Identifying Predictors of Hospital Admission from the ED Among the Elderly

项目总结： 虽然老年患者的住院治疗通常会在适当的时候提供净收益，但住院治疗 对于老年患者来说，也存在重大风险，包括身体和认知能力不可逆转的下降 功能状态，往往导致生活质量的丧失和更大的安置在养老院的风险。老年人 患者在医院内摔倒、精神错乱、药物相互作用、医院感染的风险也增加， 和医疗差错。因此，尽管过度使用医院影响到所有年龄段的人，但过度使用医院已经 对老年人的影响极不成比例。在这一点上，几乎没有经验数据能提供帮助。 描述与老年人入院率相关的因素或复杂程度 老年患者常见的社会、认知和身体因素导致较高的住院率 适用于在急诊科(ED)就诊的患者。此外，与个人相关的因素 通常决定是否入院的急诊医生(EP)，以及哪些医院 目前接受治疗的患者可能会进一步影响入院的可能性。医疗保健的支付方式变化 也可能影响老年患者的住院率，是可用于 影响招生。特别是，最近问责性关怀组织(ACO)的出现 减少全球支出和提高质量的激励措施可能会不同地减少招生人数。 这项拟议的研究将利用医疗保险受益人及其护理提供者的数据来实现三个目标 主要目标。使用来自联邦医疗保险计划目标1和2的具有全国代表性的数据将检查 急诊科老年患者入院率的预测因素和变异 条件。我们还将研究影响录取决定的因素是否也与 不良结果，包括死亡率和急诊复诊。将从我们的小说中提取潜在的因素 概念框架，包括患者、内科、医院和市场特征。在目标2中，我们将 用健康和退休研究中的数据补充这些措施，以检查独特的 老年人包括功能状态、认知和社会支持。目标3将作为概念的证明和 将评估联邦医疗保险的责任医疗组织计划的影响，该计划通过系统 作为对支付激励的回应，改变将从减少潜在的可自由支配的入学人数中受益 去医院。 这些目标是重要的和及时的，建立在安全减少招生的科学前提之上 最终可能导致护理质量的提高，保持独立性，减少 死亡率和可观的成本节约。

Project Summary: While hospitalizations for older patients generally provide a net benefit when appropriate, hospitalizations for older patients also carry significant risks including an irreversible decline in both physical and cognitive functional status, often resulting in loss of quality of life and greater risk of placement in nursing homes. Elderly patients are also at increased risk of in-hospital falls, delirium, medication interactions, nosocomial infections, and medical errors. Thus, while excess use of the hospital affects all age groups, overuse of the hospital has substantially disproportionate consequences for the elderly. To this point there is little empirical data to help characterize the factors associated with admission rates for the elderly or the extent to which the complex social, cognitive, and physical factors common to elderly patients contribute to higher rates of hospitalization for patients who present for care in the Emergency Department (ED). Additionally, factors related to individual emergency physicians (EPs) who typically make the decision whether to admit or not, and the hospitals where patients present for care may further influence the likelihood of admission. Payment changes in health care also may influence rates of hospitalization for elderly patients and are crucial policy levers available to influence admissions. In particular, the recent advent of Accountable Care Organizations (ACOs) with incentives to reduce spending globally and improve quality may differentially reduce admissions. The proposed study will utilize data on Medicare beneficiaries and their care providers to accomplish three key aims. Using nationally representative data from the Medicare program aims 1 and 2 will examine the predictors of and variation in rates of admission of elderly patients from the ED focusing on discretionary conditions. We also will examine whether factors that influence the decision to admit are also associated with adverse outcomes, including mortality and ED revisits. Potential factors will be drawn from our novel conceptual framework and include patient, EP, hospital, and market characteristics. In Aim 2, we will supplement these measures with data from the Health and Retirement Study to examine measures unique to the elderly including functional status, cognition, and social support. Aim 3 will serve as a proof of concept and will evaluate the impact of Medicare's Accountable Care Organization programs, which through systems changes as a response to payment incentives would benefit from reducing potentially discretionary admissions to the hospital. These aims are important and timely and built upon the scientific premise that safely reducing admissions from the ED could ultimately result in improved quality of care, maintenance of independence, reduced mortality, and substantial cost savings.