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Assessing the Quality of Care Provided to Older Persons with Frailty in Five Canadian Provinces, Using Administrative Data

  • Cynthia Kendell (a1), Beverley Lawson (a2), Joseph H. Puyat (a3), Robin Urquhart (a1) (a4), Arminée Kazanjian (a3), Grace Johnston (a5), Sharon E. Straus (a6) (a7), Pierre Durand (a8) (a9) (a10), Lucille Juneau (a8) (a9), Alexis F. Turgeon (a10) (a11), France Légaré (a9) (a10) (a12), Michèle Aubin (a8) (a9) (a10) (a12), Louis Rochette (a13) and Anik M.C. Giguere (a8) (a9) (a10) (a12)...

Abstract

We examined the quality of care provided to older persons with frailty in five Canadian provinces, using administrative health data. In each province, we identified two cohorts of older persons with frailty: decedents and living persons. Using decision rules, we considered individuals to be frail if they were long-term care residents, terminally ill, or met at least two of seven domains, which were based on frailty scales, geriatrician discussions, and health service utilization indicators. We assessed quality of care using selected quality indicators: decrease in length of hospital stay, decrease in the number of in-patient readmissions, decrease in the number of emergency department visits, increase in the level of family physician continuity of care, decrease in the use of mechanical ventilation, and decrease in the number of admissions to intensive care. Using regression analyses, we also found male sex and older age were associated with poorer quality of care in both cohorts. This study provides baseline data for evaluating future efforts to improve the quality of care provided to older persons with frailty.

Nous avons examiné la qualité des soins fournis aux personnes âgées fragiles dans cinq provinces canadiennes à partir de données administratives sur la santé. Dans chaque province, nous avons considéré les personnes âgées fragiles en fonction de deux cohortes : les personnes décédées et les personnes vivantes. Des règles de décision ont été utilisées pour déterminer quelles personnes étaient frêles, soit celles résidant en établissement de soins de longue durée, qui étaient en phase terminale ou dont le profil correspondait à deux des sept domaines identifiés. Ces domaines étaient fondés sur des échelles de fragilité, des discussions avec des gériatres et des indicateurs d’utilisation des services de santé. Nous avons évalué la qualité des soins à l’aide des indicateurs de qualité suivants : diminution de la durée de l’hospitalisation, diminution du nombre de réadmissions à l’hôpital, diminution du nombre de visites à l’urgence, augmentation de la continuité des soins fournis par un médecin de famille, diminution de l’utilisation de la ventilation mécanique et diminution du nombre d’admissions aux soins intensifs. À l’aide d’analyses de régression, nous avons également constaté que le sexe masculin et l’âge avancé étaient associés à une moins bonne qualité de soins dans les deux cohortes. Cette étude fournit des données de base qui permettront d’évaluer les futurs efforts visant à améliorer la qualité des soins offerts aux personnes âgées fragiles.

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Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Anik M.C. Giguere, Ph.D. Laval University Pavillon Ferdinand-Vandry, Office 2881-C 1050 Avenue de la Médecine Québec (QC) Canada, G1V 0A6 (anik.giguere@fmed.ulaval.ca)

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A.M.C.G., C.K., B.L., and R.U. conceived and designed this study. All authors contributed to the interpretation of findings. A.M.C.G. and C.K. wrote the first draft of this manuscript. All authors revised and approved the final manuscript. We gratefully acknowledge Sharon Jhang, Jim Si, Refik Saskin, and Alejandro Gonzalez for conducting the analyses in Alberta, Ontario, and Quebec. We also acknowledge the help of Jayna Holroy-Leduc in accessing data in Alberta, and the help of Serge Dumont and Helena Daudt in selecting the quality indicators. This research was funded by the Canadian Frailty Network, which is supported by the Government of Canada through the Networks of Centres of Excellence (NCD) program. We also received funding from University Laval Research Chair on Aging (Quebec City), and in-kind contributions from the Quebec Excellence Centre on Aging (Quebec City). A.F.T. is the Canada Research Chair in Critical Care Neurology and Trauma. A.M.C.G. is funded by a Research Scholar Junior 2 Career Development Award by the Fonds de Recherche du Québec—Santé.

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