Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries

• Main Authors: Wright Kara B (Author), Geweke John F (Author), Wallace Robert B (Author), Bentler Suzanne (Author), Liu Li (Author), Jones Michael P (Author), Cook Elizabeth A (Author), Obrizan Maksym (Author), Kaskie Brian (Author), Chrischilles Elizabeth A (Author), Pavlik Claire E (Author), Ohsfeldt Robert L (Author), Rosenthal Gary E (Author), Wolinsky, Fredric D (Author)
• Format: Book
• Published: BMC, 2010-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

<p>Abstract</p> <p>Background</p> <p>Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.</p> <p>Methods</p> <p>We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents ≥70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.</p> <p>Results</p> <p>Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).</p> <p>Conclusions</p> <p>We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.</p>

Item Description

10.1186/1472-6963-10-173
1472-6963