Search

PurposeRemote patient monitoring (RPM) and virtual visits have the potential to transform care delivery and outcomes but require intentional planning around how these technologies contribute to integrated care. Since maturity models are useful frameworks for understanding current performance and motivating progress, the authors developed a model describing the features of RPM that can advance integrated care.Design/methodology/approachThis work was led by St. Joseph's Health System Centre for Integrated Care in collaboration with clinical and programme leads and frontline staff offering RPM services as part of Connected Health Hamilton in Ontario, Canada. Development of the maturity model was informed by a review of existing telehealth maturity models, online stakeholder meetings, and online interviews with clinical leads, programme leads, and staff.FindingsThe maturity model comprises 4 maturity levels and 17 sub-domains organised into 5 domains: Technology, Team Organisation, Programme Support, Integrated Information Systems, and Performance and Quality. An implementation pillars checklist identifies additional considerations for sustaining programmes at any maturity level. Finally, the authors apply one of Connected Health Hamilton's RPM programmes to the Team Organisation domain as an example of the maturity model in action.Originality/valueThis work extends previous telehealth maturity models by focussing on the arrangement of resources, teams, and processes needed to support the delivery of integrated care. Although the model is inspired by local programmes, the model is highly transferable to other RPM programmes.

To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients.Retrospective cohort.Home care recipients age 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1, 2018 and August 31, 2020.Data were collected using the interRAI home care. Outcomes of interest were distressing decline in social participation and social withdrawal. Independent variables were entered into multivariable longitudinal generalized estimating equations. Interaction terms with the pandemic were tested. Those significant at P.01 were retained in final models and reported as odds ratios (ORs), 95% confidence intervals (CIs).We compared 26,492 and 19,126 home care recipients before and during the pandemic, respectively. The pandemic was associated with greater odds of experiencing distressing social decline (OR 1.28, 95% CI 1.22‒1.34) and withdrawal (OR 1.09, 95% CI 1.04‒1.15). Living alone (OR 1.13, 95% CI 1.05‒1.22), frailty (OR 3.21, 95% CI 2.76‒3.73), health instability (OR 2.22, 95% CI 2.02‒2.44), and depression (OR 2.14, 95% CI 2.01‒2.29) increased the odds of distressing social decline. Older age (OR 0.71, 95% CI 0.65‒0.77), functional impairment (OR 0.58, 95% CI 0.51‒0.67), and receiving caregiving (OR 0.73, 95% CI 0.67‒0.79) decreased the odds. Home care recipients with mild/moderate dementia were less likely to experience distressing social decline during the pandemic. Those who lived alone were more likely. Frailty (OR 9.49, 95% CI 7.69‒11.71) and depression (OR 2.76, 95% CI 2.55‒3.00) increased the odds of social withdrawal. Functional impairment (OR 0.32, 95% CI 0.27‒0.39), congestive heart failure (OR 0.77, 95% CI 0.70‒0.84), and receiving caregiving (OR 0.50, 95% CI 0.46‒0.55) decreased the odds. Home care recipients age 18‒64 years and older than 75 years were less likely to experience social withdrawal during the pandemic.Social support interventions should focus on supporting those living alone, with frailty, health instability, or depression.

In Ontario, new home care clients are screened with the interRAI Contact Assessment and only those expected to require longer-term services receive the comprehensive RAI-Home Care assessment. Although Ontario adopted this two-step approach in 2010, it is unknown whether the assessment guidelines were implemented as intended. To evaluate implementation fidelity, the purpose of this study is to compare expected to actual client profiles and care co-ordinator practice patterns. We linked interRAI CA and RAI-HC assessments and home care referrals and services data for a retrospective cohort of adult home care clients admitted in FY 2016/17. All assessments were done by trained health professionals as part of routine practice. Descriptive analyses were used to evaluate congruency between recommended and actual practice. Adjusted cause-specific hazards and logistic approaches were used to examine time to RAI-HC assessment and being a high-priority client. Of 225,989 unique home care clients admitted to the publicly funded home care program, about three-quarters of clients were assessed with the interRAI CA only (27.9% completed the Preliminary Screener only and 46.6% completed both the Preliminary Screener and Clinical Evaluation). There was substantial agreement between the skip logic and completion of the Clinical Evaluation section (Cohen's kappa = 0.67 [95% CI: 0.66-0.67]). One-quarter of clients were assessed with both the interRAI CA and RAI-HC. As expected, RAI-HC assessed clients were older, reported more health needs, and often received home care services for6 months. Clients in higher Assessment Urgency Algorithm (AUA) levels were significantly more likely to receive a RAI-HC assessment and be assigned to a higher home care priority level; however, 28.3% of clients in the highest AUA level did not receive a RAI-HC assessment. We conclude that the use of the interRAI CA and RAI-HC balances the investment of time and resources with the information and tools to deliver high-quality, holistic, and client-centred care. The interRAI CA guides the care co-ordinator to screen every client for a broad range of possible needs and tailor further assessment to each client's unique needs. We recommend integrating the AUA into provincial assessment guidelines as well as developing a new quality indicator focused on measuring access to the home care system.

Background In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA. Methods We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA). Results In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person. Interpretation Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care.

We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients.

Long-stay home care clients mostly reside in private homes or retirement homes, and the type of residence may influence risk factors for long-term care placement. This multi-state analytic study uses RAI-Home Care and administrative data from the Hamilton Niagara Haldimand Brant Local Health Integration Network to model conceptualized states of risk at baseline through a 13-month follow-up period. Modifiable risk factors in these states were client loneliness or depressive symptoms, and caregiver distress. A higher adjusted likelihood of being discharged deceased was found for the lowest-risk clients in retirement homes. Adjusting for client, service, and caregiver characteristics, retirement home residency was associated with higher likelihood of placement in a long-term care home; reduced caregiver distress; and increased client loneliness/depression. As an alternative to private home settings as the location for aging in place among these long-stay home care clients, retirement home residency represents some trade-offs between client and informal caregiver.

Equitable access to care is a fundamental principle of Canada’s healthcare system. In Ontario, the absence of a provincial standard to support consistent decision making around urgent admissions to long-term care homes has led to variation in practice across the province. A working group was established in 2014 to develop an evidence-informed decision support tool to promote consistency in care planning regarding urgent admissions to long-term care homes. The resulting CRISIS algorithm demonstrates good prognostic ability, with the proportion of patients urgently admitted to a long-term care home within 90 days ranging from 2.4% in the lowest risk level to 39.9% in the highest risk level. The implementation of the algorithm will improve equity in access to long-term care homes in Ontario.

RÉSUMÉLes conséquences associées aux événements indésirables dans les soins à domicile sont variées et multifactorielles. La présente étude visait à tester un système d’évaluation joignant deux outils de mesures dans le but d’identifier les bénéficiaires de soins à domicile dont le risque de placement dans un établissement de soins de longue durée ou de décès dans l’année suivante est plus élevé. Les deux outils de mesure sont tirés du Système d’évaluation d’interRAI (Resident Assessment Instrument-Home Care; RAI-HC), un outil d’évaluation standardisé et détaillé. Les personnes présentant des scores élevés à l’algorithme de la Méthode d’attribution des niveaux de priorité (Method for Assigning Priority Levels; MAPLe) et à l’Échelle de mesure des changements de l’état de santé, des maladies en phase terminale, des signes et des symptômes (Changes in Health, End-stage disease, Signs and Symptoms; CHESS) étaient plus à risque de placement ou de décès, et leur risque de subir ces événements plus tôt comparativement aux autres patients était plus que doublé. Le groupe cible était aussi plus susceptible de présenter des problèmes d’humeur et de relations sociales, et leurs aidants risquaient davantage de souffrir de détresse, ce qui indiquerait que ces personnes et leurs aidants pourraient avoir besoin de soins de santé mentale et d’interventions psychosociales, en plus des soins médicaux et des services de soutien personnels. Les agences de soins à domicile pourraient utiliser ce système d’évaluation pour identifier les patients en soins prolongés à la maison chez qui une approche de soins coordonnés plus intensive serait nécessaire pour mieux atténuer et gérer les risques liés à leur condition.