Trajectories of Healthcare Services for Elder Persons - A Retrospective Study in Sherbrooke, Quebec
Bibliographic record
Abstract
This is a longitudinal study using health administrative data of a cohort of 65+ adults, living in the city of Sherbrooke, Quebec, Canada from Jan 2011 to Dec 2015. We merged five databases including all individual visits to emergency room (ER), hospitalisations (CH), geriatric wards, admissions to intermediate and long term care (IC, LTC) facilities, and home care (HC) services. The objectives of this study were: 1) to provide a 5-year portrait of the use of health services of the 65+ population in the city of Sherbrooke, Quebec, 2) to identify the most common trajectories followed by elder patients over five years, and 3) to gather evidence on the relationship between the intensity of HC and further ER visits and hospitalisations. The cohort of services’ users represents 59% of Sherbrooke’s 65+ population. The most frequent trajectory found was ER and CH, which speaks of a health care system hospital - centered. The majority of deaths occurred during a hospital stay (CH, ~55%) or in a long-term care facility (LTC, ~28%). We also found 1 652 (8.4%) admissions to LTC facilities, with 43% of them coming straight from a hospital for an average of one month before LTC admission. Individuals having received at least one home care visit represent 34% of the original cohort and generated 52% of services excluding home care. Data visualisation diagrams indicate that earlier HC visits were followed by less ER visits and even less hospitalisations, when compared with users receiving HC later on our study interval. Finally, we found an important reduction of home care services, mainly for those users with high intensity of services; this fact underlines the system’s inability to refocus health care services on home care.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".