Rabeenthira Prakathesh, Zagrodney Katherine A P, King Emily C, Nichol Kathryn A, McKay Sandra M
Public Health Agency of Canada, Toronto, ON, Canada.
VHA Home HealthCare, Toronto, ON, Canada.
Health Serv Insights. 2025 Apr 29;18:11786329251335877. doi: 10.1177/11786329251335877. eCollection 2025.
With an increasing reliance on homecare and a scarcity of providers, there is potential to gain insight from existing administrative data to optimize planning and care delivery. To enable more accurate predictions of service use, it is important to understand the degree to which various factors influence clients' difficult decisions to temporarily pause their receipt of necessary homecare services.
We utilized a large, longitudinal, administrative dataset to examine the relative effects of client-level factors on the outcomes of (1) placing a hold on homecare services and (2) the length of a homecare service hold, through stratified regression analyses separated by pre-, early-, and mid-pandemic periods.
Descriptive summaries of the samples consisted of graphical representation and frequencies (proportions) or means. The relationship between client sociodemographic and homecare utilization factors on the service hold initiation and length were evaluated using mixed-effects logistic and linear regression, respectively, stratified by pre-, early-, and mid-pandemic periods. Odds ratios (OR) for hold initiation and exponentiated estimates for hold length were calculated with corresponding 95% confidence intervals.
Findings provide a better understanding of the decisions made by a large sample of homecare clients to pause their homecare services in pre-, early-, and mid-pandemic scenarios. Frequency and length of service holds more than doubled in the early-pandemic period; although hold frequencies then returned to pre-pandemic rates, hold durations remained slightly longer. There were notable differences over time, but generally, clients with higher care needs had a reduced likelihood of placing a hold on homecare services. Shorter homecare tenure and previously cancelling individual homecare visits were also good indicators of future service decisions.
Findings are relevant for organizations providing homecare services, policymakers, and those interested in predicting homecare utilization for resource allocation planning with the goal of optimal care delivery.
随着对家庭护理的依赖增加以及提供者的短缺，有可能从现有的行政数据中获得见解，以优化规划和护理服务。为了能够更准确地预测服务使用情况，了解各种因素在多大程度上影响客户做出暂时停止接受必要家庭护理服务这一艰难决定非常重要。
我们利用一个大型的纵向行政数据集，通过按疫情前、疫情早期和疫情中期进行分层回归分析，研究客户层面因素对（1）暂停家庭护理服务以及（2）家庭护理服务暂停时长这两个结果的相对影响。
样本的描述性总结包括图形表示和频率（比例）或均值。分别使用混合效应逻辑回归和线性回归评估客户社会人口统计学因素与家庭护理利用因素对服务暂停起始和时长的关系，并按疫情前、疫情早期和疫情中期进行分层。计算暂停起始的比值比（OR）和暂停时长的指数估计值以及相应的95%置信区间。
研究结果有助于更好地理解大量家庭护理客户在疫情前、疫情早期和疫情中期情况下做出暂停家庭护理服务的决定。在疫情早期，服务暂停的频率和时长增加了一倍多；尽管暂停频率随后恢复到疫情前水平，但暂停持续时间仍略长。随着时间推移存在显著差异，但总体而言，护理需求较高的客户暂停家庭护理服务的可能性较低。较短的家庭护理期限和之前取消个人家庭护理访视也是未来服务决策的良好指标。
研究结果与提供家庭护理服务的组织、政策制定者以及那些有兴趣预测家庭护理利用情况以进行资源分配规划以实现最佳护理服务的人相关。
