Open Access Research article

Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study

Diane M Doran1*, John P Hirdes2, Regis Blais3, G Ross Baker4, Jeff W Poss2, Xiaoqiang Li1, Donna Dill5, Andrea Gruneir6, George Heckman7, Hélène Lacroix8, Lori Mitchell9, Maeve O’Beirne10, Nancy White11, Lisa Droppo12, Andrea D Foebel2, Gan Qian1, Sang-Myong Nahm1, Odilia Yim1, Corrine McIsaac13 and Micaela Jantzi2

Author Affiliations

1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada

2 School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

3 Department of Health Administration, University of Montreal, Station Centre-ville, PO Box 6128, Montréal, Québec, H3C 3J7, Canada

4 Institute of Health Policy, Management, and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada

5 Department of Health and Wellness, Nova Scotia Department of Health and Wellness, Barrington Tower, 7th Fl., 1894 Barrington Street, Halifax, NS, B3J 2A8, Canada

6 Women’s College Research Institute, Women’s College Hospital, 790 Bay Street, 7th floor, Toronto, ON, M5G 1N8, Canada

7 School of Public Health and Health Systems, and Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

8 Saint Elizabeth Health Care, 90 Allstate Parkway, Suite 300, Markham, ON, L3R 9Z9, Canada

9 Home Care Program, Winnipeg Regional Health Authority, 3rd Floor – 496 Hargrave Sreet, Winnipeg, MB, R3A 0X7, Canada

10 Department of Family Medicine & Department of Community Health Sciences, University of Calgary, G-012 HSC, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada

11 Canadian Institute for Health Information (retired), 13 Graham Avenue, Ottawa, ON, K1S 0B6, Canada

12 Ontario Association of Community Care Access Centres, 130 Bloor Street West, Suite 200, Toronto, ON, M5S 1N5, Canada

13 Cape Breton University, 1250 Grand Lake Road Sydney, P.O. Box 5300, Nova Scotia, B1P 6L2, Canada

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BMC Health Services Research 2013, 13:227  doi:10.1186/1472-6963-13-227

Published: 22 June 2013



Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario.


A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences.


The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death.


Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.