Monday, October 19, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Michele A. Kohli, PhD1, Deborah Marshall, PhD2, Jan Barnsley, PhD3 and Peter C. Coyte, PhD3, (1)i3 Innovus, Burlington, ON, Canada, (2)University of Calgary, Calgary, AB, Canada, (3)University of Toronto, Toronto, ON, Canada
Purpose: In Ontario, access to publicly funded home care services is managed by Community Care Access Centres (CCACs). The CCACs employ case managers who assess the needs of all potential clients and prioritize the allocation of services. The purpose of this study was to examine the relative impact of patient and case manager factors in decisions about the allocation of personal support and homemaking services to long-term patients. Method: A discrete choice experiment (DCE) was designed using 7 patient factors deemed to be important by case managers through qualitative case studies and focus groups. In a self-administered internet-based survey, respondents were presented with two hypothetical patient descriptions constructed using the patient factors, and asked to prioritize one client for personal support services and one for homemaking services. A total of 163 case managers in 8 of the 14 CCACs across Ontario completed the survey. Multinomial logistic regression analysis was used to determine the relative impact of the patient factors on the choice of hypothetical patients in the survey. Selected respondent characteristics were tested to determine if they explained variance in choice behaviour. Result: The relative importance of the patient factors in personal support prioritization decisions were: 1) ability to safely bathe; 2) level of informal support; 3) continence or ability to safely ambulate; and 4) ability to pay for service or availability of community services. Choices significantly varied by the rurality and service experience of the case manager respondents. The relative importance of the patient factors in homemaking prioritization decisions were: 1) difficulty in homemaking, or level of informal caregiver support; 2) ability to safely bathe; 3) continence; 4) ability to safely ambulate, or ability to pay for service; and 5) availability of community services. Choices significantly varied by the rurality, service experience and informal caregiving experience of the case manager respondents. Conclusion: This type of survey is a first step in understanding the variability in personal support and homemaking service allocation decision across Ontario.
Candidate for the Lee B. Lusted Student Prize Competition
