title: Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study.
abstract: In an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such as pain. The purpose of this research study was to investigate whether therapeutic self-care ability explained variation in the frequency and types of adverse events experienced by home care clients.
  
  
  
  A retrospective cohort design was used, utilizing secondary databases available for Ontario home care clients from the years 2010 to 2012. The data were derived from (1) Health Outcomes for Better Information and Care; (2) Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting System; and (4) Discharge Abstract Database. Descriptive analysis was used to identify the types and prevalence of adverse events experienced by home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care ability and the occurrence of adverse events in home care.
  
  
  
  The results indicated that low therapeutic self-care ability was associated with an increase in adverse events. In particular, logistic regression results indicated that low therapeutic self-care ability was associated with an increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication.
  
  
  
  This study advances the understanding about the role of therapeutic self-care ability in supporting the safety of home care clients. High levels of therapeutic self-care ability can be a protective factor against the occurrence of adverse events among home care clients. A clear understanding of the nature of the relationship between therapeutic self-care ability and adverse events helps to pinpoint the areas of home care service delivery required to improve clients' health and functioning. Such knowledge is vital for informing health care leaders about effective strategies that promote therapeutic self-care, as well as providing evidence for policy formulation in relation to risk mitigation in home care.
authors.affiliation: Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, ON, L1H 7K4, Canada. winnie.sun@mail.utoronto.ca.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada. winnie.sun@mail.utoronto.ca.
authors.forename: Winnie
authors.initials: W
authors.lastname: Sun
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Doran
authors.affiliation: Institute of Health Policy Management and Evaluation, University Toronto, 155 College Street, 4th floor, Toronto, ON, M5T 3M6, Canada.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Peter
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D061214:Patient Safety / Q000592:standards; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D012648:Self Care / Q000592:standards / Q000706:statistics & numerical data*
keywords: Adverse events; Home care safety; Self-care; Self-management