Journal article
Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries
BMC health services research, Vol.10(1), pp.173-173
06/21/2010
DOI: 10.1186/1472-6963-10-173
PMCID: PMC2903585
PMID: 20565949
Abstract
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. 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 >or=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. 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). 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.
Details
- Title: Subtitle
- Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries
- Creators
- Brian Kaskie - Department of Health Management and Policy, College of Public Health, the University of Iowa, Iowa City, Iowa, USA. brian-kaskie@uiowa.eduMaksym ObrizanElizabeth A CookMichael P JonesLi LiuSuzanne BentlerRobert B WallaceJohn F GewekeKara B WrightElizabeth A ChrischillesClaire E PavlikRobert L OhsfeldtGary E RosenthalFredric D Wolinsky
- Resource Type
- Journal article
- Publication Details
- BMC health services research, Vol.10(1), pp.173-173
- DOI
- 10.1186/1472-6963-10-173
- PMID
- 20565949
- PMCID
- PMC2903585
- NLM abbreviation
- BMC Health Serv Res
- ISSN
- 1472-6963
- eISSN
- 1472-6963
- Publisher
- England
- Grant note
- R21 AG-031307 / NIA NIH HHS U01 AG009740 / NIA NIH HHS R21 AG-030333 / NIA NIH HHS R01 AG-022913 / NIA NIH HHS
- Language
- English
- Date published
- 06/21/2010
- Academic Unit
- Statistics and Actuarial Science; Pharmacy; Health Management and Policy; Epidemiology; Economics; Biostatistics; Nursing; College of Public Health; Injury Prevention Research Center; Public Policy Center (Archive); Geographical and Sustainability Sciences; Internal Medicine
- Record Identifier
- 9983985947202771
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