Government policy and infrastructure have a substantial impact on hospitalization of older adults, according to a University of Waterloo study.
The study examined the experiences of 254,664 patients in home-care programs and 162,045 residents in long-term care in Alberta, British Columbia and Ontario.
It found that home-care patients in Alberta and British Columbia are more likely to be sent to hospital than those in Ontario, regardless of the severity of a person's medical condition. The study also found that long-term care residents in Alberta and B.C. were half as likely to be sent to hospital compared with those in Ontario.
"We were surprised by the magnitude of the influence of health care policies, infrastructure and professional practices," said George Heckman, a public health professor at the University of Waterloo and Schlegel Research Chair in Geriatrics. "It's important to understand the factors that send vulnerable populations to hospital because hospitals are generally where health complications arise."
"Often, patients are too sick to be rapidly discharged from hospital, and as their numbers continue to rise, it can lead to hallway medicine," added Heckman. "Since many governments have identified hallway medicine as a challenge they'd like to address, learning how to change health care so that it is focused on patients' needs instead of system needs and design quirks will be key."
The researchers used several comprehensive data sets, including data from the Canadian Institute for Health Information and several interRAI assessment systems, to track emergency department visits, hospitalizations and death.
Heckman said the next step is to examine the healthcare policies in the three provinces to determine why these regional differences exist. Alberta, for instance, has increased the focus on assisted living in recent years, which could explain why there were fewer transfers to hospital from long-term care.
The study, "Regional variations of care in home care and long-term care: a retrospective cohort study," was authored by Paul Hébert (Université de Montréal), Anne Morinville (Université de Montréal), Andrew Costa (McMaster), George Heckman (Waterloo and Schlegel-UW Research Institute for Aging), and John Hirdes (Waterloo). It was published in CMAJ Open.