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Adverse Events in Home Care: Identifying and Responding with interRAI Scales and Clinical Assessment Protocols

  • Chi-Ling Joanna Sinn (a1), Raquel Souza Dias Betini (a1), Jennifer Wright (a2), Lorri Eckler (a2), Byung Wook Chang (a3), Sophie Hogeveen (a1), Luke Turcotte (a1) and John P. Hirdes (a1)...


Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.

Les conséquences associées aux événements indésirables dans les soins à domicile sont variées et multifactorielles. La présente étude visait à tester un système d’évaluation joignant deux outils de mesures dans le but d’identifier les bénéficiaires de soins à domicile dont le risque de placement dans un établissement de soins de longue durée ou de décès dans l’année suivante est plus élevé. Les deux outils de mesure sont tirés du Système d’évaluation d’interRAI (Resident Assessment Instrument-Home Care; RAI-HC), un outil d’évaluation standardisé et détaillé. Les personnes présentant des scores élevés à l’algorithme de la Méthode d’attribution des niveaux de priorité (Method for Assigning Priority Levels; MAPLe) et à l’Échelle de mesure des changements de l’état de santé, des maladies en phase terminale, des signes et des symptômes (Changes in Health, End-stage disease, Signs and Symptoms; CHESS) étaient plus à risque de placement ou de décès, et leur risque de subir ces événements plus tôt comparativement aux autres patients était plus que doublé. Le groupe cible était aussi plus susceptible de présenter des problèmes d’humeur et de relations sociales, et leurs aidants risquaient davantage de souffrir de détresse, ce qui indiquerait que ces personnes et leurs aidants pourraient avoir besoin de soins de santé mentale et d’interventions psychosociales, en plus des soins médicaux et des services de soutien personnels. Les agences de soins à domicile pourraient utiliser ce système d’évaluation pour identifier les patients en soins prolongés à la maison chez qui une approche de soins coordonnés plus intensive serait nécessaire pour mieux atténuer et gérer les risques liés à leur condition.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adresées à: Chi-Ling Joanna Sinn, BSc, Doctoral Candidate School of Public Health and Health Systems University of Waterloo 200 University Avenue West Waterloo, ON N2L 3G1 <>


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We gratefully acknowledge Jonathan Chen from University of Waterloo/interRAI Canada; Lori Borovoy and Charlene Brown from Central Local Health Integration Network; and Leigh Scott and Deborah Gollob, formerly with Central Community Care Access Centre.

This work was funded by Central Local Health Integration Network and the Ontario Ministry of Health and Long-Term Care.

C. J. Sinn received a Doctoral Research Award from the Canadian Institutes of Health Research (Application number: 355806). S. Hogeveen received a Frederick Banting and Charles Best Canada Graduate Scholarship from the Canadian Institutes of Health Research.



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