title: Incidence and risk factors for unplanned transfers to acute general hospitals from an intermediate care and rehabilitation geriatric facility.
abstract: OBJECTIVE
  Unplanned acute hospital transfers (AT) from post-acute or long-term care facilities represent critical transitions, which expose patients to negative health outcomes and increase the burden of the emergency departments that receive these patients. We aim at determining incidence and risk factors for AT during the first 30 days of admission at an intermediate care and rehabilitation geriatric facility (ICGF).
  
  
  METHODS
  Prospective cohort study conducted in an ICGF of Barcelona, Spain. Sociodemographics, main diagnostics, and variables of the comprehensive geriatric assessment were recorded at admission. At the moment of AT, suspected diagnostic motivating the transfer was recorded. Multivariable Cox proportional hazard models were used to evaluate the association between admission characteristics and AT.
  
  
  RESULTS
  We included 1505 patients (mean age + standard deviation = 81.31 ± 7.06, 65.7% women). AT were 217 (14.4%, 5.64/1000 days of stay) resulting in only 81 final hospitalizations (37% of AT), whereas 136 patients returned to ICGF after visiting the emergency department. Principal triggers of AT were cardiovascular, falls/orthopedic, and gastrointestinal problems. Being admitted to ICGF after a general surgery [hazard ratio (HR) 1.88; 95% confidence interval (CI) 1.21-2.94; P < .001], taking 8 or more drugs at admission (HR 1.98; 95% CI 1.37-2.86; P < .001) and living with a partner (HR 1.35; 95% CI 1.01-1.81; P = .05) were independently associated with a higher risk of AT.
  
  
  CONCLUSIONS
  In our sample, clinical and social characteristics at admission to an ICGF are associated with a higher risk of AT. A relevant proportion of AT is not admitted to the acute hospital, suggesting perhaps some avoidable AT. Identification of risk factors might be relevant to design strategies to reduce AT.
authors.affiliation: Parc Sanitari Pere Virgili, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: danicolprim@outlook.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Colprim
authors.affiliation: Parc Sanitari Pere Virgili, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012307:Risk Factors
keywords: Risk factors; acute hospital transfers; intermediate care facilities; rehospitalization