# Identifying Predictors of Hospital Admission from the ED Among the Elderly

> **NIH AHRQ R01** · HARVARD MEDICAL SCHOOL · 2020 · $360,000

## Abstract

Project Summary:
 While hospitalizations for older patients generally provide a net benefit when appropriate, hospitalizations
for older patients also carry significant risks including an irreversible decline in both physical and cognitive
functional status, often resulting in loss of quality of life and greater risk of placement in nursing homes. Elderly
patients are also at increased risk of in-hospital falls, delirium, medication interactions, nosocomial infections,
and medical errors. Thus, while excess use of the hospital affects all age groups, overuse of the hospital has
substantially disproportionate consequences for the elderly. To this point there is little empirical data to help
characterize the factors associated with admission rates for the elderly or the extent to which the complex
social, cognitive, and physical factors common to elderly patients contribute to higher rates of hospitalization
for patients who present for care in the Emergency Department (ED). Additionally, factors related to individual
emergency physicians (EPs) who typically make the decision whether to admit or not, and the hospitals where
patients present for care may further influence the likelihood of admission. Payment changes in health care
also may influence rates of hospitalization for elderly patients and are crucial policy levers available to
influence admissions. In particular, the recent advent of Accountable Care Organizations (ACOs) with
incentives to reduce spending globally and improve quality may differentially reduce admissions.
 The proposed study will utilize data on Medicare beneficiaries and their care providers to accomplish three
key aims. Using nationally representative data from the Medicare program aims 1 and 2 will examine the
predictors of and variation in rates of admission of elderly patients from the ED focusing on discretionary
conditions. We also will examine whether factors that influence the decision to admit are also associated with
adverse outcomes, including mortality and ED revisits. Potential factors will be drawn from our novel
conceptual framework and include patient, EP, hospital, and market characteristics. In Aim 2, we will
supplement these measures with data from the Health and Retirement Study to examine measures unique to
the elderly including functional status, cognition, and social support. Aim 3 will serve as a proof of concept and
will evaluate the impact of Medicare's Accountable Care Organization programs, which through systems
changes as a response to payment incentives would benefit from reducing potentially discretionary admissions
to the hospital.
 These aims are important and timely and built upon the scientific premise that safely reducing admissions
from the ED could ultimately result in improved quality of care, maintenance of independence, reduced
mortality, and substantial cost savings.

## Key facts

- **NIH application ID:** 10015296
- **Project number:** 5R01HS025408-04
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Bruce E. Landon
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $360,000
- **Award type:** 5
- **Project period:** 2017-09-30 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10015296

## Citation

> US National Institutes of Health, RePORTER application 10015296, Identifying Predictors of Hospital Admission from the ED Among the Elderly (5R01HS025408-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10015296. Licensed CC0.

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