• Jane McCusker, Nandini Dendukuri, Pierre Tousignant, Josée Verdon, Louise Poulin de Courval, and Eric Belzile.
• Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montréal, Québec, Canada. jane.mccusker@mcgill.ca
• Acad Emerg Med. 2003 Mar 1;10(3):233-43.

ObjectivesA two-stage intervention comprising screening and a brief standardized nursing assessment and referral, for emergency department (ED) patients aged 65 years and over, reduced the rate of functional decline four months after the visit, without increasing societal costs. In this study, the authors investigated the effects of the intervention on the process of care at, and during the month after, the ED visit.MethodsPatients at four Montreal hospital EDs were randomized by day of visit to the intervention or to usual care. Patients admitted to the hospital were excluded. Measures of process of care included: referrals and visits to the primary physician and to the local community health center, for home care or other services, and return ED visits. Data sources included hospital charts, patient questionnaires, and provincial administrative databases.ResultsThe study sample included 166 intervention and 179 control group patients ready for discharge from the ED. Intervention group patients were more likely to have a chart-documented referral to their local community health center [adjusted odds ratio (OR) 4.0, 95% confidence interval (95% CI) = 1.7 to 9.5] and their primary physician [adjusted OR 1.9, 95% CI = 1.0 to 3.4], and to have received home care services one month after the ED visit [adjusted OR 2.3, 95% CI = 1.1 to 5.1]. Unexpectedly, they were also more likely to make a return visit to the ED [adjusted OR 1.6, 95% CI = 1.0 to 2.6].ConclusionsThe beneficial outcomes of the intervention appear to result primarily from the early provision of home care rather than early contact with the primary physician.

20 keywords...

hide…