Adverse events experienced by homecare
patients: a scoping review of the literature
PAUL MASOTTI, MARYANN MCCOLL AND MICHAEL GREEN
Centre for Health Services and Policy Research, Queen’s University, Kingston, ONT, Canada
Address reprint requests to: Paul Masotti, Centre for Health Services and Policy Research, Queen’s University, Kingston, ONT, Canada.
Tel: þ613-549-1232; Fax: þ613-549-7896; E-mail: email@example.com
Accepted for publication 5 January 2010
Purpose. The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experi-
enced by homecare patients.
Data sources. The literature search covered published and grey literature between 1998 and 2007. Databases searched
included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National
Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography.
Study selection. Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion cri-
teria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a
characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and
(iii) were in English.
Data extraction. A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories:
definitions, rates, causes, consequences, interventions and policy.
Results. Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters,
wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1%
with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with
communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination
Conclusion. A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are
needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will
experience adverse events.
Keywords: home care services, adverse events, medical errors, patient safety, falls, infections
Adverse events occur in all healthcare delivery settings. To
date, most research has focused on patients in hospitals and
other settings; whereas, much less has targeted patients in
homecare. Despite the lack of adverse event research in
homecare, it is reasonable to expect that adverse events
occur in all homecare settings. In addition, in homecare the
number and types of professionals who need to communi-
cate with each other and the client and caregiver may be
large and they may rarely meet . When compared with
acute care, we know that homecare services are delivered dif-
ferently and in a less structured setting. This presents policy
implications at both organization and system levels. For
example, McGraw et al.  argue that organizations ‘need to
recognize that the challenges and hazards that exist in
delivering primary health care in the home are very different
from those in bounded organizational settings such as hospi-
tals’. Lang et al.  further suggest that addressing safety in
home care will require significant changes in the ‘underlying
institutionally oriented assumptions and guiding frameworks’.
Lang and Edwards  may have best described the issue by
suggesting that we need to consider the fact that the home is
designed for living and not for healthcare services.
Further complicating the environment is the trend towards
an increased reliance upon family or other unpaid caregivers
with sufficient attention to educating or training them. This
adds complexity and clearly differentiates homecare from
acute care. Safety concerns related to characteristics of the
homecare patients’ local community environment can also be
associated with patient and caregiver safety . Thus the
more complex yet less structured nature of homecare
International Journal for Quality in Health Care vol. 22 no. 2
# The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care;
all rights reserved115
International Journal for Quality in Health Care 2010; Volume 22, Number 2: pp. 115–125
Advance Access Publication: 10 February 2010
by guest on October 29, 2015
suggests that variables associated with adverse events in
homecare differ from other settings and that the potential
for adverse events in homecare may be higher than for
patients in acute care or other institutional settings.
Adverse events in homecare will continue to emerge as an
important health policy issue for other factors that include
increased demand and cost. We can expect to see the
demand for homecare to increase and to be driven by a com-
bination of both population and health system characteristics
that include demographic changes, technological advances,
healthcare system restructuring and policy shifts and consu-
mer preferences [5, 6]. With the rise in demand, we will typi-
cally see cost increases. For example, with the exception of
drugs, homecare expenses in Canada have increased more
rapidly than all other healthcare expenditures [5, 7].
Given the above, we need a better understanding of
adverse events in the context of homecare. A summary of
what is known and not known about adverse events in
different international settings can help decision-makers
identify and prioritize patient safety policy. In this paper, we
present an overview of a longer report on homecare safety
commissioned in 2007 by the Canadian Institutes of Health
Research, Institute of Health Services and Policy Research
. Scoping reviews are designed to address this need and
are typically used to draw on the main findings of research
to present an overview of what is known on specific topics
and to identify research gaps .
We limited our focus to patients who were receiving care
under the direction of a homecare organization. This
decision was based upon a research need identified by an
Ontario homecare provider and our belief that this would
provide valuable information on the potential for direct
harm to patients. Nevertheless, we acknowledge that the
overall topic is broad and that adverse events in homecare
could be experienced by patients, providers, caregivers and
family. The next section describes the methods and is fol-
lowed by an overview of our key findings.
Adverse events experienced by homecare patients were ident-
ified as a priority issue by three Community Care Access
Centres that were responsible for organizing the delivery of
homecare services to 15 000 active clients in Ontario,
Canada . In a research agenda setting meeting, the main
research question identified was: what is known from the
existing literature about the occurrence of adverse events
experienced by patients in the delivery of homecare services?
To address this question, we used the five-stage methodologi-
cal framework for conducting scoping studies developed by
Arksey and O’Malley : (i) identifying the research question;
(ii) identifying relevant studies; (iii) study selection for more
detailed analysis; (iv) charting the data; and (v) collating,
summarizing and reporting the results. The operational defi-
nition of adverse events applied in this study is a modified
version of the one used by Masotti et al. : ‘events or
occurrences which become apparent during the delivery of
home care services, and which have a negative impact on
patient care, patient outcomes, family or support care and
resources utilization’. Specifically, our focus was on the
potential for harm to patients. Given this we excluded
adverse events experienced by individuals other than the
Our purpose was to map the extent and range of existing
research and other relevant literature. In scoping review
studies (unlike systematic reviews), researchers do not evalu-
ate the quality of the studies. Scoping review studies are gen-
erally intended to draw on the main findings of research and
to present an overview of what is known on the specific
topic. O’Malley and Croucher  suggest that scoping
reviews can be seen as a: ‘preliminary attempt to provide an
overview of existing literature that identifies areas where
more research might be required’.
The literature search covered indexed and unindexed pub-
lished literature and grey literature during the 1998–2007
time period. Major databases consulted for the indexed pub-
lished literature were: MEDLINE, EMBASE, CINAHL and
EBM REVIEWS including the Cochrane Library and
Foundation Bibliography and the Agency for Healthcare
Research and Quality and Patient Safety Net bibliography,
both of which are dedicated specifically to the study of
patient safety, were searched. Search strategies for each data-
base were developed using natural language text words and
controlled vocabulary terms specific to each database, I.E.
MeSH, Emtree headings, Cinahl headings and Thesaurus of
Aging Terminology headings for MEDLINE, EMBASE,
CINAHL and Ageline, respectively. In addition, 13 journals,
considered appropriate for homecare and patient safety, were
searched manually. This was followed by a World Wide Web
search using Google Advanced mode to identify relevant
grey literature. The grey literature search was limited to
Canadian content. We included both federal and provincial
health ministry websites and major Canadian organizations
involved in patient safety and homecare.
Papers eligible for review included research studies, review
articles, policy papers, opinion articles and legal briefs.
Specific inclusion criteria were: (i) homecare/healthcare
related services provided in the home; (ii) services were pro-
vided by a healthcare professional or caregiver under the
direction of homecare professionals; and (iii) addressed some
characteristic relevant to adverse events experienced by
patients (e.g. occurrences, rates, definitions, policy, prevention
or outcomes). Papers were excluded if they (i) were
non-English;(ii) did not
experienced adverse events; or (iii) addressed ambulatory/
Masotti et al.
by guest on October 29, 2015
out-patients or services generally not supervised by home-
care. The purpose of the inclusion and exclusion criteria was
to ensure that the papers addressed both care that was pro-
vided under the direction of homecare organizations and
some aspect of adverse events experienced by patients. The
timing of the adverse event (antecedent or outcome) includ-
ing whether paid providers or caregivers were present was
not part of the inclusion/exclusion criteria.
A preliminary pool of 1007 articles was identified using
the search strategies. Titles and abstracts were reviewed using
the inclusion/exclusion criteria and resulted in a total of 340
papers selected for full review in more detail. A detailed
analysis of the 340 papers resulted in a selection of 193
papers that was further reduced to 168 following team adju-
dication of papers that were considered a questionable fit for
the inclusion criteria. Data from the final 168 papers were
charted according to the following categories: (i) definitions
and types; (ii) rates (incidence/prevalence); (iii) causes; (iv)
consequences; (v) interventions; and (vi) policy suggestions/
implications. Where appropriate this data was further charted
depending upon its specific relevance to patients, providers,
healthcare organizations or the health system.
In this general overview, we present the results in the follow-
ing order: (i) definitions issues that emerged; (ii) studies
reporting multiple adverse event rates; (iii) adverse event
analysis categories that emerged from our analysis; (iv) preva-
lence/incidence rates; (v) causes; (vi) consequences; and
An adverse event is a term that is used frequently in the litera-
ture. However, there does not appear to be a commonly
accepted standardized definition for adverse events that
occur in homecare. Differences in definitions used vary
based upon outcomes such as the requirement for harm or
increased resources utilization versus the potential for these
to occur. Examples that illustrate the differences are in
Table 1. The literature indicated a need for clarity and stan-
dardization regarding what truly constitutes an adverse event.
For example, there are times when the same conditions exist
(e.g. medication error, patient characteristics or other antece-
dents) but result in different outcomes (e.g. injury versus no
observable injury). There also appears to be a lack of clarity
regarding what is an adverse event and what is the conse-
quence of an adverse event. For example, unplanned hospi-
talizations or emergent care have been both described as an
adverse event and the consequence or outcome of an
In the adverse drug event literature, we found that it was
common to use the term adverse drug events when the
focus was on the discussion or reporting of occurrences of
problems such as polypharmacy or medication related errors
such as: administration errors, wrong dose or inappropriate
medications. This also highlighted issues relating to oper-
ational definitions of what constitutes an adverse event
versus the antecedent or outcome of an adverse event.
Studies reporting multiple/overall adverse
Comparing the adverse event rates reported in the different
studies in each country presents challenges based upon study
differences such as: (i) operational definitions for adverse
events; (ii) the different adverse event types that were evalu-
ated; and (iii) different patient populations. For example, the
Australian studies evaluated hospital-in-the-home patients
who may not have the same characteristics as Medicare/
Medicaid patients in the USA. Table 2 illustrates the different
adverse event types evaluated in three different studies.
Seven studies in three countries (one in Canada; three in
USA; three in Australia) reported rates for overall or multiple
adverse event types. Rates reported ranged from 3.5 to
15.1% [12–18]. Johnson  found a 5.5% rate in a random
sample of 400 Winnipeg homecare clients. The American
studies reported results of large sample studies that evaluated
the Outcome and Assessment Information Set (OASIS)
database that includes reporting for 13 specific adverse event
outcomes for all Medicare/Medicaid homecare patients. In
one example, Madigan evaluated the entire 2003 OASIS
database comprising 3 013 287 patients and found a 13.1%
Caplan et al.  Unintended injury or
complication—only if it results
in disability, death or prolonged
hospital stay and is caused by
Medicare & Medicaid
reflects a serious health problem
or decline in health status for an
Masotti et al.  Events or occurrences, which
become apparent during the
delivery of homecare services
and which have a negative or
potentially negative impact on
patient care, patient outcomes,
family or support care and
Johnson Any harm to the client that
negatively affects their overall
health and/or functioning and is
the result of care actions and/or
inactions rather than the client’s
Table 1 Adverse event definitions
Low frequency-negative or
untoward event that potentially
Adverse events in homecare
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overall rate . Although these studies were not prospective
cohort studies with extensive chart reviews, the results clearly
suggest that adverse events occur frequently and the
American studies also suggested that rates for some types
are similar across time and different locations (Table 3).
Adverse event analysis categories
We identified eight thematic categories that were distinct
enough to warrant category-specific analyses. Six categories
address specific adverse event types, whereas the remaining
two categories were broader in scope. We acknowledge that
other appropriate categories exist and that the categories we
identified may not be mutually exclusive. The number of
papers per category are: (i) adverse drug events (42), (ii) line-
related (33), (iii) technology-related (16), (iv) infections and
urinary catheters (11), (v) wounds (10), (vi) falls (7),
(vii) studies reporting multiple/overall rates (7), and (viii)
Adverse drug events are typically defined as injuries resulting
from medical interventions relating to the use of a drug .
The line-related adverse event category included adverse event
associated with medical interventions that included the inser-
tion of a line through the skin and other tissue. Examples of
three commonly reported line-related adverse events include:
(i) line/catheter occlusion; (ii) catheter site infections; and
Technology-related adverse events are associated with the use of
medical equipment and technology used to deliver health
care and include oxygen therapy, ventilators, dialysis and
equipment/computer operational failures [43–55]. Adverse
events in the infections and urinary catheter-related category
excluded line-related and wound-related infections. Examples
of three commonly reported adverse events in this category
were urinary tract infections (UTIs), community-acquired
pneumonia and hospital-acquired infections [7, 33, 34, 56–
60]. Adverse events in the wounds category were associated
with disruptions in structural integrity and included surgical,
burns, infections, pressure-ulcers and vascular-leg ulcers. Falls
were adverse events associated with injury caused by
unplanned movements to the ground or another plane .
Papers in the other adverse event category typically addressed
topics that include healthcare policy, legal issues, general
patient safety and reporting and data collection. Papers in the
multiple/overall rates category evaluated patient populations for
multiple types of adverse events that typically were not
limited to a specific adverse event type such as adverse drug
stream infections [20–42].
The previous section, ‘studies reporting multiple/overall
adverse event rates’, was limited to seven papers and did not
provide an adequate description of what the literature
revealed about adverse event rates in homecare. Table 4 illus-
trates specific rates. The following provides a general over-
view of results for the specific analysis categories. The
prevalence estimates given below should be interpreted with
caution because of variations in study design and sampling.
Adverse drug events and line-related adverse events were
the most frequently reported and had the highest proportion
of events. Johnson  found that adverse drug events rep-
resented 23.1% of all adverse events in a sample of
Canadian homecare clients, whereas the Joint Commission
on Patient Safety indicated that 20–30% of homecare
patients were at risk for medication errors and that when
errors occurred in the home, 12% of the patients
1. Emergent care for
injury caused by a fall
2. Increase in the
number of pressure
3. Emergent care for
4. Substantial decline
in management of
6. Emergent care for
7. Emergent care for
8. Development of
9. Substantial decline
in three or more
10. Discharged to the
11. Discharged to the
12. Discharged to the
13. Unexpected death
Table 2 Adverse event types evaluated in three studies in
Australia (Liu and
a. Allergic reaction
effect of medication
e. Deep venous
vi. Otherf. Haemorrhage due
g. Failed diagnosis
h. Failed treatment
Masotti et al.
by guest on October 29, 2015
experienced harm (Note: reported medication error rates,
which do not always result in adverse events, ranged from 19
to 77%) [62–71]. The most frequently reported types of
line-related adverse events were catheter-related blood stream
There were fewer studies that reported adverse event rates
for the remaining categories. However, Johnson  found
that falls represented 61% of all types of adverse events
experienced and that 46% of falls resulted in injury. When
discussing wounds, Madigan  suggested that 60% of
homecare referrals required wound management. In addition,
a 20% point prevalence wound rate has been reported .
Infections also occur frequently. For example, Mananagan
et al.  reported that 16% of the 5148 homecare patients
in their study had infections during the study period and that
8% of those were homecare acquired and of the infections
50% were UTIs and 37.9% were skin infections. In another
study, Patte et al.  reported a hospital-acquired infection
rate of 6.3/100 in sample of 376 homecare patients. In
addition, home ventilator use was associated with predictable
equipment failure rates [43, 44]. This suggests that other
technology-related adverse event rates may also be predict-
able given that both human error and equipment failure are
likely to occur.
Our methods included the assumption that factors associated
with the cause or increased risk of adverse events could be
grouped into two broad categories: (i) patient-level character-
istics (includes patient, home environment and caregiver/
family) and (ii) healthcare organization and system-level
characteristics. Our definition of healthcare organizations
included homecare agencies and their associated staff, and
other clinical providers who work with patients. Many papers
in all adverse event analysis categories provided information
(both evidence based and opinion based) that addressed
causes of adverse events.
Patient-level characteristics. Commonly reported patient-level
characteristics associated with cause or increased risk were (i)
increased age and co-morbidities [14, 15, 18, 56, 58, 61, 63,
66, 67, 73–80]; (ii) gender [14, 66, 67, 81]; (iii) depression,
cognitive impairments, functional status/limitations [14, 56,
58, 62, 64, 66, 67, 73, 80–88]; (iv) patient compliance [73,
80, 82, 83, 89–91]; and (v) living alone or no caregiver [63,
65, 67, 80, 92].
Organization and system-level characteristics. Across the literature
it was clear that communication issues (including patient
education) and/or local system-level integration issues, such
as coordination and collaboration, were believed to be
associated with the primary causes of adverse events [14, 16,
56, 63–65, 73, 75, 80, 82, 86, 87, 89, 91–105]. Other
commonly reported factors associated with cause or
increased risk included: (i) team experience, training or
knowledge [74, 79, 84, 87, 92, 100, 103, 106–108]; (ii) team
workload [73, 74, 99, 103, 106]; (iii) medication errors [19,
62, 70, 73, 85, 89, 92, 108]; (iv) unrecognized polypharmacy
[63, 65, 66, 85, 86, 92]; (v) drug label instructions [87, 88,
100]; and (vi) inadequate patient monitoring/assessment [63,
67, 74, 87, 100, 102, 108].
Emergent care for injury caused by a fall or accident
Emergent care for wound infections, deteriorating wound status
Emergent care for improper medication admin, medication side
Emergent care for hypo/hyperglycemia
Development of UTI
Increase in the number of pressure ulcers
Substantial decline in 3 or more ADLs
Substantial decline in management of oral medications
Unexpected nursing home admission
Discharged to the community needing wound care or medication
Discharged to the community needing toileting assistance
Discharged to the community with behavioral problems
Table 3 Adverse event rates in two American studies
OASIS adverse eventCrisler and Richard
September 1999 to
Madigan et al.
October 2000 to
to March 2001
Values are represented in percentage. Crisler and Richard  reported overall USA rates/reference points for the 13 Adverse Event
Outcomes in the OASIS data set used by the Centers for Medicare and Medicaid. Madigan et al.  looked at rates in both Ohio and
Michigan during two time periods: October to December 2000 and January to March 2001.
Adverse events in homecare
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As expected and aligned with the different definitions for
adverse events, reported consequences exist on a continuum
that can range from barely observable occurrences to those
that have high health and economic costs. Examples of
health consequences include functional loss or decline,
illness, temporary injury/pain, permanent injury/harm, and
death [13, 16–18, 21, 25, 28, 31, 35, 39, 56, 59, 63, 70, 73,
74, 80, 88, 92, 104, 105, 108–115]. Economic consequences
include increased need for treatment or care, increased
patient or caregiver time and unplanned hospitalization [16–
18, 20–22, 24, 27, 28, 31, 35, 36, 42, 56, 59, 73, 80, 81, 101,
102, 105, 110–119]. In addition, in the Canadian study that
evaluated multiple adverse event rates, Johnson  reported
that 69.3% of the adverse events resulted in temporary
harm, 4% in permanent harm, 4% in permanent placement
and 15.4% resulted in unneeded hospitalizations. Franklin
 also suggested that harm is more likely to result from
adverse events associated with intravenous errors because of
the immediate absorption of the drug and the inability to
recall it after it is given. Whereas, Fortinsky found that 9%
of homecare patients were hospitalized due to wounds (com-
pared with 7% for falls, the next most frequent cause).
Fortinsky  also reported that the odds of being hospital-
ized were much higher for a homecare patient with a wound
versus one without.
Other reported consequences of interest include the fol-
lowing: (i) burns associated with patients on oxygen therapy
who smoke ; (ii) patient initiated lawsuits [53, 98];
(iii) delayed therapy [22, 28, 118]; and (iv) increased emer-
gency room visits for patients on ventilators, home oxygen
and suction machines following power outages .
To be identified as an intervention, the main criteria used
was the requirement that the article discussed or presented
evidence of a formal program that was designed with the
objective of identifying adverse events, decreasing rates or
reducing their impact.
Our analysis revealed an abundance of policy or best prac-
however, there was a paucity of actual intervention models or
intervention effectiveness studies. For example, we only
found a total of 18 interventions documented in five of the
eight categories: adverse drug events (4); line-related adverse
events (3); wounds (2); falls (4) and other adverse events (5).
However, many of the examples we included did not meet
full inclusion criteria for our operational definition of
Characteristics of intervention models the authors con-
sidered successful or potentially effective included (i) improv-
ing staff knowledge and training; (ii) increased patient
monitoring and reporting by providers; (iii) use of computer-
ized screening to identify potential adverse drug events; (iv)
implementing required standardized reporting; (v) improved
collaboration/communication between local providers (acute
care, primary care and homecare); (vi) using an appropriate
Adverse drug events
Line-related adverse events
Catheter-related blood stream infection
Catheter site infections
Table 4 Reported adverse event rates by type
Category Reported rates
3.64–72% [62, 63, 73, 81, 89, 109–111, 116, 118, 126]
0.19–3.3/1000 catheter days [27, 28, 112, 127–131]
0.4–2.1/1000 catheter days [29, 31, 34, 36]
0.51–3.1/1000 catheter days [27–29, 31]
3.7–9.1% [27–29, 31]
34%  Associated with home parenteral nutrition
Associated with home ventilators
Infections and urinary catheters
189 events per 150 patients in 1 year 
25/1000 person years 
1.04 infections/infected patient ratio 
0.87–1.93 infections/1000 ventilator days 
2.79–3.4/1000 catheter days [34, 59, 106]
43% with indwelling catheters 
Homecare-acquired infections/other complications
2–6% [15, 132]
27% onetime 
10% ?1 
Masotti et al.
by guest on October 29, 2015
interdisciplinary team mix; (vii) focus on both patient
(includes home and caregivers) and provider level character-
istics; and (viii) targeting identified adverse events for further
comprehensive investigation into patient-level and provider-
level characteristics [13, 15, 31, 60, 65, 72, 76, 78, 86, 89,
Our findings are the result of a comprehensive five-stage
structured approach to conducting a review of the body of
English language indexed and unindexed literature that was
published/made available during the 1998–2007 time
period. Our scoping review identified six key categories of
events recognized in the published literature: adverse drug
events, line related, technology related, infections/urinary
catheters, wounds and falls. Although these categories were
the ones that emerged from our review, we recognize that
other appropriate categories or sub-categories exist. Given
this, we suggest that a better understanding of adverse
events in homecare would result from research that utilizes a
typology that places similar adverse event types into
appropriate categories for evaluation based upon shared
characteristics (e.g. biological, causes, outcomes, patient sub-
populations, provider-level characteristics and treatment
type). For example, gender-based analyses would be appro-
priate given that women live longer and consequently may
have the unfortunate experience of transitioning from care-
giver to patient.
A second finding of this study relates to the relatively
small international body of evidence addressing overall
adverse event incident and prevalence rates. The results of
our scoping review suggest that it is reasonable to conclude
that adverse events in homecare occur frequently and with
some degree of predictability for specific types. However,
one should not interpret the results to reflect the true experi-
ence of homecare patients in multiple homecare settings.
This assertion is based upon the following: (i) few studies
reported rates and evaluating the quality of those studies was
outside of the scope of this scoping review study; (ii) none
of the studies were large sample prospective cohort studies;
(iii) different adverse event definitions were used and studies
did not evaluate the same groups of adverse event types; and
(iv) some adverse event types still need to be identified and
defined before they can be documented. Given this, we
hypothesize that the actual rates experienced by homecare
patients could be higher. Consequently, we suggest that
measuring the rates of adverse events in homecare settings
should be considered a priority health policy issue.
One conclusion from our research was that policy aimed
at preventing or reducing the impact of adverse events will
need to target multilevel changes (e.g. patient, caregiver,
home environment, provider, organization and healthcare
system levels). The literature clearly indicated that between
and within organization communication issues (includes
patient and caregiver education), provider education and local
health system-level integration issues were perceived to be
associated with primary causes of adverse events. There is a
clear need for a system-level approach that includes increased
focus on caregivers and the home environment. In addition,
system-wide initiatives that will support the continued ability
to understand adverse events and improve patient safety
include: (i) acceptance and implementation of a standardized
definition for adverse events and for specific adverse event
types; (ii) required data collection and reporting of specific
adverse events; and (iii) system-wide surveillance. However,
effective policy will require more knowledge and conse-
quently, more research.
In general, there is a need for multiple large sample cohort
studies designed to improve our understanding of character-
istics associated with the occurrence of adverse events.
Ideally, this research would increase our understanding of
rates, risks and outcomes for specific adverse event types in
different homecare subpopulations and under different
models of delivery. This research should evaluate patient-
level, provider/organization-level and local healthcare system-
level factors associated with adverse events as well as the
relationships between the different levels.
This scoping review study revealed three primary research
areas that need to be addressed to increase our knowledge
about adverse events in homecare: (i) incidence rates (e.g. for
multiple adverse event types and homecare patients with
different characteristics); (ii) multi-level variables associated
with the occurrence of adverse events (e.g. patient/provider/
system-level variables associated with causes and conse-
quences); and (iii) information on effective interventions and
best practices (e.g. to identify, prevent or reduce the impact
of adverse events). However, a first step in effectively
approaching these research areas would be the development
and acceptance of a standardized definition for an adverse
event and for specific adverse event types.
We would also like to acknowledge the contributions of
Margaret Darling and Nadia Zurba from the Centre for
Health Services and Policy Research, Queen’s University.
This work was supported by the Canadian Institutes of
Health Research—Institute of Health Services and Policy
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