Derivation and Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips Scale for Classifying the Risk of Emergency Department Use in Frail Community‐Dwelling Older Adults

Costa, Andrew P.; Hirdes, John P.; Bell, Chaim M.; Bronskill, Susan E.; Heckman, George A.; Mitchell, L. Brent; Poss, Jeffery W.; Sinha, Samir K.; Stolee, Paul

doi:10.1111/jgs.13336

Cited by 41 publications

(56 citation statements)

References 28 publications

(49 reference statements)

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“…DIVERT was developed to evaluate levels of risk for home care clients visiting an ED but without considering means of transportation to the ED. The DIVERT scores presented for this cohort overall are relatively similar to previous findings (2), with the largest number of clients having a score of 2 and the fewest having a score of 6. Other variables reflecting social factors were tested that could have an association with access to other means of transportation that may influence a patient's decision to call emergency services.…”

Section: Discussionsupporting

confidence: 85%

“…(2) The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale generates six levels of risk for ED visits-from one (lowest score) to six (highest score)-following a standardized home care assessment. (2) Scores are determined by a variety of factors including past use, clinical diagnoses, key interventions, and other assessment findings (see Figure 1). (2) The performance of the DIVERT scale as a pre-emptive case finding tool is driven in part by community dwelling older adults' history of emergency department visits and hospital admission.…”

Section: Introductionmentioning

confidence: 99%

“…(2) Scores are determined by a variety of factors including past use, clinical diagnoses, key interventions, and other assessment findings (see Figure 1). (2) The performance of the DIVERT scale as a pre-emptive case finding tool is driven in part by community dwelling older adults' history of emergency department visits and hospital admission. (2) It differs from other predictive tools by using ongoing symptoms and health conditions to differentiate levels of risk.…”

Section: Introductionmentioning

confidence: 99%

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Indicators of paramedic service use by community dwelling older adults

et al. 2019

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Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indicators of paramedic service use by community dwelling older adults

et al. 2019

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“…This speaks to the overall challenge of defining subpopulations of older ED users and the ongoing efforts to reduce frequent ED visits. Use of prognostic measures, such as the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, can assist in systematically identifying frail community‐dwelling older adults who are at highest risk of ED use. Ongoing validation of the DIVERT Scale used in conjunction with preventative interventions shows promise in reducing frequent ED visits.…”

Section: Discussionmentioning

confidence: 99%

Predictors of frequent emergency department visits among rural older adults in Ontario using the Resident Assessment Instrument-Home Care

Neufeld

Viau

Hirdes

et al. 2015

Aust J Rural Health

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“…8 In addition, 29% of all ED visits by older adults are related to injury such as falls which are known to increase with age, decline in Activities of Daily Living (ADLs), and associated frailty. 3,13 Further, studies suggest that the frequency of physical and psychological symptoms, as well as the severity of these symptoms may be one of the leading causes of ED utilization in the U.S. 8,14–16 In addition, palliative care patients may use the emergency department to address pain and symptom management rather than accessing primary care providers or hospice services. 16–18 Further, there may be differences between rural and urban dwelling older adults in regards to access to primary care providers and receiving age-appropriate care in rural emergency departments due to geographic barriers and poverty.…”

Section: Reasons For Ed Utilization In Community-dwelling Older Adultsmentioning

confidence: 99%

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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Derivation and Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips Scale for Classifying the Risk of Emergency Department Use in Frail Community‐Dwelling Older Adults

Cited by 41 publications

References 28 publications

Indicators of paramedic service use by community dwelling older adults

Indicators of paramedic service use by community dwelling older adults

Predictors of frequent emergency department visits among rural older adults in Ontario using the Resident Assessment Instrument-Home Care

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

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