A collaboration between the Canadian Longitudinal Study on Aging (CLSA) and Health Data Research Network (HDRN) Canada is allowing researchers access linked CLSA cohort data at provincial health administrative data centres across the country to explore the intersection between aging and health-care utilization.
The CLSA interviewed Dr. Aaron Jones, an assistant professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University, about his study, catalyzing a novel linkage between the CLSA and provincial data centres to examine the role of home-care payment source on health service outcomes in Ontario.
What is your interest in home care and why is it essential to consider as we age?
Canada’s population is growing older and many Canadians want to be able to stay in their homes for as long as possible as they age. This can become challenging as health needs arise and it becomes more difficult for individuals to perform everyday tasks around the house. This is where home care plays a fundamental role in enabling older adults to age in their preferred location.
How does home-care funding vary across provinces, and what are the implications?
Home care doesn’t fall under the Canada Health Act the same way that doctor and hospital services do, and this leads to more variation in the way that home care is funded and delivered across the country. All provinces provide publicly funded home-care services, but your experience as a home-care client varies from province to province. Based on where you live, you would experience differences in whether you are eligible for services at all, how many hours of care you could receive, and whether you would be required to pay for part or all of your care. Another implication in the way home care is considered under the Canada Health Act, is that there is a large market for private home-care services. We know that there are a lot of unmet home-care needs among Canadian older adults and that purchasing private care may be their only option to meet those needs in the home at the same time, but not everyone has the means to be able to do that.
What is administrative health data?
Health administrative data is routinely collected as part of the normal operation of the health system. Nearly every interaction that a patient has with the health system produces some type of record that can be used anonymously for research purposes. This can include physician visits, hospital admissions, emergency room visits, and home care – assuming it has been publicly funded. Administrative data is very advantageous as it contains accurate health system data on nearly everyone in a province. However, it can also be challenging to use because it is not collected for research purposes and sometimes important pieces of data that researchers would like to have are not available.
In lay terms, what research are you undertaking and what do you hope to learn?
My research team and I are seeking to understand how many CLSA participants are accessing public and/or private home care and to describe the differences between participants who are accessing public care, private care, or both. We would also like to understand how the use of public and private home care influences future health system use such as hospital admissions, emergency department visits, or admissions to long-term care homes.
How will the study benefit from using linked CLSA data with provincial administrative health data to carry out its objectives?
Administrative health databases have excellent records on publicly funded health-care use, but do not have any data on home care that was privately purchased. By linking data from CLSA to health administrative data, we can combine one of the only sources of data on private home-care use in Canada to comprehensive, “gold standard” data on health system outcomes.
Are there plans to conduct this research using administrative health data from other provinces?
With the necessary funding, we would love to be able to do that in the future. Variation in the health system across Canada is often seen as a negative thing, but I think we also need to view it as an opportunity. It’s a natural experiment that we can leverage to learn more about how home care affects patient outcomes.
How will the results of this study inform strategies, capacity planning and funding decisions to support public home-care systems?
Better data around the degree of private and public use of home care, and on the individuals using care can further shed light on the capacity and funding challenges facing the sector. Home-care resources are limited and provinces must make critical decisions on how to best allocate the available care. The evidence we will generate around the relationship between home-care use and other health-system use will help inform those decisions, including better funding for the sector overall.
Aaron Jones
Assistant Professor, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University
Aaron Jones is an assistant professor, site director at ICES McMaster and the research director at the Waterloo Regional Campus of the Michael G. DeGroote School of Medicine at McMaster University. He holds the Schlegel Chair in Clinical Epidemiology and Aging. Dr. Jones is a health services researcher and biostatistician with expertise in the use of health administrative data and data science methodologies. His research program investigates the health service use of older adults with on-going care needs, with the goal of discovering how to better organize, manage, and deliver the care that older adults need to age well in their preferred location. His work has been supported by the Canadian Institutes of Health Research and the Alzheimer Society of Canada.
