Chi-Ling Joanna Sinn1, George Heckman2, Jeffrey W Poss2, Graziano Onder2, Davide Liborio Vetrano2, John Hirdes2. 1. School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden cjsinn@uwaterloo.ca. 2. School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA. METHODS: We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA). RESULTS: In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person. INTERPRETATION: Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA. METHODS: We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA). RESULTS: In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person. INTERPRETATION: Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care. Copyright 2020, Joule Inc. or its licensors.
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