Using the Past to Predict the Future: Latent Class Analysis of Patterns of Health Service Use of Older Adults in the Emergency Department

Hastings, S. Nicole; Whitson, Heather E.; Sloane, Richard; Landerman, Lawrence R.; Horney, Carolyn; Johnson, Kimberly S.

doi:10.1111/jgs.12746

Cited by 31 publications

(27 citation statements)

References 24 publications

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“…There is widespread agreement that structural changes are needed to improve health outcomes for older people and to simultaneously reduce National Health System costs [15]. The perception that there is an increasing number of ED geriatric frequent users and the lack of scientific literature on this topic prompted us to evaluate the characteristics of this emerging phenomenon: the elderly as ED “frequent users”.…”

Section: Introductionmentioning

confidence: 99%

Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

et al. 2016

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IntroductionThe elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with “elderly frequent users”.Material and MethodsA retrospective study was performed during the calendar year 2014 (1st January 2014 – 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models.ResultsA total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4–1.7) and hospitalization (OR 3.8: CI 3.7–4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9–3.2).DiscussionOlder patients presented clinical and social characteristics related to the definition of “elderly frail frequent users”. The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established.ConclusionEnhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly.

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Section: Introductionmentioning

confidence: 99%

Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

et al. 2016

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“…[20] We want to identify patient subgroups with different patterns of inpatient lengths of stay. [21,22] Policymakers, payers, and clinicians seeking to improve care and reduce spending in these groups could design interventions tailored to subpopulations. Previous work has shown substantial heterogeneity in the patterns of health care utilization among patients with lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Identifying and Interpreting Subgroups in Health Care Utilization Data with Count Mixture Regression Models

Kurz

Hatfield

2018

Preprint

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Inpatient care is a large share of total health care spending, making analysis of inpatient utilization patterns an important part of understanding what drives health care spending growth. Common features of inpatient utilization measures such as length of stay and spending include zero inflation, over-dispersion, and skewness, all of which complicate statistical modeling. Moreover, latent subgroups of patients may have distinct patterns of utilization and relationships between that utilization and observed covariates. In this work, we apply and compare likelihood-based and parametric Bayesian mixtures of Negative Binomial and zero-inflated Negative Binomial regression models. In a simulation, we find that the Bayesian approach finds the true number of mixture components more accurately than using information criteria to select among likelihood-based finite mixture models. When we apply the models to data on hospital lengths of stay for patients with lung cancer, we find distinct subgroups of patients with different means and variances of hospital days, health and treatment covariates, and relationships between covariates and length of stay.

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“…In addition, many developed nations anticipate a steady rise of ED utilization, which may result in increased health care resource consumption. 7,8 While the rise in ED utilization among older adults is a nursing concern, there are limited studies concerning ED utilization by community-dwelling older adults published in nursing journals, and more nurse-led interdisciplinary research needs to be conducted to fill this gap. The rise in ED use is also concerning because ED use is associated with negative health outcomes, especially in older adults.…”

Section: Introduction and Review Of Literaturementioning

confidence: 99%

“…8 Older adults are also 5.6 times more likely to be hospitalized from the emergency department, and the risks for repeat ED visits increases with age. 2,6,7 Once admitted to the hospital, inadequate discharge planning for older adults with multifaceted co-morbidities is common. 7,10 This is further complicated by a lack of home follow-up or home follow up that does not address the chronic symptom self-management in older adults recently discharged from the hospital potentially leading to repeat ED visits.…”

Section: Introduction and Review Of Literaturementioning

confidence: 99%

“…2,6,7 Once admitted to the hospital, inadequate discharge planning for older adults with multifaceted co-morbidities is common. 7,10 This is further complicated by a lack of home follow-up or home follow up that does not address the chronic symptom self-management in older adults recently discharged from the hospital potentially leading to repeat ED visits. However, multidisciplinary nurse-directed transitional care programs have been successful in reducing hospitalization, and ED visits.…”

Section: Introduction and Review Of Literaturementioning

confidence: 99%

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ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults

Dermody¹,

Sawyer²,

Kennedy³

et al. 2017

Journal of Emergency Nursing

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Background The rise in emergency department (ED) utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to positively impact the care of older adults. Symptoms have been associated with ED utilization, however, it remains unclear if symptoms are the primary reason for ED utilization. Purpose Describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department. Examine the differences in self-reported symptoms among those who utilized the emergency department, and those who did not. Procedures A prospective longitudinal design was used. The sample included 403 community-dwelling older adults 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. Main Findings Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance, and fair/poor well-being were significantly associated with ED utilization. Conclusions Several symptoms were common among this cohort of older adults. However, there were no significant differences in the types of symptoms reported by older adults who utilized the emergency department compared to those who did not use the emergency department. Based on these findings, symptoms among community-dwelling older adults may not be the primary reason for ED utilization.

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Using the Past to Predict the Future: Latent Class Analysis of Patterns of Health Service Use of Older Adults in the Emergency Department

Cited by 31 publications

References 24 publications

Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

Identifying and Interpreting Subgroups in Health Care Utilization Data with Count Mixture Regression Models

ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults

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