THE DIVERT-CARE CATALYST TRIAL: TARGETED CHRONIC-DISEASE MANAGEMENT FOR HOME CARE CLIENTS

Home care patients are a large population of vulnerable older adults living in the community. They are medically complex, access care across settings, have very high rates emergency department use, and have relatively poor access to effective chronic disease management. We tested a multi-disciplinary intervention deployed with a case-finding tool to determine its ‘real-world’ effectiveness. A cardio-respiratory disease management intervention was developed based on existing guidelines and deployed using the validated Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) Scale. Intervention components were refined and delivered by a multi-disciplinary group of geriatricians, cardiologists, primary care providers, home care coordinators, nurses, and pharmacists. Components included: sustained self-care training, patient self-care resources, medication review, advanced care planning, clinician communication tools, and staff education. We conducted a non-randomized pragmatic cluster trial. One hundred home care patients from three geographic areas were enrolled for the intervention over 6 months. The control group included patients who met the same eligibility in the six surrounding geographic areas. A city-wide control group was also included ad hoc. Data were analyzed based on intent-to-treat. The absolute risk of an emergency department visit was reduced by 20% over the 7-month follow-up. Nursing costs increased by approximately $4 per day, or approximately $500 over the entire follow-up period. Results were similar with the ad hoc control group. Targeted, multi-component cardio-respiratory disease management interventions are feasible and effective for home care clients. The trial received honours from provincial heath care organizations. A large pragmatic cluster-randomized trial is being planned.