Impacts of Increased Home Care Investments on Health System Service Utilization

Introduction: A Canadian home care performance measurement framework does not exist. This research examined the impact of Federal and Provincial investments in home care programs in Alberta. We identified the need for financially focused home care system indicators, refined indicators through a modified Delphi approach, and applied selected indicators within the Alberta context. Methods: We conducted a three-phase multistage, mixed-methods study. 1.) Through a scoping review, we identified measures, frameworks and related evaluation tools specific to the IHI Quadruple Aim as applied to home care programs. 2.) We identified core financially focused measurement indicators using a modified Delphi process and a Content Analysis approach. 3.) We applied the newly identified indicators to Alberta Health Services data for home care clients from 2015 to 2020. The identified indicators were examined through trend analyses and a cost-effectiveness analysis economic evaluation. Results: In the first study, we reviewed 3,475 potential documents, leading to 105 articles for performance and quality indicator (PQI) extraction, identifying 829 unique PQIs. Under the IHI Quadruple Aim, 661 PQIs were Clinical Outcomes, 35 Healthcare Provider Satisfaction, 99 Patient Experience, and 34 Financial. In our second phase, 12 panellists comprised the first round and selected 30 PQIs. The second round, comprising eight panellists, resulted in consensus on three PQIs: “Average cost per day per home care client,” “Home care service cost per client over time,” and “Home care funding as a percentage of health care expenditures.” In our third phase, trend analyses identified that enhanced home care investments per client and overall expenditures in Alberta led to a decrease in acute care usage. Over five years, the model estimated a reduction of 346,200 patient days in acute care. An additional $240.3M in home care investments yielded a Cost Effectiveness Ratio of 694:1 in acute care beds days avoided. Conclusions: Our research identified and applied new cost-based indicators effectively portraying how targeted funding affects utilization, revealing that enhancing home care programs improves system cost-effectiveness. Policymakers are encouraged to incorporate these novel indicators into their measurement frameworks to gauge the effects of home care investments on the overall health system.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor dc:publisher.institution

Graduate Studies

Year dc:date.issued

2024

Author dc:creator

• Jajszczok, Max

Advisors dc:contributor.advisor

• Quan, Hude
• Eastwood, Catherine A.

Committee members dc:contributor.committeemember

• Lu, Mingshan
• Cunningham, Ceara

• home care
• economic analysis
• quality
• performance
• outcomes
• evaluation
• cost-effectiveness

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

en

DOI

https://dx.doi.org/10.11575/PRISM/46842

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/119333