Objectives
To identify predictors of hospital inpatient admission of older Medicare patients following discharge from the emergency department.
Design
Retrospective cohort study
Setting
284 non-federal California hospitals
Participants
505,315 visits of patients age >65 years (yrs) with Medicare insurance discharged from California EDs in 2007.
Measurement
Using the California Office of Statewide Health Planning and Development files, predictors of a hospital inpatient admission within 7 days of ED discharge in older adults (age > 65 yrs) 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 (Age 70–74 Adjusted Odds Ration=AOR 1.12, 95% Confidence Interval=CI 1.07–1.17; Age 75–79 AOR 1.18, 95% CI 1.13–1.23; Age 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
A total of 4.6% of older adults with Medicare insurance have a hospital inpatient admission after discharge. Chronic conditions such as renal disease and heart failure were associated with the greatest odds of admission.