Electronic transfers

Study finds long-term residents in retirement homes

INDIANAPOLIS – Residents of long-term nursing homes are frequently transferred to hospital. Dispelling the hypothesis that as individuals age and become more frail, higher rates of transfer from nursing homes to hospitals occur, a groundbreaking study from the Regenstrief Institute and Indiana University School of Medicine shows that residents under 60 experience twice the resident transfer rate. 80 years and over.

Transfers from a nursing home to a hospital are stressful for residents and their families, increase the costs of care, and can lead to unintended consequences such as hospital-acquired infections, as well as cognitive and functional decline. But how age predicts transfers was not well understood before.

“It is estimated that about one in six residents of a nursing home in the United States is under the age of 65,” said Wanzhu Tu, PhD, of the Regenstrief Institute and the IU School of Medicine, who led the new study. “Knowing and understanding age-specific hospital transfer rates, as we do now, could inform benchmarks for care delivery and help design targeted strategies to reduce hospital transfers. that better recognize and respond to the diverse needs of nursing home residents of different ages, especially younger residents.

Using state-of-the-art analytical methods, the researchers determined that annual hospital transfer rates actually decline with age, but not in a linear fashion. Transfer rates were highest in the under 60 age group; rates slowly declined between 60 and 80, then the decline in transfer rates accelerated after 80.

Researchers reported that residents under the age of 60 had a different clinical profile than older residents, with younger residents suffering more from sepsis, daily pain, anemia and being more likely to require dialysis or dialysis. tube feeding. Older residents were more likely to suffer from cognitive decline, dementia and diabetes. Older residents were also more likely to have advance care planning instructions reflecting their preferences for comfort care rather than aggressive treatment.

2015-16 data on long-term care home residents aged 19 to 103 was collected in a study called OPTIMISTIC (an acronym for Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care), a $ 30.3 million Regenstrief Institute-Indiana project. Center for Medicare and Medicaid Services (CMS) funded University School of Medicine project to reduce avoidable hospital transfers. OPTIMISTIC reduced the relative risk of potentially avoidable hospitalizations by 33% and the relative risk of all hospitalizations by 19%, producing a net saving of $ 3.4 million in Medicare spending over the first four years of the project.

“There is a large population of youth in care in nursing homes and little is known about them and how best to tailor quality improvement programs to meet their needs,” said Kathleen. Unroe, study co-author, MD of Regenstrief Institute and IU School of Medicine. “This article highlights some key differences in the nursing home population by age.”

“Hospital transfer rates by age among residents of long-term nursing homes” is published online ahead of print in Age and aging by Oxford University Press on behalf of the British Geriatrics Society. The authors, in addition to Drs. Tu and Unroe, are researchers at the Regenstrief Institute and the IU School of Medicine Nicole R. Fowler, PhD; Jennifer L. Carnahan, MD, MPH; Greg A. Sachs, MD; Susan E. Hickman, PhD, as well as Ruohong Li, PhD, former IU medical school graduate student; Timothy E. Stump, MS of IU School of Medicine and Justin Blackburn, PhD, MPH, of IU Richard M. Fairbanks School of Public Health. Dr Hickman also holds an appointment with the IU School of Nursing.

Study research was funded by grant 1E1CMS331488 from the Centers for Medicare and Medicaid Services (CMS).

About Wanzhu Tu, PhD

In addition to his research role at the Regenstrief Institute, Wanzhu Tu, PhD, is Professor of Biostatistics and Health Data Science at Indiana University School of Medicine and the Richard M. Fairbanks School of Public Health at IUPUI .

About Kathleen Unroe, MD, MHA, MS

In addition to being a researcher at the Regenstrief Institute, Kathleen Unroe, MD, MHA, is an associate professor at Indiana University School of Medicine and a practicing geriatrician.

About the Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and achieve true health. A key research partner of Indiana University, Regenstrief and her researchers are responsible for a growing number of major innovations and studies in healthcare. Examples range from developing global health information technology standards that enable the use and interoperability of electronic health records, to improving patient-physician communications, to creating models of care. that inform practice and improve the lives of patients around the world.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible to all. His vision continues to guide the research mission of the institute.

About UI Faculty of Medicine

The IU School of Medicine is the largest medical school in the United States and is ranked among the nation’s top medical schools annually by US News & World Report. The school offers high-quality medical education, access to cutting-edge medical research, and a rich campus life in nine cities across Indiana, including rural and urban areas still known for their quality of life.


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