This research was supported by grants from the National Institute on Aging (R01 AG08211 and R29 AG11407) and a Pfizer/Foundation for Health in Aging Junior Faculty Scholarship for Research on Health Outcomes in Geriatrics to Dr. Boockvar. Presented in part at the 2003 meeting of the American Geriatrics Society, Baltimore, Maryland.
Outcomes of Infection in Nursing Home Residents with and without Early Hospital Transfer
Article first published online: 30 MAR 2005
Journal of the American Geriatrics Society
Volume 53, Issue 4, pages 590–596, April 2005
How to Cite
Boockvar, K. S., Gruber-Baldini, A. L., Burton, L., Zimmerman, S., May, C. and Magaziner, J. (2005), Outcomes of Infection in Nursing Home Residents with and without Early Hospital Transfer. Journal of the American Geriatrics Society, 53: 590–596. doi: 10.1111/j.1532-5415.2005.53205.x
- Issue published online: 30 MAR 2005
- Article first published online: 30 MAR 2005
- nursing homes;
- treatment outcome
Objectives: To compare outcomes of infection in nursing home residents with and without early hospital transfer.
Design: Observational cohort study.
Setting: Fifty-nine nursing homes in Maryland.
Participants: Two thousand one hundred fifty-three individuals admitted to nursing homes between 1992 and 1995.
Measurements: Incident infection was recorded when a new infectious diagnosis was documented in the medical record or nonprophylactic antibiotic therapy was prescribed. Early hospital transfer was defined as transfer to the emergency department or admission to the hospital within 3 days of infection onset. Infection, resident, and facility characteristics were entered into a multivariate model to create a propensity score for early hospital transfer. Association between early hospital transfer and outcomes of infection, namely pressure ulcers and death between Days 4 and 34 after infection onset, were examined, controlling for propensity score.
Results: Four thousand nine hundred ninety infections occurred in 1,301 residents. Genitourinary (28%), skin (19%), upper respiratory (13%), and lower respiratory (12%) were the most common types. Three hundred seventy-five episodes in which residents survived 3 days (7.6%) resulted in early hospital transfer. In multivariate regression, individuals with early hospital transfer had higher mortality (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.04–1.99) and, in 1-month survivors, a greater occurrence of pressure ulcers (OR 1.61, 95% CI=1.17–2.20) than those without, after adjusting for propensity score.
Conclusion: Using observational data and propensity score methods, outcomes were worse in nursing home residents transferred to the hospital within 3 days of infection onset than in those who remained in the nursing home.