title: Variation in Emergency Department Transfer Rates from Nursing Homes in Ontario, Canada.
abstract: Nursing home (NH) residents are frequently transferred to the emergency department (ED) but there is little data on inter-facility variation, which has implications for intervention planning and implementation.
  
  
  
  To describe variation in ED transfer rates (TRs) across NHs and the association with NH characteristics.
  
  
  
  Retrospective cohort study using linked administrative data from Ontario.
  
  
  
  71,780 residents of 604 NHs in 2010 and followed for one year.
  
  
  
  Funnel plots were used to identify high transfer NHs and logistic regression to test the association with NH location, size, ownership and historical ED transfer rate.
  
  
  
  One-year ED transfer rates ranged from 4.3% to 58.6% (mean 28.4%); 115 (19%) NHs were considered high. Being within five minutes of an ED, larger size and high historical ED transfer rate were associated with being a high ED transfer home.
  
  
  
  There was substantial variation across NHs. Consideration of characteristics such as proximity to an ED may be important in the development and targeting of different interventions for NHs.
authors.affiliation: Assistant Professor, Department of Family Medicine, University of Alberta, Edmonton, AB.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Scientist, Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.affiliation: Analyst, Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: Alice
authors.initials: A
authors.lastname: Newman
authors.affiliation: Professor, Department of Medicine, Mount Sinai Hospital/University of Toronto, Toronto, ON.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Medical Geographer, Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: Peter
authors.initials: P
authors.lastname: Gozdyra
authors.affiliation: Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.affiliation: Senior Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009864:Ontario; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult