ABSTRACT
Care transitions have justly received increasing attention and rate of emergent care use is an important quality indicator. Emergency transport rates for community dwelling elders have been documented as high as 179 per 1,000 persons per year with over 15 million elders using the hospital emergency department (ED) in 1995(Ackermann et aI., 1998; Strange, & Chen, 1998; Svenson, 2000). Studies of large data sets have shown that multiple factors correlate with emergent care use, including patient co-morbidity and care processes (Phillips et aI., 2005). Several studies have shown that pro-active care management can reduce hospitalization rates, both for particular diagnoses such as congestive heart failure and for a broad spectrum of conditions when they occur in conjunction with co-morbidity and risk factors for frailty (Aminzadeh & Dalziel, 2002; McCusker & Verdon, 2006; Murtaugh & Litke, 2002).
