Utilization of Emergency Room and Hospitalization by Chinese Nursing Home Residents: A Cross-Sectional Study

Abstract

This study determined factors associated with increased use of emergency room (ER) and hospitalization of Chinese nursing home residents. A cross-sectional study. The setting was 14 nursing homes in Hong Kong. Participants were 1820 Chinese nursing home residents. Data on facility factors and resident factors were collected. Resident factors were mainly collected by the Minimum Data Set-Resident Assessment Instrument 2.0 (MDS-RAI 2.0). Residing in a for-profit home (OR=6.51), having less than one third of time spent in activities (OR=1.84), having had recent fall (OR=3.81), having renal failure (OR=3.17), having had recent initiation of new medications (OR=1.42), and having had recent physician visit (OR=1.67) were factors associated with increased use of ER. Male gender (OR=1.49), having a body mass index (BMI) less than 18.5 kg/m(2) (OR=1.51), being more functionally dependent (OR=1.18 per 1-point increment in the ADL Hierarchy Scale), having higher burden of illness (OR=1.29 per 1-point increment in the CHESS score), having a feeding tube (OR=3.07), having an indwelling urinary catheter (OR=2.75), having had recent fall (OR=1.94), having respiratory tract infection (OR=2.05), having Parkinson's disease (OR=1.55), having anemia (OR=1.70), having had recent initiation of new medications (OR=2.08), and having had recent physician visit (OR=1.83) were factors associated with increased risk of hospitalization. Although some of the associated factors reflect frailty characteristics of residents, differences in association between for-profit and not-for-profit institutions provide evidence of overreliance on the ER, perhaps as a result of inadequate primary care support.