Linkage of social care and hospital admissions data to explore non-delivery of planned home care for older people in Scotland

Abstract

Purpose: As part of a pilot study assessing the feasibility of record-linking health and social care data, we examined patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. We also assessed whether non-delivery was associated with subsequent emergency hospital admission. Design: After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission. Findings: There were 4,170 instances of ‘No Access’ non-delivery among 1,411 people, and 960 instances of ‘Service Refusal’ non-delivery among 427 people. The median number of undelivered visits was two among the one third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding. Research Implications: This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes. Practical Implications: Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance.