|Institution:||University of Saskatchewan|
|Keywords:||Post-acute Home Care, Program Evaluation, Nursing Care, Administrative Data, Chart Review, Wound Care, Unexpected Health Symptoms, Adverse Events, Health Policy, Epidemiology|
|Full text PDF:||http://hdl.handle.net/10388/ETD-2014-12-1859|
Aggressive hospital discharge policies adopted in the 1990s led to an influx of patients recovering from acute illness accessing post-acute home care services. Performance of the post-acute home care program in the Saskatoon Health Region was examined using formative program evaluation methods. Brief surveys of clients and nurse providers captured: care objectives and service outcomes; patient-centeredness; trust in providers; health improvement/decline; emotional/social functioning; functional status; injury avoidance; and overall quality. For clients, perceptions of quality were significantly affected by patient centeredness and experiencing unexpected health complications, which accounted for 83.0% of the variation. For nurse providers, overall quality of care was significantly related to patient centeredness, service outcomes, team communication and injury avoidance. Analysis revealed for clients with complex needs, the service period could be extended from 60 to 97 days which would cover 50.0% of clients. The research examining administrative data predicted the dependent variable Log of Total Care Hours (TCH) to enable analysis using General Linear Modelling. The results showed post-acute home care clients referred from Emergency Departments received approximately 84.2 % more TCH; post-acute home care clients referred from Surgical wards received approximately 42.1% more TCH; and post-acute home care clients referred from Cardiology received approximately 66.3% more TCH than clients referred from the community. Furthermore, single clients received more TCH than married clients. Nursing chart reviews of post-acute home care clients with wound care also predicted the Log of TCH to enable analysis using General Linear Modelling. Post-admission, 11.3% of post-acute home care clients receiving wound care displayed clinical signs and symptoms of emerging infection, while 19.7% displayed clinical signs and symptoms of acquired infection. Post-acute home care clients receiving wound care experiencing injury, trauma or harm while admitted to home care received approximately 53.3% TCH; and post-acute home care clients who acquired an infection after admission received approximately 70.2% TCH. The implications of this research suggest there is room to improve post-acute home care services to address client re-hospitalisation, unexpected health symptoms/complications, and wound care.