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J Am Geriatr Soc. 2009 Oct;57(10):1856-61. doi: 10.1111/j.1532-5415.2009.02434.x. Epub 2009 Aug 20.

Emergency department discharge diagnosis and adverse health outcomes in older adults.

Author information

1
Center for Health Services Research in Primary Care, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, USA. hasti003@mc.duke.edu

Abstract

OBJECTIVES:

To determine the relationship between the reason for an emergency department (ED) visit and subsequent risk of adverse health outcomes in older adults discharged from the ED.

DESIGN:

Secondary analysis of data from the Medicare Current Beneficiary Survey.

SETTING:

ED.

PARTICIPANTS:

One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees aged 65 and older discharged from the ED between January 2000 and September 2002.

MEASUREMENTS:

Independent variables were ED discharge diagnosis groups: injury or musculoskeletal (MSK) (e.g., fracture, open wound), chronic condition (e.g., chronic obstructive pulmonary disorder, heart failure), infection, non-MSK symptom (e.g., chest pain, abdominal pain), and unclassified. Adverse health outcomes were hospitalization or death within 30 days of the index ED visit.

RESULTS:

Injury or MSK was the largest ED diagnosis group (31.4%), followed by non-MSK symptom (22.2%), chronic condition (20.9%), and infection (7.8%); 338 (17.8%) had ED discharge diagnoses that were unclassified. In adjusted analyses, a discharge diagnosis of injury or MSK condition was associated with lower risk of subsequent adverse health outcomes (hazard ratio (HR)=0.69, 95% confidence interval (CI)=0.50-0.96) than for all other diagnosis groups. Patients seen in the ED for chronic conditions were at greater risk of adverse outcomes (HR=1.86, 95% CI=1.37-2.52) than all others. There were no significant differences in risk between patients with infections, those with non-MSK symptoms, and the unclassified group.

CONCLUSION:

Adverse health outcomes were common in older patients with an ED discharge diagnosis classified as a chronic condition. ED discharge diagnosis may improve risk assessment and inform the development of targeted interventions to reduce adverse health outcomes in older adults discharged from the ED.

PMID:
19694872
PMCID:
PMC2866093
DOI:
10.1111/j.1532-5415.2009.02434.x
[Indexed for MEDLINE]
Free PMC Article

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