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Evaluating the Association between the Implementation of the PoET Southwest Spread Project and Reductions in Acute Care Transfers from Long-Term Care: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data.
- Source :
-
Journal of the American Medical Directors Association . Dec2023, Vol. 24 Issue 12, p1888-1897. 10p. - Publication Year :
- 2023
-
Abstract
- To measure changes in resident-level acute care transfer rates after the PoET Southwest Spread Project (PSSP), and to identify patient and long-term care (LTC) home characteristics associated with acute care transfers after program launch. Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. Sixty publicly funded LTC homes (PSSP = 30; control = 30) in Ontario, Canada, from November 2019 to December 2021. We matched 30 PSSP homes to 30 control homes with similar characteristics and described incidence rates for resident-level acute care transfers during the 7-month post-implementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and acute care transfers during the post-implementation period. We adjusted resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent sub-cohort to measure transfer patterns during the last 2 months of life. A matched cohort of 8894 residents (PSSP = 4103; control = 4791) was captured. Incidence rates of transfers increased during the post-implementation period for both PSSP (78.8 to 80.9 transfers per 1000 person-months) and control residents (66.9 to 67.9 transfers per 1000 person-months). After adjusting for covariates of interest, PSSP exposure was associated with a reduction in acute care transfers during the post-implementation period after adjusting for covariates (incidence rate ratio, 0.73; 95% CI, 0.62–0.87; P =.0002). Older age and select health regions were associated with reduced transfers, whereas higher comorbidity status and higher COVID-19 outbreak days were associated with increases. Similar patterns persisted for transfers during the last 2 months of life. This study systematically evaluated the impact of an ethics-based health care intervention in LTC using health care utilization databases. PoET implementation is associated with reduced acute care transfer rates, especially in the last 2 months of life in LTC. [ABSTRACT FROM AUTHOR]
- Subjects :
- *EVALUATION of human services programs
*CONFIDENCE intervals
*RESEARCH methodology
*AGE distribution
*REGRESSION analysis
*HOSPITAL admission & discharge
*NURSING care facilities
*HUMAN services programs
*COMPARATIVE studies
*SEX distribution
*MEDICAL care use
*CRITICAL care medicine
*DESCRIPTIVE statistics
*LONG-term health care
*LONGITUDINAL method
*COMORBIDITY
Subjects
Details
- Language :
- English
- ISSN :
- 15258610
- Volume :
- 24
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Journal of the American Medical Directors Association
- Publication Type :
- Academic Journal
- Accession number :
- 173858384
- Full Text :
- https://doi.org/10.1016/j.jamda.2023.08.024