AOR = 1.18, 95% CI = 1.13–1.23; ≥80: AOR = 1.4, 95% CI = 1.35–1.46), skilled nursing facility use (AOR = 1.82, 95% CI = 1.72–1.94), leaving the ED against medical advice (AOR = 1.82, 95% CI = 1.67–1.98), and the following diagnoses with the highest odds of admission: end-stage renal disease (AOR = 3.83, 95% CI = 2.42–6.08), chronic renal disease (AOR = 3.19, 95% CI = 2.26–4.49), and congestive heart failure (AOR = 3.01, 95% CI = 2.59–3.50).

  Conclusion Five percent of older Medicare beneficiaries have a hospital inpatient admission after discharge from the ED. Chronic conditions such as renal disease and heart failure were associated with the greatest odds of admission.