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

• Published in: BMC health services research 2018-04, Vol.18 (1), p.248-248, Article 248
• Main Authors: McGregor, Margaret J, Cox, Michelle B, Slater, Jay M, Poss, Jeff, McGrail, Kimberlyn M, Ronald, Lisa A, Sloan, John, Schulzer, Michael
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; British Columbia; Care and treatment; Community medicine; Comparative analysis; Controlled Before-After Studies; Emergency Service, Hospital - statistics & numerical data; Facilities and Services Utilization; Family practice/general practice/primary care; Female; Frail Elderly; Geriatric medicine/care of the elderly; Home care services; Home Care Services - organization & administration; Home Care Services - statistics & numerical data; Homecare; Hospital utilization; Hospitalization - statistics & numerical data; Hospitals - statistics & numerical data; House Calls - statistics & numerical data; Humans; Male; Outcome Assessment (Health Care); Patient Discharge - statistics & numerical data; Primary Health Care - statistics & numerical data; Retrospective Studies
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3040-y

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. 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. 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. 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.