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Egbujie BA, Turcotte LA, Heckman GA, Morris JN, Hirdes JP. Functional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces. J Am Med Dir Assoc 2024; 25:282-289. [PMID: 37839468 DOI: 10.1016/j.jamda.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period. DESIGN We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic. SETTING AND PARTICIPANTS Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale). METHODS We fit a generalized estimating equation model with adjustment for repeated measures to obtain the adjusted odds of functional decline between COVID period exposed and unexposed pre-pandemic residents. RESULTS LTC residents experienced slightly higher rates of functional decline during the first wave of the COVD-19 pandemic compared with the pre-pandemic period (23.3% vs 22.3%; P < .0001). The adjusted odds of functional decline were slightly greater during the pandemic (odds ratio [OR], 1.17; 95% CI, 1.15-1.20). Likewise, residents receiving care in large homes (OR, 1.20; 95% CI, 1.17-1.24) and urban-located LTC homes (OR, 1.20; 95% CI, 1.17-1.23), were more likely to experience functional decline during the COVID-19 pandemic. The odds of functional decline were also only significantly higher during the pandemic for LTC home residents in British Columbia (OR, 1.17; 95% CI, 1.11-1.23) and Ontario (OR, 1.25; 95% CI, 1.21-1.29). CONCLUSIONS AND IMPLICATIONS This study provides evidence that the odds of experiencing functional decline were somewhat greater during the first wave of the COVID-19 pandemic. It highlights the need to maintain physical activity and improve nutrition among older adults during periods of stress. The information would be helpful to health administrators and decision-makers seeking to understand how the COVID-19 pandemic and associated public health measures affected LTC residents' health outcomes.
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Affiliation(s)
- Bonaventure A Egbujie
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Luke A Turcotte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John N Morris
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Alter DA, Rosenfeld A, Fang J, Ko DT, Cohen L, Yu B, Austin PC. The Relationship Between Residential Mobility and Mortality Following Acute Myocardial Infarction. Can J Cardiol 2024; 40:18-27. [PMID: 37726076 DOI: 10.1016/j.cjca.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The extent to which residential mobility is associated with declining health among disease-specific populations, such as survivors of acute myocardial infarction (AMI), remains unknown. METHODS This prospective cohort study consisted of 3377 patients followed from index AMI (December 1, 1999 to March 30, 2003) to death or the last available follow-up date (March 30, 2020) in Ontario, Canada. Each residential postal code move from a patient's sentinel AMI event was tracked. Time-varying Cox proportional hazards examined the associated impact of each residential postal code move on mortality after adjusting for age, sex, baseline socioeconomic, psychosocial factors, changes in neighbourhood income level from each residential move, preexisting cardiovascular and noncardiovascular illnesses, and rural residence. All models evaluated death and long-term care institutionalisation as competing risks to distinguish mortality from other end-of-life destination outcomes among community-dwelling populations. RESULTS The study sample included 3369 patients with 1828 (54.3%) having at least 1 residential move throughout the study; 86.5% of patients either died in the community or moved from a community dwelling into a long-term care facility as an end-of-life destination. When adjusted for baseline factors and changing neighbourhood socioeconomic status over time, each residential move was associated with a 12% higher rate of death (adjusted hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.05-1.19; P < 0.001) and a 26% higher rate of long-term care end-of-life institutionalisation (adjusted HR 1.26, 95% CI 1.14-1.58; P < 0.001). CONCLUSIONS Residential mobility was associated with higher mortality after AMI. Further research is needed to better evaluate intermediary causal pathways that may explain why residential mobility is associated with end-of-life outcomes.
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Affiliation(s)
- David A Alter
- ICES, Toronto, Ontario, Canada; KITE Resarch Institute, Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
| | - Aaron Rosenfeld
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Lucas Cohen
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Bing Yu
- ICES, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
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Wilson R, Cuthbertson L, Sasaki A, Russell L, Kazis LE, Sawatzky R. Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes. THE GERONTOLOGIST 2023; 63:1467-1477. [PMID: 36866495 PMCID: PMC10581377 DOI: 10.1093/geront/gnad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C). RESEARCH DESIGN AND METHODS Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability. RESULTS A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70). DISCUSSION AND IMPLICATIONS This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.
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Affiliation(s)
- Rozanne Wilson
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver, British Columbia, Canada
| | - Ayumi Sasaki
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lara Russell
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lewis E Kazis
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, Massachusetts, USA
- Department of Pulmonary Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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Rousseau MC, Conus F, El-Zein M, Benedetti A, Parent ME. Ascertaining asthma status in epidemiologic studies: a comparison between administrative health data and self-report. BMC Med Res Methodol 2023; 23:201. [PMID: 37679673 PMCID: PMC10486089 DOI: 10.1186/s12874-023-02011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Studies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources. METHODS We used administrative health data (1983-2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement. RESULTS Applying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52-0.63) to 0.67 (95% CI: 0.62-0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25-0.65 comparing ≥ 1 health services to none). CONCLUSIONS These findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.
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Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
- School of Public Health, Université de Montréal, Montréal, QC, Canada.
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Direction des enquêtes de santé, Direction principale des statistiques sociales et de santé, Institut de la statistique du Québec, Montréal, QC, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- School of Public Health, Université de Montréal, Montréal, QC, Canada
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Havaei F, Kobekyaa F, Ma A, MacPhee M, Zhang W, Kaulius M, Ahmadi B, Boamah S, Easterbrook A, Salmon A. A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents. Healthcare (Basel) 2023; 11:2187. [PMID: 37570427 PMCID: PMC10418466 DOI: 10.3390/healthcare11152187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, provides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. METHODS A longitudinal mixed methods study took place within two publicly funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. RESULTS Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rate reductions. Qualitative analyses yielded three positive impact themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). CONCLUSIONS The Synergy tool provides useful data for enhancing a 'fit' between resident needs and available staff.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Francis Kobekyaa
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Andy Ma
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Wei Zhang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
| | - Megan Kaulius
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Bahar Ahmadi
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Sheila Boamah
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Amy Salmon
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Turcotte LA, McArthur C, Poss JW, Heckman G, Mitchell L, Morris J, Foebel AD, Hirdes JP. Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables. Health Serv Insights 2023; 16:11786329231174745. [PMID: 37220547 PMCID: PMC10196682 DOI: 10.1177/11786329231174745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.
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Affiliation(s)
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jeff W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Andrea D Foebel
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Hogan DB, Campitelli MA, Bronskill SE, Iaboni A, Barry HE, Hughes CM, Gill SS, Maxwell CJ. Trends and correlates of concurrent opioid and benzodiazepine and/or gabapentinoid use among Ontario nursing home residents. J Am Geriatr Soc 2023. [PMID: 36942992 DOI: 10.1111/jgs.18320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND A concern with long-term opioid use is the increased risk arising when opioids are used concurrently with drugs that can potentiate their associated adverse effects. The drugs most often encountered are benzodiazepines (BZDs) and gabapentinoids. Our study objectives were to examine trends in the concurrent use of opioids and BZDs, or gabapentinoids, in a Canadian nursing home population over an 11-year period, and current resident-level correlates of this concurrent use. METHODS We conducted a population-based, repeated cross-sectional study among Ontario nursing home residents (>65 years) dispensed opioids between April 2009 and February 2020. For the last study year, we examined cross-sectional associations between resident characteristics and concurrent use of opioids with BZDs or gabapentinoids. Linked data on nursing home residents from clinical and health administrative databases was used. The yearly proportions of residents who were dispensed an opioid concurrently with a BZD or gabapentinoid were plotted with percent change derived from log-binomial regression models. Separate modified Poisson regression models estimated resident-level correlates of concurrent use of opioids with BZDs or gabapentinoids. RESULTS Over the study period, among residents dispensed an opioid there was a 53.2% relative decrease (30.7% to 14.4%) in concurrent BZD and a 505.4% relative increase (4.4% to 26.6%) in concurrent gabapentinoid use. In adjusted models, increasing age and worsening cognition were inversely associated with the concurrent use of both classes, but most other significantly related covariates were unique to each drug class (e.g., sex and anxiety disorders for BZD, pain severity and presence of pain-related conditions for gabapentinoids). CONCLUSIONS Co-administration of BZDs or gabapentinoids in Ontario nursing home residents dispensed opioids remains common, but the pattern of co-use has changed over time. Observed covariates of concurrent use in 2019/20 suggest distinct but overlapping resident populations requiring consideration of the relative risks versus benefits of this co-use and monitoring for potential harm.
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Affiliation(s)
- David B Hogan
- Department of Medicine, Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather E Barry
- School of Pharmacy, Primary Care Research Group, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- School of Pharmacy, Primary Care Research Group, Queen's University Belfast, Belfast, UK
| | - Sudeep S Gill
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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8
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Schoebrechts E, de Almeida Mello J, Vandenbulcke P, Palmers E, Declercq A, Declerck D, Duyck J. International Delphi Study to Optimize the Oral Health Section in interRAI. J Dent Res 2023:220345231156162. [PMID: 36919900 DOI: 10.1177/00220345231156162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Introduction: The oral health (OH) of care-dependent older people is generally poor. Since caregivers are mainly responsible for older people's daily care, they can be considered important intermediaries to improve their OH by performing regular OH assessments. The interRAI instruments are introduced in 37 countries to assess care needs and facilitate care planning across different health care settings. The oral health section (OHS) within the interRAI instrument used in long-term care facilities was optimized for the Belgian context to identify residents who need assistance with daily oral care and/or need to be referred to a dentist. This Delphi study evaluated whether the OHS is also relevant and useful in other countries and modified the OHS accordingly until an international consensus was reached. Participants were experts in OH for older people. During 2 rounds of online questionnaires, experts rated the content, assessment process, triggering of Clinical Assessment Protocols, and accompanying guidelines and instruction videos of the optimized OHS. Based on the experts' comments and suggestions collected during the first round, the OHS was adjusted and presented to the experts in the second round for re-evaluation. The first and second questionnaires were completed by 48 and 42 oral health experts from 29 and 27 countries where the interRAI instruments are introduced, respectively. Five experts from 5 countries where interRAI is not introduced also participated in both rounds. After the second round, a consensus of over 86% was reached on all criteria. International consensus on the OHS was reached, considering national and cultural differences that may affect OH. The next step in this research is to evaluate the assessment process to identify potential barriers and facilitators to achieving reliable OH assessments internationally. Furthermore, the effect of the OHS at the level of the resident and of the caregivers will be evaluated.
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Affiliation(s)
- E Schoebrechts
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - J de Almeida Mello
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium.,LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - P Vandenbulcke
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - E Palmers
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - A Declercq
- LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.,Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - D Declerck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - J Duyck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
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Public Reporting of Performance Indicators in Long-Term Care in Canada: Does it Make a Difference? Can J Aging 2022; 41:565-576. [PMID: 35403595 DOI: 10.1017/s0714980821000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Evidence of the impact of public reporting of health care performance on quality improvement is not yet sufficient for definitive conclusions to be drawn, despite the important policy implications. This study explored the association of public reporting of performance indicators of long-term care facilities in Canada with performance trends. We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, whereas the other 8 are not publicly reported, between the fiscal years 2011-2012 and 2018-2019. Data from 1,087 long-term care facilities were included. Improving trends were observed among publicly reported indicators more often than among indicators that were not publicly reported. Our analysis also suggests that the association between publication of data and improvement is stronger among indicators for which there was no improvement prior to publication and among the worst performing facilities.
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10
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Correia RH, Dash D, Poss JW, Moser A, Katz PR, Costa AP. Physician Practice in Ontario Nursing Homes: Defining Physician Commitment. J Am Med Dir Assoc 2022; 23:1942-1947.e2. [PMID: 35609638 DOI: 10.1016/j.jamda.2022.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/31/2022] [Accepted: 04/17/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To characterize the practice profile of nursing home (NH) physicians in Ontario, Canada. DESIGN Population-based cross-sectional study. SETTING AND PARTICIPANTS A total of 1527 most responsible physicians (MRPs) across 626 NHs in Ontario, Canada, for the calendar year, 2017. METHODS We examined physician services within all publicly regulated and funded NH facilities. Descriptive summaries were generated to characterize MRPs and their practice patterns by the physician's primary practice location, the NH facility size, and the proportion of physician billings that occurred within NHs. Community sizes were classified into quintiles based on population size and assigned as urban or rural. The number of ministry-designated NH beds were assessed by quintiles to examine physician services by facility size. We also assessed the proportion of physician billings within NHs by quintiles. RESULTS MRPs tended to be older, male, and practice family medicine. The majority of MRPs practiced in communities with populations exceeding 100,000 residents, although physicians with greater NH billings tended to practice in rural locations. The mean number of NH residents that a physician was MRP for was positively associated with the community size. Physicians provided care for more NH residents than they were assigned most responsible. Fifty-one percent of physicians were MRP for 90% of all NH residents. CONCLUSIONS AND IMPLICATIONS Our work provides an exemplar for characterizing physician commitment in NHs, using 2 approaches, according to the NH specialist model. We demonstrated the medical practice characteristics, locations, and billing patterns of physicians within Ontario NHs. Future work can investigate the association between physician commitment and the quality of care provided to NH residents. A greater understanding of physician commitment may lead to the development of quality metrics based on physician practice patterns.
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Affiliation(s)
- Rebecca H Correia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Moser
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Paul R Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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11
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Kajdacsy-Balla Amaral AC, Hill AD, Pinto R, Fu L, Morinville A, Heckman G, Hébert P, Hirdes J. The effects of acute care hospitalization on health and cost trajectories for nursing home residents: A matched cohort study. Medicine (Baltimore) 2022; 101:e31021. [PMID: 36254032 PMCID: PMC9575775 DOI: 10.1097/md.0000000000031021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Thirty five percent to sixty seven percent of admissions to acute care hospitals from nursing homes are potentially preventable. Limited data exist regarding clinical and cost trajectories post an acute care hospitalization. To describe clinical impact and post-hospitalization costs associated with acute care admissions for nursing home residents. Analysis of population-based data. The 65,996 nursing home residents from a total of 645 nursing homes. Clinical outcomes assessed with the Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scores, and monthly costs. Post-index date, hospitalized residents worsened their clinical conditions, with increases in CHESS scores (CHESS 3 + 24.5% vs 7.6%, SD 0.46), more limitations in activities of daily living (ADL) (86.1% vs 76.0%, SD 0.23), more prescriptions (+1.64 95% CI 1.43-1.86, P < .001), falls (30.9% vs 18.1%, SD 0.16), pressure ulcers (16.4% vs 8.6%, SD 0.37), and bowel incontinence (47.3% vs 39.3%, SD 0.35). Acute care hospitalizations for nursing home residents had a significant impact on their clinical and cost trajectories upon return to the nursing home. Investments in preventive strategies at the nursing home level, and to mitigate functional decline of hospitalized frail elderly residents may lead to improved quality of care and reduced costs for this population. Pre-hospitalization costs were not different between the hospitalized and control groups but showed an immediate increase post-hospitalization (CAD 1882.60 per month, P < .001).
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Affiliation(s)
- Andre Carlos Kajdacsy-Balla Amaral
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea D Hill
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Anne Morinville
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - George Heckman
- Research Institute for Ageing, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Hébert
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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12
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Iacono A, Campitelli MA, Bronskill SE, Hogan DB, Iaboni A, Maclagan LC, Gomes T, Tadrous M, Evans C, Gruneir A, Guan Q, Hadjistavropoulos T, Cotton C, Gill SS, Seitz DP, Ho J, Maxwell CJ. Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis. Drugs Aging 2022; 39:811-827. [PMID: 35976489 PMCID: PMC9381389 DOI: 10.1007/s40266-022-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.
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Affiliation(s)
- Anita Iacono
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tara Gomes
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Unity Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qi Guan
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Sudeep S Gill
- ICES, Toronto, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Dallas P Seitz
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. .,ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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13
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Giosa JL, Saari M, Holyoke P, Hirdes JP, Heckman GA. Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol. BMJ Open 2022; 12:e060339. [PMID: 35953249 PMCID: PMC9379487 DOI: 10.1136/bmjopen-2021-060339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term 'life care' at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults. METHODS AND ANALYSIS An explanatory sequential mixed methods design will be applied across three phases. In the quantitative phase, secondary data analysis will be applied to historical Ontario Home Care data to develop unique groupings of patient needs according to known predictors of residential LTC home admission, and to define unique patient vignettes using dominant care needs. In the qualitative phase, a modified eDelphi process and focus groups will engage community-based clinicians, older adults and family caregivers in the development of needs-based home care packages. The third phase involves triangulation to determine initial model feasibility. ETHICS AND DISSEMINATION This study has received ethics clearance from the University of Waterloo Research Ethics Board (ORE #42182). Results of this study will be disseminated through peer-reviewed publications and local, national and international conferences. Other forms of knowledge mobilisation will include webinars, policy briefs and lay summaries to elicit support for implementation and pilot testing phases.
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Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Margaret Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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14
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Screening malnutrition in long-term care facility: A cross-sectional study comparing mini nutritional assessment (MNA) and minimum data set (MDS). Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Northwood M, Turcotte LA, McArthur C, Egbujie BA, Berg K, Boscart VM, Heckman GA, Hirdes JP, Wagg AS. Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model. J Am Med Dir Assoc 2022; 23:1683-1690.e2. [PMID: 35870485 DOI: 10.1016/j.jamda.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
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Affiliation(s)
| | - Luke A Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Adrian S Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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16
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Musa MK, Akdur G, Brand S, Killett A, Spilsbury K, Peryer G, Burton JK, Gordon AL, Hanratty B, Towers AM, Irvine L, Kelly S, Jones L, Meyer J, Goodman C. The uptake and use of a minimum data set (MDS) for older people living and dying in care homes: a realist review. BMC Geriatr 2022; 22:33. [PMID: 34996391 PMCID: PMC8739629 DOI: 10.1186/s12877-021-02705-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Care homes provide long term care for older people. Countries with standardised approaches to residents' assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents' everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. METHODS The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders' consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. RESULTS Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents' data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents' care CONCLUSIONS: Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. REGISTRATION PROSPERO registration number CRD42020171323.
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Affiliation(s)
- Massirfufulay Kpehe Musa
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Gizdem Akdur
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Sarah Brand
- National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, UK
| | - Anne Killett
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration, Yorkshire and Humber, Leeds, UK
| | - Guy Peryer
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Adam Lee Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration, East Midlands (ARC-EM), Leicester, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration, North East and North Cumbria, Newcastle, UK
| | - Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- NIHR Applied Research Collaboration, Surrey and Sussex, Kent, UK
| | - Lisa Irvine
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Sarah Kelly
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Liz Jones
- National Care Forum, Friars House, Manor House Drive, Coventry, UK
| | - Julienne Meyer
- Care for Older People, School of Health Sciences, Division of Nursing, City, University of London, London, UK
| | - Claire Goodman
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration East of England, Cambridge, UK
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17
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Adekpedjou R, Heckman GA, Hébert PC, Costa AP, Hirdes J. Outcomes of advance care directives after admission to a long-term care home: DNR the DNH? BMC Geriatr 2022; 22:22. [PMID: 34979935 PMCID: PMC8725447 DOI: 10.1186/s12877-021-02699-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Residents of long-term care homes (LTCH) often experience unnecessary and non-beneficial hospitalizations and interventions near the end-of-life. Advance care directives aim to ensure that end-of-life care respects resident needs and wishes. METHODS In this retrospective cohort study, we used multistate models to examine the health trajectories associated with Do-Not-Resuscitate (DNR) and Do-Not-Hospitalize (DNH) directives of residents admitted to LTCH in Ontario, Alberta, and British Columbia, Canada. We adjusted for baseline frailty-related health instability. We considered three possible end states: change in health, hospitalization, or death. For measurements, we used standardized RAI-MDS 2.0 LTCH assessments linked to hospital records from 2010 to 2015. RESULTS We report on 123,003 LTCH residents. The prevalence of DNR and DNH directives was 71 and 26% respectively. Both directives were associated with increased odds of transitioning to a state of greater health instability and death, and decreased odds of hospitalization. The odds of hospitalization in the presence of a DNH directive were lowered, but not eliminated, with odds of 0.67 (95% confidence interval 0.65-0.69), 0.63 (0.61-0.65), and 0.47 (0.43-0.52) for residents with low, moderate and high health instability, respectively. CONCLUSION Even though both DNR and DNH orders are associated with serious health outcomes, DNH directives were not frequently used and often overturned. We suggest that policies recommending DNH directives be re-evaluated, with greater emphasis on advance care planning that better reflects resident values and wishes.
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Affiliation(s)
- Rhéda Adekpedjou
- Carrefour de l'innovation et de l'évaluation en santé, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
- Schlegel Research Institute for Aging, Waterloo, Canada.
| | - Paul C Hébert
- Carrefour de l'innovation et de l'évaluation en santé, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - John Hirdes
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
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18
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Hirdes JP, Morris JN, Perlman CM, Saari M, Betini GS, Franco-Martin MA, van Hout H, Stewart SL, Ferris J. Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments. Front Psychiatry 2022; 13:787463. [PMID: 35586405 PMCID: PMC9108209 DOI: 10.3389/fpsyt.2022.787463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mood disturbance is a pervasive problem affecting persons of all ages in the general population and the subset of those receiving services from different health care providers. interRAI assessment instruments comprise an integrated health information system providing a common approach to comprehensive assessment of the strengths, preferences and needs of persons with complex needs across the continuum of care. OBJECTIVE Our objective was to create new mood scales for use with the full suite of interRAI assessments including a composite version with both clinician-rated and self-reported items as well as a self-report only version. METHODS We completed a cross-sectional analysis of 511,641 interRAI assessments of Canadian adults aged 18+ in community mental health, home care, community support services, nursing homes, palliative care, acute hospital, and general population surveys to develop, test, and refine new measures of mood disturbance that combined clinician and self-rated items. We examined validity and internal consistency across diverse care settings and populations. RESULTS The composite scale combining both clinician and self-report ratings and the self-report only variant showed different distributions across populations and settings with most severe signs of disturbed mood in community mental health settings and lowest severity in the general population prior to the COVID-19 pandemic. The self-report and composite measures were strongly correlated with each other but differed most in populations with high rates of missing values for self-report due to cognitive impairment (e.g., nursing homes). Evidence of reliability was strong across care settings, as was convergent validity with respect to depression/mood disorder diagnoses, sleep disturbance, and self-harm indicators. In a general population survey, the correlation of the self-reported mood scale with Kessler-10 was 0.73. CONCLUSIONS The new interRAI mood scales provide reliable and valid mental health measures that can be applied across diverse populations and care settings. Incorporating a person-centered approach to assessment, the composite scale considers the person's perspective and clinician views to provide a sensitive and robust measure that considers mood disturbances related to dysphoria, anxiety, and anhedonia.
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Affiliation(s)
- John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Margaret Saari
- SE Research Centre, SE Health and Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gustavo S Betini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Hein van Hout
- Department of General Practice and Medicine for Older Persons, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shannon L Stewart
- Faculty of Education, Western University (Canada), London, ON, Canada
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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19
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Lee DS, Ma S, Chu A, Wang CX, Wang X, Austin PC, McAlister FA, Kalmady SV, Kapral MK, Kaul P, Ko DT, Rochon PA, Schull MJ, Rubin BB, Wang B. Predictors of mortality among long-term care residents with SARS-CoV-2 infection. J Am Geriatr Soc 2021; 69:3377-3388. [PMID: 34409590 DOI: 10.1111/jgs.17425] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND While individuals living in long-term care (LTC) homes have experienced adverse outcomes of SARS-CoV-2 infection, few studies have examined a broad range of predictors of 30-day mortality in this population. METHODS We studied residents living in LTC homes in Ontario, Canada, who underwent PCR testing for SARS-CoV-2 infection from January 1 to August 31, 2020, and examined predictors of all-cause death within 30 days after a positive test for SARS-CoV-2. We examined a broad range of risk factor categories including demographics, comorbidities, functional status, laboratory tests, and characteristics of the LTC facility and surrounding community were examined. In total, 304 potential predictors were evaluated for their association with mortality using machine learning (Random Forest). RESULTS A total of 64,733 residents of LTC, median age 86 (78, 91) years (31.8% men), underwent SARS-CoV-2 testing, of whom 5029 (7.8%) tested positive. Thirty-day mortality rates were 28.7% (1442 deaths) after a positive test. Of 59,702 residents who tested negative, 2652 (4.4%) died within 30 days of testing. Predictors of mortality after SARS-CoV-2 infection included age, functional status (e.g., activity of daily living score and pressure ulcer risk), male sex, undernutrition, dehydration risk, prior hospital contacts for respiratory illness, and duration of comorbidities (e.g., heart failure, COPD). Lower GFR, hemoglobin concentration, lymphocyte count, and serum albumin were associated with higher mortality. After combining all covariates to generate a risk index, mortality rate in the highest risk quartile was 48.3% compared with 7% in the first quartile (odds ratio 12.42, 95%CI: 6.67, 22.80, p < 0.001). Deaths continued to increase rapidly for 15 days after the positive test. CONCLUSIONS LTC residents, particularly those with reduced functional status, comorbidities, and abnormalities on routine laboratory tests, are at high risk for mortality after SARS-CoV-2 infection. Recognizing high-risk residents in LTC may enhance institution of appropriate preventative measures.
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Affiliation(s)
- Douglas S Lee
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Ted Rogers Centre for Heart Research, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shihao Ma
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Department of Computer Science, University of Toronto, Toronto, Canada.,Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Canada
| | - Anna Chu
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chloe X Wang
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Xuesong Wang
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Peter C Austin
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Finlay A McAlister
- Alberta SPOR Unit, University of Alberta, Edmonton, Canada.,Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sunil V Kalmady
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Moira K Kapral
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dennis T Ko
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paula A Rochon
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital, Toronto, Canada
| | - Michael J Schull
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Barry B Rubin
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Vascular Surgery, University Health Network, Toronto, Canada
| | - Bo Wang
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Department of Computer Science, University of Toronto, Toronto, Canada.,Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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20
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Ravaut M, Harish V, Sadeghi H, Leung KK, Volkovs M, Kornas K, Watson T, Poutanen T, Rosella LC. Development and Validation of a Machine Learning Model Using Administrative Health Data to Predict Onset of Type 2 Diabetes. JAMA Netw Open 2021; 4:e2111315. [PMID: 34032855 PMCID: PMC8150694 DOI: 10.1001/jamanetworkopen.2021.11315] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Systems-level barriers to diabetes care could be improved with population health planning tools that accurately discriminate between high- and low-risk groups to guide investments and targeted interventions. Objective To develop and validate a population-level machine learning model for predicting type 2 diabetes 5 years before diabetes onset using administrative health data. Design, Setting, and Participants This decision analytical model study used linked administrative health data from the diverse, single-payer health system in Ontario, Canada, between January 1, 2006, and December 31, 2016. A gradient boosting decision tree model was trained on data from 1 657 395 patients, validated on 243 442 patients, and tested on 236 506 patients. Costs associated with each patient were estimated using a validated costing algorithm. Data were analyzed from January 1, 2006, to December 31, 2016. Exposures A random sample of 2 137 343 residents of Ontario without type 2 diabetes was obtained at study start time. More than 300 features from data sets capturing demographic information, laboratory measurements, drug benefits, health care system interactions, social determinants of health, and ambulatory care and hospitalization records were compiled over 2-year patient medical histories to generate quarterly predictions. Main Outcomes and Measures Discrimination was assessed using the area under the receiver operating characteristic curve statistic, and calibration was assessed visually using calibration plots. Feature contribution was assessed with Shapley values. Costs were estimated in 2020 US dollars. Results This study trained a gradient boosting decision tree model on data from 1 657 395 patients (12 900 257 instances; 6 666 662 women [51.7%]). The developed model achieved a test area under the curve of 80.26 (range, 80.21-80.29), demonstrated good calibration, and was robust to sex, immigration status, area-level marginalization with regard to material deprivation and race/ethnicity, and low contact with the health care system. The top 5% of patients predicted as high risk by the model represented 26% of the total annual diabetes cost in Ontario. Conclusions and Relevance In this decision analytical model study, a machine learning model approach accurately predicted the incidence of diabetes in the population using routinely collected health administrative data. These results suggest that the model could be used to inform decision-making for population health planning and diabetes prevention.
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Affiliation(s)
- Mathieu Ravaut
- Layer 6 AI, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Vinyas Harish
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | | | | | | | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tristan Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | | | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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21
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Kerminen HM, Jäntti PO, Valvanne JNA, Huhtala HSA, Jämsen ERK. Risk factors of readmission after geriatric hospital care: An interRAI-based cohort study in Finland. Arch Gerontol Geriatr 2021; 94:104350. [PMID: 33516078 DOI: 10.1016/j.archger.2021.104350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify risk factors for readmission after geriatric hospital care. METHODS A retrospective cohort study of 1,167 community-dwelling patients aged ≥70 years who were hospitalised in two geriatric hospitals and discharged to their homes over a three-year period. We combined the results of the interRAI-post acute care instrument (interRAI-PAC) with hospital discharge records. Factors associated with readmissions within 90 days following discharge were analysed using logistic regression analysis. RESULTS The patients' mean age was 84.5 (SD 6.2) years, and 71% (n = 827) were women. The 90-day readmission rate was 29.5%. The risk factors associated with readmission in the univariate analysis were as follows: age, admission from home vs. acute care hospital, Alzheimer's disease, unsteady gait, fatigue, unstable conditions, Activities of Daily Living Hierarchy Scale (ADLH) score, Cognitive Performance Scale (CPS) score, body mass index (BMI), frailty index, bowel incontinence, hearing difficulties, and poor self-rated health. In the multivariable analysis, age of ≥90 years, ADLH ≥1, unsteady gait, BMI <25 or ≥30 kg/m 2 , and frailty remained as risk factors for readmission. Surgical operation during the treatment period was associated with a lower readmission risk. CONCLUSIONS AND IMPLICATIONS InterRAI-PAC performed upon admission to geriatric hospitals revealed patient-related risk factors for readmission. Based on the identified risk factors, we recommend that the patient's functional ability, activities of daily living (ADL) needs, and individual factors underlying ADL disability, as well as nutritional and mobility problems should be carefully addressed and managed during hospitalization to diminish the risk for readmission.
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Affiliation(s)
- Hanna M Kerminen
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland.
| | - Pirkko O Jäntti
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland
| | - Jaakko N A Valvanne
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland
| | - Heini S A Huhtala
- Tampere University, Faculty of Social Sciences, P.O. Box 100, 33014, Tampere University, Finland
| | - Esa R K Jämsen
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland
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22
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Watt JA, Campitelli MA, Maxwell CJ, Guan J, Maclagan LC, Gomes T, Bokhari M, Straus SE, Bronskill SE. Fall-Related Hospitalizations in Nursing Home Residents Co-Prescribed a Cholinesterase Inhibitor and Beta-Blocker. J Am Geriatr Soc 2021; 68:2516-2524. [PMID: 33460072 DOI: 10.1111/jgs.16710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the association between hospitalization for a fall-related injury and the co-prescription of a cholinesterase inhibitor (ChEI) among persons with dementia receiving a beta-blocker, and whether this potential drug-drug interaction is modified by frailty. DESIGN Nested case-control study using population-based administrative databases. SETTING All nursing homes in Ontario, Canada. PARTICIPANTS Persons with dementia aged 66 and older who received at least one beta-blocker between April 2013 and March 2018 following nursing home admission (n = 19,060). MEASUREMENTS Cases were persons with dementia with a hospitalization (emergency department visit or acute care admission) for a fall-related injury with concurrent beta-blocker use. Each case (n = 3,038) was matched 1:1 to a control by age (±1 year), sex, cohort entry year, frailty, and history of fall-related injuries. The association between fall-related injury and exposure to a ChEI in the 90 days prior was examined using multivariable conditional logistic regression. Secondary exposures included ChEI type, daily dose, incident versus prevalent use, and use in the prior 30 days. Subgroup analyses considered frailty, age group, sex, and history of hospitalization for fall-related injuries. RESULTS Exposure to a ChEI in the prior 90 days occurred among 947 (31.2%) cases and 940 (30.9%) controls. In multivariable models, no association was found between hospitalization for a fall-related injury and prior exposure to a ChEI in persons with dementia dispensed beta-blockers (adjusted odds ratio = .96, 95% confidence interval = .85-1.08). Findings were consistent across secondary exposures and subgroup analyses. CONCLUSION Among nursing home residents with dementia receiving beta-blockers, co-prescription of a ChEI was not associated with an increased risk of hospitalization for a fall-related injury. However, we did not assess for its association with falls not leading to hospitalization. This finding could inform clinical guidelines and shared decision making between persons with dementia, caregivers, and clinicians concerning ChEI initiation and/or discontinuation.
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Affiliation(s)
- Jennifer A Watt
- St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Tara Gomes
- St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Bokhari
- Toronto General Hospital, Toronto, Ontario, Canada.,Mount Sinai Medical Center, New York, New York City, USA
| | - Sharon E Straus
- St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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23
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Chai Y, Luo H, Yip PSF, Perlman CM, Hirdes JP. Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study. J Am Med Dir Assoc 2021; 22:2160-2168.e18. [PMID: 33454310 DOI: 10.1016/j.jamda.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS The LTC data were collected using Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and Resident Assessment Instrument-Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included. METHODS Adjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models. RESULTS Records were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31-25.40] for LTCF and 46.64 (44.24-49.12) for HC. In LTCF, the strongest risks were younger age (60-74 years vs 90+: HR, 6.00; 95% CI, 3.24-11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32-5.16; schizophrenia: 2.31; 1.47-3.62; depression: 2.29; 1.80-2.92), daily severe pain (2.01; 1.30-3.11), and daily tobacco consumption (1.78; 1.29-2.45). For those receiving HC, the strongest risk factors were younger age (60-74 years vs 90+: 2.54; 1.97-3.28), psychiatric disorders (2.20; 1.93-2.50), daily tobacco consumption (2.08; 1.81-2.39), and frequent falls (1.98; 1.46-2.68). All model interactions between setting and factors were significant. CONCLUSIONS AND IMPLICATIONS There was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.
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Affiliation(s)
- Yi Chai
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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24
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de Almeida Mello J, Cès S, Vanneste D, Van Durme T, Van Audenhove C, Macq J, Fries B, Declercq A. Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study. BMC Geriatr 2020; 20:195. [PMID: 32503445 PMCID: PMC7275336 DOI: 10.1186/s12877-020-01593-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons’ needs. Methods This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010–2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up. Results A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model. Conclusions The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community.
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Affiliation(s)
| | - Sophie Cès
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Dirk Vanneste
- LUCAS, Center for Care Research and Consultancy, KULeuven, Leuven, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | | | - Jean Macq
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Brant Fries
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Anja Declercq
- LUCAS, Center for Care Research and Consultancy, KULeuven, Leuven, Belgium.,CeSO: Centre for Sociological Researc, KULeuven, Leuven, Belgium
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25
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The Post-Acute Delayed Discharge Risk Scale: Derivation and Validation With Ontario Alternate Level of Care Patients in Ontario Complex Continuing Care Hospitals. J Am Med Dir Assoc 2020; 21:538-544.e1. [DOI: 10.1016/j.jamda.2019.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 11/20/2022]
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Lane NE, Stukel TA, Boyd CM, Wodchis WP. Long-Term Care Residents' Geriatric Syndromes at Admission and Disablement Over Time: An Observational Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 74:917-923. [PMID: 29955879 PMCID: PMC6521919 DOI: 10.1093/gerona/gly151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/29/2023] Open
Abstract
Background Disablement occurs when people lose their ability to perform activities of daily living (ADLs) like bathing and dressing, and is measured as the rate of increasing disability over time. We examined whether balance impairment, cognitive impairment, or pain among residents at admission to long-term care homes were predictive of their rate of disablement over the subsequent 2 years. Methods Linked administrative databases were used to conduct a longitudinal cohort study of 12,334 residents admitted to 633 long-term care (LTC) homes between April 1, 2011 and March 31, 2012, in Ontario, Canada. Residents received an admission assessment of disability upon admission to LTC using the RAI-MDS 2.0 ADL long-form score (ADL LFS, range 0–28) and at least two subsequent disability assessments. Multivariable regression models estimated the adjusted association between balance impairment, cognitive impairment, and pain present at admission and residents’ subsequent disablement over 2 years. Results This population sample of newly admitted Ontario long-term care residents had a median disability score of 13 (interquartile range [IQR] = 7, 19) at admission. Greater balance impairment and cognitive impairment at admission were significantly associated with faster resident disablement over 2 years in adjusted models, while daily pain was not. Conclusions Balance impairment and cognitive impairment among newly admitted long-term care home residents are associated with increased rate of disablement over the following 2 years. Further research should examine the mechanisms driving this association and identify whether they are amenable to intervention.
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Affiliation(s)
- Natasha E Lane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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28
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Hoben M, Yoon MN, Lu L, Estabrooks CA. If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes-Part I. Gerodontology 2019; 37:153-163. [PMID: 31774205 DOI: 10.1111/ger.12449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/26/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items collected by nursing home (NH) care staff to (a) assessments collected by trained research assistants (RAs) and (b) "gold standard" clinical assessments by dental hygienists (DHs). BACKGROUND Routine collection of RAI oral/dental items is mandatory in most Canadian NHs. However, the performance of these items is less than optimal and oral/dental problems are severely under-reported. Accurate assessment is a prerequisite for preventing, detecting and treating oral health problems. Not knowing the reasons for performance problems is a barrier to improving performance of the RAI oral/dental items. MATERIALS AND METHODS We included 103 NH residents from 4 NHs in Edmonton, Alberta, Canada. Using Kappa statistics, we compared the agreement of residents' last (no older than 90 days) RAI assessment with RAI assessments completed by trained RAs and "gold standard" clinical assessments by DHs. We also assessed the inter-rater reliability (IRR) of RA and DH assessments. RESULTS Care staff assessments had poor agreement with RA and DH assessments (Kappa < 0.2 for most items). RAs and DHs identified more oral/dental problems than care staff. However, IRR of RA assessments was low (Kappa < 0.7 for 7/9 items). IRR of DH assessments was acceptable (Kappa > 0.7) for most items. CONCLUSIONS The quality of RAI oral/dental assessments can be improved by better training care staff and ensuring appropriate time to do the assessments. However, remaining problems-even with trained RAs-suggest that rewording some of the items or supplementing them by more robust tools may be required.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Minn N Yoon
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lily Lu
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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29
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Hill A, Ramsey C, Dodek P, Kozek J, Fransoo R, Fowler R, Doupe M, Wong H, Scales D, Garland A. Examining mechanisms for gender differences in admission to intensive care units. Health Serv Res 2019; 55:35-43. [PMID: 31709536 DOI: 10.1111/1475-6773.13215] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate whether the male predominance of older people admitted to intensive care units (ICUs) is due to gender differences in the presence of spouses, partners, or children; rates of gender-specific disease; or triage decisions made by health system personnel. DATA SOURCES AND COLLECTION Three population-based datasets, 2004-2012, of Canadians ≥65 years: provincial health care data from Manitoba (n = 250 190) and national data of nursing home residents (n = 133 982) and community-based homecare recipients (n = 210 090). STUDY DESIGN Retrospective observational study, using multivariable Cox proportional hazards and logistic regression. PRINCIPAL FINDINGS Males predominated in ICU admissions: from Manitoba (hazard ratio [HR] = 1.87, 95% CI = 1.80-1.95), nursing homes (HR = 1.47, 1.35-1.60), and homecare (odds ratio = 1.14, 1.11-1.17). Adjustment for spouses, partners, and children did not attenuate this effect. The HR for gender was lower by 13.5 percent, relative, after excluding ICU care for cardiac causes. Male predominance was not present during a second ICU admission among survivors of a first ICU-containing hospitalization (HR = 1.07, 0.96-1.20). CONCLUSIONS In three older cohorts, the male predominance of ICU admission was not explained by gender differences in the presence of a spouse, partner, or children, or cardiac disease rates. The third finding suggests that triage bias is unlikely to be responsible for the male predominance.
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Affiliation(s)
- Andrea Hill
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Clare Ramsey
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean Kozek
- Department of Family and Community Medicine, Providence Health Care, Vancouver, BC, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Fowler
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Malcolm Doupe
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Hubert Wong
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Damon Scales
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Allan Garland
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Campitelli MA, Maxwell CJ, Maclagan LC, Ko DT, Bell CM, Jeffs L, Morris AM, Lapane KL, Daneman N, Bronskill SE. One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins. CMAJ 2019; 191:E32-E39. [PMID: 30642823 DOI: 10.1503/cmaj.180853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Guidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting. METHODS We conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively. RESULTS Using propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins. INTERPRETATION The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events.
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Affiliation(s)
- Michael A Campitelli
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Colleen J Maxwell
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Laura C Maclagan
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Dennis T Ko
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Chaim M Bell
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Lianne Jeffs
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Andrew M Morris
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Kate L Lapane
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Nick Daneman
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass
| | - Susan E Bronskill
- ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
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Iaboni A, Campitelli MA, Bronskill SE, Diong C, Kumar M, Maclagan LC, Gomes T, Tadrous M, Maxwell CJ. Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study. CMAJ Open 2019; 7:E582-E589. [PMID: 31551235 PMCID: PMC6759016 DOI: 10.9778/cmajo.20190052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. METHODS We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. RESULTS Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). INTERPRETATION Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.
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Affiliation(s)
- Andrea Iaboni
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Michael A Campitelli
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Susan E Bronskill
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Christina Diong
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Matthew Kumar
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Laura C Maclagan
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Tara Gomes
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Mina Tadrous
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont
| | - Colleen J Maxwell
- Toronto Rehabilitation Institute (Iaboni), University Health Network; Department of Psychiatry (Iaboni), University of Toronto; ICES (Campitelli, Bronskill, Diong, Kumar, Maclagan, Gomes, Tadrous, Maxwell); Institute of Health Policy, Management and Evaluation (Bronskill, Gomes), University of Toronto; Sunnybrook Research Institute (Bronskill), Sunnybrook Health Sciences Centre; Women's College Research Institute (Bronskill, Tadrous), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes, Tadrous), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Tadrous), University of Toronto, Toronto, Ont.; Schools of Pharmacy and of Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.
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Turcotte LA, Perlman CM, Fries BE, Hirdes JP. Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals. BMC Health Serv Res 2019; 19:218. [PMID: 30953489 PMCID: PMC6451230 DOI: 10.1186/s12913-019-4024-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background Post-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals. Methods Using information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2.0 (MDS 2.0), a sample of 91,113 episodes of care for patients admitted to Complex Continuing Care hospitals between March 31, 2001 and March 31, 2013 was established. All patients in the sample were either discharged to a residential long-term care facility (e.g., nursing home) or to the community. Long-stay patients for each discharge destination were identified based on a length of stay in the 95th percentile. A series of multivariate logistic regression models predicting long-stay patient status for each discharge destination pathway were fit to characterize the association between demographic factors, residential history, health severity measures, and service utilization on prolonged length of stay in post-acute care. Results Risk factors for prolonged length of stay in the adjusted models included functional and cognitive impairment, greater pressure ulcer risk, paralysis, antibiotic resistant and HIV infection need for a feeding tube, dialysis, tracheostomy, ventilator or a respirator, and psychological therapy. Protective factors included advanced age, medical instability, a greater number of recent hospital and emergency department visits, cancer diagnosis, pneumonia, unsteady gait, a desire to return to the community, and a support person who is positive towards discharge. Aggressive behaviour was only a risk factor for patients discharged to residential long-term care facilities. Cancer diagnosis, antibiotic resistant and HIV infection, and pneumonia were only significant factors for patients discharged to the community. Conclusions This study identified several patient attributes and process of care variables that are predictors of prolonged length of stay in post-acute care hospitals. This is valuable information for care planners and health system administrators working to improve patient flow in Complex Continuing Care and other post-acute care settings such as skilled nursing and inpatient rehabilitation facilities.
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Affiliation(s)
- Luke A Turcotte
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Chris M Perlman
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Brant E Fries
- Geriatrics Center, Department of Internal Medicine and School of Public Health, University of Michigan, Ann Arbor, USA
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Hébert PC, Morinville A, Costa A, Heckman G, Hirdes J. Regional variations of care in home care and long-term care: a retrospective cohort study. CMAJ Open 2019; 7:E341-E350. [PMID: 31110112 PMCID: PMC6527434 DOI: 10.9778/cmajo.20180086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many aging adults undergo progressive loss of autonomy, develop increasingly complex medical needs and experience multiple care transitions. We sought to determine the degree of variation in rates of transfer from home care services and long-term care in several Canadian jurisdictions. METHODS In this retrospective cohort study, we examined transitions from home care services and long-term care to different possible end states: change in health stability (getting better or worse), transfer to hospital, transfer to another care setting or death. We used standardized interRAI assessments from long-term care and home care linked to hospital records (data from the Discharge Abstract Database and National Ambulatory Care Reporting System) from 2010 to 2016. Multistate modelling was used to adjust for patients with complex health status and transitions in care. RESULTS We report data for 254 664 patients in home care programs and 162 045 residents in long-term care. Compared with patients in Ontario, patients requiring home care services in Alberta and British Columbia had increased odds of being admitted to hospital regardless of the underlying severity of illness (the adjusted odds ratios [OR] ranged from 2.08 to 3.77 in Alberta and from 1.28 to 1.46 in BC). Residents in long-term care in Alberta and BC had less than half the odds of being transferred to hospital, independent of all other factors, when compared with long-term care residents in Ontario (the adjusted OR ranged from 0.38 to 0.39 in Alberta and from 0.33 to 0.44 in BC). INTERPRETATION Significant variations in transfer rates were observed between provinces, even after controlling for individual patient characteristics. These results suggest that transfers to hospital are largely driven by health care policies, health care professional practice patterns and available infrastructure rather than individual patient needs.
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Affiliation(s)
- Paul C Hébert
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont.
| | - Anne Morinville
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
| | - Andrew Costa
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
| | - George Heckman
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
| | - John Hirdes
- Département de médecine (Hébert), Université de Montréal and Centre hospitalier de l'Université de Montréal, Montréal, Que.; Novartis Pharmaceuticals Canada Inc. (Morinville), Dorval, Que.; Centre de recherche du Centre hospitalier de l'Université de Montréal (Hébert) (Morinville, during the conduct of the study), Montréal, Que.; Departments of Medicine, and Health Research Methods, Evidence, and Impact (Costa), McMaster University, Hamilton, Ont.; Research Institute for Aging, School of Public Health and Health Systems (Heckman); School of Public Health and Health Systems (Hirdes), University of Waterloo, Waterloo, Ont
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Saxena FE, Bronskill SE, Brown KA, Campitelli MA, Garber G, Langford B, Maxwell CJ, McCormack D, Schwartz KL, Daneman N. The Association of Resident Communication Abilities and Antibiotic Use in Long-Term Care. J Am Geriatr Soc 2019; 67:1164-1173. [PMID: 30690721 DOI: 10.1111/jgs.15771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether decreased communication ability among long-term care residents is associated with increased antibiotic exposure. DESIGN Retrospective cohort study. SETTING All long-term care homes in Ontario, Canada. PARTICIPANTS All adults aged 66 years or older residing in long-term care and undergoing a full assessment between January 1 and December 31, 2016 (N = 87,947). MEASUREMENTS Data were obtained from linkable, population-wide administrative data sets. Residents were identified, and characteristics were abstracted from the Resident Assessment Instrument Minimum Dataset version 2.0. The primary predictors of interest were residents' ability to make themselves understood and ability to understand others. The primary outcome was antibiotic days of treatment per 1000 resident days in the 90 days following assessment (obtained from the Ontario Drug Benefits Database). RESULTS Those who were sometimes/rarely/never able to make themselves understood received 50.7 antibiotic days per 1000 person-days of follow-up, compared to 62.1 received by those who were able to make themselves understood. Those who were sometimes/rarely/never able to understand others received 50.0 antibiotic days per 1000 person-days of follow-up, compared to 61.4 by those who were able to understand others. Multivariable Poisson regression, accounting for resident characteristics, confirmed that compared to those with highest levels of communication ability, those who could sometimes/rarely/never make themselves understood had significantly fewer days on antibiotics (rate ratio [RR] = 0.76; confidence interval [95% CI] = 0.73-0.79) as did those who could sometimes/rarely/never understand others (RR = 0.76; 95% CI = 0.74-0.79). CONCLUSION Poor resident communication ability is not a driver of antibiotic overuse in long-term care. In fact, lower ability to understand others and/or be understood by others is associated with less antibiotic exposure. Further work is needed to optimize antibiotic use in long-term care residents across the entire spectrum of communication skills.
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Affiliation(s)
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kevin A Brown
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | | | - Gary Garber
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bradley Langford
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Kevin L Schwartz
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Nick Daneman
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
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Heckman GA, Hirdes JP, Hébert PC, Morinville A, Amaral ACKB, Costa A, McKelvie RS. Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure. J Am Med Dir Assoc 2018; 20:438-443. [PMID: 30573437 DOI: 10.1016/j.jamda.2018.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To understand how a heart failure diagnosis and admission health instability predict health transitions and outcomes among newly admitted nursing home residents. DESIGN Retrospective cohort study of linked administrative data, including the Continuing Care Report System MDS 2.0 for nursing homes, the Discharge Abstract Database for hospitalized patients, and National Ambulatory Care Reporting System to track emergency department visits. SETTING AND PARTICIPANTS Older adults, aged 65 years and above, admitted to nursing homes in Ontario, Alberta, and British Columbia, Canada, from 2010 to 2016. MEASURES Mortality and hospitalization were plotted over 1 year. Multistate Markov models were used to estimate adjusted odds ratios (ORs) for transitions to different states of health in stability, hospitalization, and death, stratified by heart failure diagnosis and by interRAI Changes in Health and End-stage disease Signs and Symptoms (CHESS) score, at 90 days following admission to a nursing home. RESULTS The final sample included 143,067 residents. Adverse events were most common in the first 90 days. A diagnosis of heart failure predicted worsening health instability, hospitalizations, and mortality. The effect of heart failure on hospitalizations and death was strongest for low baseline health instability (CHESS = 0; OR 1.63, 95% confidence interval (CI) 1.58-1.68, and OR 1.71, 95% CI 1.57-1.86, respectively), versus moderate instability (CHESS = 1-2; OR 1.36, 95% CI 1.32-1.39, and OR 1.48, 95% CI 1.41-1.55), versus high instability (CHESS = 3; OR 1.12, 95% CI 1.03-1.23, and OR 1.21, 95% CI 1.11-1.32). The magnitude of the impact of a heart failure diagnosis was greatest for lower baseline health instability. Residents with the highest degree of health instability were also most likely to die in hospital. CONCLUSIONS AND IMPLICATIONS A diagnosis of heart failure and health instability provide complementary information to predict transfers, deaths, and adverse outcomes. Clearly identifying these at-risk patients may be useful in targeting interventions in nursing homes.
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Affiliation(s)
- George A Heckman
- Research Institute for Ageing, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - John P Hirdes
- Research Institute for Ageing, Waterloo, Ontario, Canada
| | - Paul C Hébert
- Département de Médecine, Université de Montréal et Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Anne Morinville
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Andre C K B Amaral
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Costa
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Turcotte LA, Tran J, Moralejo J, Curtin-Telegdi N, Eckel L, Hirdes JP. Evaluation of a staff training programme to reimplement a comprehensive health assessment. BMJ Open Qual 2018; 7:e000353. [PMID: 30555932 PMCID: PMC6267310 DOI: 10.1136/bmjoq-2018-000353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 11/03/2022] Open
Abstract
Background Health information systems with applications in patient care planning and decision support depend on high-quality data. A postacute care hospital in Ontario, Canada, conducted data quality assessment and focus group interviews to guide the development of a cross-disciplinary training programme to reimplement the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 comprehensive health assessment into the hospital's clinical workflows. Methods A hospital-level data quality assessment framework based on time series comparisons against an aggregate of Ontario postacute care hospitals was used to identify areas of concern. Focus groups were used to evaluate assessment practices and the use of health information in care planning and clinical decision support. The data quality assessment and focus groups were repeated to evaluate the effectiveness of the training programme. Results Initial data quality assessment and focus group indicated that knowledge, practice and cultural barriers prevented both the collection and use of high-quality clinical data. Following the implementation of the training, there was an improvement in both data quality and the culture surrounding the RAI-MDS 2.0 assessment. Conclusions It is important for facilities to evaluate the quality of their health information to ensure that it is suitable for decision-making purposes. This study demonstrates the use of a data quality assessment framework that can be applied for quality improvement planning.
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Affiliation(s)
- Luke A Turcotte
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jake Tran
- The Salvation Army Toronto Grace Health Centre, Toronto, Ontario, Canada
| | - Joshua Moralejo
- The Salvation Army Toronto Grace Health Centre, Toronto, Ontario, Canada
| | - Nancy Curtin-Telegdi
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Leslie Eckel
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Maclagan LC, Bronskill SE, Guan J, Campitelli MA, Herrmann N, Lapane KL, Hogan DB, Amuah JE, Seitz DP, Gill SS, Maxwell CJ. Predictors of Cholinesterase Discontinuation during the First Year after Nursing Home Admission. J Am Med Dir Assoc 2018; 19:959-966.e4. [PMID: 30262440 DOI: 10.1016/j.jamda.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/24/2018] [Accepted: 07/28/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES For persons with dementia, the appropriate duration of cholinesterase inhibitor (ChEI) use remains unclear. We examined patterns of ChEI use during nursing home (NH) transition and the factors associated with discontinuation following admission. DESIGN Population-based retrospective cohort study using linked health administrative and Resident Assessment Instrument Minimum Dataset, version 2.0 databases. SETTING AND PARTICIPANTS A total of 47,851 older adults (mean age = 84.8 years, standard deviation = 6.8) with dementia newly admitted to a NH in Ontario, Canada between 2011 and 2015. MEASUREMENTS ChEI use at admission and during the following year was identified from prescription claims. Resident sociodemographic and health characteristics at admission, including a 72-item frailty index, were derived from the Resident Assessment Instrument Minimum Dataset 2.0. Additional resident and prescriber characteristics were derived from administrative data. Discontinuation was defined as a 30+-day gap in ChEI supply. Multivariable subdistribution hazard models were used to estimate the independent effect of resident frailty and other factors on ChEI discontinuation. RESULTS Approximately one-third (17,560) of residents with dementia were on a ChEI at admission. Among this group, 17.7% (3110) discontinued use over follow-up. Incidence of discontinuation was significantly higher among residents with syncope [subdistribution hazard ratio, sHR = 2.21, 95% confidence interval, CI (1.52, 3.22)], more severe behavioral symptoms [sHR = 1.79, 95% CI (1.57, 2.05)], cognitive impairment [sHR = 1.26, 95% CI (1.07, 1.48)], higher frailty, [sHR = 1.19, 95% CI (1.04, 1.36)], and a primary prescriber active in the NH [sHR = 1.28, 95% CI (1.14, 1.45)]. A significantly lower incidence was observed for older and unmarried residents and those with a longer duration of use. CONCLUSIONS/IMPLICATIONS Less than one-fifth of residents on a ChEI at admission discontinued use during the following year. Although some of the predictors of discontinuation align with past research and current clinical recommendations, others were unexpected and point to novel drivers of ChEI use. Future investigations should explore the varied reasons underlying these associations and resident outcomes associated with ChEI discontinuation.
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Affiliation(s)
- Laura C Maclagan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Nathan Herrmann
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph E Amuah
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dallas P Seitz
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada; Providence Care Hospital, Kingston, Ontario, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
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Doupe MB, Poss J, Norton PG, Garland A, Dik N, Zinnick S, Lix LM. How well does the minimum data set measure healthcare use? a validation study. BMC Health Serv Res 2018; 18:279. [PMID: 29642929 PMCID: PMC5896092 DOI: 10.1186/s12913-018-3089-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/03/2018] [Indexed: 11/15/2022] Open
Abstract
Background To improve care, planners require accurate information about nursing home (NH) residents and their healthcare use. We evaluated how accurately measures of resident user status and healthcare use were captured in the Minimum Data Set (MDS) versus administrative data. Methods This retrospective observational cohort study was conducted on all NH residents (N = 8832) from Winnipeg, Manitoba, Canada, between April 1, 2011 and March 31, 2013. Six study measures exist. NH user status (newly admitted NH residents, those who transferred from one NH to another, and those who died) was measured using both MDS and administrative data. Rates of in-patient hospitalizations, emergency department (ED) visits without subsequent hospitalization, and physician examinations were also measured in each data source. We calculated the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and overall agreement (kappa, κ) of each measure as captured by MDS using administrative data as the reference source. Also for each measure, logistic regression tested if the level of disagreement between data systems was associated with resident age and sex plus NH owner-operator status. Results MDS accurately identified newly admitted residents (κ = 0.97), those who transferred between NHs (κ = 0.90), and those who died (κ = 0.95). Measures of healthcare use were captured less accurately by MDS, with high levels of both under-reporting and false positives (e.g., for in-patient hospitalizations sensitivity = 0.58, PPV = 0.45), and moderate overall agreement levels (e.g., κ = 0.39 for ED visits). Disagreement was sometimes greater for younger males, and for residents living in for-profit NHs. Conclusions MDS can be used as a stand-alone tool to accurately capture basic measures of NH use (admission, transfer, and death), and by proxy NH length of stay. As compared to administrative data, MDS does not accurately capture NH resident healthcare use. Research investigating these and other healthcare transitions by NH residents requires a combination of the MDS and administrative data systems. Electronic supplementary material The online version of this article (10.1186/s12913-018-3089-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malcolm B Doupe
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada. .,Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
| | - Jeff Poss
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada
| | - Peter G Norton
- University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Allan Garland
- Faculty of Health Sciences, University of Manitoba, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Natalia Dik
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Shauna Zinnick
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, 4th floor, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
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Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3. Qual Life Res 2018; 27:1295-1309. [PMID: 29435802 PMCID: PMC5891555 DOI: 10.1007/s11136-018-1800-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/24/2022]
Abstract
Background Health-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3. Methods interRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents. Results The mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings. Discussion The present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.
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Bala SS, Narayan SW, Nishtala PS. Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment. Eur J Clin Pharmacol 2018; 74:645-653. [PMID: 29330585 DOI: 10.1007/s00228-018-2412-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The prescription of potentially inappropriate medications (PIMs) is associated with an increase in adverse events, prescribing cascades, high health-care costs, morbidity, and mortality in the elderly. The overarching objective of this study is to examine the prevalence of PIMs in the elderly, applying the 2012 American Geriatrics Society Beers criteria for the study period 2012-2014, and the updated 2015 Beers criteria for 2015. METHODS The study population (N = 70,479) included a continuously recruited national cohort of community-dwelling older (aged ≥ 65 years) New Zealanders who had undertaken the International Resident Assessment Instrument-Home Care (interRAI-HC) assessments between September 2012 and October 2015. Exposure of PIMs 90 days before and after assessment, and 90-180 days after assessment are reported. RESULTS Exposure to PIMs was highest in individuals aged over 95 years and in males. The average number of PIMs prescribed 90 days before assessment during the period 2015 was marginally higher compared to 2012-2014 (0.19 versus 0.04), and a greater number of individuals were exposed to one or more PIMs in 2015 compared to 2012-2014 (7.13 versus 2.17%). The prevalence of PIMs 90 days before and after assessment was 2.17 and 6.92% for 2012-2014, and 7.13 and 24.7% for 2015, respectively. The percent change in PIMs in 2012-2014 and 2015 after 90 days of assessment were 4.70% (confidence interval (CI) 4.50%, 5.00%, p < 0.001) and 17.60% (95% CI 16.80%, 18.30%, p < 0.001), respectively. The majority of PIMs prescribed belonged to the therapeutic class of medications acting on the central nervous system and the gastrointestinal system. CONCLUSION Geriatric risk assessments may provide a vital opportunity to review medication lists by multidisciplinary teams with a view to reducing PIMs and unnecessary polypharmacy in older adults. Comprehensive geriatric risk assessment has the potential to reduce adverse medication outcomes and costs associated with inappropriate prescribing in a vulnerable population of older adults.
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Affiliation(s)
- Sharmin S Bala
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand.
| | - Sujita W Narayan
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Prasad S Nishtala
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand
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Heckman GA, Crizzle AM, Chen J, Pringsheim T, Jette N, Kergoat MJ, Eckel L, Hirdes JP. Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 7:103-115. [PMID: 27689617 DOI: 10.3233/jpd-160931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes. OBJECTIVES The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population. METHODS Population-based cross-sectional cohort study. Residents with PD and/or Parkinsonism living in long-term care (LTC) facilities in 6 Canadian provinces and 1 Northern Territory and Complex Continuing Care (CCC) facilities in Manitoba and Ontario, Canada. The RAI MDS 2.0 instrument was used to assess all LTC residents and CCC residents. Clinical characteristics and the prevalence of major comorbidities were examined. Multivariate modeling was used to identify the characteristics of PD residents most associated with the prescription of antipsychotics and the use of restraints in LTC and CCC facilities. RESULTS Residents with PD in LTC and CCC exhibit a high prevalence of dementia, major psychiatric disorders, stroke, heart failure, chronic obstructive pulmonary disease and diabetes mellitus. More than 90% of LTC and CCC residents with PD had cognitive impairment; with more than half having moderate to severe impairment. Residents with PD were more likely to receive antipsychotics than those without PD. Antipsychotic use was associated with psychosis and aggressive behaviours, but also with unsteady gait and higher comorbidity and medication count. Similarly, although more common in CCC than LTC facilities, both psychosis and aggressive behaviours were associated with restraint use, as was greater cognitive and functional impairment, and urinary incontinence. Younger age, male gender, and lower physician access were all associated with greater antipsychotic and restraint use. CONCLUSIONS LTC and CCC residents with PD are very complex medically. Use of antipsychotics and restraints is common, and their use is often associated with factors other than psychosis or aggression.
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Affiliation(s)
- George A Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Alexander M Crizzle
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jonathen Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences and Hotchkiss Brain Institute and Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences and Hotchkiss Brain Institute and Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | | | - Leslie Eckel
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Hogeveen SE, Chen J, Hirdes JP. Evaluation of data quality of interRAI assessments in home and community care. BMC Med Inform Decis Mak 2017; 17:150. [PMID: 29084534 PMCID: PMC5663080 DOI: 10.1186/s12911-017-0547-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this project is to describe the quality of assessment data regularly collected in home and community, with techniques adapted from an evaluation of the quality of long-term care data in Canada. METHODS Data collected using the Resident Assessment Instrument - Home Care (RAI-HC) in Ontario and British Columbia (BC) as well as the interRAI Community Health Assessment (CHA) in Ontario were analyzed using descriptive statistics, Pearson's r correlation, and Cronbach's alpha in order to assess trends in population characteristics, convergent validity, and scale reliability. RESULTS Results indicate that RAI-HC data from Ontario and BC behave in a consistent manner, with stable trends in internal consistency providing evidence of good reliability (alpha values range from 0.72-0.94, depending on the scale and province). The associations between various scales, such as those reflecting functional status and cognition, were found to be as expected and stable over time within each setting (r values range from 0.42-0.45 in Ontario and 0.41-0.43 in BC). These trends in convergent validity demonstrate that constructs in the data behave as they should, providing evidence of good data quality. In most cases, CHA data quality matches that of RAI-HC data quality and shows evidence of good validity and reliability. The findings are comparable to the findings observed in the evaluation of data from the long-term care sector. CONCLUSIONS Despite an increasingly complex client population in the home and community care sectors, the results from this work indicate that data collected using the RAI-HC and the CHA are of an overall quality that may be trusted when used to inform decision-making at the organizational- or policy-level. High quality data and information are vital when used to inform steps taken to improve quality of care and enhance quality of life. This work also provides evidence that a method used to evaluate the quality of data obtained in the long-term care setting may be used to evaluate the quality of data obtained through community-based measures.
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Affiliation(s)
- Sophie E Hogeveen
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Jonathan Chen
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Rios S, Perlman CM, Costa A, Heckman G, Hirdes JP, Mitchell L. Antipsychotics and dementia in Canada: a retrospective cross-sectional study of four health sectors. BMC Geriatr 2017; 17:244. [PMID: 29061129 PMCID: PMC5651600 DOI: 10.1186/s12877-017-0636-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Antipsychotic medications are not recommended for the management of symptoms of dementia, particularly among persons with no behavioral or psychological symptoms. We examine patterns of antipsychotic medication use among persons with dementia across health sectors in Canada, with a focus on factors related to use among those without behavioral or psychotic symptoms. Methods Using a retrospective cross-sectional design, this study examines antipsychotic use among adults aged 65 or older with dementia in home care (HC), complex continuing care (CCC), long-term care (LTC), and among alternate level care patients in acute hospitals (ALC). Using clinical data from January 1, 2009 to December 31, 2014, the prevalence of antipsychotic medication use was estimated by the presence of behavioral and psychotic symptoms. Logistic regression was used to identify sector specific factors associated with antipsychotic use in the absence of behavioral and psychotic symptoms. Results The total prevalence of antipsychotic use among older adults with dementia was 26% in HC, 54% in ALC, 41% in CCC, and 48% in LTC. This prevalence ranged from 38% (HC) to 73% (ALC) for those with both behavioral and psychotic symptoms and from 15% (HC) to 31% (ALC) among those with no symptoms. The regression models identified a number of variables were related to antipsychotic use in the absence of behavior or psychotic symptoms, such as bipolar disorder (OR = 6.63 in CCC; OR = 5.52 in LTC), anxious complaints (OR = 1.54 in LTC to 2.01 in CCC), and wandering (OR = 1.83 in ALC). Conclusions Potentially inappropriate use of antipsychotic medications is prevalent among older adults with dementia across health sectors. The variations in prevalence observed from community to facility based care suggests that system issues may exist in appropriately managing persons with dementia. Electronic supplementary material The online version of this article (10.1186/s12877-017-0636-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian Rios
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Andrew Costa
- Schlegel Research Institute for Aging, Waterloo, ON, Canada.,Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lori Mitchell
- Winnipeg Regional Health Authority (WRHA) Home Care Program, Winnipeg, MB, Canada
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Smith M, Lix LM, Azimaee M, Enns JE, Orr J, Hong S, Roos LL. Assessing the quality of administrative data for research: a framework from the Manitoba Centre for Health Policy. J Am Med Inform Assoc 2017; 25:224-229. [PMID: 29025002 DOI: 10.1093/jamia/ocx078] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/22/2017] [Accepted: 07/04/2017] [Indexed: 11/13/2022] Open
Abstract
The growth of administrative data repositories worldwide has spurred the development and application of data quality frameworks to ensure that research analyses based on these data can be used to draw meaningful conclusions. However, the research literature on administrative data quality is sparse, and there is little consensus regarding which dimensions of data quality should be measured. Here we present the core dimensions of the data quality framework developed at the Manitoba Centre for Health Policy, a world leader in the use of administrative data for research purposes, and provide examples and context for the application of these dimensions to conducting data quality evaluations. In sharing this framework, our ultimate aim is to promote best practices in rigorous data quality assessment among users of administrative data for research.
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Affiliation(s)
- Mark Smith
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mahmoud Azimaee
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justine Orr
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Say Hong
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Pressure Ulcers Among Newly Admitted Nursing Home Residents: Measuring the Impact of Transferring From Hospital. Med Care 2017; 54:584-91. [PMID: 27177296 DOI: 10.1097/mlr.0000000000000522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pressure ulcers (PUs) are reported more often among newly admitted nursing home (NH) residents who transfer from hospital versus community. We examine for whom this increased risk is greatest, further defining hospitalized patients most in need of better PU preventive care. RESEARCH DESIGN Retrospective observational cohort study. SUBJECTS All NH residents (N=5617) newly admitted between April 1, 2008 and March 31, 2012 in Winnipeg, MB, Canada. MEASURES RAI-MDS 2.0 data were linked to administrative health care use files capturing each person's NH admission date, their presence of a PU at this time, whether they transferred into NH from hospital or community, and their PU susceptibility (eg, amount of help needed to maneuver in bed or to transfer from one surface to another, frequency of incontinence, presence of diabetes, amount of food consistently left uneaten). Log-binomial regression with interaction terms was used to analyze data. RESULTS 67.6% of our cohort transferred into a NH directly from hospital; 9.2% of these residents were reported to have a stage 1+ PU on NH admission versus 2.6% of those who transferred from community. From regression models, transferring from hospital versus community was associated with increased PU risk equally across various subgroups of less and more susceptible residents. CONCLUSIONS Transferring from hospital versus community places both more and less susceptible newly admitted NH residents at increased PU risk. Using evidence-based preventive care practices is thus needed for all subgroups of hospital patients before NH use, to help reduce PU risk.
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Lane NE, Wodchis WP, Boyd CM, Stukel TA. Disability in long-term care residents explained by prevalent geriatric syndromes, not long-term care home characteristics: a cross-sectional study. BMC Geriatr 2017; 17:49. [PMID: 28183274 PMCID: PMC5301427 DOI: 10.1186/s12877-017-0444-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Self-care disability is dependence on others to conduct activities of daily living, such as bathing, eating and dressing. Among long-term care residents, self-care disability lowers quality of life and increases health care costs. Understanding the correlates of self-care disability in this population is critical to guide clinical care and ongoing research in Geriatrics. This study examines which resident geriatric syndromes and chronic conditions are associated with residents’ self-care disability and whether these relationships vary across strata of age, sex and cognitive status. It also describes the proportion of variance in residents’ self-care disability that is explained by residents’ geriatric syndromes versus long-term care home characteristics. Methods We conducted a cross-sectional study using a health administrative cohort of 77,165 long-term care home residents residing in 614 Ontario long-term care homes. Eligible residents had their self-care disability assessed using the RAI-MDS 2.0 activities of daily living long-form score (range: 0–28) within 90 days of April 1st, 2011. Hierarchical multivariable regression models with random effects for long-term care homes were used to estimate the association between self-care disability and resident geriatric syndromes, chronic conditions and long-term care home characteristics. Differences in findings across strata of sex, age and cognitive status (cognitively intact versus cognitively impaired) were examined. Results Geriatric syndromes were much more strongly associated with self-care disability than chronic conditions in multivariable models. The direction and size of some of these effects were different for cognitively impaired versus cognitively intact residents. Residents’ geriatric syndromes explained 50% of the variation in their self-care disability scores, while characteristics of long-term care homes explained an additional 2% of variation. Conclusion Differences in long-term care residents’ self-care disability are largely explained by prevalent geriatric syndromes. After adjusting for resident characteristics, there is little variation in self-care disability associated with long-term care home characteristics. This suggests that residents’ geriatric syndromes—not the homes in which they live—may be the appropriate target of interventions to reduce self-care disability, and that such interventions may need to differ for cognitively impaired versus unimpaired residents. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0444-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natasha E Lane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada.
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Toronto Rehabilitation Institute, 550 University Avenue, 3rd Floor, Toronto, ON, M5G 2A2, Canada
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, 1830 E. Monument St, Baltimore, MD, 21287, USA.,Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.,Johns Hopkins Center on Aging and Health, 2024 E. Monument St, Suite 2-700, Baltimore, MD, 21205, USA
| | - Thérèse A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
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Hoben M, Poss JW, Norton PG, Estabrooks CA. Oral/dental items in the resident assessment instrument - minimum Data Set 2.0 lack validity: results of a retrospective, longitudinal validation study. Popul Health Metr 2016; 14:36. [PMID: 27785121 PMCID: PMC5073836 DOI: 10.1186/s12963-016-0108-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/10/2016] [Indexed: 01/13/2023] Open
Abstract
Background Oral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. However, psychometric properties of RAI-MDS 2.0 oral/dental items have been challenged and criterion validity of these items has never been assessed. Methods We used 73,829 RAI-MDS 2.0 records (13,118 residents), collected in a stratified random sample of 30 urban nursing homes in Western Canada (2007–2012). We derived a subsample of all residents (n = 2,711) with an admission and two or more subsequent annual assessments. Using Generalized Estimating Equations, adjusted for known covariates of nursing home residents’ oral health, we assessed the association of oral/dental problems with time, dentate status, dementia, debris, and daily cleaning. Results Prevalence of oral/dental problems fluctuated (4.8 %–5.6 %) with no significant differences across time. This range of prevalence is substantially smaller than the ones reported by studies using clinical assessments by dental professionals. Denture wearers were less likely than dentate residents to have oral/dental problems (adjusted odds ratio [OR] = 0.458, 95 % confidence interval [CI]: 0.308, 0.680). Residents lacking teeth and not wearing dentures had higher odds than dentate residents of oral/dental problems (adjusted OR = 2.718, 95 % CI: 1.845, 4.003). Oral/dental problems were more prevalent in persons with debris (OR = 2.187, 95 % CI: 1.565, 3.057). Of the other variables assessed, only age at assessment was significantly associated with oral/dental problems. Conclusions Robust, reliable RAI-MDS 2.0 oral health indicators are vital to monitoring and improving oral health related quality and safety in nursing homes. However, severe underdetection of oral/dental problems and lack of association of well-known oral health predictors with oral/dental problems suggest validity problems. Lacking teeth and not wearing dentures should be considered an indicator for urgent oral/dental treatment needs. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0108-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Hoben
- Knowledge Utilization Studies Program (KUSP), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB Canada
| | - Carole A Estabrooks
- Knowledge Utilization Studies Program (KUSP), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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Schluter PJ, Ahuriri-Driscoll A, Anderson TJ, Beere P, Brown J, Dalrymple-Alford J, David T, Davidson A, Gillon DA, Hirdes J, Keeling S, Kingham S, Lacey C, Menclova AK, Millar N, Mor V, Jamieson HA. Comprehensive clinical assessment of home-based older persons within New Zealand: an epidemiological profile of a national cross-section. Aust N Z J Public Health 2016; 40:349-55. [DOI: 10.1111/1753-6405.12525] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/01/2015] [Accepted: 12/01/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Philip J. Schluter
- School of Health Sciences; University of Canterbury; New Zealand
- School of Nursing, Midwifery and Social Work; The University of Queensland
| | | | - Tim J. Anderson
- Department of Medicine; University of Otago; New Zealand
- New Zealand Brain Research Institute
| | - Paul Beere
- GeoHealth Laboratory; University of Canterbury; New Zealand
| | - Jennifer Brown
- Department of Mathematics and Statistics; University of Canterbury; New Zealand
| | - John Dalrymple-Alford
- New Zealand Brain Research Institute
- Department of Psychology; University of Canterbury; New Zealand
| | - Timothy David
- UC High Performance Computing; University of Canterbury; New Zealand
| | | | - Deborah A. Gillon
- Centre for Postgraduate Nursing Studies; University of Otago; New Zealand
| | - John Hirdes
- School of Public Health and Health Systems; University of Waterloo; Ontario Canada
| | - Sally Keeling
- Department of Medicine; University of Otago; New Zealand
| | - Simon Kingham
- GeoHealth Laboratory; University of Canterbury; New Zealand
- GeoHealth Laboratory; University of Canterbury; New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI); University of Otago; New Zealand
- Department of Psychological Medicine; University of Otago; New Zealand
| | - Andrea K. Menclova
- Department of Economics and Finance; University of Canterbury; New Zealand
| | | | - Vince Mor
- School of Public Health; Brown University; Rhode Island USA
| | - Hamish A. Jamieson
- Department of Medicine; University of Otago; New Zealand
- Canterbury District Health Board; New Zealand
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Bartfay E, Bartfay WJ, Gorey KM. Dementia care in Ontario, Canada: evidence of more timely diagnosis among persons with dementia receiving care at home compared with residential facilities. Public Health 2016; 130:6-12. [DOI: 10.1016/j.puhe.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 06/26/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022]
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50
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Kosteniuk JG, Morgan DG, O'Connell ME, Kirk A, Crossley M, Teare GF, Stewart NJ, Bello-Haas VD, Forbes DA, Innes A, Quail JM. Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study. BMC Geriatr 2015; 15:73. [PMID: 26135912 PMCID: PMC4489119 DOI: 10.1186/s12877-015-0075-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/16/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Determining the epidemiology of dementia among the population as a whole in specific jurisdictions - including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria. METHODS We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescription Drug, and RAI-MDS, i.e., Long-term Care). RESULTS A total of 3,270 incident cases of dementia (7.28 per 1,000 PAR) and 13,012 prevalent cases (28.16 per 1,000 PAR) were identified during 2012/13. This study found the incidence rate increased by 2.8 to 5.1 times and the prevalence rate increased by 2.6 to 4.6 times every 10 years after 45 years of age. Overall, the age-standardised incidence rate was significantly lower among females than males (7.04 vs. 7.65 per 1,000 PAR) and the age-standardised prevalence rate was significantly higher among females than males (28.92 vs. 26.53 per 1,000 PAR). Over one-quarter (28 %) of all incident cases were admitted to long-term care before a diagnosis was formally recorded in physician or hospital data, and nearly two-thirds of these cases were identified at admission with impairment at the moderate to very severe level or a disease category of Alzheimer's disease/other dementia. CONCLUSIONS Linking multiple sources of registry data contributes to our understanding of the epidemiology of dementia across multiple segments of the population, inclusive of individuals residing in long-term care. This information is foundational for public awareness and policy recommendations, health promotion and prevention strategies, appropriate health resource planning, and research priorities.
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Affiliation(s)
- Julie G Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, PO Box 23, 104 Clinic Place, Saskatoon, S7N 2Z4, SK, Canada.
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Andrew Kirk
- Division of Neurology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Margaret Crossley
- Department of Psychology (Professor Emerita), University of Saskatchewan, Saskatoon, SK, Canada.
| | - Gary F Teare
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada.
| | - Norma J Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Dorothy A Forbes
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Anthea Innes
- Bournemouth University Dementia Institute, Bournemouth University, Dorset, UK.
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