Abstract
Health-care restructuring has increased the focus on integrating health care. Therefore the study purpose was to quantify patient movement from hospital to home care before restructuring occurred in a health planning district. Hospital discharge abstracts and home care records identified patients with a hip fracture who used home care (n=353). Patients from acute care were more likely than rehabilitation or convalescent in-patients to wait >3 days for home care after hospital discharge (RR 1.54, 95% CI 1.18, 2.00). Institution-dwellers were more likely than community-dwellers to wait >3 days for home care (RR 2.35, 95% CI 1.86, 2.97). Home care rehabilitation clients were more likely than non-rehabilitation users to wait >3 days for home care (RR 2.10, 95% CI 1.42, 3.09). Waiting time for home care is associated with hospital care setting and the home care service utilized. Evaluations of restructuring efforts should consider accounting for these relationships.
Résumé
La restructuration des soins de santé a braqué les projecteurs sur la question de l’intégration des soins. Nous avons cherché à quantifier les mouvements de patients entre l’hôpital et les soins à domicile avant la restructuration d’un district de planification sanitaire. Le registre des sorties des hôpitaux et les dossiers de soins à domicile recensent les cas de fracture de la hanche où les patients ont reçu des soins à domicile (n=353). Les patients des soins actifs étaient plus susceptibles que les patients hospitalisés en réadaptation ou en convalescence d’attendre plus de trois jours avant de recevoir des soins à domicile après leur sortie de l’hôpital (RR 1,54, 95 % IC 1,18, 2,00). Les patients hospitalisés étaient plus susceptibles que les patients dans la communauté d’attendre plus de trois jours avant de recevoir des soins à domicile (RR 2,35, 95 % IC 1,86, 2,97). Les clients des soins de réadaptation à domicile étaient plus susceptibles que les usagers d’autres soins d’attendre plus de trois jours avant de recevoir des soins à domicile (RR 2,10, 95 % IC 1,42, 3,09). Le délai d’attente des soins à domicile est lié au fait d’être hospitalisé ou non et au service reçu à domicile. Dans les évaluations des efforts de restructuration, il faudrait songer à tenir compte de ces liens.
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