Abstract
BackgroundAs 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.MethodsThis 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.ResultsBefore 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.ConclusionsAfter 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.
Highlights
As individuals age, they are more likely to experience increasing frailty and more frequent use of hospital services
One third of the Home-based primary care (HBPC) and one quarter of the Home care (HC) group were over 90 years of age (33.3% versus 25.4%, p = 0.024) (Table 2)
HBPC recipients presented to the emergency department (ED) with significantly higher acuity compared to HC recipients (as measured by a higher proportion of Canadian Triage and Acuity Scale (CTAS) 1 to 3 at the time of presentation to the ED (p = 0.008)) (Table 2) and spent a greater number of days in hospital per 1000 patient days (PD), 41.8 (40.7, 42.8) versus 18.6 (18.2, 19.1) (p < .0001) (Table 2)
Summary
They are more likely to experience increasing frailty and more frequent use of hospital services. We explored whether initiating home-based primary care in a frail homebound cohort, influenced hospital use. 489 [1]) and is highly associated with older age [2] It is estimated 5.6% of the general population is homebound as a result of frailty [3] and primary care medical health services are poorly designed for these individuals. While frail older people are most likely to use acute hospital care (ED visits and hospital admissions), they are least likely to benefit [8, 9] and most likely to experience harm from such services [10]. Research has further demonstrated an inverse association between ED use and access to primary care among older adults [11, 12]
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