The association between home care visits and same-day emergency department use: a case–crossover study
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BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. METHODS: We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. RESULTS: A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. INTERPRETATION: Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation.
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Individuals receiving nursing and therapies tend to be younger, have fewer functional and cognitive impairments, and more likely to be post-acute compared with patients receiving personal support.
“Previous work indicates that individuals receiving nursing and therapies tend to be younger, have fewer functional and cognitive impairments, and more likely to be post-acute compared with patients receiving personal support.15”
From Impact of the COVID-19 pandemic on home care services among community-dwelling adults with dementia (2021) · cites this paper as [15]
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Self-citation
- Authors
- Jones, A., Schumacher, C., Bronskill, S. E., Campitelli, M. A., Poss, J. W., Seow, H., & Costa, A. P.
- Affiliations
- University of Waterloo (CA)
- ORCID
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2018-04-30
- Volume
- 190
- Issue
- 17
- Pages
- E525-E531
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC5929891
- OpenAlex
- W2799920860
- Cited by
- 40
- References
- 26
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 11 · 2020: 5 · 2019: 4 · 2018: 3
- FWCI
- 7.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- home-visit care, emergency department utilization, home care nursing, emergency department diversion, health care utilization
- MeSH terms
- Facilities and Services Utilization, Adult, Aged, Aged, 80 and over, Continuity of Patient Care, Day Care, Medical, Emergency Service, Hospital, Female, Home Care Services, House Calls, Humans, Length of Stay, Male, Middle Aged, Ontario, Case-Control Studies, Cross-Over Studies, Young Adult
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