Comparison of care utilisation and medical institutional death among older adults by home care facility type: a retrospective cohort study in Fukuoka, Japan

• Published in: BMJ open Vol. 11; no. 4; p. e041964
• Main Authors: Kim, Sung-A, Babazono, Akira, Jamal, Aziz, Li, Yunfei, Liu, Ning
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 14.04.2021; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Aged; Chronic illnesses; Cohort analysis; Expenditures; Health care policy; Health Facilities; Health Policy; Home Care Services; Home health care; Hospitalization; Hospitals; Humans; Insurance claims; Integrated delivery systems; Japan - epidemiology; Older people; Palliative care; Patients; Retrospective Studies; Japan; United States > US; health policy; health services administration & management; health economics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-041964

ObjectivesWe compared the care services use and medical institutional deaths among older adults across four home care facility types.DesignThis was a retrospective cohort study.SettingWe used administrative claims data from April 2014 to March 2017.ParticipantsWe included 18 347 residents of Fukuoka Prefecture, Japan, who received home care during the period, and aged ≥75 years with certified care needs of at least level 3. Participants were categorised based on home care facility use (ie, general clinics, Home Care Support Clinics/Hospitals (HCSCs), enhanced HCSCs with beds and enhanced HCSCs without beds).Primary and secondary outcome measuresWe used generalised linear models (GLMs) to estimate care utilisation and the incidence of medical institutional death, as well as the potential influence of sex, age, care needs level and Charlson comorbidity index as risk factors.ResultsThe results of GLMs showed the inpatient days were 54.3, 69.9, 64.7 and 75.0 for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs and general clinics, respectively. Correspondingly, the numbers of home care days were 63.8, 51.0, 57.8 and 29.0. Our multivariable logistic regression model estimated medical institutional death rate among participants who died during the study period (n=9919) was 2.32 times higher (p<0.001) for general clinic users than enhanced HCSCs with beds users (relative risks=1.69, p<0.001).ConclusionsParticipants who used enhanced HCSCs with beds had a relatively low inpatient utilisation, medical institutional deaths, and a high utilisation of home care and home-based end-of-life care. Findings suggest enhanced HCSCs with beds could reduce hospitalisation days and medical institutional deaths. Our study warrants further investigations of home care as part of community-based integrated care.