Identifying Predictors of Hospital Admission from the ED Among the Elderly

从急诊科确定老年人入院的预测因素

• 批准号: 10015296
• 负责人: Bruce E. Landon
• 金额: $ 36万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10015296
• 关键词: Identifying; Predictors; Hospital; Admission; ED

Project Summary: While hospitalizations for older patients generally provide a net benefit when appropriate, hospitalizations for older patients also carry significant risks including an irreversible decline in both physical and cognitive functional status, often resulting in loss of quality of life and greater risk of placement in nursing homes. Elderly patients are also at increased risk of in-hospital falls, delirium, medication interactions, nosocomial infections, and medical errors. Thus, while excess use of the hospital affects all age groups, overuse of the hospital has substantially disproportionate consequences for the elderly. To this point there is little empirical data to help characterize the factors associated with admission rates for the elderly or the extent to which the complex social, cognitive, and physical factors common to elderly patients contribute to higher rates of hospitalization for patients who present for care in the Emergency Department (ED). Additionally, factors related to individual emergency physicians (EPs) who typically make the decision whether to admit or not, and the hospitals where patients present for care may further influence the likelihood of admission. Payment changes in health care also may influence rates of hospitalization for elderly patients and are crucial policy levers available to influence admissions. In particular, the recent advent of Accountable Care Organizations (ACOs) with incentives to reduce spending globally and improve quality may differentially reduce admissions. The proposed study will utilize data on Medicare beneficiaries and their care providers to accomplish three key aims. Using nationally representative data from the Medicare program aims 1 and 2 will examine the predictors of and variation in rates of admission of elderly patients from the ED focusing on discretionary conditions. We also will examine whether factors that influence the decision to admit are also associated with adverse outcomes, including mortality and ED revisits. Potential factors will be drawn from our novel conceptual framework and include patient, EP, hospital, and market characteristics. In Aim 2, we will supplement these measures with data from the Health and Retirement Study to examine measures unique to the elderly including functional status, cognition, and social support. Aim 3 will serve as a proof of concept and will evaluate the impact of Medicare's Accountable Care Organization programs, which through systems changes as a response to payment incentives would benefit from reducing potentially discretionary admissions to the hospital. These aims are important and timely and built upon the scientific premise that safely reducing admissions from the ED could ultimately result in improved quality of care, maintenance of independence, reduced mortality, and substantial cost savings.

项目摘要： 虽然老年患者的住院通常在适当时提供净收益，但住院 对于老年患者，还具有重大风险，包括身体和认知的不可逆转下降 功能状态，通常导致生活质量损失和疗养院安置的更大风险。老年 患者还处于院内跌倒，del妄，药物相互作用，医院感染的风险增加， 和医疗错误。因此，尽管医院过多使用会影响所有年龄段，但医院过度使用 对老年人的后果严重不成比例。至此，几乎没有经验数据可以帮助 表征与老年人的入院率相关的因素或复合物的程度 老年患者常见的社会，认知和身体因素会导致住院率更高 适用于在急诊科（ED）中出席护理的患者。此外，与个人有关的因素 急诊医生（EPS）通常会决定是否承认，以及医院 出席护理的患者可能会进一步影响入院的可能性。医疗保健的付款变化 还可能影响老年患者的住院率，并且是可用的关键政策杠杆 影响入院。特别是，最近的负责护理组织（ACO）与 降低全球支出和提高质量的激励措施可能会差异降低入学。 拟议的研究将利用有关医疗保险受益人及其护理提供者的数据来完成三个 关键目标。使用Medicare计划的全国代表性数据目标1和2将检查 ED专注于eD的老年患者入院率的预测因素和差异 状况。我们还将检查影响承认决定的因素是否也与 不利的结果，包括死亡率和ED重新审视。潜在因素将从我们的小说中汲取 概念框架，包括患者，EP，医院和市场特征。在AIM 2中，我们将 通过健康和退休研究的数据来补充这些措施，以检查独特的措施 老年人，包括功能状况，认知和社会支持。 AIM 3将作为概念证明， 将评估Medicare负责任的护理组织计划的影响，该计划通过系统 对付款激励措施的回应变化将受益于减少潜在的酌处入学 去医院。 这些目标是重要和及时的，并建立在科学前提的基础上，可以安全地减少入院。 从ED中最终可能会改善护理质量，维护独立性，减少 死亡率和大量成本节省。