Grant: CIHR Fellowship

Hospital care is the largest category of Canadian health care expenditure. The main users of hospital acute care are older adults over the age of 65, particularly those that are frail. Home care clients are amongst the most frail and at risk seniors living in the community. Provinces are attempting to align community health care services in order to meet the needs and preferences of frail older adults as well as avoid costly acute hospital use. The effect of system-level factors on unplanned acute care use by frail older adults, such as the use of community-based health services, is largely unknown. An expansion of census-level research is required in this area in order to effectively organize health services in the community. The objective of this Postdoctoral research program will be to determine the influence of system-level factors on the patterns of acute care service utilization among home care clients age 65 and older (accounting for 17% of all seniors in Ontario). This retrospective cohort study will be conducted with the extensive use of population-level clinical and administrative data as well as advanced multilevel modeling. As such, this research project leverages information systems that are the product of substantial public investment. This research will produce publications as well as useful policy support tools. In particular, the policy support tools will help health care administrators at the local and provincial level to improve the effectiveness of community-based primary health care and supportive care. Knowledge produced by this study will provide concrete directions for improving service provision and program planning for provincial aging at home and primary care initiatives.