Table 3:
Effect of province on home care transitions: odds of transition from baseline health instability score in home care to another health instability score (if the patient stayed in home care) or to hospital, death, long-term care or other setting at 6-mo follow-up
| Region | Adjusted odds ratio (95% CI) for transition at 6-mo follow-up (T2)* | ||||||
|---|---|---|---|---|---|---|---|
| Remained in home care; health instability score† | Admitted to hospital | Died | Admitted to long-term care | Discharged to other setting‡ | |||
| Low (0) | Medium (1, 2) | High (≥ 3) | |||||
| Alberta (Ref. = Ontario); health instability score at baseline (T1)† | |||||||
| Low (0) | – | 0.82 (0.75–0.90) | NS | 2.08 (1.92–2.24) | 1.80 (1.48–2.20) | 0.26 (0.18–0.36) | 0.67 (0.62–0.72) |
| Medium (1, 2) | 1.85 (1.71–2.00) | – | NS | 2.44 (2.30–2.59) | 2.11 (1.84–2.42) | 0.42 (0.35–0.49) | 1.14 (1.07–1.21) |
| High (≥ 3) | 4.83 (3.82–6.12) | 1.80 (1.51–2.16) | – | 3.77 (3.24–4.40) | 2.63 (2.09–3.32) | NS | 2.67 (2.26–3.16) |
| British Columbia (Ref. = Ontario); health instability score at baseline (T1)† | |||||||
| Low (0) | – | 1.44 (1.38–1.51) | 1.98 (1.80–2.18) | 1.46 (1.39–1.54) | 0.46 (0.37–0.56) | 0.55 (0.48–0.62) | 0.31 (0.30–0.33) |
| Medium (1, 2) | 1.67 (1.60–1.73) | – | 1.45 (1.39–1.52) | 1.39 (1.35–1.43) | 0.54 (0.49–0.60) | 0.76 (0.72–0.81) | 0.62 (0.60–0.64) |
| High (≥ 3) | 3.13 (2.81–3.48 | 1.39 (1.30–1.48) | – | 1.28 (1.21–1.35) | 0.39 (0.34–0.45) | 0.85 (0.78–0.93) | 1.53 (1.44–1.63) |
Note: CI = confidence interval, NS = not significant, Ref. = reference category.
Multistate transition models were adjusted for home nursing visits, age, sex, marital status, Activities of Daily Living Hierarchy Scale score, Cognitive Performance Scale score, diagnosis (binary variables for chronic obstructive pulmonary disease, pneumonia, diabetes, arthritis, renal failure, urinary tract infection, Alzheimer’s dementia and related dementias, heart failure, cancer, depression), day of stay and functional improvement potential.
Health instability was measured with the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS); higher scores indicate greater instability.
Other settings typically involved discontinuation of home care services (i.e., discharge from the program).