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Nursing home residents stuck in the ...

Stephens, Caroline E.

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Nursing home residents stuck in the revolving door of the emergency room: Does cognitive impairment make a difference?

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Nursing home residents stuck in the revolving door of the emergency room: Does cognitive impairment make a difference?/
Author:	Stephens, Caroline E.
Description:	256 p.
Notes:	Source: Dissertation Abstracts International, Volume: 71-12, Section: A, page: .
Contained By:	Dissertation Abstracts International71-12A.
Subject:	Gerontology. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3426220
ISBN:	9781124266114

Nursing home residents stuck in the revolving door of the emergency room: Does cognitive impairment make a difference?
Stephens, Caroline E.

Nursing home residents stuck in the revolving door of the emergency room: Does cognitive impairment make a difference? - 256 p.

Source: Dissertation Abstracts International, Volume: 71-12, Section: A, page: .

Thesis (Ph.D.)--University of California, San Francisco, 2010.

Significance. Nursing home (NH) residents use the ED at higher rates than community-dwelling older adults & nearly 2/3 of NH residents cared for in the ED have cognitive impairment (CI). Studies indicate hospitalization of nursing home residents is frequent and often preventable, however little is known about ED use by residents with CI.

ISBN: 9781124266114Subjects--Topical Terms:

533633
Gerontology.

Nursing home residents stuck in the revolving door of the emergency room: Does cognitive impairment make a difference?
LDR:03443nam 2200361 4500 001 1391502
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020 $a 9781124266114
035 $a (UMI)AAI3426220
035 $a AAI3426220
040 $a UMI $c UMI
100 1 $a Stephens, Caroline E. $3 1669937
245 1 0 $a Nursing home residents stuck in the revolving door of the emergency room: Does cognitive impairment make a difference?
300 $a 256 p.
500 $a Source: Dissertation Abstracts International, Volume: 71-12, Section: A, page: .
500 $a Adviser: Charlene Harrington.
502 $a Thesis (Ph.D.)--University of California, San Francisco, 2010.
520 $a Significance. Nursing home (NH) residents use the ED at higher rates than community-dwelling older adults & nearly 2/3 of NH residents cared for in the ED have cognitive impairment (CI). Studies indicate hospitalization of nursing home residents is frequent and often preventable, however little is known about ED use by residents with CI.
520 $a Methods. Utilizing a 5% random sample of Medicare beneficiaries residing in NHs in the U.S. (n=132,753, of whom 76,961 had CI), this secondary analysis of 2006 MDS & Medicare claims data examined the prevalence of and factors associated with ED use with & without hospitalization, and preventable ED use, and how such utilization varied by the presence & severity of CI. Descriptive statistics were used to describe the study sample. Multinomial logistic regression was used to estimate the dichotomous dependent variables; Poisson regression was used to estimate the continuous dependent variables, controlling for sociodemographic/health characteristics.
520 $a Results. Sixty two percent (n=82,335) of the sample had an ED visit with or without hospital admission. Residents with CI had fewer total number of ED visits/year compared to those without CI. Controlling for acuity and other factors, the odds and rates of ED use with & without hospitalization varied by both presence & severity of CI. Odds of any ED visit were highest for residents with very mild CI and risk declined as CI worsened. There was a similar trend for ED visits resulting in hospitalization, with 13% higher odds for residents with very mild CI compared to residents without CI; risk also declined as CI worsened. Risk of ED use without hospitalization was greatest for those with mild CI and moderate-severe CI, with 7-12% higher odds of an ED visit without hospitalization/year than those without CI. Almost 24% (n=31,566) of the sample had a potentially preventable ED visit. Residents with very mild-mild CI were at highest risk, with 10-15% higher odds of a preventable ED visit compared to those without CI.
520 $a Implications. Identifying & modifying factors responsible for ED use during an illness episode may result in more appropriate use of the ED, reduced costs & better health outcomes. Using preventable ED use as a NH quality indicator may be warranted.
590 $a School code: 0034.
650 4 $a Gerontology. $3 533633
650 4 $a Health Sciences, Nursing. $3 1017798
650 4 $a Health Sciences, Epidemiology. $3 1019544
690 $a 0351
690 $a 0569
690 $a 0766
710 2 $a University of California, San Francisco. $b Nursing. $3 1029161
773 0 $t Dissertation Abstracts International $g 71-12A.
790 1 0 $a Harrington, Charlene, $e advisor
790 1 0 $a Blegen, Mary $e committee member
790 1 0 $a Miller, Bruce $e committee member
790 1 0 $a Newcomer, Robert $e committee member
790 $a 0034
791 $a Ph.D.
792 $a 2010
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3426220