Did Ontario's End-of-Life Care Strategy Reduce Acute Care Service Use?: The need to use quality indicators for improvement
Notice bibliographique
Résumé
The objective of this study was to evaluate whether Ontario's End-of-Life Care Strategy, which aimed to shift care from acute settings to the home, improved performance on quality indicators for end-of-life home care patients in use of more home care services and fewer acute care services. The study cohort included patients at the end of life admitted into home care between April 1, 2005, and September 30, 2006, and who died before April 1, 2007. Based on their admission date, patients were divided into three six-month periods corresponding to the six months prior to the strategy's implementation compared with the 12 months after. Patients were excluded if they were admitted to home care more than six months prior to death. Average hours per week of nursing and personal support worker (PSW) services were measured for the last 12 weeks of life. The use of acute care services in the last month of life was measured by the proportion of patients who had an in-hospital death, had hospitalizations, visited the emergency department (ED) and spent more than 14 days in hospital. Among home care patients (n = 9,368), per-patient use of home care and acute care did not change significantly over the time periods. The pattern of average nursing and PSW hours per week used in the last 12 weeks of life did not change a year after the strategy implementation, averaging 3.8 nursing hours per week and 3.8 PSW hours per week over the study period. The proportion of in-hospital deaths remained stable at approximately 38% over the study period. Approximately 16% of patients had an ED visit and 32% had a hospitalization in the last two weeks of life across time periods. Similarly the proportion of patients who had zero, one or greater than one ED visit or hospitalization remained constant across time periods. In conclusion, one year after the strategy's implementation, individual patients' use of end-of-life home care and acute care services remained unchanged. The strategy may require more time for its impact to be fully achieved. Measuring these quality indicators across regions may help to monitor and evaluate interventions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».