Outcomes of Infection in Nursing Home Residents with and without Early Hospital Transfer

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Abstract
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.