Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-18T10:45:57.981Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergency Department Visit Rates and Patterns in Canada’s Vancouver Coastal Health Region*

Published online by Cambridge University Press:  01 April 2014

Margaret J. McGregor ,
Kimberlyn M. McGrail ,
Riyad B. Abu-Laban ,
Lisa A. Ronald ,
Jennifer Baumbusch ,
Douglas Andrusiek  and
Michelle B. Cox
Margaret J. McGregor*
Affiliation:
Department of Family Practice, University of British Columbia, Vancouver, Canada Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology & Evaluation, Vancouver UBC Centre for Health Services and Policy Research, Vancouver
Kimberlyn M. McGrail
Affiliation:
UBC Centre for Health Services and Policy Research, Vancouver UBC School of Population and Public Health, Vancouver
Riyad B. Abu-Laban
Affiliation:
Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology & Evaluation, Vancouver UBC Department of Emergency Medicine, Vancouver
Lisa A. Ronald
Affiliation:
Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology & Evaluation, Vancouver
Jennifer Baumbusch
Affiliation:
UBC School of Nursing, Vancouver
Douglas Andrusiek
Affiliation:
Emergency and Health Services Commission, Vancouver
Michelle B. Cox
Affiliation:
Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology & Evaluation, Vancouver
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Margaret J. McGregor, M.D., M.H.Sc. University of British Columbia Department of Family Practice Room 713, 828 West 10th Avenue Vancouver, BC V5Z 1L8 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

This study used administrative health data to describe emergency department (ED) visits by residents from assisted living and nursing home facilities in the Vancouver Coastal Health region, British Columbia. We compared ED visit rates, the distribution of visits per resident, and ED dispositions of the assisted living and nursing home populations over a 3-year period (2005–2008). There were 13,051 individuals in our study population. Visit rates (95% confidence interval) were 124.8 (118.1–131.7) and 64.1 (62.9–65.3) visits per 100 resident years in assisted living and nursing home facilities respectively. A smaller proportion of ED visits by assisted living residents resulted in hospital admission compared to nursing home residents (45% vs. 48%, p < .01). The ED visit rate among assisted living residents is significantly higher compared to that among nursing home residents. Future research is needed into the underlying causes for this finding.

Résumé

Cette étude a utilisé des données sur la santé administratives pour décrire des visites effectuées par les résidents de vie assistée et ceux des foyers de soins infirmiers à domicile au service d’urgence (SU) dans la région de Vancouver Coastal Health, Colombie-Britannique. Nous avons comparé taux de visite SU, la répartition des visites par résident, et les dispositions SU des deux populations—d’aide à la vie autonome ou du foyer de soins infirmiers pendant une période de 3 ans (2005-2008). Il y avait 13 051 personnes dans la population étudiée. Taux de visite (intervalle de confiance de 95 pourcent) étaient de 124,8 (118,1 à 131,7) et 64,1 (62,9 à 65,3) visites par 100 ans résidants dans les logements avec assistance et les foyers de soins infirmier à domicile, respectivement. Une plus faible proportion de visites à l’urgence par les résidents de vie assistée ont entraîné une hospitalisation par rapport aux résidents des foyers de soins (45% vs 48%, p<0,01). Le taux de visite à l’urgence chez les résidents de vie assistée est significativement plus élevée par rapport à celle des résidents des foyers de soins. De nouvelles recherches s’imposent sur les causes sous-jacentes de cette constation.

Keywords

agingassisted livinghospital transfernursing homeresidential long-term carevieillissmentaide à la vie autonomefoyer de soins infirmierscentre d’hébergement et de soins de longue durée
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 33 , Issue 2 , June 2014 , pp. 154 - 162
Copyright
Copyright © Canadian Association on Gerontology 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This study was supported by an operating grant from the Vancouver Foundation (2008–2011), the University of British Columbia’s Department of Family Practice Community Geriatrics and Vancouver General Hospital’s Department of Family Practice. Margaret McGregor was supported by a Vancouver Foundation Community-Based Clinician Investigator Award (2007–2011). We gratefully acknowledge the following individuals: Penny Brasher, VCHRI’s Centre for Clinical Epidemiology and Evaluation, who contributed to the original data extraction and management; Lisa Kuramoto, VCHRI’s Centre for Clinical Epidemiology and Evaluation, and Michael Schulzer, UBC Department of Statistics, who contributed to the data management and analytic approach; Kia Salomons, research assistant who coordinated the data extraction; Susan Sirrett, Patricia Chung, and Colin Sue (VCH Decision Support), Carole Astley and Catherine Barnardo (Fraser Health Decision Support), and Karl Newholm and Areta Wong (Providence Health Care Decision Support), all of whom assisted in data extraction from their respective administrative databases; and the librarians of the BC College of Physicians and Surgeons Library who assisted with literature searches.

References

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behaviour, 36(1), 1–10.CrossRefGoogle ScholarPubMed
Andersen, R. M., & Newman, J. M. (2005). Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 83(4). Retrieved 11 September 2011 fromhttp://www.milbank.org/uploads/documents/QuarterlyCentennialEdition/Societal%20and%20Indv.pdf.CrossRefGoogle Scholar
BC Ministry of Health. (2007). Office of the Assisted Living Registrar. Registrant Handbook. Policy 5: Registrant Entry and Exit. Retrieved 22 September 2011 fromhttp://www.health.gov.bc.ca/library/publications/year/2007/handbook_Entry_and_Exit.pdf.Google Scholar
BC Ministry of Health. (2009). Community Care and Assisted Living Act. Retrieved 22 June 2011 fromhttp://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/96_2009.Google Scholar
BC Ministry of Health. (2011). Home and Community Care Policy Manual. Retrieved 22 September 2011 fromhttp://www2.gov.bc.ca/gov/topic.page?id=8F569BDA913540DCAB75145DBB6070CE.Google Scholar
Canadian Healthcare Association. (2009). Guide to Canadian Healthcare Facilities 2009-2010. Ottawa, ON: Author.Google Scholar
Beveridge, R. (1998). CAEP issues. The Canadian Triage and Acuity Scale: A new and critical element in health care reform. Canadian Association of Emergency Physicians. Journal of Emergency Medicine 16(3), 507–511.Google Scholar
Canadian Institute for Health Information. (2011). Healthcare in Canada, 2011: A focus on seniors and aging. Retrieved 22 September 2011 fromhttp://secure.cihi.ca/free_products/HCIC_2011_seniors_report_en.pdf.Google Scholar
Canadian Institute for Health Information. (2010). Seniors’ use of emergency departments in Ontario, 2004-2005 to 2008-2009. Retrieved 22 September 2011 fromhttp://secure.cihi.ca/free_products/seniors_ed_e.pdf.Google Scholar
Cohen, M., Tate, J., & Baumbush, J. (2009). An uncertain future for seniors: BC’s restructuring of home and community health care, 2001-2008. Vancouver, BC, Canadian Centre for Policy Alternatives.Google Scholar
Doupe, M., Kozyrskyj, A., Soodeen, R. A., Derksen, S., Burchill, C., & Huq, S. (2008). An initial analysis of emergency department and urgent care in Winnipeg. Winnipeg, MN: Manitoba Centre For Health Policy.Google Scholar
Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. Journal of Gerontology Series A: Biolological Sciences and Medical Sciences, 59(3), 255–263.CrossRefGoogle ScholarPubMed
Gillick, M. R., Serrell, N. A., & Gillick, L. S. (1982). Adverse consequences of hospitalization in the elderly. Social Science and Medicine, 16(10), 1033–1038.CrossRefGoogle ScholarPubMed
Gruneir, A., Bell, C. M., Bronskill, S. E., Schull, M., Anderson, G. M., & Rochon, P. A. (2010). Frequency and pattern of emergency department visits by long-term care residents: A population-based study. Journal of the American Geriatrics Society, 58(3), 510–517.CrossRefGoogle ScholarPubMed
Hastings, S. N., Oddone, E. Z., Fillenbaum, G., Sloane, R. J., & Schmader, K. E. (2008). Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department. Medical Care, 46(8), 771–777.CrossRefGoogle ScholarPubMed
Hastings, S. N., Purser, J. L., Johnson, K. S., Sloane, R. J., & Whitson, H. E. (2008). Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. Journal of the American Geriatrics Society, 56(9), 1651–1657.CrossRefGoogle Scholar
Loeb, M., Carusone, S. C., Goeree, R., Walter, S. D., Brazil, K., Krueger, P., et al. (2006). Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: A randomized controlled trial. Journal of the American Medical Association, 295(21), 2503–2510.CrossRefGoogle ScholarPubMed
McGrail, K. M., Broemeling, A. M., McGregor, M., Salomons, K., Ronald, L. A., & McKendry, R. (2008). Home health services in British Columbia: A portrait of users and trends over time. Vancouver, BC, UBC Centre for Health Services and Policy Research.Google Scholar
McGrail, K. M., Meredith, L., McGregor, M. J., Broemeling, A. M., Salomons, K., & Peterson, S. (2010). Who uses assisted living in British Columbia?: An initial exploration. Vancouver, BC, UBC Centre for Health Services and Policy Research.Google Scholar
McGregor, M. J., Abu-Laban, R. B., Ronald, L. A., McGrail, K. M., Andrusiek, D., Baumbusch, J., et al. (2014). Nursing home characteristics associated with resident transfers to emergency departments. Canadian Journal on Aging / La Revue canadienne du viellissement, 33(1), 38–48.CrossRefGoogle ScholarPubMed
Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., et al. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489–495.Google Scholar
Ronald, L. A., McGregor, M. J., McGrail, K. M., Tate, R. B., & Broemeling, A. M. (2008). Hospitalization rates of nursing home residents and community-dwelling seniors in British Columbia. Canadian Journal of Aging, 27(1), 109–115.CrossRefGoogle ScholarPubMed
Rosenberg, T. (2012). Acute hospital use, nursing home placement, and mortality in a frail community-dwelling cohort managed with Primary Integrated Interdisciplinary Elder Care at Home. Journal of the American Geriatric Society, 60(7), 1340–1346.Google Scholar
Schull, M. J., Kiss, A., & Szalai, J. P. (2007). The effect of low-complexity patients on emergency department waiting times. Annals of Emergency Medicine, 49(3), 257–264.CrossRefGoogle ScholarPubMed
Strain, L. A., Maxwell, C. J., Wanless, D., & Gilbart, E. (2011). Designated assisted living (DAL) and long-term care (LTC) in Alberta: Selected highlights from the Alberta Continuing Care Epidemiological Studies (ACCES). Retrieved 13 October 2012 fromhttp://www.ab-cca.ca/uploads/files/Documents/ACCES%20Final%20Report%202011.pdf.Google Scholar
Vedel, I., Monette, M., Beland, F., Monette, J., & Bergman, H. (2011). Ten years of integrated care: Backwards and forwards. The case of the province of Quebec, Canada. International Journal of Integrated Care, 11, e004.Google Scholar
Vu, M. Q., Weintraub, N., & Rubenstein, L. Z. (2006). Falls in the nursing home: Are they preventable? Journal of the American Medical Directors Association, 7(3), S53–S58.CrossRefGoogle ScholarPubMed
Wilson, D., & Truman, C. (2005). Comparing the health services utilization of long-term-care residents, home-care recipients, and the well elderly. Canadian Journal of Nursing Research, 37(4), 139–154.Google ScholarPubMed