Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-22T22:02:36.478Z Has data issue: false hasContentIssue false
  • English
  • Français

Nursing Home Characteristics Associated with Resident Transfers to Emergency Departments*

Published online by Cambridge University Press:  03 January 2014

Margaret J. McGregor ,
Riyad B. Abu-Laban ,
Lisa A. Ronald ,
Kimberlyn M. McGrail ,
Douglas Andrusiek ,
Jennifer Baumbusch ,
Michelle B. Cox ,
Kia Salomons ,
Michael Schulzer  and
Lisa Kuramoto
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 ([email protected])
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

agingquality of carehospital transfernursing homeresidential long-term-carestaffingownershipvieillissementtransferts des hôpitaux aux maisons de soins infirmiersqualité de soinsmaisons (foyers) de soins infirmierssoins de longue durée en établissementdotation en personnelpropriété
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 33 , Issue 1 , March 2014 , pp. 38 - 48
Copyright
Copyright © Canadian Association on Gerontology 2013 

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

*

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).

References

Abu-Laban, R. B. (2006). The junkyard dogs find their teeth: Addressing the crisis of admitted patients in Canadian emergency departments. Canadian Journal of Emergency Medicine, 8(6), 388–391.CrossRefGoogle ScholarPubMed
Ackermann, R. J., & Kemle, K. A. (1998). The effect of a physician assistant on the hospitalization of nursing home residents. Journal of the American Geriatrics Society, 46(5), 610–614.CrossRefGoogle ScholarPubMed
Allman, R. M., Laprade, C. A., Noel, L. B., Walker, J. M., Moorer, C.A., Dear, M. R., et al. (1986). Pressure sores among hospitalized patients. Annals of Internal Medicine, 105(3), 337–342.CrossRefGoogle ScholarPubMed
American Health Care Association, Research and Reimbursement Department. (2010). Trends in nursing facility characteristics. Retrieved 9 September 2011 from http://www.ahcancal.org/research_data/trends_statistics/Documents/trends_nursing_facilities_characteristics_Dec2010.pdf.Google Scholar
Barry, T. T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist, 45(3), 309–317.CrossRefGoogle ScholarPubMed
British Columbia Ministry of Health. (2011). Home and community care policy manual. Retrieved September 9, 2011, from http://www2.gov.bc.ca/gov/topic.page?id=8F569BDA913540DCAB75145DBB6070CE.Google Scholar
Berta, W., Laporte, A., & Valdmanis, V. (2005). Observations on institutional long-term care in Ontario: 1996-2002. Canadian Journal on Aging, 24(1), 71–84.CrossRefGoogle ScholarPubMed
Bottrell, M. M., O’Sullivan, J. F., Robbins, M. A., Mitty, E. L., & Mezey, M. D. (2001). Transferring dying nursing home residents to the hospital: DON perspectives on the nurse’s role in transfer decisions. Geriatric Nursing, 22(6), 313–317.CrossRefGoogle Scholar
Bravo, G., Charpentier, M., Dubois, M. F., DeWals, P., & Emond, A. (1998). Profile of residents in unlicensed homes for the aged in the eastern townships of Quebec. Canadian Medical Association Journal, 159(2), 143–148.Google ScholarPubMed
Carter, M.W., & Porell, F.W. (2005). Vulnerable populations at risk of potentially avoidable hospitalizations: The case of nursing home residents with Alzheimer’s disease. American Journal of Alzheimer’s Disease and other dementias, 20(6), 349–358.CrossRefGoogle ScholarPubMed
Casarett, D., Karlawish, J., Morales, K., Crowley, R., Mirsch, T., & Asch, D. A. (2005). Improving the use of hospice services in nursing homes: A randomized controlled trial. JAMA, 294(2), 211–217.CrossRefGoogle ScholarPubMed
Castle, N. G. (2001). Administrator turnover and quality of care in nursing homes. The Gerontologist, 41(6), 757–767.CrossRefGoogle ScholarPubMed
Castle, N. G., & Lin, M. (2010). Top management turnover and quality in nursing homes. Health Care Management Review, 35(2), 161–174.CrossRefGoogle ScholarPubMed
Comondore, V. R., Devereaux, P. J., Zhou, Q., Stone, S. B., Busse, J. W., Ravindran, N. C., et al. (2009). Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. British Medical Journal, 339, b2732.CrossRefGoogle ScholarPubMed
Decker, F. H. (2008). The relationship of nursing staff to the hospitalization of nursing home residents. Research in Nursing and Health, 31(3), 238–251.CrossRefGoogle Scholar
Dosa, D. (2005). Should I hospitalize my resident with nursing home-acquired pneumonia? Controversies in Long-term Care, 6(5), 327–333.Google ScholarPubMed
Doupe, M., Brownell, M., Kozyrskyj, A., Dik, N., Burchill, C., Dahl, M., et al. (2006). Using administrative data to develop indicators of quality care in personal care homes. Manitoba, Canada: Manitoba Centre for Health Policy, Dept of Community Health Sciences, Faculty of Medicine, University of Manitoba.Google Scholar
Fried, T. R., Gillick, M. R., & Lipsitz, L. A. (1997). Short-term functional outcomes of long-term care residents with pneumonia treated with and without hospital transfer. Journal of the American Geriatric Society, 45(3), 302–306.CrossRefGoogle ScholarPubMed
Frohlich, N., De Coster, C., & Dik, N. (2006). Estimating personal care home bed requirements. Manitoba, Canada: Manitoba Centre for Health Policy, Faculty of Medicine, University of Manitoba.Google Scholar
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
Harnett, C. E. (2012). Overcrowding at Royal Jubilee hits highest level: Seven ambulances in queue, 28 patients await beds. Retrieved 9 June 2012 from http://www.vancouversun.com/health/Overcrowding+Royal+Jubilee+hits+highest+level/6255084/story.html.Google Scholar
Harrington, C., Woolhandler, S., Mullan, J., Carrillo, H., & Himmelstein, D. U. (2001). Does investor ownership of nursing homes compromise the quality of care? American Journal of Public Health, 91(9), 1452–1455.CrossRefGoogle ScholarPubMed
Hillmer, M. P., Wodchis, W. P., Gill, S. S., Anderson, G. M., & Rochon, P. A. (2005). Nursing home profit status and quality of care: Is there any evidence of an association? Medical Care Research & Review, 62(2), 139–166.CrossRefGoogle ScholarPubMed
Horn, S. D., Buerhaus, P., Bergstrom, N., & Smout, R. J. (2005). RN staffing time and outcomes of long-stay nursing home residents: Pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care. American Journal of Nursing, 105(11), 58–70.CrossRefGoogle ScholarPubMed
Hutt, E., Ecord, M., Eilertsen, T. B., Frederickson, E., & Kramer, A. M. (2002). Precipitants of emergency room visits and acute hospitalization in short-stay medicare nursing home residents. Journal of American Geriatrics Society, 50(2), 223–229.CrossRefGoogle ScholarPubMed
Hutt, E., Frederickson, E., Ecord, M., & Kramer, A. M. (2003). Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure. Journal of American Medical Directors Association, 4(4), 195–199.CrossRefGoogle ScholarPubMed
Intrator, O., Castle, N. G., & Mor, V. (1999). Facility characteristics associated with hospitalization of nursing home residents: Results of a national study. Medical Care, 37(3), 228–237.CrossRefGoogle ScholarPubMed
Intrator, O., Zinn, J., & Mor, V. (2004). Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. Journal of American Geriatrics Society, 52(10), 1730–1736.CrossRefGoogle ScholarPubMed
Kramberger, A. (2012). ER overcrowding a priority for health centre, chief says. Retrieved 11 March 2012 from http://www.edmontonjournal.com/health/overcrowding+priority+health+centre+chief+says/6438714/story.html.Google Scholar
Mah, R. (2009). Emergency department overcrowding as a threat to patient dignity. CJEM, 11(4), 365–374.CrossRefGoogle ScholarPubMed
McGregor, M. J., Baumbusch, J., Abu-Laban, R. B., McGrail, K. M., Andrusiek, D., Globerman, J., et al. (2011). A survey of nursing home organizational characteristics associated with potentially avoidable hospital transfers and care quality in one large British Columbia health region. Canadian Journal on Aging, 30(4), 551–561.CrossRefGoogle ScholarPubMed
McGregor, M., Pare, D., Wong, A., Cox, M. B., & Brasher, P. (2010). Correlates of a “do not hospitalize” designation: In a sample of frail nursing home residents in Vancouver. Canadian Family Physician, 56(11), 1158–1164.Google Scholar
McGregor, M. J., & Ronald, L. A. (2011). Residential long-term care for Canadian seniors: Non-profit, for-profit or does it matter? Montreal: IRPP Institute for Research in Public Policy.Google Scholar
McGregor, M. J., Tate, R. B., McGrail, K. M., Ronald, L. A., Broemeling, A. M., & Cohen, M. (2006). Care outcomes in long-term care facilities in British Columbia, Canada. Does ownership matter? Medical Care, 44(10), 929–935.CrossRefGoogle ScholarPubMed
McGregor, M. J., Tate, R. B., Ronald, L. A., McGrail, K. M., Cox, M. B., Berta, W., et al. (2010). Staffing in long-term care in British Columbia, Canada: A longitudinal study of differences by facility ownership, 1996–2006. Health Reports, 21(4), 1–7.Google Scholar
Molloy, D. W., Guyatt, G. H., Russo, R., Goeree, R., O’Brien, B. J., Bedard, M., et al. (2000). Systematic implementation of an advance directive program in nursing homes: A randomized controlled trial. JAMA, 283(11), 1437–1444.CrossRefGoogle ScholarPubMed
O’Neill, C., Harrington, C., Kitchener, M., & Saliba, D. (2003). Quality of care in nursing homes: An analysis of relationships among profit, quality, and ownership. Medical Care, 41(12), 1318–1330.CrossRefGoogle ScholarPubMed
Provincial Emergency Services Advisory Panel. (2009). Improving access to quality care for emergency department patients in British Columbia. Retrieved 9 June 2012 from http://www.health.gov.bc.ca/cpa/mediasite/pdf/report-of-the-ed-decongestion-expert-panel.pdf.Google Scholar
Quach, C., McArthur, M., McGeer, A., Li, L., Simor, A., Dionne, M., et al. (2012). Risk of infection following a visit to the emergency department: A cohort study. CMAJ, 184(4), E232–E239.CrossRefGoogle Scholar
Ramage-Morin, P. L. (2006). Successful aging in healthcare institutions (Report No. 82–003). Supplement to Health Reports, Volume 16. Ottawa, ON: Statistics Canada.Google Scholar
Rantz, M. J., Hicks, L., Grando, V., Petroski, G. F., Madsen, R. W., Mehr, D. R., et al. (2004). Nursing home quality, cost, staffing, and staff mix. The Gerontologist, 44(1), 24–38.CrossRefGoogle ScholarPubMed
Reid, R. C., & Chappell, N. L. (2003). Staff ratios and resident outcomes in special care units: Do activity aides make a difference? Journal of Applied Gerontology, 22(1), 89–103.CrossRefGoogle Scholar
Schull, M. J. (2006). Hospital surge capacity: If you can’t always get what you want, can you get what you need? Annals of Emergency Medicine, 48(4), 389–390.CrossRefGoogle ScholarPubMed
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
Shapiro, E., & Tate, R. B. (1995). Monitoring the outcomes of quality of care in nursing homes using adminstrative data. Canadian Journal of Aging, 14(4), 755–768.CrossRefGoogle Scholar
Tang, M., Woo, J., Hui, E., Chan, F., Lee, J., Sham, A., et al. (2010). Utilization of emergency room and hospitalization by Chinese nursing home residents: A cross-sectional study. Journal of Americal Medical Directors Association, 11(5), 325–332.CrossRefGoogle ScholarPubMed
Young, Y., Barhydt, N. R., Broderick, S., Colello, A. D., & Hannan, E. L. (2010). Factors associated with potentially preventable hospitalization in nursing home residents in New York state: A survey of directors of nursing. Journal of American Geriatrics Society, 58(5), 901–907.CrossRefGoogle Scholar
Zimmerman, S., Gruber-Baldini, A. L., Hebel, J. R., Sloane, P. D., & Magaziner, J. (2002). Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration, and social factors. Journal of the American Geriatric Society, 50(12), 1987–1995.CrossRefGoogle ScholarPubMed