Factors associated with health care trajectories of people living with dementia
Notice bibliographique
Résumé
Background: This is a collaborative project between the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada (PHAC) that supports the implementation of the national dementia strategy through the Enhanced Dementia Surveillance Initiative. Approach: We used hospital, primary care and pharmaceuticals data holdings to create a cohort of individuals with a first record of dementia in 207 in 4 provinces (Alberta, British Columbia, Ontario and Newfoundland and Labrador - where there is nearly complete health administrative data). We then followed the cohort for 5 fiscal years (FY207 - 2022) after linking their records with home care and long-term care data to identify care trajectories and respective clinical and socio-demographic profiles. We interviewed 4 individuals, unpaid caregivers and health care professionals (from family practice and home care fields), to get insights on data findings related to healthcare provision across various settings, identify further research questions and bring context to our preliminary findings. We examined: ) factors associated with transitions to long-term care using logistic regression and 2) how hospitalizations prior to long-term care transition were different by trajectory and the presence of concurrent mental health disorders. Results: The results from the longitudinal analysis showed that in addition to clinical characteristics such as severe cognitive impairment, transitions from home care to long-term care were associated with equity factors (e.g., living in a rural or remote area) and caregiver mental wellbeing. Among people living with dementia who received long-term care during our study period: those who had not received publicly funded long-stay home care were more likely to be hospitalized at least once in the 3 months prior to their transition into long-term care (8% vs 5%).those with concurrent mental health disorders were more likely to be designated alternate level of care (ALC) patients (8 vs 74%) and have more ALC days (40 vs 27 days) prior to transitioning to long-term care compared to those without concurrent mental health disorders.Conclusion: Our study reveals how factors beyond clinical characteristics are associated with admissions to long-term care. In addition, it shows how hospitalizations prior to long-term care admissions are proportionally higher for people living with dementia without home care support or with a concurrent mental health disorder. This suggests that policies aimed at improving access to long-term care could benefit from considering equity factors, availability of formal and informal support, and the needs of people living with dementia with concurrent mental health disorders.
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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 | 0,004 |
| 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 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| 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 ».