HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.

From Unemployment to Sustainable Livelihoods in Ottawa's Technology Sector (Working Paper 44)

Since submission of the draft report to the OECD‐LEED Program on 30 June 2007, a unique seven‐years retrospective study of the unemployed high technology workers was released by Statistics Canada.1 Drawing upon Statistics Canada’s confidential Longitudinal Worker File – itself constructed from four administrative data sources that linked Records of Employment and tax filer information by the Social Insurance Number and firm‐level data by a company identifier – this study was able to identify and trace the re‐employment of those permanently laid off in the high‐tech industry by location. The findings are stunning.

Leaving and Coming Back to Canada : Evidence from Longitudinal Data (Working Paper 32)

The paper exploits the unique strengths of Statistics Canada's Longitudinal Administrative Database ("LAD"), constructed from individuals' tax records, to shed new light on the extent and nature of the emigration of Canadians to other countries and their patterns of return over the period 1982-1999. The empirical evidence begins with some simple graphs of the overall rates of leaving over time, and follows with the presentation of the estimation results of a model that essentially addresses the question: "who moves?" The paper then analyses the rates of return for those observed to leave the country - something for which there is virtually no existing evidence. Simple return rates are reported first, followed by the results of a hazard model of the probability of returning which takes into account individuals' characteristics and the number of years they have already been out of the country. Taken together, these results provide a new empirical basis for discussions of emigration in general, and the brain drain in particular. Of particular interest are the ebb and flow of emigration rates observed over the last two decades, including a perhaps surprising turndown in the most recent years after climbing through the earlier part of the 1990s; the data on the number who return after leaving, the associated patterns by income level, and the increases observed over the last decade.