PT  - JOURNAL ARTICLE
AU  - Jones, Aaron
AU  - Schumacher, Connie
AU  - Bronskill, Susan E.
AU  - Campitelli, Michael A.
AU  - Poss, Jeffrey W.
AU  - Seow, Hsien
AU  - Costa, Andrew P.
TI  - The association between home care visits and same-day emergency department use: a case–crossover study
AID  - 10.1503/cmaj.170892
DP  - 2018 Apr 30
TA  - Canadian Medical Association Journal
PG  - E525--E531
VI  - 190
IP  - 17
4099  - http://www.cmaj.ca/content/190/17/E525.short
4100  - http://www.cmaj.ca/content/190/17/E525.full
SO  - CMAJ2018 Apr 30; 190
AB  - 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.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.180263