ArticleBMC health services research2026
A spatiotemporal analysis of administrative emergency hospitalization data (2012-2021) to assess outreach service adequacy to elderly residential care homes in Hong Kong.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHong Kong’s rapidly aging population has heightened demand for hospital services, particularly among residents of residential care homes for the elderly (RCHEs). This study examined spatiotemporal trends and facility-level factors associated with emergency hospitalization transfers from RCHEs to inform the allocation and service planning of community geriatric assessment team (CGAT) outreach support from hospitals.
methodsA retrospective spatiotemporal cohort analysis was conducted using data from 801 RCHEs and 18 public emergency hospitals in Hong Kong from 2012 to 2021, encompassing 838,779 emergency admission episodes among adults aged 65 years and older. Admissions trends were analyzed, and spatial clustering of beds-adjusted admission rates was assessed using global Moran’s I and local Getis-Ord Gi* statistics. Facility-level predictors of hot/cold spot classification, including bed capacity, staffing levels, government subsidy status, proximity to hospitals, and CGAT service utilization, were evaluated using generalized linear mixed-effects models (GLMMs).
resultsRCHE residents accounted for 23.6% of all emergency admissions among older adults. In the pre-pandemic period from 2012 to 2019, overall elderly admissions and hospital stays increased by 23.5% and 34.6%, respectively. Despite a sharp decline in 2020, both metrics returned to 2017 levels by 2021, with RCHE-sourced transfers consistently exceeding 20%. Significant spatial clustering was observed annually (Moran’s I: 0.055–0.130, all p-values < 0.001), with 10.9–20.0% of RCHEs identified as high-transfer-rate hot spots across the study years, concentrated in four urban districts. GLMMs revealed that smaller facilities (OR = 1.21, 95% CI: 1.05–1.40), those with lower staffing levels (OR = 1.28, 95% CI: 1.07–1.54), closer proximity to hospitals, and lower outreach service utilization were more likely to be high-transfer-rate hot spots. Conversely, greater distance to hospitals and higher outreach use predicted low-transfer-rate cold spots.
conclusionsRCHE residents are frequent users of hospital emergency services. Spatial disparities in emergency admissions are associated with facility-level factors like low staffing, limited outreach, and geographic proximity to hospitals. Identifying hot spots facilitates a targeted review of whether CGAT resources are adequately distributed and staffed, how efficiently they operate, and whether RCHEs in those areas have sufficient staffing and care quality.
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