BC Health Authorities are taking a home-based approach to provide services to seniors in the comfort and safety of their homes. This home-based care follows a ‘Home is Best’ philosophy, and falls under the Integrated Primary and Community Care’s (IPCC) ‘Home First’ program. To optimize available resources and care delivery, research is needed to determine which patients will thrive with this type of care, and to create a sustainable strategy for future patients.
In collaboration with leaders from Vancouver Coastal Health (VCH), IHSTS is undertaking an evaluation of the clinical and cost effectiveness of delivery of the ‘Home First’ program. The project began in 2014, and is led by William Hall, Craig Mitton and Stirling Bryan from the Centre for Clinical Epidemiology and Evaluation at the Vancouver Coastal Health Research Institute and the University of British Columbia.
The researchers began with a scoping exercise. Their overview of the literature showed that there are many different interventions and services designed to help seniors be well at home. One type of service, called Preventative Home Visits was found to be suitable for patients with many different conditions – but findings on health outcomes and cost are mixed. Additionally, internal evaluations of ‘Home First’ in VCH have suggested that the program provides benefit. However, limitations in methodology do not allow for determination of cost-effectiveness or which individuals benefited in the program. To provide conclusive evidence, more rigorous evaluation is needed.
During the next phase of work, the project team will focus on:
- Which patients experience the greatest health improvements and fewest re-admissions to acute care within the ‘Home First’ program?
- What is the cost-effectiveness of this program?
- What will the cost implications of this program be in the future?
To address these questions, the researchers are working with leaders from home care and decision support services at VCH to identify data that will support the modeling and simulation efforts. Ultimately, we hope that the statistical tools developed from this project will give clinicians greater insight into their patients, and enable appropriate allocation of resources for the delivery of high quality care to one of our most vulnerable populations.