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BMC Health Serv Res. 2018 Apr 5;18(1):248. doi: 10.1186/s12913-018-3040-y.

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

Author information

1
Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. mrgret@mail.ubc.ca.
2
UBC Centre for Health Services and Policy Research, Vancouver, Canada. mrgret@mail.ubc.ca.
3
UBC School of Population and Public Health, Vancouver, Canada. mrgret@mail.ubc.ca.
4
Vancouver Coastal Health's Research Institute's Centre for Epidemiology and Evaluation, Vancouver, Canada. mrgret@mail.ubc.ca.
5
Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
6
Community Geriatric Programs, VCH, Vancouver, Canada.
7
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
8
UBC Centre for Health Services and Policy Research, Vancouver, Canada.
9
UBC School of Population and Public Health, Vancouver, Canada.
10
Pacific Parkinson's Research Centre, Vancouver, Canada.
11
Vancouver Coastal Health's Research Institute's Centre for Epidemiology and Evaluation, Vancouver, Canada.

Abstract

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.

KEYWORDS:

Community medicine; Family practice/general practice/primary care; Geriatric medicine/care of the elderly; Homecare

PMID:
29622006
PMCID:
PMC5887263
DOI:
10.1186/s12913-018-3040-y
[Indexed for MEDLINE]
Free PMC Article

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