title: Assessing adverse events among home care clients in three Canadian provinces using chart review.
abstract: OBJECTIVE
  The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found.
  
  
  METHODS
  This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009-2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada.
  
  
  RESULTS
  The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients' decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation.
  
  
  CONCLUSIONS
  Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as 'informal' caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety.
authors.affiliation: Department of Health Administration, University of Montreal, , Montréal, Québec, Canada.
authors.forename: Régis
authors.initials: R
authors.lastname: Blais
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sears
authors.forename: Diane
authors.initials: D
authors.lastname: Doran
authors.forename: G Ross
authors.initials: GR
authors.lastname: Baker
authors.forename: Marilyn
authors.initials: M
authors.lastname: Macdonald
authors.forename: Lori
authors.initials: L
authors.lastname: Mitchell
authors.forename: Stéphane
authors.initials: S
authors.lastname: Thalès
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D016001:Confidence Intervals; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data* / Q000639:trends; D061214:Patient Safety; D011787:Quality of Health Care; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Adverse events, epidemiology and detection; Chart review methodologies; Patient safety