Utilization of emergency room and hospitalization by chinese nursing home residents: A cross-sectional study

Abstract

Objectives: This study determined factors associated with increased use of emergency room (ER) and hospitalization of Chinese nursing home residents. Design: A cross-sectional study. Setting: The setting was 14 nursing homes in Hong Kong. Participants: Participants were 1820 Chinese nursing home residents. Measurements: Data on facility factors and resident factors were collected. Resident factors were mainly collected by the Minimum Data Set-Resident Assessment Instrument 2.0 (MDS-RAI 2.0). Results: Residing in a for-profit home (OR=6.51), having less than one third of time spent in activities (OR=1.84), having had recent fall (OR=3.81), having renal failure (OR=3.17), having had recent initiation of new medications (OR=1.42), and having had recent physician visit (OR=1.67) were factors associated with increased use of ER. Male gender (OR=1.49), having a body mass index (BMI) less than 18.5kg/m2 (OR=1.51), being more functionally dependent (OR=1.18 per 1-point increment in the ADL Hierarchy Scale), having higher burden of illness (OR=1.29 per 1-point increment in the CHESS score), having a feeding tube (OR=3.07), having an indwelling urinary catheter (OR=2.75), having had recent fall (OR=1.94), having respiratory tract infection (OR=2.05), having Parkinson's disease (OR=1.55), having anemia (OR=1.70), having had recent initiation of new medications (OR=2.08), and having had recent physician visit (OR=1.83) were factors associated with increased risk of hospitalization. Conclusions: Although some of the associated factors reflect frailty characteristics of residents, differences in association between for-profit and not-for-profit institutions provide evidence of overreliance on the ER, perhaps as a result of inadequate primary care support. © 2010 American Medical Directors Association.