Emergency Department Use
among Older Adults
AcademyHealth
June
Ju
e 29,
9, 2010
0 0
A k
Acknowledgements
l d
t
Fred Wolinsky, PI
Max Ob
M
Obrizan,
i
Mik
Mike JJones, JJason H
Hockenberry,
k b
Suzanne Bentler, Paula Weigel, Robert B
Wallace Bob Ohsfeldt,
Ohsfeldt & Gary E.
E Rosenthal
Wallace,
NIH – NIA R21 Grant AG031307-01
University of Iowa
College of Public Health
Department of Health Management and Policy
I t d ti
Introduction
Institute of Medicine (2006)
(
)
Triaging vs Group Management
Role of Older Adults
Ad lts in ED crisis
University of Iowa
College of Public Health
Department of Health Management and Policy
P i
Previous
W
Workk
Severity of individual visits
 30% were severe
 33% not severe
 37% indeterminate
Capture individual patterns of ED visits over time
University of Iowa
College of Public Health
Department of Health Management and Policy
R
Research
h Obj
Objectives
ti
Classify individuals into groups
 Dominant pattern of severe ED use
 Dominant pattern of non-severe ED use
Differentiate groups
University of Iowa
College of Public Health
Department of Health Management and Policy
St d Design
Study
D i
Observation of large
g national
sample over a 17 year period
f
from
1990-2007
1990 2007
Link AHEAD interviews with
Medicare claims data
University of Iowa
College of Public Health
Department of Health Management and Policy
S
Sample
l
1993 – 1994 Baseline:
 N = 7,447
AHEAD + Claims
 N = 5,510 (74% of original sample)
University of Iowa
College of Public Health
Department of Health Management and Policy
Claims
University of Iowa
College of Public Health
Department of Health Management and Policy
E i d
Episodes
Severe Episode
p
 Probability
y of ED >75%
Non-Severe Episode
p
 Probability of ED care <25%
25%
University of Iowa
College of Public Health
Department of Health Management and Policy
41,739 ED claims
27, 623 ED claims
20 169 Episodes of ED care
20,169
University of Iowa
College of Public Health
Department of Health Management and Policy
A l i
Analysis
Multivariable logistic regression
 Demographic variables
 Socioeconomic characteristics
 Health
H lth status
t t
 Geographic variables
 Health services use

Change in self rated health
Group stratification by frequency
University of Iowa
College of Public Health
Department of Health Management and Policy
Results
Sample of 5,510
(100.0%)
No ED episodes
1,240 (22.5%)
Clinically Non-Severe
Modified NYU 1
1,076 (19.5%)
Classified
3,201 (58.1%)
Unclassified
1,069 (19.4%)
Indeterminant Pattern
Modified NYU 2
1,177 (21.4%)
Clinically Severe
Modified NYU 3
948 (17.2%)
University of Iowa
College of Public Health
Department of Health Management and Policy
ALL
<3
>3
Age Above Median
1.520*
1.267
1.728*
African American
0.784
0.588
1.020
Hispanic
0.895
0.833
1.248
Men
1 280*
1.280
1 788*
1.788
1 006
1.006
Lives Alone
1.195
1.393
1.119
# of Insur Health Policies
0 947
0.947
0 610*
0.610*
1 323*
1.323*
Body-Mass Index
1.013
1.002
1.022
Former Smoker
1.175
1.149
1.236
Current Smoker
1.601*
1.998*
1.447
Between 1&2 Drinks
0.692*
0.759
0.651
More than 3 Drinks
0.903
White (ref)
Never Smoked (ref)
No Drinks (ref)
University of Iowa
College of Public Health
0.744
Department of Health Management 1.352
and Policy
Self-Reported Health E/VG/G (ref)
ALL
<3
>3
Fair Self-Reported Health
1.052
1.101
0.955
P
Poor
S
Self-Reported
lf R
t dH
Health
lth
1 207
1.207
0 902
0.902
1 363
1.363
IADL 1 or More
1.021
1.401
0.820
Arthritis
0.605*
0.856
0.454*
Diabetes
1.795*
3.559*
1.250
Heart Disease
1.699*
1.550*
1.790*
Hypertension
1.323*
1.408*
1.222
Lung Disease
0.727
0.582
0.900
P
Psych.
h P
Problems
bl
0 997
0.997
1 348
1.348
0 803
0.803
Stroke
0.787
0.970
0.741
4 or More Morbid Conditions
1 484*
1.484
1 014
1.014
1 896*
1.896
Hospitalized in last 12 mo.
1.260
1.281
1.213
Visits to MDs in 2 yrs
1.001
1.016
0.990
Upper 20% beds per 1,000
0.780
0.855
0.646*
Upper 20% MDs per 1,000
1.096
1.486
0.853
Distance to ED
0 992
0.992
0 985
0.985
0 993
0.993
Population > 1 mln
0.987
0.826
Population < 20 000
0 863
University of Iowa
1.091
College of Public Health
Department of Health Management and Policy
0 784
0 908
Di
Discussion
i
External validity
 5k + subjects
 17 years off observation
b
ti
 20k + episodes
Patterns of ED use are pluralistic
University of Iowa
College of Public Health
Department of Health Management and Policy
G
Group
Differences
Diff
Severe
 Greater morbidity
Non-severe
 Not observed
University of Iowa
College of Public Health
Department of Health Management and Policy
I li ti
Implications
Severe Group
 Place increasing demand on ED
Non-severe Group
 Disproportionate share of excess
University of Iowa
College of Public Health
Department of Health Management and Policy
Emergency Department Use
among Older Adults
AcademyHealth
June
Ju
e 29,
9, 2010
0 0