Daniel M Kobewka1, Elizabeth Kunkel2, Amy Hsu3, Robert Talarico4, Peter Tanuseputro5. 1. Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada; University of Ottawa, School of Epidemiology & Public Health, Ottawa, Ontario, Canada. Electronic address: dkobewka@toh.on.ca. 2. Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada. 3. Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada. 4. ICES uOttawa, Ottawa, Ontario, Canada. 5. Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada; University of Ottawa, School of Epidemiology & Public Health, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada.
Abstract
OBJECTIVES: To investigate whether same-day physician access in long-term care homes reduces resident emergency department (ED) visits and hospitalizations. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 161 long-term care homes in Ontario, Canada, and 20,624 residents living in those homes. METHODS: We administered a survey to Ontario long-term care homes from March to May 2017 to collect their typical wait time for a physician visit. We linked the survey to administrative databases to capture other long-term care home characteristics, resident characteristics, hospitalizations, and ED visits. We defined a cohort of residents living in survey-respondent homes between January and May 2017 and followed each resident for 6 months or until discharge or death. We estimated negative binomial regression models on counts of hospitalizations and ED visits with random intercepts for long-term care homes. We controlled for residents' sociodemographic and illness characteristics, long-term care home size, chain status, rurality, and nurse practitioner access. RESULTS: Fifty-two homes (32%) reported same-day physician access. Among residents of homes with same-day physician access, 9% had a hospitalization and 20% had an ED visit during follow-up. In contrast, among residents in homes without same-day access, 12% were hospitalized and 22% visited an ED. The adjusted hospitalization and ED rates among residents of homes with same-day physician access were 21% lower (rate ratio = 0.79, P = .02) and 14% lower (rate ratio = 0.86, P = .07), respectively, than residents of other homes. We estimate that nearly 1 in 6 resident hospitalizations could be prevented if all long-term care homes had same-day physician access. CONCLUSIONS AND IMPLICATIONS: Residents of long-term care homes with same-day physician access experience lower hospitalization and ED visit rates than residents in homes that wait longer for physicians, even after adjusting for important resident and home characteristics. Improved on-demand access to physicians has the potential to reduce hospital transfer rates. Crown
OBJECTIVES: To investigate whether same-day physician access in long-term care homes reduces resident emergency department (ED) visits and hospitalizations. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 161 long-term care homes in Ontario, Canada, and 20,624 residents living in those homes. METHODS: We administered a survey to Ontario long-term care homes from March to May 2017 to collect their typical wait time for a physician visit. We linked the survey to administrative databases to capture other long-term care home characteristics, resident characteristics, hospitalizations, and ED visits. We defined a cohort of residents living in survey-respondent homes between January and May 2017 and followed each resident for 6 months or until discharge or death. We estimated negative binomial regression models on counts of hospitalizations and ED visits with random intercepts for long-term care homes. We controlled for residents' sociodemographic and illness characteristics, long-term care home size, chain status, rurality, and nurse practitioner access. RESULTS: Fifty-two homes (32%) reported same-day physician access. Among residents of homes with same-day physician access, 9% had a hospitalization and 20% had an ED visit during follow-up. In contrast, among residents in homes without same-day access, 12% were hospitalized and 22% visited an ED. The adjusted hospitalization and ED rates among residents of homes with same-day physician access were 21% lower (rate ratio = 0.79, P = .02) and 14% lower (rate ratio = 0.86, P = .07), respectively, than residents of other homes. We estimate that nearly 1 in 6 resident hospitalizations could be prevented if all long-term care homes had same-day physician access. CONCLUSIONS AND IMPLICATIONS: Residents of long-term care homes with same-day physician access experience lower hospitalization and ED visit rates than residents in homes that wait longer for physicians, even after adjusting for important resident and home characteristics. Improved on-demand access to physicians has the potential to reduce hospital transfer rates. Crown
Authors: Maya M Jeyaraman; Leslie Copstein; Nameer Al-Yousif; Rachel N Alder; Scott W Kirkland; Yahya Al-Yousif; Roger Suss; Ryan Zarychanski; Malcolm B Doupe; Simon Berthelot; Jean Mireault; Patrick Tardif; Nicole Askin; Tamara Buchel; Rasheda Rabbani; Thomas Beaudry; Melissa Hartwell; Carolyn Shimmin; Jeanette Edwards; Gayle Halas; William Sevcik; Andrea C Tricco; Alecs Chochinov; Brian H Rowe; Ahmed M Abou-Setta Journal: BMJ Open Date: 2021-05-10 Impact factor: 2.692
Authors: Rebecca H Correia; Fabrice I Mowbray; Darly Dash; Paul R Katz; Andrea Moser; Ryan P Strum; Aaron Jones; Ahmad von Schlegell; Andrew P Costa Journal: BMC Geriatr Date: 2022-04-12 Impact factor: 3.921