Association between types of home healthcare and emergency house calls, hospitalization, and end‐of‐life care in Japan

Author:

Sun Yu123,Iwagami Masao23ORCID,Komiyama Jun13,Sugiyama Takehiro2345,Inokuchi Ryota23,Sakata Nobuo236,Ito Tomoko2,Yoshie Satoru2789ORCID,Matsui Hiroki10,Kume Keitaro11,Sanuki Masaru11,Kato Genta12,Mori Yukiko13,Ueshima Hiroaki14,Tamiya Nanako23

Affiliation:

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

2. Health Services Research and Development Center University of Tsukuba Ibaraki Japan

3. Department of Health Services Research, Institute of Medicine University of Tsukuba Ibaraki Japan

4. Diabetes and Metabolism Information Center Research Institute, National Center for Global Health and Medicine Tokyo Japan

5. Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine Tokyo Japan

6. Heisei Medical Welfare Group Research Institute Tokyo Japan

7. Institute of Gerontology, The University of Tokyo Tokyo Japan

8. Institute for Future Initiatives, The University of Tokyo Tokyo Japan

9. Department of Health Policy and Management, School of Medicine Keio University Tokyo Japan

10. Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan

11. Department of Clinical Medicine University of Tsukuba Ibaraki Japan

12. Solutions Center for Health Insurance Claims Kyoto University Hospital Kyoto Japan

13. Division of Medical Information Technology and Administration Planning Kyoto University Hospital Kyoto Japan

14. Center for Innovative Research and Education in Data Science Institute for Liberal Arts and Sciences, Kyoto University Kyoto Japan

Abstract

AbstractBackgroundTo meet the increasing demand for home healthcare in Japan, as part of the national healthcare system, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012 respectively. This study aimed to evaluate whether HCSCs has succeeded in providing 24‐h home care services through the end of life.MethodsA retrospective cohort study was conducted using the national database in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and September 2015, and used general clinics, conventional HCSCs, or enhanced HCSCs. Each patient was followed up for 6 months after the first visit. The outcome measures were (i) emergency house call(s), (ii) hospitalization(s), and (iii) end‐of‐life care defined as in‐home death. Multivariable logistic regression analyses were performed for statistical analysis.ResultsThe analysis included 160,674 patients, including 13,477, 64,616, and 82,581 patients receiving regular home visits by general clinics, conventional HCSCs, and enhanced HCSCs respectively. Compared to general clinics, the use of conventional and enhanced HCSCs was associated with an increased likelihood of emergency house calls (adjusted odds ratio [aOR] and 95% confidence intervals [CIs] of 1.62 [1.56–1.69] and 1.86 [1.79–1.93], respectively) and a decreased likelihood of hospitalizations (aOR [95% CIs] of 0.86 [0.82–0.90] and 0.88 [0.84–0.92] respectively). Among 39,082 patients who died during the follow‐up period, conventional and enhanced HCSCs had more in‐home deaths (aOR [95% CIs] of 1.46 [1.33–1.59] and 1.60 [1.46–1.74], respectively) compared to general clinics.ConclusionsHCSCs (especially enhanced HCSCs) provided more emergency house calls, reduced hospitalization, and enabled expected deaths at home, suggesting that further promotion of HCSCs (especially enhanced HSCSs) would be advantageous.

Funder

Ministry of Health, Labour and Welfare

Publisher

Wiley

Subject

Geriatrics and Gerontology

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