A before-after study of hospital use in two frail populations receiving different home-based services over the same time in Vancouver, Canada

Autor: Michelle B. Cox, Jay Slater, Jeff Poss, Margaret J. McGregor, Lisa A. Ronald, John P. Sloan, Kimberlyn McGrail, Michael Schulzer
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Frail Elderly
Health informatics
Homecare
Health administration
03 medical and health sciences
0302 clinical medicine
Outcome Assessment
Health Care
medicine
Humans
030212 general & internal medicine
Aged
Retrospective Studies
Aged
80 and over
Personal care
Geriatric medicine/care of the elderly
British Columbia
Primary Health Care
business.industry
lcsh:Public aspects of medicine
030503 health policy & services
Health Policy
Nursing research
Public health
lcsh:RA1-1270
Retrospective cohort study
Emergency department
Home Care Services
Community medicine
Hospitals
Patient Discharge
Hospitalization
House Calls
Controlled Before-After Studies
Emergency medicine
Cohort
Female
Family practice/general practice/primary care
0305 other medical science
business
Emergency Service
Hospital
Facilities and Services Utilization
Research Article
Zdroj: BMC Health Services Research
BMC Health Services Research, Vol 18, Iss 1, Pp 1-11 (2018)
ISSN: 1472-6963
Popis: Background: As individuals age, they are more likely to experience increasing frailty and more frequent use of hospital services. First, we explored whether initiating home-based primary care in a frail homebound cohort, influenced hospital use. Second, we explored whether initiating regular home care support for personal care with usual primary care, in a second somewhat less frail cohort, influenced hospital use. Methods: This was a before-after retrospective cohort study of two frail populations in Vancouver, Canada using administrative data to assess the influence of two different services started in two different cohorts over the same time period. The participants were 246 recipients of integrated home-based primary care and 492 recipients of home care followed between July 1st, 2008 and June 30th, 2013 before and after starting their respective services. Individuals in each group were linked to their hospital emergency department visit and discharge abstract records. The main outcome measures were mean emergency department visit and hospital admission rates per 1000 patient days for 21 months before versus the period after receipt of services, and the adjusted incidence rate ratios (IRRs) on these outcomes post receipt of service. Results: Before versus after starting integrated home-based primary care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 4.1 (3.8, 4.4) versus 3.7 (3.3, 4.1), and hospital admissions rates were 2.3 (2.1, 2.5) versus 2.2 (1.9, 2.5). Before versus after starting home care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 3.0 (2.8, 3.2) versus 4.0 (3.7, 4.3) visits and hospital admissions rates were 1.3 (1.2, 1.4) versus 1.9 (1.7, 2.1). Home-based primary care IRRs were 0.91 (0.72, 1.15) and 0.99 (0.76, 1.27) and home care IRRs were 1.34 (1.15, 1.56) and 1.46 (1.22, 1.74) for emergency department visits and hospital admissions respectively. Conclusions: After enrollment in integrated home-based primary care, emergency department visit and hospital admission rates stabilized. After starting home care with usual primary care, emergency department visit and hospital admission rates continued to rise.
Databáze: OpenAIRE
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