Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: A retrospective cohort study.

Author:

Hamasaki Yoko1,Sakata Nobuo2,Jin Xueying3,Sugiyama Takehiro4,Morita Kojiro5,Uda Kazuaki4,Matsuda Shinya6,Tamiya Nanako4

Affiliation:

1. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki

2. Heisei Medical Welfare Research Institute, Tokyo

3. Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu

4. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki

5. Global Nursing Research Center, Graduate School of Medicine, University of Tokyo

6. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu

Abstract

Abstract Background Wide variations in facility staffing may lead to differences in care, and consequently, adverse outcomes such as hospitalizations. However, few studies focused on types of occupations. Therefore, we aimed to examine the association between a wide variety of facility staffing and potentially avoidable hospitalizations of nursing home residents in Japan.Methods In this retrospective cohort study using long-term care and medical insurance claims data in Ibaraki Prefecture from April 2018 to March 2019, we identified individuals aged 65 years and above who were newly admitted to nursing homes. In addition, facility characteristic data were obtained from the long-term care insurance service disclosure system. Subsequently, we conducted a multivariable Cox regression analysis and evaluated the association between facility staffing and potentially avoidable hospitalizations.Results A total of 2909 residents from 235 nursing homes were included. The cumulative incidence of potentially avoidable hospitalizations at 180 days was 14.2% (95% confidence interval [CI] 12.7–15.8). Facilities with full-time physicians (adjusted hazard ratio [HR]: 0.59, 95% CI: 0.37–0.94) and a higher number of dietitians (HR: 0.72, 95% CI: 0.54–0.97) were significantly associated with a lower likelihood of potentially avoidable hospitalizations. In contrast, having nurses or trained caregivers during the night shift (HR: 1.72, 95% CI: 1.25–2.36) and a higher number of care managers (HR: 1.37, 95% CI: 1.03–1.83) were significantly associated with a high probability of potentially avoidable hospitalizations.Conclusions We revealed that variations in facility staffing were associated with potentially avoidable hospitalizations. The results suggest that optimal allocation of human resources, such as dietitians and physicians, may be essential to reduce potentially avoidable hospitalizations. To provide appropriate care to nursing home residents, it is necessary to establish a system to effectively allocate limited resources. Further research is warranted on the causal relationship between staff allocation and unnecessary hospitalizations, considering the confounding factors.

Publisher

Research Square Platform LLC

Reference35 articles.

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2. Ministry of Health Labour and Welfare. 179th meeting of the long-term care insurance subcommittee of the social security council (Japanese) [Available from: https://www.mhlw.go.jp/content/12300000/000648154.pdf.

3. Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: Patterns and risk factors;Bogaisky M;J Am Geriatr Soc,2015

4. Facility characteristics associated with hospitalization of nursing home residents: Results of a national study;Intrator O;Med Care,1999

5. Nursing home characteristics and potentially preventable hospitalizations of long-stay residents;Intrator O;J Am Geriatr Soc,2004

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