Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data
Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data
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通过事件功能残疾风险评估量表累积的长期护理福利：长期护理收据数据的六年随访研究
DOI：
10.11236/jph.21-056
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发表时间：
2021
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影响因子：
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通讯作者：
斉藤雅茂・辻大士・藤田欽也・近藤尚己・相田潤・尾島俊之・近藤克則
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作者：
太田 岳;任 書晃;日比野 浩;斉藤雅茂・辻大士・藤田欽也・近藤尚己・相田潤・尾島俊之・近藤克則
目的本研究旨在评估公共长期护理（LTC）保险服务的累积福利成本的差异，使用风险评估量表评分，预测老年人的事件功能障碍。方法在2010年进行了一项基线调查，涉及来自日本12个市政府的65岁及以上的个人，他们没有资格享受公共LTC保险福利（应答率：64.7%）。使用公共LTC索赔记录，我们跟踪了46，616名个人在大约六年（长达76个月）的时间内的LTC服务成本。我们使用风险评估量表评估意外功能残疾（0-48）。我们采用了经典的线性回归模型，Tobit回归模型，以及对缺失值进行多重插补的线性回归。总体而言，7，348（15.8%）的参与者在随访期间使用了LTC服务。意外功能性残疾的风险评估分数与每人长期护理服务的累积成本、长期护理服务的使用期长短以及证明有长期护理/支持需要和超过长期护理2级的人的比例呈正相关。在调整混杂变量后，LTC服务的6年累积成本每点风险评分高出约3.16万日元（95%置信区间[CI]：28.3至35.0）。低评分组（风险评分≤ 16）的成本高出约8900日元（95% CI：6.5 - 11.3），高分组（风险评分≥ 17）高出75300日元（95% CI：67.4 - 83.1）。当我们采用其他估计模型时，主要结果和趋势没有很大不同。结论在本研究中，风险评估量表评分可以估计后续LTC受益成本。改善和维持风险评估评分可变方面的社区干预措施可能有助于减少城市内的公共LTC福利。
Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people. Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values. Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95% CI: 6.5 to 11.3) higher in the low score group (risk score≤ 16), and JPY 75.3 thousand (95% CI: 67.4 to 83.1) higher in the high score group (risk score≥ 17). When we adopted other estimated models, the major results and trends were not largely different. Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.