• Nancy Sears, G Ross Baker, Jan Barnsley, and Sam Shortt.
• Department of Health Sciences, St. Lawrence College, Room 33260, 100 Portsmouth Avenue, Kingston, ON, Canada K7L 5A6. nsears@sl.on.ca
• Int J Qual Health Care. 2013 Feb 1; 25 (1): 16-28.

ObjectiveIncidence of adverse events (AEs) among home care patients and preventability ratings were estimated. Risk factors, AE types and factors associated with AEs were identified.DesignThis study used a stratified, randomized sample of home care patients discharged in the fiscal year 2004/05. Trained nurse reviewers completed retrospective chart abstractions; charts for cases that were positive for screening criteria suggesting the presence of AEs were reviewed by trained physicians to determine the presence of and preventability of AEs.SettingThree publicly funded home care programs in Ontario, Canada.Main Outcome MeasuresPrevalence and types of AEs; ratings of preventability.ResultsAt least one screening criterion was positively identified in 286 (66.5%) of 430 cases. Physician reviewers identified 61 AEs in 55 (19.2%) of the 286 (12.8% of the 430) cases. The AE rate was 13.2 per 100 home care cases [95% confidence interval (CI): 10.4-16.6%, standard error 1.6%]. 32.7% (20 of 61 AEs) of the AEs were rated as having >50% probability of preventability; 6 deaths (10.9% of patients with an AE; 1.4% of all patients) occurred in AE-positive patients. The most common AEs were falls and adverse drug events.ConclusionsProviding health care through home care programs creates unintended harm to patients. The incidence rate of AEs of 13.2% suggests a significant number of home care patients experience AEs, one-third of which were considered preventable. Improvements in patient and informal caregiver education, skill development and clinical planning may be useful interventions to reduce AEs.

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