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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

Authors: Chi-Ling Joanna Sinn, Aaron Jones, Janet Legge McMullan, Nancy Ackerman, Nancy Curtin-Telegdi, Leslie Eckel, John P. Hirdes

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances.

Methods

The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services.

Results

The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice.

Conclusions

The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.
Literature
1.
2.
3.
Canadian Home Care Association. Portraits of home care in Canada. Mississauga: Canadian Home Care Association; 2013.
4.
5.
6.
Ministry of Health and Long-Term Care. Policy Guideline for Community Care Access Centre and Community Support Service Agency Collaborative Home and Community-Based Care Coordination, April 2014. 2014.
7.
8.
Carpenter I, Hirdes J. Using interRAI assessment systems to measure and maintain quality of long-term care. Good Life Old Age Monit. Improv. Qual. Long-Term Care. OECD/European Commission. 2013:93–139.
9.
Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, et al. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45:1017–24.CrossRefPubMed
10.
Hirdes JP, Ljunggren G, Morris JN, Frijters DH, Finne Soveri H, Gray L, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277.CrossRefPubMedPubMedCentral
11.
Landi F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C, et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care. 2000;38:1184–90.CrossRefPubMed
12.
Hogeveen S, Chen J, Hirdes JP. Evaluation of data quality of interRAI assessments in home and community care. BMC Med Inform Decis Mak. 2017;17:150.
13.
Strobl C, Malley J, Tutz G. An introduction to recursive partitioning: rationale, application and characteristics of classification and regression trees, bagging and random forests. Psychol Methods. 2009;14:323–48.CrossRefPubMedPubMedCentral
14.
Jensen D, Schmill M. Adjusting for multiple comparisons in decision tree pruning. Proc Third Int Conf Knowl Discov Data Min. 1997. p. 195–8.
15.
Morris J, Fries B, Morris S, Scaling ADLs within the MDS. J Gerontol. 1999;54:M546–53.CrossRef
16.
Fraser KD, Estabrooks C. What factors influence case managers’ resource allocation decisions? A systematic review of the literature. Med Decis Mak. 2008;28:394–410.CrossRef
17.
Corazzini-Gomez K. The relative effects of home care client characteristics on the resource allocation process: do personality and demeanor matter? The Gerontologist. 2002;42:740–50.CrossRefPubMed
18.
Crook WP, Vinton LA. Study of case managers’ decision-making processes. J Case Manag. 2000;2:211–5.
19.
Thompson C, Cullum N, McCaughan D, Sheldon T, Raynor P. Nurses, information use, and clinical decision making—the real world potential for evidence-based decisions in nursing. Evid Based Nurs. 2004;7:68–72.CrossRefPubMed
20.
Reschovsky JD, Rich EC, Lake TK. Factors contributing to variations in physicians’ use of evidence at the point of care: a conceptual model. J Gen Intern Med. 2015;30(Suppl 3):555–61.CrossRefPubMedCentral
21.
Fraser KD, Estabrooks C, Allen M, Strang V. Factors that influence case managers’ resource allocation decisions in pediatric home care: an ethnographic study. Int J Nurs Stud. 2009;46:337–49.CrossRefPubMed
22.
Corazzini KN. Case management decision making: goal transformation through discretion and client interpretation. Home Health Care Serv Q. 2000;18:81–96.CrossRefPubMed
23.
24.
Smith ME, Baker CR, Branch LG, Walls RC, Grimes RM, Karklins JM, et al. Case-mix groups for VA hospital-based home care. Med Care. 1992;30:1–16.CrossRefPubMed
25.
Health Care Financing Administration. Medicare program; prospective payment system for home health agencies. Fed Regist. 2000;65:41128–214.
26.
Carpenter I, Gambassi G, Topinkova E, Schroll M, Finne-Soveri H, Henrard J-C, et al. Community care in Europe. The aged in home care project (AdHOC). Aging Clin Exp Res. 2004;16:259–69.CrossRefPubMed
27.
Branch LG, Goldberg HBA. Preliminary case-mix classification system for Medicare home health clients. Med Care. 1993;31:309–21.CrossRefPubMed
28.
Poss JW, Hirdes JP, Fries BE, McKillop I, Chase M. Validation of resource utilization groups version III for home care (RUG-III/HC): evidence from a Canadian home care jurisdiction. Med Care. 2008;46:380–7.CrossRefPubMed
29.
Björkgren MA, Fries BE, Shugarman LR. A RUG-III case-mix system for home care. Can J Aging Rev Can Vieil. 2000;19:106–25.CrossRef
30.
Carrera F, Pavolini E, Ranci C, Sabbatini A. Long-Term Care Systems in Comparative Perspective: Care Needs, Informal and Formal Coverage, and Social Impacts in European Countries. Reforms Long-Term Care Policies Eur. New York: Springer; 2013. p. 23–52.
Metadata
Title
Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care
Authors
Chi-Ling Joanna Sinn
Aaron Jones
Janet Legge McMullan
Nancy Ackerman
Nancy Curtin-Telegdi
Leslie Eckel
John P. Hirdes
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2737-7

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