The Influence of Nursing Home Resident Characteristics and Physician Models of Care on Hospital Transfers in Ontario


Residents of Long-Term Care facilities (LTC) are amongst the frailest seniors in the health system. They are often referred to the Emergency Department (ED) despite the provision of 24-hour care in their institutions. Data shows that one quarter of LTC residents are transferred to the ED at a rate of once every six months and approximately 25% of these are potentially avoidable. Similarly, research suggests that 55% of hospitalizations of LTC residents in Ontario are for potentially avoidable conditions. Acute episodes involving frail older adults are associated with a high incidence of adverse events, prolonged hospital stays, and increased costs. LTC residents are particularly vulnerable to iatrogenesis during hospitalization when compared to equivalent care provided in their usual place of residence. A better understanding of the relationship between nursing home resident characteristics and attending physician models of care on hospital transfers in Ontario will allow clinicians and health system planners to increase the effectiveness of chronic disease management in nursing homes.

Our Approach

We will identify a population-based cohort of adult nursing home residents (using the Continuing Care Reporting System (CCRS)) who are nested within different physician’s models of care and linked to it to administrative health databases (e.g., National Ambulatory Care Reporting System Metadata (NACRS), Discharge Abstract Database (DAD) to understand the influence of nursing home resident characteristic and attending physician models of care on hospital transfers in Ontario.

Our Team

Team Leads:

Andrew P. Costa, PhD | McMaster University

Operation Team:

Ahmad Rahim, MSc. | IC/ES - McMaster University

Jeff Poss, PhD | University of Waterloo

Aaron Jones, MSc., PhD (c) | McMaster University


Susan Bronskill, MSc, PhD | IC/ES - Central


Institute for Clinical Evaluative Sciences

Institute for Clinical Evaluative Sciences



Health System Research Fund (HSRF)

Health System Research Fund (HSRF)