# PA-20-070 Identifying Predictors of Hospital Admission from the ED Among the Elderly

> **NIH AHRQ R01** · HARVARD MEDICAL SCHOOL · 2021 · $398,823

## Abstract

Project Summary:
 The ongoing COVID-19 pandemic has had a dramatic impact on emergency care. Reports from around
the country suggest that ED visits for non-COVID related conditions such as acute myocardial infarction and
stroke have plummeted by 30-50%, and anecdotal data suggests that overall visit volume for non-COVID
related conditions has also decreased. Conditional on presenting to the ED, the pandemic also is changing
how ED providers approach the decision to admit a patient to the hospital. There may be a number of
motivations involved in this decision-making, some related to system-level factors such as capacity constraints
and some related to changes in assessments of the risks and benefits of hospitalization for individual patients.
 The emergency department (ED) is the primary source for hospital admissions in the US. Over 70% of
hospital admissions among Medicare patients originate from the ED at an extraordinary cost to Medicare.1
Rates of hospital admission from the ED vary widely across regions, hospitals, and even across physicians
within hospitals. A critical need exists to determine the extent to which factors related to the COVID-19
pandemic have altered provider decision-making in the ED and whether these decisions are associated with
greater harm for patients. Lessons learned from these analyses will be vital to guiding ED providers in
approaching the decision to admit during future phases of this pandemic as well as under similar
circumstances that might arise. Moreover, there is a possibility that for some non-COVID related conditions
hospitalization rates pre-COVID-19 were too high (low-value admissions), and that admission rates are now
more optimal. Thus, there could be longer term improvements in the efficiency of the health care delivery
system that can be gained by optimizing the use of inpatient hospital care, its most expensive component.
 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 aim 1 will examine the extent to
which the COVID-19 pandemic has impacted ED visit rates for specific diagnoses in parts of the country more
and less effected by the pandemic. The second aim will then examine how admission decisions from the ED
have been impacted. Finally, aim 3 will examine the impact of changes in admission on patient outcomes
including 30-day mortality and ED revisits. The second and third aims will use rigorous quasi-experimental
methods to compare changes in the outcomes of interest in areas of the country more and less impacted by
the COVID-19 pandemic. Our central hypotheses are that the rate of admission will be decreased (across a
broad array of non-COVID-19 related conditions) during the time of the pandemic, that greater decreases in
admission will be seen for areas that were particularly impacted by COVID-19, and that these decreases in
admission rates will be associated wit...

## Key facts

- **NIH application ID:** 10175813
- **Project number:** 3R01HS025408-04S1
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Bruce E. Landon
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $398,823
- **Award type:** 3
- **Project period:** 2017-09-30 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10175813

## Citation

> US National Institutes of Health, RePORTER application 10175813, PA-20-070 Identifying Predictors of Hospital Admission from the ED Among the Elderly (3R01HS025408-04S1). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10175813. Licensed CC0.

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