The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

Abstract

Clinically important negative effects on HRQL were observed for clients with a previous diagnosis of stroke, osteo- and rheumatoid arthritis, or CHF, as well as with increasing levels of multimorbidity. Findings provide baseline preference-based HRQL scores for home care clients with different diagnoses and may be useful for identifying, targeting and evaluating care strategies toward populations with significant HRQL impairments.

Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort

“…This prevalence is comparable to that found in other studies of the home care sector in Ontario [21,22], and larger than in the general population in the province [36] or elsewhere [37]. The high prevalence of multimorbidity we observed in our cohort is consistent with previous studies on comorbidity among persons with dementia residing in a community setting [2,38,39], where hypertension, osteoarthritis, and diabetes are commonly reported.…”

“…Each condition was defined at the time of index RAI-HC assessment using historical data. Consistent with previous studies on multimorbidity in Ontario [22,23,25,26], these conditions were selected based on their large economic impact and high prevalence in the general population [27–29], and included the following: acute myocardial infarction, asthma, any cancer, cardiac arrhythmia, chronic coronary syndrome, chronic obstructive pulmonary disorder, congestive heart failure, diabetes, hypertension, non-psychotic mood and anxiety disorders, other mental illnesses (which included schizophrenia, delusions, and other psychoses; personality disorders; and substance abuse), osteoarthritis, osteoporosis, renal failure, rheumatoid arthritis, and stroke (excluding transient ischemic attack). All cases were identified from Ontario Health Insurance Plan database and Discharge Abstract Database (DAD) data using ICD-9 and -10 codes.…”

“…In Ontario, as elsewhere, the home care sector is a growing component of healthcare delivery that helps older adults to maintain independence within their home residence while reducing overall health system costs. Individuals with dementia comprise a large proportion of this population [21,22]. As a secondary objective, we tested whether COC had a direct association with healthcare utilization and whether COC modified the associations between multimorbidity and the hospitalization and ED visit outcomes.…”

The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada

“…We included Ontario residents who received publicly funded home care services from April 1, 2007 to March 31, 2015 and who were hospitalized within 2 years of their first home care assessment, conducted using the Resident Assessment Instrument for Home Care (RAI-HC) [31]. Respondents of the RAI-HC are typically frail (e.g., have limitations in activities in daily living and limited life expectancy), and are assessed for language status [32,33]. We excluded residents who were older than 105 years of age at the time of the study or not eligible for Ontario's universal health insurance plan (i.e., the Ontario Health Insurance Plan (OHIP)) during the study period.…”

“…The RAI-HC database, which captures the baseline characteristics of Ontario residents receiving publicly funded home care services for at least 60 consecutive days or while waiting for admission into long-term care [35], allowed us to study a cohort of frail, older residents with an increased risk of hospitalization and harm [32,33]. Residents who completed more than one home care assessment were indexed at the time of their first assessment and followed for 2 years.…”