Document Type : Original Article

Authors

1 Department of Family Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan

2 The Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan

3 Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

4 Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan

5 Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Abstract

Background 
The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments (EDs). However, scientific evidence regarding the association between home-based healthcare services and ED uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for ED visits among patients receiving publicly-funded homecare services.

Methods 
The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and ED visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned ED utilizations.

Results 
Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio [OR] = 1.33, 95% CI = 1.05 to 1.70), male caregiver (OR = 0.18, 95% CI = 0.05 to 0.66), duration of introducing homecare services (OR = 0.97, 95% CI = 0.95 to 1.00), working experience of dedicated nurses (OR = 0.89, 95% CI = 0.79 to 0.99) and number of ED utilizations within previous past year before enrollment (OR = 1.54, 95% CI = 1.14 to 2.10) as significant determinants for unplanned ED visits.

Conclusion 
The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent ED visits among patients receiving homecare services.

Keywords