• Aaron Jones, Connie Schumacher, Susan E Bronskill, Michael A Campitelli, Jeffrey W Poss, Hsien Seow, and Andrew P Costa.
• Department of Health Research Methods, Evidence, and Impact (Jones, Schumacher, Seow, Costa), McMaster University, Hamilton, Ont.; Institute for Clinical Evaluative Sciences (Bronskill, Campitelli); Institute of Health Policy, Management & Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Poss), University of Waterloo, Waterloo, Ont.; Departments of Oncology (Seow) and Medicine (Costa), McMaster University, Hamilton, Ont.
• CMAJ. 2018 Apr 30; 190 (17): E525-E531.

BackgroundThe extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care.MethodsWe conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day.ResultsA total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits.InterpretationPatients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation.© 2018 Joule Inc. or its licensors.

28 keywords...

hide…