Grant: Catyalyst Grant: Health Services and Systems for an Aging Population

Each year 12 million people visit an emergency department (ED) in Canada, with the highest rates among the elderly (age>75). Some will be admitted to hospital, but many are discharged directly home. Between the extremes of admitted and discharged patients there are patients for whom both options are possible. Discharge from the ED avoids the cost of a hospital stay, risk of a hospital-acquired infection, delirium, and cognitive decline in older persons. However, in order to safely discharge these patients a "system" must be in place to ensure a prompt followup appointment with the family physician (FP). Older persons need this system the most, as they may be less able to arrange and push for early followup care, AND are at higher risk of poor outcomes. The Problem: With the aging of the population, ED visits are expected to accelerate. Using atrial fibrillation (AF) patients as an example, it is estimated that 5.6 million people will have AF by 2050, a 250% increase over the current rate. ED visits for AF increased by 88% from 1994 to 2006, and can be expected to increase similarly for other chronic diseases too. Methods: Using databases that include all Ontario ED visits, we will identify older patients seen in an Ontario ED with 1 of 3 common chronic diseases: AF, high blood pressure, and heart failure. We will identify a group of older patients for whom ER doctors would standardly recommend an early follow-up appointment. We will see how many of those patients saw a doctor within 3, 7, and 30 days of the ED visit. Next we will determine whether lack of followup was associated with more deaths, return ED visits, and taking recommended medications. Impact: The study will provide the first scientific evidence as to whether the current system of care between the ED and FP is adequate. It will allow us to make informed decisions around a future intervention study that aims to improve the transition of care between ED and FP, for the patients who need it most.