P3‐388: Trends in Health System use by Persons with Dementia in Ontario from 2007 and 2013: A Population‐Based Study
Bibliographic record
Abstract
Dementia contributes to nursing home admission and, for quality of life and cost saving reasons, health systems are interested in expanding services to support living at home longer. The study objectives were to describe the level and trend in health care service use by community-dwelling adults with dementia in Ontario. Population-based, repeated cross-sectional cohorts of community-dwelling adults aged 40 years and older with pre-existing dementia were identified on April 1st of each year from 2007 to 2013 using a validated algorithm in linked administrative data. Persons with dementia were compared to a 1:1 matched control group based on age, sex, geographic region and comorbidity level. Trends in yearly rates of health service use were assessed using regression models for serially correlated data. Rates accounted for transitions from the community (long-term care placement (LTC) and death). Community-dwelling persons with dementia were more likely than matched controls to be placed in LTC (11.8% vs. 1.5% in 2013; p<0.001) and use home care (45.8% vs 23.2%; p<0.001) but equally likely to visit family physicians (93.9% vs. 94.8% in 2013) and specialists (87.1% vs. 89.4%). Overall, LTC placement decreased slightly among community-dwelling persons with dementia, from 13.3% to 11.8% between 2007 and 2013 (p<0.001), while the proportion who died in the community remained stable (7.3% in 2013). Rates of personal/homemaking home care increased over time (41.6 to 67.9 visits per person-year; p<0.001), rates of family physician visits decreased (14.1 to 12.3 visits per person-year; p<0.001) and rates of acute care (0.39 to 0.40 hospitalizations per person-year) remained stable. Trends were similar for matched controls. These data suggest rates of LTC placement may be declining while access to home care appears to be growing. Health care service utilization in other sectors is similar to matched controls. Further research is required to understand transitions to LTC and optimizing care in the community for persons with dementia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".