Emergency department utilization patterns among older adults

Fredric D. Wolinsky, Li Liu, Thomas R. Miller, Hyonggin An, John F. Geweke, Brian Kaskie, Kara B. Wright, Elizabeth A. Chrischilles, Claire E. Pavlik, Elizabeth A. Cook, Robert L. Ohsfeldt, Kelly K. Richardson, Gary E. Rosenthal, Robert B. Wallace

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background. We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them. Methods. A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used. Results. The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns. Conclusions. Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

Original languageEnglish
Pages (from-to)204-209
Number of pages6
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume63
Issue number2
DOIs
Publication statusPublished - 2008 Jan 1
Externally publishedYes

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Current Procedural Terminology
Short-Term Memory
Hospital Emergency Service
Medicare
Interviews
Morbidity
Statistical Factor Analysis
Logistic Models
Education
Health
Surveys and Questionnaires

Keywords

  • Emergency department
  • Medicare, Claims data
  • Utilization patterns

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology

Cite this

Emergency department utilization patterns among older adults. / Wolinsky, Fredric D.; Liu, Li; Miller, Thomas R.; An, Hyonggin; Geweke, John F.; Kaskie, Brian; Wright, Kara B.; Chrischilles, Elizabeth A.; Pavlik, Claire E.; Cook, Elizabeth A.; Ohsfeldt, Robert L.; Richardson, Kelly K.; Rosenthal, Gary E.; Wallace, Robert B.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 63, No. 2, 01.01.2008, p. 204-209.

Research output: Contribution to journalArticle

Wolinsky, FD, Liu, L, Miller, TR, An, H, Geweke, JF, Kaskie, B, Wright, KB, Chrischilles, EA, Pavlik, CE, Cook, EA, Ohsfeldt, RL, Richardson, KK, Rosenthal, GE & Wallace, RB 2008, 'Emergency department utilization patterns among older adults', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 63, no. 2, pp. 204-209. https://doi.org/10.1093/gerona/63.2.204
Wolinsky, Fredric D. ; Liu, Li ; Miller, Thomas R. ; An, Hyonggin ; Geweke, John F. ; Kaskie, Brian ; Wright, Kara B. ; Chrischilles, Elizabeth A. ; Pavlik, Claire E. ; Cook, Elizabeth A. ; Ohsfeldt, Robert L. ; Richardson, Kelly K. ; Rosenthal, Gary E. ; Wallace, Robert B. / Emergency department utilization patterns among older adults. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2008 ; Vol. 63, No. 2. pp. 204-209.
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abstract = "Background. We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them. Methods. A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used. Results. The majority (56.6{\%}) of participants had no ED visits during the 4-year period. Just 5.7{\%} had only low-intensity ED use patterns, whereas 28.9{\%} used the ED only for high-intensity visits, and 8.7{\%} had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns. Conclusions. Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.",
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AU - Miller, Thomas R.

AU - An, Hyonggin

AU - Geweke, John F.

AU - Kaskie, Brian

AU - Wright, Kara B.

AU - Chrischilles, Elizabeth A.

AU - Pavlik, Claire E.

AU - Cook, Elizabeth A.

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N2 - Background. We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them. Methods. A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used. Results. The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns. Conclusions. Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

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