Amy T. Hsu

Bruyère Research Institute

Objectives: In Canada, alternate-level-of-care (ALC) beds in hospitals may be used when patients who do not require the intensity of services provided in an acute care setting are waiting to be discharged to a more appropriate care setting. However, when there is a lack of care options for patients waiting to be discharged, it contributes to prolo...

Background Functional outcomes are central to decision-making by older adults (OA), but long-term risks after cancer surgery have not been described beyond 1 year for this population. This study aimed to evaluate long-term health care support needs by examining homecare use after cancer surgery for OA.Methods This population-based study investigate...

Background Frailty is characterized by vulnerability to stressors due to an accumulation of multiple functional deficits. Frailty is increasingly recognized as a risk factor for accelerated functional decline, increasing dependency, and risk of mortality. The objective of this study was to examine the association of frailty, at the time of critical...

Objective Older adults account for a significant portion of Canadian immigrants, yet characteristics and health outcomes of older immigrants in nursing homes have not been studied. We aimed to describe the prevalence of immigrants living in nursing homes, their characteristics, and their hospitalization and mortality rates compared to long-term res...

Objective Older adults value and benefit from the long-standing relationship they have with their family physicians. This dynamic has not been researched in a long-term care (LTC, ie, nursing home) setting. We sought to determine the proportion of LTC residents who retain their community family physician within the first 180 days of LTC, and the re...

Background: After diagnosis of a health condition, information about survival and potential transition from community into institutional care can be helpful for patients and care providers. We sought to describe the association between a new diagnosis of dementia and risk of admission to a long-term care home and death at 5 years. Methods: We co...

Background Palliative care is associated with improved symptom control and quality of life in people with heart failure. There is conflicting evidence as to whether it is associated with a greater likelihood of death at home in this population. The objective of this study was to describe the delivery of newly initiated palliative care services in a...

This retrospective cohort study describes the rates, location, and determinants of specialist physician visits among 257,216 long-term care (LTC) residents across 648 LTC homes in Ontario, Canada, between 2007 and 2016. Visit rates in the last year of life were calculated for a sub-cohort of residents who died in LTC between 2013 and 2016. Visits w...

Abstract Background Medical Assistance in Dying (MAID) in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened...

Background Palliative care aims to improve quality of life by relieving physical, emotional, and spiritual suffering. Health system planning can be informed by evaluating cost and effectiveness of health care delivery, including palliative care. Aim The objectives of this article were to describe and critically appraise economic evaluations of pal...

Background While most patients desire to die at home or in a community-based hospice, the transition from hospital to community settings often lacks streamlined coordination of care to ensure that adequate support is provided in the preferred care setting. The impact of hospital-based palliative care consultations on post-discharge care and outcome...

Background: The aim was to characterize end-of-life care in patients who have had a leg amputated for peripheral artery disease (PAD) or diabetes. Methods: This was a population-based retrospective cohort study of patients with PAD or diabetes who died in Ontario, Canada, between 2011 and 2017. Those who had a leg amputation within 3 years of de...

Objectives: To investigate whether same-day physician access in long-term care homes reduces resident emergency department (ED) visits and hospitalizations. Design: Retrospective cohort study. Setting and participants: 161 long-term care homes in Ontario, Canada, and 20,624 residents living in those homes. Methods: We administered a survey t...

Purpose Among individuals with COPD and/or lung cancer, to describe end-of-life health service utilization, costs, and place of death; to identify predictors of home palliative care use, and to assess benefits associated with palliative care use. Patients and methods We conducted a retrospective population-based study using provincial linked healt...

Background: Alcohol use causes a large burden on the health of Canadians, and alcohol-related harms appear to be increasing in many high-income countries. We sought to analyze changes in emergency department visits attributable to alcohol use, by sex, age and neighbourhood income over time. Methods: All individuals aged 10 to 105 years living in...

Background: Discharging patients from inpatient palliative care units to the community is aligned with patients' desires to be cared for and die at home. However, there is little research examining patient outcomes after discharge. Objective: To describe the outcomes of patients discharged from an inpatient palliative care unit. Design: A single-...

Background: Although bariatric surgery is the most effective treatment for severe obesity, weight regain may still occur. While non-modifiable factors associated with weight regain have been explored, modifiable factors responsible for weight regain are understudied. This scoping review aimed to identify modifiable behaviors associated with weight...

Objectives To describe the rate of do-not-resuscitate (DNR) and do-not-hospitalize (DNH) orders among residents newly admitted into long-term care homes. We also assessed the association between DNR and DNH orders with hospital admissions, deaths in hospital, and survival. Design A retrospective cohort study. Setting and participants Admissions i...

Background: Approximately half of decedents in Ontario, Canada, receive some palliative care, but little is known about the influence of language on the nature of these services. Objective: To examine differences between English- and French-speaking residents of Ontario in end-of-life care and outcomes (e.g., health care costs and location of de...

Introduction Current approaches to the development and application of predictive studies is inefficient and difficult to reproduce. Thousands of predictive health algorithms have been developed; however, less than 2\% have been assessed outside their original setting and even fewer have been applied and evaluated in practice. Objectives and Approa...

Introduction In Ontario, only 52% of people received palliative care in their last year of life, with only 20\% of those receiving it at home, which can improve the dying experience. Existing algorithms identifying people at end-of-life can potentially improve access to palliative care but are difficult for patients to understand. Objectives and A...

Background: To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets ('generalist palliative care'). Specialists should have skills for managing complex and difficult cases ('specialist palliative care') and co-exist to support generalists through consultation care and transfer of care. Little inf...

Background While most individuals wish to die at home, the reality is that most will die in hospital. Aim To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital. Design Observational retrospective cohort study, examining location of death and health care in the last year of...

Checklist of items that should be included in reports of cohort studies. (DOCX)

Logistic regression for hospital deaths excluding decedents who had a long-term care (i.e., nursing home) stay in their last 30 days of life, Ontario decedents (n = 205,431), fiscal year 2010/11 to 2012/13. (DOCX)

Codes used to identify the home based physician visits. (DOCX)

Background: The "Surprise Question" (SQ) is often used to identify patients who may benefit from a palliative care approach. The time frame of the typical question (a 12-month prognosis) may be unsuitable for identifying residents in nursing homes since it may not be able to differentiate between those who have a more imminent risk of death within...

Preoperative frailty predicts adverse postoperative outcomes. Recommendations for preoperative assessment of elderly patients include performing a frailty assessment. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical health care professionals' perception and use of frailty asses...

Introduction The burden of disease from dementia is a growing global concern as incidence increases dramatically with age, and average life expectancy has been increasing around the world. Planning for an ageing population requires reliable projections of dementia prevalence; however, existing population projections are simple and have poor predict...

Background: Preoperative frailty predicts adverse postoperative outcomes. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical healthcare professionals' use of frailty assessment for perioperative care. Methods: Healthcare professionals caring for patients enrolled at a Canadian...

Healthcare use in the year prior to death represents a large portion of healthcare spending by older adults. While Canada is considered to have advanced integration of palliative care services within our healthcare system, much of this care is still delivered in hospitals and with varying levels of access according to cause of death trajectory and...

Respite care involves providing short-term/temporary relief to individuals who are providing care to a family member or loved one. The main objective of this work was to better understand how different models of short-stay respite care affect outcomes for caregivers, care recipients, and healthcare resource utilization (including potentially delayi...

Objectives: To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. Design: Retrospective cohort study. Setting: A total of 640 publicly funded nursing homes (also known as long-term care facilities) i...

Introduction Older adults living in the community often have multiple, chronic conditions and functional impairments. A challenge for healthcare providers working in the community is the lack of a predictive tool that can be applied to the broad spectrum of mortality risks observed and may be used to inform care planning. Objective To predict surv...

Research Objectives: Currently, methods of evaluating the different facets of performance in long-term care (LTC) are underdeveloped in Canada. While it is not the only approach to performance measurement, efficiency analysis is a useful tool in addressing the challenge of resource allocation within budget constraints. Therefore, the objectives of...

Introduction: With uncertainty surrounding the true impact of the ageing population, financing the future of high quality long-term care (LTC) depends on two pivotal factors: cost control and more efficient use of resources. However, the relationships between inputs (and their costs), quality of care and operational efficiency - and what factors de...