Adverse health outcomes after discharge from the emergency department--incidence and risk factors in a veteran population.
BACKGROUND
An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system.


OBJECTIVE
1) To describe the frequency and type of adverse health outcomes among older veterans discharged from the ED, and 2) To determine risk factors associated with adverse outcomes.


METHODS
Retrospective, cohort study at an academically affiliated VA medical center.


METHODS
A total of 942 veterans > or = 65 years old discharged from the ED.


RESULTS
Primary dependent variable was adverse outcome, defined as a repeat VA ED visit, hospitalization, and/or death within 90 days. Overall, 320 (34.0%) patients experienced an adverse outcome: 245 (26%) returned to the VA ED but were not admitted, 125 (13.3%) were hospitalized, and 23 (2.4%) died. In adjusted analyses, higher score on the Charlson Comorbidity Index (hazard ratio [HR] 1.11; 95% CI 1.03, 1.21), ED visit within the previous 6 months (HR 1.64; 95% CI 1.30, 2.06), hospitalization within the previous 6 months (HR 1.70, 95% CI 1.30, 2.22), and triage to the emergency unit (compared to urgent care clinic) (HR 1.76, 95% CI 1.32, 2.36) were independently associated with higher risk of adverse outcomes.


CONCLUSIONS
More than 1 in 3 older veterans discharged from the ED experienced a significant adverse outcome within 90 days of ED discharge. Identifying veterans at greatest risk for adverse outcomes after ED discharge can inform the design and targeting of interventions to reduce morbidity and costs in this group.
Hastings
S Nicole
SN
Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. hasti003@mc.duke.edu
Schmader
Kenneth E
KE
Sloane
Richard J
RJ
Weinberger
Morris
M
Goldberg
Kenneth C
KC
Oddone
Eugene Z
EZ
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D014768:Virginia