Title | Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries. |
Publication Type | Journal Article |
Year of Publication | 2010 |
Authors | Kaskie, B, Obrizan, M, Cook, EA, Jones, MP, Liu, L, Bentler, SE, Wallace, RB, Geweke, JF, Wright, KB, Chrischilles, EA, Pavlik, CE, Ohsfeldt, RL, Rosenthal, GE, Wolinsky, FD |
Journal | BMC Health Serv Res |
Volume | 10 |
Pagination | 173 |
Date Published | 2010 Jun 21 |
ISSN Number | 1472-6963 |
Keywords | Aged, Aged, 80 and over, Cohort Studies, Emergency Service, Hospital, Humans, Insurance Claim Review, Medicare, Prospective Studies, Severity of Illness Index, United States |
Abstract | BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. |
DOI | 10.1186/1472-6963-10-173 |
User Guide Notes | |
Endnote Keywords | HOSPITALIZATION/emergency department service use/emergency department service use/medicare/predictive validity/predictive validity |
Endnote ID | 25020 |
Alternate Journal | BMC Health Serv Res |
Citation Key | 7526 |
PubMed ID | 20565949 |
PubMed Central ID | PMC2903585 |
Grant List | U01 AG009740 / AG / NIA NIH HHS / United States R01 AG-022913 / AG / NIA NIH HHS / United States R21 AG-031307 / AG / NIA NIH HHS / United States R21 AG-030333 / AG / NIA NIH HHS / United States |