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

Objectives: This study determined factors associated with increased use of emergency room (ER) and hospitalization of Chinese nursing home residents. Design: A cross-sectional study. Setting: The setting was 14 nursing homes in Hong Kong. Participants: Participants were 1820 Chinese nursing home residents. Measurements: 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). Results: 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. Conclusions: 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. (J Am Med Dir Assoc 2010; 11: 325-332)