Concept: Home Care and Hospitalizations

Introduction

Examining home care use around hospitalizations is difficult especially because individuals could have more than one episode of home care, as well as more than one hospital admission. Thus, A Look at Home Care in Manitoba focused on an individual's first inpatient hospitalization or outpatient procedure ¹ during the year. This document describes some of the issues involved in identifying relevant hospitalizations based on analyses done for the home care report.

Identifying relevant hospitalization

Using the hospital data, only discharges that occurred in the specific year of interest were kept (that had a postal code beginning with R and a municipal code not equal to 900). Hospital types that were included were teaching, urban community, major rural, intermediate rural, small rural, small multi-use, northern isolated. Nursing stations, chronic and rehab, PCH and out-of-province hospitals were excluded. Only inpatient and surgical outpatient records were kept. If hospitalizations overlapped, they were joined into one continuous episode. From this resulting file, only the first hospitalization per person was selected.

The definition of surgical outpatient missed some procedures such as outpatient angioplasty and dialysis that are performed in cardiac suites (i.e. not performed in an operating room).

Hospitalizations & Home Care

The resulting hospitalization file was merged to the home care file for the year of interest. If an individual did not have a home care record open within 30 days after their hospital separation, they were classified as "hospitalized, not discharged to home care". Individuals who had an open home care record within 30 days after hospitalization were divided into two groups:


1. "Post-Hospitalization group" - individuals who had not been registered as home care clients for at least 30 days prior to being hospitalized and who then were registered with home care after their hospitalization/outpatient episode (within 30 days of discharge). In some cases the home care record may have been opened during (but not before) the hospitalization.
   
   
2. "Pre- and Post- Hospitalization group" - individuals who within 30 days prior to the start of their hospitalization had been registered with home care and who continued to be registered with home care after discharge or who were re-registered with home care within 30 days after discharge.

Note: Classifying patients as Post-Hospitalization or Pre- and Post- Hospitalization is somewhat complex. There were many different scenarios of the timing between starting and stopping home care and going into and coming out of hospital, so that decision rules had to be developed.

Lengths of registration in home care for post-hospitalization home care clients

Examining post-hospitalization individuals who were discharged within the first 6 months of 1998/99 allowed us to track the length of home care registration for at least 6 months following hospital discharge. Thus we could determine what proportion of Post-Hospitalization clients were registered in home care after discharge for 1-7 days, 8-30 days, 1-3 months, 3-6 months and over 6 months ² .

Footnotes

¹ For our analysis, surgical outpatients were defined as patients identified in Hospital Discharge Abstracts data as outpatients, and who underwent major surgery (based on Diagnosis Related Groups (DRG™) in an operating room.

² Note that a programming error occurred for figure 6.4 of the deliverable, and the categories actually used were 0-7 days, 8-30 days, 1-6 months, 6-8 months, and >8 months. I don't recommend using these again because there is not sufficient follow-up time for some of the home care clients to correctly identify the last 2 of these groups.