The association between home care visits and same-day emergency department use: a case–crossover study

Abstract

CMAJ | APRIL 30, 2018 | VOLUME 190 | ISSUE 17 E525 O lder adults are more likely to use the emergency depart-ment, have longer lengths of stay in the emergency department and are more likely to be admitted to hos-pital from the emergency department than younger patents. 1–3 Despite being highly used by older adults, the emergency depart-ment is often not the ideal place for seniors to receive care. Older adults are increasingly presenting to the emergency department with complex care needs that require greater assessment and coordination than the traditional disease-centric and episodic models of care typically permit. 4–6 Increased access to publicly funded home and community care has been suggested as a way to reduce or prevent unneces-sary or avoidable visits to the emergency department. 7–9 How-ever, evidence on the relation between home care and emergency department use is limited and mixed. Several clinical trials have tested enhanced models of home care and found no effect on emergency department use, whereas increased levels of home care service have been associated with a reduction in emergency department use in patients receiving palliative care. 10–12 Within health systems, concerns persist that home care has evolved into a task-focused, visit-based, contracted service model that precludes comprehensive practice, and that this task-based model contributes to silos of care. 13 There have been calls to shift home care to a more comprehensive, team-based prac-tice model that supports disease management in the home. ABSTRACT BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We exam-ined the association between home care visits and same-day emergency depart-ment use among patients receiving pub-licly funded home care.