title: Sex differences in home care performance: a population-based study.
abstract: BACKGROUND
  Home care services play an integral role in promoting independence, reducing hospital admission and readmission rates, and preventing or delaying nursing home admission among older adults. Despite important sex differences in functional status and use of services by recipients of home care, differences in home care performance measures by sex have not been examined.
  
  
  OBJECTIVE
  To assess sex differences in the quality of publicly funded home care services in Ontario, Canada.
  
  
  METHODS
  Validated, publicly reported home care quality indicators derived from the Resident Assessment Instrument for Home Care using the 2009 and 2010 Home Care Reporting System database were assessed for 119,795 Ontario home care clients aged 65 years and older. Unadjusted and risk-adjusted sex differences in performance were examined provincially and by health region.
  
  
  RESULTS
  In unadjusted analyses, there were sex differences in health outcomes on all indicators examined (decline or failure to improve in activities of daily living, cognitive decline, depressive symptoms, and pain control). After risk adjustment, differences were minimal. For example, in unadjusted analyses, 23.1% of women and 18.7% of men reported poorly controlled pain. After risk adjustment, 21.2% of women and 21.6% of men reported poorly controlled pain, with a difference of -0.4% (95% CI, -0.4% to -0.3%). Across health regions risk adjustment eliminated sex differences. There was 1.3-fold to 2.6-fold variation in performance on indicators across health regions.
  
  
  CONCLUSIONS
  After risk adjustment, no important sex differences in home care quality indicators were identified. Sizable regional variations observed indicate potential to improve home care outcomes for both women and men. Sex differences in unadjusted analyses demonstrate the value of examining both unadjusted and adjusted outcomes and suggest sex-specific strategies will likely be needed to improve home care quality.
authors.affiliation: Department of Community and Family Medicine, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: amandat.lo@mail.utoronto.ca.
authors.forename: Amanda T
authors.initials: AT
authors.lastname: Lo
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Bierman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D018574:Home Care Agencies / Q000592:standards* / Q000706:statistics & numerical data; D006699:Home Care Services / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D009864:Ontario; D011159:Population Surveillance / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012727:Sex Characteristics; D011795:Surveys and Questionnaires