The association between home care visits and same-day emergency department use: a case–crossover study

Jones, Aaron; Schumacher, Connie; Bronskill, Susan E.; Campitelli, Michael A.; Poss, Jeffrey W.; Seow, Hsien; Costa, Andrew P.

doi:10.1503/cmaj.170892

Cited by 35 publications

(49 citation statements)

References 23 publications

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“…Our results of increased ED visits concur with another study where increased ED visits in patients receiving home care has been reported. Investigators found that patients who received home care nursing visits were more likely to visit the emergency department during the event [25]. Our results also showed that INTEGRATE cases had more alternate level of care designations than controls, indicating that patients were occupying a bed in a hospital without actually requiring that intensity of health system resources.…”

Section: Discussionsupporting

confidence: 53%

Does early palliative identification improve the use of palliative care services?

Mittmann

Liu²,

MacKinnon

et al. 2020

PLoS ONE

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To evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services. Methods Between 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were likely to die within one year and would were thought to benefit from early palliative care. Patients in the INTEGRATE Intervention Group were 1:1 matched to controls selected from provincial healthcare administrative data using propensity scorematching. The use of palliative care, community-based care services (home care, physician home visit, and outpatient opioid use) and acute care (emergency department, hospitalization) was each evaluated within one year after the date of identification. The hazard ratio (HR) in the Intervention Group was calculated for each outcome. Results Of the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [HR of 1.69 (95% CI 1.56 to 1.82)]. The Intervention Group also had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07 (95% CI 1.89 to 2.27)], had physician home visits [35.5% vs. 23.7%; HR 1.63 (95% CI 1.46 to 1.92)] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43 (95% CI 1.30 to 1.57]. The Intervention Group was also more likely to have a hospitalization that was not primarily focused on palliative care (1.42 (95% CI 1.28 to 1.58)) and an unplanned emergency department visit for non-palliative care purpose (1.47 (95% CI 1.32 to 1.64)).

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Section: Discussionsupporting

confidence: 53%

Does early palliative identification improve the use of palliative care services?

Mittmann

Liu²,

MacKinnon

et al. 2020

PLoS ONE

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“…Others have suggested that mismatches between recipient needs and home care service provision result in poor outcomes, 9 and a recent study suggested that associations between home care and emergency department use may result from the limited scope of home care services and lack of integration with primary care. 14 Individuals who started in the community and were discharged to long-term care had the lowest likelihood of hospital readmission, which suggests that they were in the appropriate care setting but that the path to long-term care was marked by frequent acute care use, very long hospital stays and lengthy ALC periods. Individuals admitted from and discharged to long-term care had an increased likelihood of readmission.…”

Section: Discussionmentioning

confidence: 99%

Care setting and 30-day hospital readmissions among older adults: a population-based cohort study

Gruneir

Fung

Fischer

et al. 2018

CMAJ

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BACKGROUND: Despite the fact that many older adults receive home or longterm care services, the effect of these care settings on hospital readmission is often overlooked. Efforts to reduce hospital readmissions, including capacity planning and targeting of interventions, require clear data on the frequency of and risk factors for readmission among different populations of older adults. METHODS:We identified all adults older than 65 years discharged from an unplanned medical hospital stay in Ontario between April 2008 and December 2015. We defined 2 preadmission care settings (community, long-term care) and 3 discharge care settings (com-munity, home care, long-term care) and used multinomial regression to estimate associations with 30-day readmission (and death as a competing risk). RESULTS:We identified 701 527 individuals (mean age 78.4 yr), of whom 414 302 (59.1%) started in and returned to the community. Overall, 88 305 in dividuals (12.6%) were re admitted within 30 days, but this proportion varied by care setting combination. Rela tive to individuals returning to the community, those discharged to the community with home care (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.39-1.46) and those returning to long-term care (adjusted OR 1.35, 95% CI 1.27-1.43) had a greater risk of readmission, whereas those newly admitted to long-term care had a lower risk of readmission (adjusted OR 0.68, 95% CI 0.63-0.72). INTERPRETATION:In Ontario, about 40% of older people were discharged from hospital to either home care or long-term care. These discharge settings, as well as whether an individual was admitted to hospital from longterm care, have important implications for understanding 30-day readmission rates. System planning and efforts to reduce readmission among older adults should take into account care settings at both admission and discharge. HEALTH SERVICES

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“…Publicly funded home care services are delivered to at least 6% of Canadians aged 65–74, 15% aged 75–84% and 32% aged 85 or older 1. These home care clients are increasingly medically complex, often access care across multiple settings, have very high emergency department (ED) visitation rates and have relatively poor access to effective chronic disease management 2–4. Their frequent ED use is not congruent with chronic disease management or geriatric care principles and creates excess cost burdens on the healthcare system 5 6…”

Section: Introductionmentioning

confidence: 99%

DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care

et al. 2019

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IntroductionHome care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.Methods and analysisThe Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) — Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.Ethics and disseminationEthics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site’s ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study’s results. The results will be used to inform future support strategies for older adults receiving home care services.Trial registration number NCT03012256.

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The association between home care visits and same-day emergency department use: a case–crossover study

Cited by 35 publications

References 23 publications

Does early palliative identification improve the use of palliative care services?

Does early palliative identification improve the use of palliative care services?

Care setting and 30-day hospital readmissions among older adults: a population-based cohort study

DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care

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