Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study
Introduction Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the resident’s wishes, can result in transfers that are harmful to residents, leav...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e086932.full |
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| author | Sharon Kaasalainen Daniel I McIsaac Steven Hawken Daniel Kobewka Peter Tanuseputro Amy Hsu Robert Talarico Colleen Webber Ramtin Hakimjavadi Celeste Fung Mary M Scott Doug Manuel Christina Y Yin Jackie Kierulf Frank Molnar Sandy Shamon Aliza Moledina |
| author_facet | Sharon Kaasalainen Daniel I McIsaac Steven Hawken Daniel Kobewka Peter Tanuseputro Amy Hsu Robert Talarico Colleen Webber Ramtin Hakimjavadi Celeste Fung Mary M Scott Doug Manuel Christina Y Yin Jackie Kierulf Frank Molnar Sandy Shamon Aliza Moledina |
| author_sort | Sharon Kaasalainen |
| collection | DOAJ |
| description | Introduction Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the resident’s wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents.Method and analysis We will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders.Ethics and dissemination Ethics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars.Trial registration Open Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY). |
| format | Article |
| id | doaj-art-a3dd2b31a2dc41aaa0d8a62df999f9b9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a3dd2b31a2dc41aaa0d8a62df999f9b92025-01-21T11:40:10ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-086932Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort studySharon Kaasalainen0Daniel I McIsaac1Steven Hawken2Daniel Kobewka3Peter Tanuseputro4Amy Hsu5Robert Talarico6Colleen Webber7Ramtin Hakimjavadi8Celeste Fung9Mary M Scott10Doug Manuel11Christina Y Yin12Jackie Kierulf13Frank Molnar14Sandy Shamon15Aliza Moledina16School of Nursing, McMaster University, Hamilton, New York, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaBruyere Research Institute, Ottawa, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaBruyere Research Institute, Ottawa, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Ottawa, Ontario, CanadaBruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Medicine, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Family Medicine, University of Ottawa, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaBruyere Research Institute, Ottawa, Ontario, CanadaBruyere Research Institute, Ottawa, Ontario, CanadaN/A, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Family and Community Medicine, University of Toronto, Toronto, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaIntroduction Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the resident’s wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents.Method and analysis We will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders.Ethics and dissemination Ethics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars.Trial registration Open Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY).https://bmjopen.bmj.com/content/15/1/e086932.full |
| spellingShingle | Sharon Kaasalainen Daniel I McIsaac Steven Hawken Daniel Kobewka Peter Tanuseputro Amy Hsu Robert Talarico Colleen Webber Ramtin Hakimjavadi Celeste Fung Mary M Scott Doug Manuel Christina Y Yin Jackie Kierulf Frank Molnar Sandy Shamon Aliza Moledina Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study BMJ Open |
| title | Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study |
| title_full | Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study |
| title_fullStr | Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study |
| title_full_unstemmed | Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study |
| title_short | Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study |
| title_sort | transfer from long term care to acute care and risk of new permanent cognitive or physical disability among long term care residents in canada protocol for a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/15/1/e086932.full |
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