title: Repeated Hospital Transfers and Associated Outcomes by Residency Time Among Nursing Home Residents in Taiwan.
abstract: Nursing home residents' repeated transfers to hospital are costly and can lead to in-hospital complications and high mortality for frail residents. However, no research has examined the trajectory of residents' symptoms over their nursing home residency and its relationship to hospital transfer.
  
  
  
  The purpose of this retrospective chart-review study was to examine associations between nursing home residents' characteristics, including length of residency, and repeated hospital transfers as well as the trajectory of transfers during residency.
  
  
  
  For this retrospective study, we reviewed 583 residents' charts in 6 randomly selected nursing homes from northern Taiwan. Data were analyzed by descriptive statistics, chi-squared tests, and 1-way analysis of variance.
  
  
  
  About half of nursing home residents who had been transferred to hospital (n = 320) were transferred more than twice during their residency (50.97%). Residents who had been transferred 1, 2, 3, or ≥4 times differed significantly in length of residency (F = 3.85, P = .01), physical status (F = 2.65, P = .05), medical history of pneumonia (χ2= 13.03, P = .01), and fractures (χ2= 8.52, P = .04). Residents with different numbers of transfers differed significantly in their reasons for transfer, that is, falls (χ2= 13.01, P = .01) and tube problems (χ2= 8.87, P = .03). Among 705 total transfers, fever was the top reason for transfer, and transfer prevalence increased with nursing home residency.
  
  
  
  To decrease the chance of residents' hospital transfer, nursing home staff should be educated about recognizing and managing fever symptoms, infection-control programs such as influenza vaccination should be initiated, and fall-prevention/education programs should be started when residents first relocate to nursing homes.
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.
authors.forename: Hsiu-Hsin
authors.initials: HH
authors.lastname: Tsai
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. Electronic address: yftsai@mail.cgu.edu.tw.
authors.forename: Yun-Fang
authors.initials: YF
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychology, National Cheng Chi University, Taipei, Taiwan.
authors.forename: Chia-Yih
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care / Q000379:methods; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013624:Taiwan; D055815:Young Adult
keywords: Repeated hospital transfer; nursing home residency