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Nursing Home Characteristics Associated with Resident Transfers to Emergency Departments*

Published online by Cambridge University Press:  03 January 2014

Margaret J. McGregor*
Affiliation:
Department of Family Practice, University of British Columbia Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation Centre for Health Services and Policy Research, University of British Columbia
Riyad B. Abu-Laban
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation Department of Emergency Medicine, University of British Columbia
Lisa A. Ronald
Affiliation:
Department of Family Practice, University of British Columbia Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
Kimberlyn M. McGrail
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia School of Population and Public Health, University of British Columbia
Douglas Andrusiek
Affiliation:
Emergency and Health Services Commission
Jennifer Baumbusch
Affiliation:
School of Nursing, University of British Columbia
Michelle B. Cox
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
Kia Salomons
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
Michael Schulzer
Affiliation:
Department of Statistics, University of British Columbia
Lisa Kuramoto
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
*
Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Margaret J. McGregor, M.D., M.H.Sc. Department of Family Practice University of British Columbia Room 713, 828 West 10th Avenue Vancouver, BC V5Z 1L8 (mrgret@mail.ubc.ca)

Abstract

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff – disproportionately present in publicly owned facilities – were associated with lower transfer rates. A number of other facility organizational characteristics – unrelated to ownership – were also associated with transfer rates.

Résumé

Cette étude a examiné comment la propriété des maisons de soins infirmiers porte sur les taux de transfert des services urgences (SU), comment les caractéristiques organisationnelles des installations sont réparties entre les groupes de propriété, et comment ces caractéristiques sont associées aux taux de transfert SU. L’échantillon comprenait une cohorte rétrospective de résidents des maisons de soins infirmiers dans la région de Vancouver Coastal Health (n = 13,140). Les taux de transferts SU ont été comparés entre les différents types de propriété des foyers de soins. Pour une analyse exploratoire, des données administratives ont ensuite été liées aux données provenant d’enquêtes auprès des caractéristiques organisationnelles des installations. Taux de transfert brut (SU transferts/100 ans résidents) étaient de 69, 70 et 51, respectivement, dans les installations à but lucratif, celles à but non-lucratif et les installations publiques. Avec des contrôles pour le sexe et l’age, la propriété publique a été associée aux taux de transfert SU inférieurs à ceux des installations à but lucratif et sans but lucratif. Les résultats ont aussi démontré un montant total plus élevé associé aux heures de soins directs infirmières par journée/résident, et la présence de personnel de Allied Health – qui sont présents de manière disproportionnée dans les installations de propriété publique – ont été associés aux taux de transfert inférieurs.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2013 

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Footnotes

*

We gratefully acknowledge the following individuals: Jan Volker, M.Ed., who administered the nursing home facility survey; Judith Globerman, Ph.D., who provided valuable input into the study design and facility survey administration; Penny Brasher, biostatistician at the Vancouver Coastal Health Research Institute’s (VCHRI) Centre for Clinical Epidemiology and Evaluation who oversaw earlier versions of the data analyses; 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) who assisted in data extraction from their respective administrative databases; Edwin Mak, who assisted with database management; Stirling Bryan, head of the VCHRI’s Centre for Clinical Epidemiology and Evaluation who contributed to interpreting the data; and the librarians of the BC College of Physicians and Surgeons Library who assisted with literature searches. This study was supported by a grant from the Vancouver Foundation (operating grant 2008–2011), the UBC Department of Family Practice Division of Geriatrics, and the VGH Department of Family Practice. Margaret McGregor was supported by a Community-Based Clinician Investigator Award from the Vancouver Foundation (2007–2011).

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