@article {JonesE525, author = {Aaron Jones and Connie Schumacher and Susan E. Bronskill and Michael A. Campitelli and Jeffrey W. Poss and Hsien Seow and Andrew P. Costa}, title = {The association between home care visits and same-day emergency department use: a case{\textendash}crossover study}, volume = {190}, number = {17}, pages = {E525--E531}, year = {2018}, doi = {10.1503/cmaj.170892}, publisher = {CMAJ}, abstract = {BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care.METHODS: We conducted a population-based case{\textendash}crossover study among patients receiving publicly funded home care in the Hamilton{\textendash}Niagara{\textendash}Haldimand{\textendash}Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ({\textquotedblleft}long stay{\textquotedblright}) or short-term home care needs ({\textquotedblleft}short stay{\textquotedblright}). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day.RESULTS: A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95\% confidence interval [CI] 1.17{\textendash}1.48) and short-stay patients (OR 1.22, 95\% CI 1.07{\textendash}1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits.INTERPRETATION: Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.180263}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/190/17/E525}, eprint = {https://www.cmaj.ca/content/190/17/E525.full.pdf}, journal = {CMAJ} }