title: Are chronically ill patients high users of homecare services in Canada?
abstract: OBJECTIVE
  Chronically ill patients often need healthcare and supportive services, with formal homecare services an important source of community-based assistance. Although people diagnosed with 1 or more chronic diseases are thought to be the most common homecare clients, and perhaps the highest users of homecare services, few studies have analyzed homecare services utilization by specific clients. A study was done to determine if a relationship exists between chronic illness and homecare services utilization.
  
  
  METHODS
  Descriptive-comparative, secondary analysis of population homecare data.
  
  
  METHODS
  Three years (2003-2004, 2004-2005, and 2005-2006) of complete homecare client and services utilization data for 1 Canadian province were obtained and tested using 5 definitions of chronic illness to determine which clients among all 149,378 were high users in terms of annual homecare hours and service visits or episodes.
  
  
  RESULTS
  Two definitions revealed clients with a disproportionately large share of homecare hours and service episodes: a) clients classified by homecare case managers as "long-term" and b) clients with service spans of ≥90 days. Definitions involving medical diagnoses and International Classification of Diseases, Ninth Revision, Clinical Modification codes or chapters did not reveal high users. Age and gender also did not predict services utilization.
  
  
  CONCLUSIONS
  The comprehensive pre-service assessment completed by homecare case managers was the most successful at distinguishing people with substantial homecare service needs-people who could then be described as chronically ill. This assessment should be studied to develop a standardized minimum data tool for consistent and fair assessments.
authors.affiliation: University of Alberta, Edmonton, AB, Canada T6G 1C9. E-mail: donna.wilson@ualberta.ca.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Wilson
authors.forename: Corrine D
authors.initials: CD
authors.lastname: Truman
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Hewitt
authors.forename: Charl
authors.initials: C
authors.lastname: Els
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000416:Alberta; D002170:Canada; D002908:Chronic Disease / Q000145:classification / Q000628:therapy*; D015897:Comorbidity; D005191:Family Characteristics; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D017678:Sex Distribution; D013222:State Medicine