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23. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study.

Author

Dash, Darly, Mowbray, Fabrice I, Poss, Jeffrey W, Aryal, Komal, Stall, Nathan M, Hirdes, John P, Hillmer, Michael P, Heckman, George A, Bowdish, Dawn M E, Costa, Andrew P, and Jones, Aaron

Subjects
*FRAIL elderly, *COVID-19, *CONFIDENCE intervals, *COVID-19 vaccines, *MULTIPLE regression analysis, *RETROSPECTIVE studies, *NURSING care facilities, *RISK assessment, *PRE-tests & post-tests, *DESCRIPTIVE statistics, *RESIDENTIAL patterns, *ODDS ratio, *LONG-term health care, *LONGITUDINAL method, MORTALITY risk factors
Abstract

Background The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC. Methods We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability. Results There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41–1.65) and 1.62 (95% CrI: 1.46–1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42–1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period. Interpretation Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality. [ABSTRACT FROM AUTHOR]

Published
2023
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26. External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study

Author

Turcotte, Luke Andrew, primary, Heckman, George, additional, Rockwood, Kenneth, additional, Vetrano, Davide Liborio, additional, Hébert, Paul, additional, McIsaac, Daniel I, additional, Rhynold, Elizabeth, additional, Mitchell, Lori, additional, Mowbray, Fabrice Immanuel, additional, Larsen, Rasmus T, additional, and Hirdes, John P, additional

Published
2023
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27. Examining the utility and accuracy of the interRAI Emergency Department Screener in identifying high‐risk older emergency department patients: A Canadian multiprovince prospective cohort study

Author

Mowbray, Fabrice I., primary, Heckman, George, additional, Hirdes, John P., additional, Costa, Andrew P., additional, Beauchet, Olivier, additional, Eagles, Debra, additional, Perry, Jeffrey J., additional, Sinha, Samir, additional, Archambault, Patrick, additional, Wang, Hanting, additional, Jantzi, Michaela, additional, and Hebert, Paul, additional

Published
2023
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29. Quantifying the escalating impact of paramedic transported emergency department visits for opioid-related conditions in Ontario, Canada: A population-based cohort study.

Author

Strum, Ryan P., Mondoux, Shawn, Mowbray, Fabrice I., Miller, Paul, Worster, Andrew, Ferron, Richard, and Costa, Andrew P.

Subjects
EMERGENCY medical technicians, HOSPITAL emergency services, DRUG overdose, COHORT analysis, TRANSPORTATION of patients, OPIOID epidemic, METROPOLITAN areas
Abstract

Introduction: While overdoses comprise the majority of opioid research, the comprehensive impact of the opioid crisis on emergency departments (EDs) and paramedic services has not been reported. We examined temporal changes in population-adjusted incidence rates of ED visits and paramedic transports due to opioid-related conditions. Materials and methods: We conducted a population-based cohort study of all ED visits in the National Ambulatory Care Reporting System from January 1, 2009 to December 31, 2019 in Ontario, Canada. We included all patients with a primary diagnosis naming opioids as the underlying cause for the visit, without any other drugs or substances. We clustered geographic regions using Local Health Integration Network boundaries. Descriptive statistics, incidence rate ratios (IRR) and 95% confidence intervals (CIs) were calculated to analyze population-adjusted temporal changes. Results: Overall, 86,403 ED visits were included in our study. Incidence of opioid-related ED visits increased by 165% in the study timeframe, with paramedic transported patients increasing by 429%. Per 100,000 residents, annual ED visits increased from 40.4 to 97.2, and paramedic transported patients from 12.1 to 67.9. The proportion of opioid-related ED visits transported by paramedics increased from 35.0% to 69.9%. The medical acuity of opioid-related ED visits increased throughout the years (IRR 6.8. 95% CI 5.9–7.7), though the proportion of discharges remained constant (~75%). The largest increases in ED visits and paramedic transports were concentrated to urbanized regions. Discussion: Opioid-related ED visits and paramedic transports increased substantially between 2009 and 2019. The proportion of ED visits transported by paramedics doubled. Our findings could provide valuable support to health stakeholders in implementing timely strategies aimed at safely reducing opioid-related ED visits. The increased use of paramedics followed by high rates of ED discharge calls for exploration of alternative care models within paramedic systems, such as direct transport to specialized substance abuse centres. [ABSTRACT FROM AUTHOR]

Published
2023
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30. Validation of a classification to identify emergency department visits suitable for subacute and virtual care models: a randomised single-blinded agreement study protocol

Author

Strum, Ryan P, primary, Mondoux, Shawn, additional, Mowbray, Fabrice, additional, Worster, Andrew, additional, Griffith, Lauren E, additional, Tavares, Walter, additional, Miller, Paul, additional, Hanel, Erich, additional, Aryal, Komal, additional, Sivakumaran, Ravi, additional, and Costa, Andrew P, additional

Published
2022
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31. Prognosis of cardiac arrest in home care clients and nursing home residents: A population-level retrospective cohort study

Author

Mowbray, Fabrice I., primary, Jones, Aaron, additional, Strum, Ryan P., additional, Turcotte, Luke, additional, Foroutan, Farid, additional, de Wit, Kerstin, additional, Worster, Andrew, additional, Griffith, Lauren E., additional, Hebert, Paul, additional, Heckman, George, additional, Ko, Dennis T., additional, Schumacher, Connie, additional, Gayowsky, Anastasia, additional, and Costa, Andrew P., additional

Published
2022
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32. Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario

Author

Jones, Aaron, primary, Mowbray, Fabrice I., additional, Falk, Lindsey, additional, Stall, Nathan M., additional, Brown, Kevin A., additional, Malikov, Kamil, additional, Malecki, Sarah L., additional, Lail, Sharan, additional, Jung, Hae Young, additional, Costa, Andrew P., additional, Verma, Amol A., additional, and Razak, Fahad, additional

Published
2022
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40. Additional file 3 of Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study

Author

Correia, Rebecca H., Mowbray, Fabrice I., Dash, Darly, Katz, Paul R., Moser, Andrea, Strum, Ryan P., Jones, Aaron, von Schlegell, Ahmad, and Costa, Andrew P.

Abstract

Additional file 3: Table S2. Clinical factors associated with medical care visits without end-stage disease in the final model (sensitivity analysis).

Published
2022
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42. PROGNOSIS OF CARDIAC ARREST IN PATIENTS RECEIVING HOME CARE IN ONTARIO, CANADA

Author

Mowbray, Fabrice, Costa, Andrew, and Health Research Methodology

Subjects
geriatrics, frailty, cardiac arrest, prognosis
Abstract

PhD Thesis Background: The home care population is a cohort of medically complex older adults at risk for cardiac arrest and poor post-cardiac arrest health outcomes. Research Question: What is the prognosis of cardiac arrest among patients receiving home care, and what pre-arrest features and geriatric syndromes (e.g., frailty) are prognostic of survival and post-cardiac arrest health? Methods: Following a systematic review and meta-analysis that evaluated the prognostic association between frailty and post-cardiac arrest outcomes, a population-based retrospective cohort was created of adults (≥18 years) who received cardiac arrest care at a hospital in Ontario, Canada, between 2006 and 2018. Patients receiving home care and nursing home residents were identified using the Home Care Dataset and the Continuing Care Reporting System. Arrests were analyzed overall and within distinct sub-groups of in-hospital (IHCA) and out-of-hospital cardiac arrests (OHCA). The primary outcome for this thesis was 30-day survival post-cardiac arrest. Frailty was measured using the Clinical Frailty Scale and a valid frailty index. The odds of survival from cardiac arrest were estimated using multivariable logistic regression. Prognostic models were internally validated using bootstrap resampling (n= 2000). Results: We found high certainty evidence for an association between the Clinical Frailty Scale and death prior to hospital discharge after IHCA (OR = 2.93; 95% CI = 2.43 – 3.53) after adjusting for age as a minimum confounder. Our retrospective cohort contained 86,836 unique adult cardiac arrests, of which 39,610 were OHCA and 47,226 were IHCA. Patients receiving home care represented 10.7% of the cohort and were less likely to survive to hospital discharge (RD = -6.4; 95%CI = -7.4– -5.2) and one-year (RD = -12.8; 95%CI = -14.6 – -10.9) post-cardiac arrest compared to community-dwelling individuals receiving no support in the community. Frail patients receiving home care had worse odds of 30-day survival when measured with the CFS (OR=0.78; 95%CI = 0.61-0.98) and a frailty index (OR=0.89; 95%CI = 0.85-0.95), after adjusting for age, sex, and arrest setting. My prognostic model out-performed the two valid frailty measures and demonstrated fair discriminative accuracy (AUROC = 0.66; 95%CI=0.65-0.65) and good calibration (Slope = 0.95) for group-level prognostication when internally validated among patients receiving home care. Conclusion:Patients receiving home care have a worse absolute risk of death when compared to community-dwelling individuals receiving no community-based support services. Frailty is associated with survival and post-cardiac arrest declines in cognition and function when evaluated in patients receiving home care. The prognostic model developed within my thesis outperformed the ability of frailty to predict 30-day survival and is suitable for group-level prognostication. Dissertation Doctor of Philosophy (PhD) The proportion of older adults receiving home care is growing. The home care population is frail and medically complex, with a greater risk for cardiac arrest. This thesis aims to evaluate the prognosis and prognostic factors influencing survival and other health outcomes, to develop a statistical model that can predict 30-day survival post-cardiac arrest. Findings from my research demonstrate that patients receiving home care have worse survival outcomes post-cardiac arrest compared to well-being older adults living in the community. In my research, frailty was associated with survival and declines in post-cardiac arrest functional independence and cognitive performance among patients receiving home care. Our statistical model performed better than valid frailty measures and had respectable accuracy for group-level prognostication. The home care population is ideally positioned for proactive and shared decision-making about end-of-life care preferences, bearing in mind their receipt of detailed and routine health assessments.

Published
2022

47. Prognostic association of frailty with post-arrest outcomes following cardiac arrest: A systematic review and meta-analysis

Author

Mowbray, Fabrice I., primary, Manlongat, Donna, additional, Correia, Rebecca H., additional, Strum, Ryan P., additional, Fernando, Shannon M., additional, McIsaac, Daniel, additional, de Wit, Kerstin, additional, Worster, Andrew, additional, Costa, Andrew P., additional, Griffith, Lauren E., additional, Douma, Matthew, additional, Nolan, Jerry P., additional, Muscedere, John, additional, Couban, Rachel, additional, and Foroutan, Farid, additional

Published
2021
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