{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:38:08Z","timestamp":1775554688575,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T00:00:00Z","timestamp":1593993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND\/OBJECTIVES<\/jats:title>\n                    <jats:p>The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a successful, multicomponent demonstration project to reduce potentially avoidable hospitalizations of long\u2010stay nursing facility residents. To continue to reduce hospital transfers, a more detailed understanding of these transfer events is needed. The purpose of this study was to describe differences in transfer events that result in treatment in the hospital versus emergency department (ED) only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>\n                      OPTIMISTIC project nurses collected data on residents who transferred. Transfer events that resulted in treatment in ED versus hospitalization were compared using\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests and chi\u2010square tests. A generalized estimating equations regression model was used to assess the associations between hospital admission and transfer characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PARTICIPANTS<\/jats:title>\n                    <jats:p>A total of 867 long\u2010stay nursing facility residents enrolled in OPTIMISTIC, January 2015 to June 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS<\/jats:title>\n                    <jats:p>Resident and transfer characteristics from Minimum Data Set and project REDCap (Research Electronic Data Capture) database, including demographics, cognitive status, comorbidities, symptoms at time of transfer, and diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The most common symptoms associated with treatment in the ED only were falls, trauma, or fracture (38% vs 10% admitted). Residents with cognitive impairment were more likely to be admitted to the hospital (odds ratio (OR) =\u20091.47; 95% confidence interval (CI) = 1.09\u20131.98;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.011). Residents with respiratory complaints were more likely to be admitted (OR\u2009=\u20092.098; 95% CI\u2009= 1.198\u20133.675;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009= .009); residents with hematological\/bleeding (nongastrointestinal) (OR\u2009=\u20090.23; 95% CI\u2009= 0.107\u20130.494;\n                      <jats:italic>P<\/jats:italic>\n                      = .0002), pain (OR\u2009=\u20090.421; 95% CI\u2009= 0.254\u20130.698;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009= .0008), or fall\/trauma\/fracture (OR\u2009=\u20090.181; 95% CI\u2009= 0.12\u20130.272;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u2009.001) were less likely to be admitted to the hospital.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Some presenting symptoms and other characteristics are more associated with ED only treatment versus hospitalization. A knowledge of who is likely to receive ED only care could prompt adoption of targeted resources and protocols to further reduce these types of transfer events. Opportunity may exist in the ED as well to reduce hospitalizations and increase discharges back to the facility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.16633","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T15:05:07Z","timestamp":1594047907000},"page":"2082-2089","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Long\u2010Stay Nursing Facility Resident Transfers: Who Gets Admitted to the Hospital?"],"prefix":"10.1111","volume":"68","author":[{"given":"Kathleen T.","family":"Unroe","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Indiana University Center for Aging Research Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey M.","family":"Caterino","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Internal Medicine The Ohio State University School of Medicine  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy E.","family":"Stump","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanzhu","family":"Tu","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Indiana University Center for Aging Research Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-4735","authenticated-orcid":false,"given":"Jennifer L.","family":"Carnahan","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Indiana University Center for Aging Research Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua R.","family":"Vest","sequence":"additional","affiliation":[{"name":"Indiana University Center for Aging Research Regenstrief Institute  Indianapolis Indiana USA"},{"name":"Department of Health Policy and Management Indiana University Richard M. Fairbanks School of Public Health at Indiana University \u2010 Purdue University Indianapolis  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg A.","family":"Sachs","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Indiana University Center for Aging Research Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E.","family":"Hickman","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Indiana University Center for Aging Research Regenstrief Institute  Indianapolis Indiana USA"},{"name":"Department of Community and Health Systems Indiana University School of Nursing  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,6]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring","author":"Levinson DR","year":"2013"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2000.tb03906.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.02768.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2009.0629"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.1179"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14879"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.7128"},{"key":"e_1_2_6_9_1","first-page":"02","volume-title":"AHRQ Quality Indicators\u2014Guide to Prevention Quality Indicators: Hospital Admission Fornambulatory Care Sensitive Conditions","year":"2001"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnw162.2418"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13141"},{"key":"e_1_2_6_12_1","volume-title":"Hospitalizations of Nursing Home Residents: Background and Options","author":"Polniaszek S","year":"2011"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-019-1028-z"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0164027512473488"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(98)70235-5"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2015.01.076"},{"issue":"10","key":"e_1_2_6_17_1","first-page":"734","article-title":"Hospitalization of nursing home residents in an acute\u2010care geriatric department: direct versus emergency room admission","volume":"3","author":"Aizen E","year":"2001","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14463"},{"key":"e_1_2_6_19_1","unstructured":"Centers for Medicare and Medicaid Services. Initiative to reduce avoidable hospitalizations among nursing facility residents.https:\/\/innovation.cms.gov\/initiatives\/rahnfr\/. Updated January 8 2020. Accessed January 30 2020."},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0000000000000334"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmp1105449"},{"key":"e_1_2_6_22_1","unstructured":"Moving care forward: Pathways home health and hospice.https:\/\/www.pathwayshealth.org\/. Published 2018. Accessed January 30 2020."},{"issue":"9","key":"e_1_2_6_23_1","first-page":"438","article-title":"Managed care for long\u2010stay nursing home residents: an evaluation of institutional special needs plans","volume":"25","author":"McGarry BE","year":"2019","journal-title":"Am J Manag Care"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2017.05.027"},{"key":"e_1_2_6_25_1","unstructured":"Data brief: sharp reduction in avoidable hospitalizations among long\u2010term care facility residents 2016. The CMS Blog (online).https:\/\/www.cms.gov\/blog\/data-brief\u2010sharp\u2010reduction\u2010avoidable\u2010hospitalizations\u2010among\u2010long\u2010term\u2010care\u2010facility\u2010residentsAccessed January 5 2020."},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.6130"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-1137-0"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2012.03920.x"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.5600\/mmrr.004.01.b01"},{"key":"e_1_2_6_30_1","unstructured":"AHRQ's safety program for nursing homes: on\u2010time falls prevention. Agency for Healthcare Research and Quality (online).https:\/\/www.ahrq.gov\/patient\u2010safety\/settings\/long\u2010term\u2010care\/resource\/ontime\/fallspx\/index.html. Accessed January 5 2020"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17-0969"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.06.012"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318785295"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2010.07.016"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.06.006"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000118"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.3928\/00989134-20171206-01"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1533317510392564"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00382.x"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.11.010"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.16633","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16633","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.16633","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16633","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T16:55:51Z","timestamp":1762188951000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.16633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,6]]},"references-count":39,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1111\/jgs.16633"],"URL":"https:\/\/doi.org\/10.1111\/jgs.16633","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,6]]},"assertion":[{"value":"2020-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}