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Frequency and Predictors of Adverse Health Outcomes in Older Medicare Beneficiaries Discharged From the Emergency Department

Hastings, S Nicole MD*†‡§; Oddone, Eugene Z. MD, MHS§∥; Fillenbaum, Gerda PhD†‡; Sloane, Richard J. MPH†; Schmader, Kenneth E. MD*†‡

doi: 10.1097/MLR.0b013e3181791a2d
Original Article

Background: Older adults who are discharged from the emergency department (ED) may be at risk for subsequent adverse outcomes; however, this has not been fully investigated in national, population-based samples. The goal of this study was to determine the frequency and predictors of adverse outcomes among older adults discharged from the ED.

Design: Secondary analysis of data from the Medicare Current Beneficiary Survey.

Subjects: A total of 1851 community-dwelling, Medicare fee-for-service enrollees, ≥65 years old who were discharged from the ED between January 2000 and September 2002.

Measures: The primary dependent variable was time to first adverse outcome defined as any repeat outpatient ED visit, hospital admission, nursing home admission or death within 90 days of the index ED visit.

Results: Six hundred twenty-three of 1851 subjects (32.9%) discharged from the ED experienced an adverse outcome within 90 days of the index visit; 17.2% returned to the ED but were not admitted, 18.3% were hospitalized, 2.6% were admitted to a nursing home, and 4.1% died. Patients who were older [hazard ratios (HR), 1.01; confidence interval (CI), 1.00–1.02], with more chronic health conditions (HR, 1.12; CI, 1.07–1.19), Medicaid insurance (HR, 1.42; CI, 1.11–1.82), and recent ED (HR, 1.46; CI, 1.17–1.82) or hospital use (HR, 1.80; CI, 1.50–2.17) were at particularly high risk.

Conclusions: A substantial proportion of older Medicare beneficiaries in this study experienced an adverse outcome after ED discharge. Further study is needed to determine whether simple prediction tools based on these identified risk factors may be useful in predicting adverse outcomes in this vulnerable population.

From the *Department of Medicine, Division of Geriatrics; †Center for the Study of Aging and Human Development, Duke University Medical Center; ‡Geriatrics Research, Education, and Clinical Center, §Center for Health Services Research in Primary Care, and ∥Division of General Internal Medicine, Veterans Affairs Medical Center, Durham, North Carolina.

Supported by VA Health Services Research and Development, Duke Aging Center's Hartford Centers of Excellence 2002-0269 and 2006-0109, Durham VAMC GRECC and Center for Health Services Research in Primary Care, and NIAID K24-AI-51324-01.

This research was conducted while Dr. Hastings was supported by a Hartford Geriatrics Health Outcomes Scholar Award from the AGS Foundation for Health in Aging/John A. Hartford Foundation.

Reprints: S. Nicole Hastings, MD, Duke University Medical Center, Room 3502, Blue Zone, Duke South, Box 3003 DUMC, Durham, NC 27710. E-mail: hasti003@mc.duke.edu.

© 2008 Lippincott Williams & Wilkins, Inc.