Abstract
Background
Nursing home (NH) residents often utilise acute health care services. However, comparative data on those are lacking.
Aims
Investigating German NH residents’ use of out-of-hours medical care (OOHC), visits to emergency departments (EDs) and acute hospital admissions (AHAs).
Methods
Using claims data of 1665 residents for 2014−2015, we conducted a retrospective cohort study, examining the incidence rates involving the different services. Multivariate Poisson regression analyses were performed to calculate relative risks (RRs). Differences in the utilisations over the days of the week and of the reasons for contacts were assessed.
Results
In total, 3576 contacts occurred (mean age 80.5 years, women 66.3%), resulting in an overall incidence rate of 2.7 per person-year (95% confidence interval 2.6−2.8). Strongest predictors were polypharmacy (RR 1.79; 95% CI 1.50−2.12), followed by male sex and higher care dependency. Among the three services AHAs showed the highest rates. Injuries were the most common reasons for visiting EDs, whereas for OOHC use and AHAs, coded diagnoses covered a broader spectrum. Utilisation of the services on weekdays varied, particularly for OOHC.
Discussion
Polypharmacy, a higher care dependency and male sex seem to play a role in predicting acute health care services. Considering the distribution of the diagnoses of all three types, certain patterns concerning the symptoms’ acuity become apparent.
Conclusions
Our findings revealed high acute health care services use among NH residents in Germany and differences among the three available services. This information can be used to design studies for investigating the appropriateness of these contacts.
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References
Chenore T, Pereira Gray DJ, Forrer J et al (2013) Emergency hospital admissions for the elderly: insights from the Devon Predictive Model. J Pub Health (Oxf) 35:616–623. https://doi.org/10.1093/pubmed/fdt009
Prince MJ, Wu F, Guo Y et al (2015) The burden of disease in older people and implications for health policy and practice. Lancet (London, England) 385:549–562. https://doi.org/10.1016/S0140-6736(14)61347-7
Hoffmann F, Boeschen D, Dörks M et al (2016) Renal insufficiency and medication in nursing home residents—a cross-sectional study (IMREN). Dtsch Arztebl Int 113:92–98. https://doi.org/10.3238/arztebl.2016.0092
Gordon AL, Franklin M, Bradshaw L et al (2014) Health status of UK care home residents: a cohort study. Age Ageing 43:97–103. https://doi.org/10.1093/ageing/aft077
Jokanovic N, Tan ECK, Dooley MJ et al (2015) Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc 16:535.e1–535.e12. https://doi.org/10.1016/j.jamda.2015.03.003
Hoffmann F, Allers K (2016) Age and sex differences in hospitalisation of nursing home residents: a systematic review. BMJ Open 6:e011912
Graverholt B, Riise T, Jamtvedt G et al (2011) Acute hospital admissions among nursing home residents: a population-based observational study. BMC Health Serv Res 11:126. https://doi.org/10.1186/1472-6963-11-126
Wang HE, Shah MN, Allman RM, Kilgore M (2011) Emergency department visits by nursing home residents in the United States. J Am Geriatr Soc 59:1864–1872. https://doi.org/10.1111/j.1532-5415.2011.03587.x
Carron P-N, Mabire C, Yersin B, Büla C (2017) Nursing home residents at the emergency department: a 6 year retrospective analysis in a Swiss academic hospital. Intern Emerg Med 12:229–237. https://doi.org/10.1007/s11739-016-1459-x
LaMantia MA, Lane KA, Tu W et al (2016) Patterns of emergency department use among long-stay nursing home residents with differing levels of dementia severity. J Am Med Dir Assoc 17:541–546. https://doi.org/10.1016/j.jamda.2016.02.011
Kirsebom M, Hedström M, Wadensten B, Pöder U (2014) The frequency of and reasons for acute hospital transfers of older nursing home residents. Arch Gerontol Geriatr 58:115–120. https://doi.org/10.1016/j.archger.2013.08.002
Givens JL, Selby K, Goldfeld KS, Mitchell SL (2012) Hospital transfers of nursing home residents with advanced dementia. J Am Geriatr Soc 60:905–909. https://doi.org/10.1111/j.1532-5415.2012.03919.x
Kada O, Janig H, Likar R et al (2017) Reducing avoidable hospital transfers from nursing homes in Austria: project outline and baseline results. Gerontol Geriatr Med 3:2333721417696671. https://doi.org/10.1177/2333721417696671
Hoffmann F, Allers K (2017) Variations over time in the effects of age and sex on hospitalization rates before and after admission to a nursing home: a German cohort study. Maturitas 102:50–55. https://doi.org/10.1016/j.maturitas.2017.04.017
Brucksch A, Hoffmann F, Allers K (2018) Age and sex differences in emergency department visits of nursing home residents: a systematic review. BMC Geriatr 18:151. https://doi.org/10.1186/s12877-018-0848-6
Burke RE, Rooks SP, Levy C et al (2015) Identifying potentially preventable emergency department visits by nursing home residents in the United States. J Am Med Dir Assoc 16:395–399. https://doi.org/10.1016/j.jamda.2015.01.076
Seeger I, Luque Ramos A, Hoffmann F (2017) Ambulante Notfallversorgung von Pflegeheimbewohnern. Z Gerontol Geriatr. https://doi.org/10.1007/s00391-017-1293-4
Grabowski DC, Stewart KA, Broderick SM, Coots LA (2008) Predictors of nursing home hospitalization: a review of the literature. Med Care Res Rev 65:3–39. https://doi.org/10.1177/1077558707308754
Hallgren J, Ernsth Bravell M, Mölstad S et al (2016) Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a 3-year follow-up. Int J Older People Nurs 11:130–139. https://doi.org/10.1111/opn.12107
AOK Bremen/Bremerhaven–Die Gesundheitskasse (2018) Eine starke Gemeinschaft. https://bremen.aok.de/inhalt/starke-gemeinschaft/. Accessed 7 Sep 2018
Busse R, Blümel M (2014) Germany: health system review. Health Syst Transit 16:xxi
Ramroth H, Specht-Leible N, Brenner H (2005) Hospitalisations before and after nursing home admission: a retrospective cohort study from Germany. Age Ageing 34:291–294. https://doi.org/10.1093/ageing/afi049
Schneeweiss S, Seeger JD, Maclure M et al (2001) Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol 154:854–864
Schneeweiss S, Wang PS, Avorn J, Glynn RJ (2003) Improved comorbidity adjustment for predicting mortality in medicare populations. Health Serv Res 38:1103–1120
Hoffmann F, van den Bussche H, Wiese B et al (2011) Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. BMC Psychiatry 11:190. https://doi.org/10.1186/1471-244X-11-190
Icks A, Scheer M, Morbach S et al (2011) Time-Dependent Impact of Diabetes on Mortality in Patients After Major Lower Extremity Amputation: survival in a population-based 5 year cohort in Germany. Diabetes Care 34:1350–1354. https://doi.org/10.2337/dc10-2341
Daly L (1992) Simple SAS macros for the calculation of exact binomial and Poisson confidence limits. Comput Biol Med 22:351–361
McGregor MJ, Abu-Laban RB, Ronald LA et al (2014) Nursing home characteristics associated with resident transfers to emergency departments. Can J Aging/La Rev Can du Vieil 33:38–48. https://doi.org/10.1017/S0714980813000615
Boyd M, Broad JB, Zhang TX et al (2016) Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand. Age Ageing 45:558–563. https://doi.org/10.1093/ageing/afw051
Augurzky B, Kopetsch T, Schmitz H (2013) What accounts for the regional differences in the utilisation of hospitals in Germany? Eur J Heal Econ 14:615–627. https://doi.org/10.1007/s10198-012-0407-6
Hoffmann F, Icks A (2012) Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor. Gesundheitswesen 74:291–297. https://doi.org/10.1055/s-0031-1275711
Hoffmann F, Schmiemann G (2017) Influence of age and sex on hospitalization of nursing home residents: a cross-sectional study from Germany. BMC Health Serv Res 17:55. https://doi.org/10.1186/s12913-017-2008-7
Klauber J, Geraedts M, Friedrich J, Wasem J (2016) Ambulante Notfallversorgung an Krankenhäusern und durch ambulante Leistungserbringer. In: Krankenhaus-Report 2016. Schwerpunkt: Ambulant im Krankenhaus. Schattauer, Stuttgart, pp 43–62
Ronald LA, McGregor MJ, McGrail KM et al (2008) Hospitalization rates of nursing home residents and community-dwelling seniors in British Columbia. Can J Aging 27:109–115. https://doi.org/10.3138/cja.27.1.109
Federal Health Monitoring-a joint task of the Robert Koch-Institute and the Federal Statistical Office (2019) The federal health monitoring system. http://www.gbe-bund.de/gbe10/pkg_isgbe5.prc_isgbe?p_uid=gast&p_aid=55531262&p_sprache=E. Accessed 6 Mar 2019
Ouslander JG, Lamb G, Perloe M et al (2010) Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs: [see editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760−761]. J Am Geriatr Soc 58:627–635. https://doi.org/10.1111/j.1532-5415.2010.02768.x
Perrin A, Tavassoli N, Mathieu C et al (2017) Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemp Clin Trials Commun 7:217–223. https://doi.org/10.1016/J.CONCTC.2017.07.005
Acknowledgements
The authors thank the “AOK Bremen/Bremerhaven−Die Gesundheitskasse” for providing data for this analysis.
Funding
The study was supported by the Innovation Fund coordinated by the Innovation Committee of the Federal Joint Committee (G-BA) in Germany (Grant Number: 01VSF16043).
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Fassmer, A.M., Hoffmann, F. Acute health care services use among nursing home residents in Germany: a comparative analysis of out-of-hours medical care, emergency department visits and acute hospital admissions. Aging Clin Exp Res 32, 1359–1368 (2020). https://doi.org/10.1007/s40520-019-01306-3
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DOI: https://doi.org/10.1007/s40520-019-01306-3