Effects of Outpatient Aftercare on Psychiatric Rehospitalization Among Children and Emerging Adults in Alberta, Canada.

OBJECTIVE: The one-year readmission rates for children and youths hospitalized for a psychiatric condition is estimated at 38%. Studies suggest that these high readmission rates result from a lack of aftercare, but evidence is mixed. This study further explored the relationship between aftercare and readmission among children and youths ages five to 24 in Alberta, Canada, by using the same study sample to identify predictors of both outcomes. METHODS: A retrospective analysis using linked administrative data was performed. Records of the index inpatient stay and any subsequent readmissions for a mental health reason between July 1, 2007, and December 31, 2012, were obtained from the Discharge Abstract Database. Data on outpatient aftercare for this sample were obtained from ambulatory care records and a patient-level physician billing database. Rates of aftercare and readmission were calculated. A Cox proportional hazards regression model was used to identify predictors of both outcomes. RESULTS: Overall, 15,628 hospitalizations were identified for 12,728 unique individuals. For these hospitalizations, aftercare services were recorded for 29.4% within one week of discharge and for 54.5% within 30 days. Fourteen percent of hospitalizations resulted in readmission within 90 days. Aftercare was associated with a 32% reduction in readmission. Prior service use, longer hospital stays, higher income, specific diagnoses, female sex, and comorbid mental health conditions were associated with a greater likelihood of aftercare receipt. CONCLUSIONS: Access to community mental health services for children and youths remains a priority. The significant role of aftercare in reducing readmission risk demonstrates the need to improve these services.

End-of-life hospital care for cancer patients: an update.

Cancer is the leading cause of death in Canada, and the number of new cases is expected to increase as the population ages and grows. This study examined the use of hospital services in the last month of life by adult cancer patients who died in Canadian acute care hospitals in fiscal year 2012-2013. Almost 25,000 Canadian cancer patients - excluding those in Quebec - died in acute care hospitals, representing approximately 45% of the estimated cancer deaths in 2012-2013. The proportion of in-hospital deaths varied across jurisdictions. Twenty-three percent of these patients were admitted to acute care multiple times in their last 28 days of life, with a higher percentage for rural (29%) compared to urban (21%) patients. Relatively few patients used intensive care units or received inpatient chemotherapy in their last 14 days of life.

Measuring and reporting on quality of care and patient safety in Canada: focusing on what matters.

Quality of Healthcare in Canada: A Chartbook is a comprehensive, useful reference that organizes the multiple measures it contains around a well-established framework. It documents Canada's performance relative to several comparator countries and over time on a large number of indicators of care quality. However, the chartbook does not identify where the gaps are in the measurement of quality of care and patient safety, and it is limited in its ability to represent the measurement required to monitor current and upcoming policy initiatives in the field of healthcare quality. Further, it fails to represent fully the perspective of the patient or to incorporate the progress made in measuring patient-centred quality of care. The authors propose four ways forward for strengthening the measurement of healthcare quality and patient safety in Canada: (1) the standardized collection of patient-reported outcome measures; (2) a focus on the standardized measurement of patient safety across the country at micro-, meso- and macro-levels; (3) the measurement of multiple morbidities and of the quality of care provided to patients with multiple chronic conditions; and (4) a design of measurement systems in ways that reflect the perspectives of patients and citizens.

Medication use among Canadian seniors.

As they age, many seniors develop a progressively more complex mix of health conditions. Multiple prescription medications are often required to help manage these conditions and control symptoms, with the goal of maintaining seniors' health for as long as possible. This article explores trends in the number and types of medications used by seniors on public drug programs in Canada. Our findings suggest that a high proportion of Canadian seniors are taking several medications, highlighting the need for medication management systems focusing on this population.