Acute health care services use among nursing home residents in Germany: a comparative analysis of out-of-hours medical care, emergency department visits and acute hospital admissions

Abstract

Background: Nursing home (NH) residents often utilise acute health care services. However, comparative data on those are lacking.

Aims: Investigating German NH residents' use of out-of-hours medical care (OOHC), visits to emergency departments (EDs) and acute hospital admissions (AHAs).

Methods: Using claims data of 1665 residents for 2014-2015, we conducted a retrospective cohort study, examining the incidence rates involving the different services. Multivariate Poisson regression analyses were performed to calculate relative risks (RRs). Differences in the utilisations over the days of the week and of the reasons for contacts were assessed.

Results: In total, 3576 contacts occurred (mean age 80.5 years, women 66.3%), resulting in an overall incidence rate of 2.7 per person-year (95% confidence interval 2.6-2.8). Strongest predictors were polypharmacy (RR 1.79; 95% CI 1.50-2.12), followed by male sex and higher care dependency. Among the three services AHAs showed the highest rates. Injuries were the most common reasons for visiting EDs, whereas for OOHC use and AHAs, coded diagnoses covered a broader spectrum. Utilisation of the services on weekdays varied, particularly for OOHC.

Discussion: Polypharmacy, a higher care dependency and male sex seem to play a role in predicting acute health care services. Considering the distribution of the diagnoses of all three types, certain patterns concerning the symptoms' acuity become apparent.

Conclusions: Our findings revealed high acute health care services use among NH residents in Germany and differences among the three available services. This information can be used to design studies for investigating the appropriateness of these contacts.

Keywords: Acute health care; Germany; Health services research; Nursing home residents; Statutory health insurance data.