As part of a pilot studyassessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. The paper also assesses whether non-delivery is associated with subsequent emergency hospital admission.
After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits were examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission.
There were 4,170 instances of “No Access” non-delivery among 1,411 people, and 960 instances of “Service Refusal” non-delivery among 427 people. The median number of undelivered visits was two among the one-third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding.
This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes.
Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance.
The authors have no conflicts of interest in relation to the submitted work. The University of Stirling was the study sponsor. The researchers were independent of the study sponsor. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Karen Methven managed the project on a day-to-day basis, and conducted preliminary analyses. Josie Evans conducted further analysis and co-wrote the paper with Karen Methven. All authors commented on drafts of the paper and approved the final version.
Evans, J., Methven, K. and Cunningham, N. (2019), "Linkage of social care and hospital admissions data to explore non-delivery of planned home care for older people in Scotland", Quality in Ageing and Older Adults, Vol. 20 No. 2, pp. 48-55. https://doi.org/10.1108/QAOA-05-2018-0018
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