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Examining Variation in Access to Post-Acute Home Care Services Erin Patterson PhD Student & Margaret Saari PhD Student Canadian Association of Health Services and Policy Research Conference 2014
Research Team and Funder Ø Erin Patterson PhD Student; Principal Investigator Ø Margaret Saari PhD Student; Co-investigator Ø Ann Tourangeau PhD; Co-investigator Funded by the Ontario Ministry of Health and LongTerm Care
Overview Ø Study overview Ø Study findings Ø Study implications
Context Ø Post-acute health care services are shifting into the community Ø Nurses provide the majority of in home post-acute health care services, including: ü Intravenous medication administration ü Post-surgical care ü Cancer treatments (e.g., chemotherapy)
Context Ø Post-acute home care: ü Admission within 7 days of hospital discharge ü Expected home care length of stay less than 60 days ü Similar to CCAC short-stay client categorization
Context Ø Ontario-based researchers have found variation in access to home care services across regions § Coyte and Young (1999) noted regional differences in the rates of post-acute home care services received between 1993 and 1995
Context Ø In 1996, Ontario introduced the Community Care Access Centers (CCACs), in part, to facilitate equitable access to home care services § However, research conducted following the introduction of the CCACs found regional variation persisted
(Laporte et al., 2007)
Context Ø Existing literature supports several factors as influencing access to home care services. These factors include: ü Age
ü Health status
ü Sex
ü Functional status
ü Race
ü Caregiver burden
ü Education
ü Region
ü Socioeconomic status
ü Agency legal status
ü Informal care
ü Previous health care
ü Living arrangement
utilization
Study Aim 1) To identify factors affecting access to home care nursing services for Ontario post-acute home care clients 2) To determine whether regional variation in access to post-acute home care services exists across Ontario
Methods: Data Sources Ø Secondary analysis of provincial administrative health service utilization data Ø Several databases were linked using a unique patient identifier, these databases included: ü Discharge Abstract Database ü Home Care Database ü Registered Persons Database
Methods: Sample Selection Ø Adult patients (18 years and older) discharged from an Ontario hospital between April 1th, 2009 and March 31st 2012 were included in the study if: ü They had a home care admission within 7 days of hospital discharge ü They were included in one of the top 25 case mix groups (according to their hospital discharge record)
Methods: Variables Ø Outcome: Access ü Home care nursing visit intensity: the number of home care nursing visits received in the first 60 days following admission to home care Ø Explanatory variables: ü Case Mix Group
ü Hospital length of stay
ü Age
ü Month & year of home
ü Sex
care admission
ü Living arrangement
ü Region
ü Residence type
ü Previous health care utilization
Methods: Statistical Analysis Ø Intensity of home care nursing services received was modeled using ordinary least-squares regression Ø Nursing visit intensity was positively skewed, and as a result was log-transformed
Results: Sample Characteristics 70 60 64.1
50
59.5
40 61.9 30 20 10
10.1
9.5
10.9
5.8
6.1
5.5
0
Age (yrs)
Mean # of nursing visits
Total Sample
Male
Hospital LOS (days)
Female
Results: Sample Characteristics Living Arrangement (%) 50 45 40
46.9
35 40.2
30
32.5
30.6
25
31.9
20 15
29.5
10 5
13.7
11.4
9.4 8.1 6.8 9.5
9.4
7
2.7 2.5 3
4.9
0
Alone
With spouse
With spouse & other family
Total
With other family
Male
Female
Other arrangements
Unkown
Results: Home Care Episodes Across CCACs North West
592
North East
493
North Simcoe Muskoka
430
Champlain
210
South East
365
Central East
325
Central
260
Toronto Central
283
Mississauga Halton
288 212
Central West HNHB
518 243
Waterloo Wellington
480
South West Erie St. Clair
726
0
100
200
300
400
500
600
700
800
Results: Top 25 Case Mix Groups CMG 221 462 387 321 806 223 464 172 320 405 182 780 385 502 139 181 196 228 200 258 537 437 162 313 487
Descrip,on Colostomy / Enterostomy Radical excision of prostate Unilateral total / radical excision of breast Unilateral knee replacement Convalescence Open large intes,ne/rectum resec,on without colostomy, planned Par,al excision / destruc,on of prostate, closed approach Coronary artery bypass graU without cardiac catheter Unilateral hip replacement Celluli,s Bypass / extrac,on of vein / artery of limb Postopera,ve complica,on except haemorrhage Repair / reconstruc,on of the breast Hysterectomy with non-‐malignant diagnosis Chronic Obstruc,ve Pulmonary Disease Abdominal aorta interven,on Heart failure without cardiac catheter Complex hernia repair Pulmonary embolism Other gastrointes,nal disorder Primary caesarean sec,on Diabetes Cardiac valve replacement Spinal vertebrae interven,on Lower urinary tract infec,on
Frequency 4,020 3,926 3,113 2,829 2,268 2,138 1,898 1,848 1,838 1,805 1,703 1,685 1,500 1,436 1,395 1,329 1,287 1,069 1,013 953 950 938 891 883 882
% of Total Sample 9.22% 9.0% 7.14% 6.48% 5.20% 4.90% 4.35% 4.24% 4.21% 4.14% 3.90% 3.86% 3.44% 3.55% 3.20% 3.05% 2.95% 2.45% 2.32% 2.18% 2.18% 2.15% 2.04% 2.20% 2.02%
Results: Care Received ü 99.5% received care from a nurse ü 7.2% received care from a physiotherapist ü 2.9% received care from a personal support worker ü 2.9% received care from an occupational therapist ü 0.7% received care from a registered dietician ü 0.4% received care from a social worker ü 36% received care from a case manager
Results: Care Provider Type
Care was delivered by not-for-profit (28.8%) and for-profit (40%) home care organizations, in 31.2% of cases the legal status of the provider agency was unknown
Results: Factors Influencing Access Ø 22.8% of variance in nursing visit intensity was explained by the variables included in this model. The following were significant predictors (p
