Predictors of Admission After Emergency Department Discharge in Older Adults

ObjectivesTo identify predictors of hospital inpatient admission of older Medicare beneficiaries after discharge from the emergency department (ED). DesignRetrospective cohort study. SettingNonfederal California hospitals (n=284). ParticipantsVisits of Medicare beneficiaries aged 65 and older discharged from California EDs in 2007 (n=505,315). MeasurementsUsing the California Office of Statewide Health Planning and Development files, predictors ofhospital inpatient admission within 7days of ED discharge in older adults (65) with Medicare were evaluated. ResultsHospital inpatient admissions within 7days of ED discharge occurred in 23,340 (4.6%) visits and were associated with older age (70-74: adjusted odds ratio (AOR)=1.12, 95% confidence interval (CI)=1.07-1.17; 75-79: AOR=1.18, 95% CI=1.13-1.23; 80: AOR= 1.4, 95% CI=1.35-1.46), skilled nursing facility use (AOR=1.82, 95% CI=1.72-1.94), leaving the ED against medical advice (AOR=1.82, 95% CI=1.67-1.98), and the following diagnoses with the highest odds of admission: end-stage renal disease (AOR=3.83, 95% CI=2.42-6.08), chronic renal disease (AOR=3.19, 95% CI=2.26-4.49), and congestive heart failure (AOR= 3.01, 95% CI=2.59-3.50). ConclusionFive percent of older Medicare beneficiaries have a hospital inpatient admission after discharge from the ED. Chronic conditions such as renal disease and heart failure were associated with the greatest odds of admission.