Predictors of Emergency Department Transfer Among Older Adults Seen by an Emergency Medicine Mobile Integrated Health Team.

Abstract

The purpose of this study was to describe the utilization of an emergency medicine-led mobile integrated health program, the Mobile Response Program (MRP), by older adults and identify predictors of being directed to the emergency department (ED). This retrospective observational cohort study included patients 65 years and older referred to MRP between 4/2021-1/2023. Collected covariates included demographics, comorbidities, referral reasons and outcomes, and for accepted referrals number of visits, tests, treatments, and disposition. We used logistic regression to identify predictors of being referred to the ED as compared to evaluation and treatment by MRP. During the study, 1167 referrals were made for older adults of which 813 were accepted and received a visit, and 129 were declined and directed to the ED. Common referral reasons included shortness of breath, cough/upper respiratory infection, soft tissue infection, volume overload, urinary complaints, and confusion. Predictors of MRP declining the referral and directing patients to the ED included confusion, fall, dizziness, and failure to thrive, whereas referrals for cough had higher odds of acceptance. Among patients with an MRP visit, 19% were directed to the ED, and an additional 4% were directed to the ED but declined to go. Predictors of ED direction after MRP visits included confusion, failure to thrive, electrocardiogram performance, and nebulizer treatments; visits with COVID testing or antibiotic administration had lower odds of being directed to the ED. Among older adults referred to the MRP for acute medical needs, most were safely treated at home. Geriatric syndromes and non-specific complaints were associated with greater odds of being directed to the ED from the original referral and after MRP evaluation. These findings can help improve the design of these programs to meet the needs of older adults.