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BMC Health Services Research

, 13:227

Quality, performance, safety and outcomes

Abstract

BackgroundHome care HC is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario.

MethodsA retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge

Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences.

ResultsThe study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death.

ConclusionsOur study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.

AbbreviationsAEAdverse Event

CCRSContinuing Care Reporting System

CHESSChanges in Health, End Stage Disease, Signs and Symptoms

CHFCongestive Heart Failure

CIConfidence Interval

CIHICanadian Institute of Health Information

COPDChronic Obstructive Pulmonary Disease

DADDischarge

Abstract Database

DSMDiagnostic and Statistics Manual of Mental Disorders

EDEmergency Department

HCHome Care

HCRSHome Care Reporting System

HIHarmful Incident

IVIntravenous

LTCLong-Term Care

MAPLeMethod for Assigning Priority Levels

MHRSMental Health Reporting System

MRDxMost responsible diagnosis

NACRSNational Ambulatory Care Reporting System

OMHRSOntario Mental Health Reporting System

ONOntario

RAI-HCResident Assessment Instrument-Home Care

RAI-MHResident Assessment Instrument-Mental Health

UTIUrinary Tract Infection

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-227 contains supplementary material, which is available to authorized users.

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Autor: Diane M Doran - John P Hirdes - Regis Blais - G Ross Baker - Jeff W Poss - Xiaoqiang Li - Donna Dill - Andrea Gruneir

Fuente: https://link.springer.com/







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