Mofina Amanda M, Guthrie Dawn M
Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave, W, Waterloo, ON N2L 3C5, Canada.
BMC Health Serv Res. 2014 Jan 25;14:37. doi: 10.1186/1472-6963-14-37.
Home care is becoming an increasingly vital sector in the health care system yet very little is known about the characteristics of home care clients and the quality of care provided in Canada. We describe these clients and evaluate home care quality indicator rates in two regions.
A cross-sectional analysis of assessments completed for older (age 65+) home care clients in both Ontario (n = 102,504) and the Winnipeg Regional Health Authority (n = 9,250) of Manitoba, using the Resident Assessment Instrument for Home Care (RAI-HC). This assessment has been mandated for use in these two regions and the indicators are generated directly from items within the assessment. The indicators are expressed as rates of negative outcomes (e.g., falls, dehydration). Client-level risk adjustment of the indicator rates was used to enable fair comparisons between the regions.
Clients had a mean age of 83.2 years, the majority were female (68.6%) and the regions were very similar on these demographic characteristics. Nearly all clients (92.4%) required full assistance with instrumental activities of daily living (IADLs), approximately 35% had activities of daily living (ADL) impairments, and nearly 50% had some degree of cognitive impairment, which was higher among clients in Ontario (48.8% vs. 37.0%). The highest quality indicator rates were related to clients who had ADL/rehabilitation potential but were not receiving therapy (range: 66.8%-91.6%) and the rate of cognitive decline (65.4%-76.3%). Ontario clients had higher unadjusted rates across 18 of the 22 indicators and the unadjusted differences between the two provinces ranged from 0.6% to 28.4%. For 13 of the 19 indicators that have risk adjustment, after applying the risk adjustment methodology, the difference between the adjusted rates in the two regions was reduced.
Home care clients in these two regions are experiencing a significant level of functional and cognitive impairment, health instability and daily pain. The quality indicators provide some important insight into variations between the two regions and can serve as an important decision-support tool for flagging potential quality issues and isolating areas for improvement.
家庭护理在医疗保健系统中日益成为一个至关重要的部门，但对于加拿大的家庭护理客户特征以及所提供护理的质量，人们了解甚少。我们描述这些客户，并评估两个地区的家庭护理质量指标率。
使用家庭护理居民评估工具（RAI-HC），对安大略省（n = 102,504）和曼尼托巴省温尼伯地区卫生局（n = 9,250）的老年（65岁及以上）家庭护理客户完成的评估进行横断面分析。该评估已获授权在这两个地区使用，指标直接从评估中的项目生成。指标以负面结果发生率（如跌倒、脱水）表示。对指标率进行客户层面的风险调整，以便在各地区之间进行公平比较。
客户的平均年龄为83.2岁，大多数为女性（68.6%），两个地区在这些人口统计学特征上非常相似。几乎所有客户（92.4%）在日常生活工具性活动（IADL）方面需要全面协助，约35%的客户存在日常生活活动（ADL）障碍，近50%的客户有一定程度的认知障碍，安大略省的客户中这一比例更高（48.8%对37.0%）。最高的质量指标率与具有ADL/康复潜力但未接受治疗的客户有关（范围：66.8%-91.6%）以及认知能力下降率（65.4%-76.3%）。在22项指标中的18项上，安大略省客户的未调整率更高，两省之间的未调整差异范围为0.6%至28.4%。对于19项进行了风险调整的指标中的13项，应用风险调整方法后，两个地区调整后率之间的差异有所缩小。
这两个地区的家庭护理客户存在显著程度的功能和认知障碍、健康不稳定及日常疼痛。质量指标为两个地区之间的差异提供了一些重要见解，可作为一个重要的决策支持工具，用于标记潜在的质量问题并确定改进领域。
