title: Emergency department visits by nursing home residents in the United States.
abstract: OBJECTIVE
  To characterize emergency department (ED) use by nursing home residents in the United States.
  
  
  METHODS
  Analysis of the National Hospital Ambulatory Medical Care Survey.
  
  
  METHODS
  U.S. EDs from 2005 to 2008.
  
  
  METHODS
  Individuals visiting U.S. EDs stratified according to nursing home residency.
  
  
  METHODS
  All ED visits by nursing home residents were identified. The demographic and clinical characteristics and ED resource utilization, length of stay, and outcomes of nursing home residents and nonresidents were compared.
  
  
  RESULTS
  During 2005 to 2008, nursing home residents accounted for 9,104,735 of 475,077,828 U.S. ED visits (1.9%; 95% confidence interval (CI) = 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were older (mean age 76.7, 95% CI = 75.8-77.5), female (63.3%), and non-Hispanic white (74.8%). Nursing home residents were more likely to have been discharged from the hospital in the prior 7 days (adjusted odds ratio (aOR = 1.4, 95% CI = 1.1-1.9), to present with fever (aOR = 1.9, 95% CI = 1.5-2.4) or hypotension (systolic blood pressure ≤90 mmHg, aOR = 1.8, 95% CI = 1.5-2.2), and to receive diagnostic tests (OR = 1.9, 95% CI = 1.6-2.2), imaging (OR = 1.5, 95% CI = 1.3-1.7), or procedures (OR = 1.6, 95% CI = 1.4-1.7) in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Nursing home residents were more likely to be admitted to the hospital (aOR = 1.8, 95% CI = 1.6-2.0) and to die (aOR = 2.3, 95% CI = 1.6-3.3).
  
  
  CONCLUSIONS
  Nursing home residents account for more than 2.2 million ED visits annually in the United States. Nursing home residents have greater medical acuity and complexity. These observations highlight the national challenges of organizing and delivering ED care to nursing home residents in the United States.
authors.affiliation: Department of Emergency Medicine, University of Alabama, Birmingham, Alabama 35249, USA. hwang@uabmc.edu
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.forename: Meredith
authors.initials: M
authors.lastname: Kilgore
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
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