Quality in primary care and use of the emergency department among home care patients
Notice bibliographique
Résumé
Background Population aging has led to an increasing number of older adults living in the community with complex care needs such as functional limitations, cognitive impairment, and multimorbidity. These individuals may need help to remain in their homes, which has created a growing demand for home care. Strategies to manage complex older adults such as home care patients safely in the community typically emphasize robust and integrated primary care. The objective of this thesis is to explore how specific measures of quality in primary care are associated with emergency department use among home care patients in Ontario. Methods I conducted four studies on varying subsets of the same population-based retrospective cohort of long-stay home care patients assessed in Ontario from 2014-2016. The first study was a descriptive examination of the entire cohort that characterized their primary care and other health system use. The second was a case-crossover study among home nursing patients examining whether access to afterhours care modifies the association between home nursing visits and same-day emergency department visits. The third study looked at physician-level provision of primary care home visits and its association with emergency department visits among home care patients with extensive functional impairments. The final study examined and compared associations between continuity of primary and specialty physician care. Results Long-stay home care patients in Ontario are high users of both primary care and the emergency department. Better access to afterhours care reduced the likelihood of an emergency department visit on the same day as a home nursing visit. Patients with extensive functional impairments whose primary care physician who provided higher levels of home visits had lower rates of emergency department use. Finally, better continuity of both primary and specialty physician care were similarly associated with lower emergency department use. Conclusion Better quality primary care integrated with other sectors of the health system is crucial to enabling home care patients to age safety in the community. Access to care is particularly important and can be improved though enhancing the availability of afterhours care and increasing the provision of home visits for those who have difficulty reaching primary care offices. Improving continuity of specialty physician care should be a health system objective alongside improving continuity of primary care.
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 machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 source (Gemma direct ou Codex distillé), 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 ».