Association of the Frequency of In-Home Care Services Utilization and the Probability of In-Home Death.
Association of the Frequency of In-Home Care Services Utilization and the Probability of In-Home Death.
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DOI：
10.1001/jamanetworkopen.2021.32787
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发表时间：
2021-11-01
影响因子：
13.8
通讯作者：
Tamiya N
中科院分区：
文献类型：
--
作者：
Abe K;Kawachi I;Watanabe T;Tamiya N
家庭护理服务是否能使受助人在生命结束时留在家中？在这项队列研究中，调查了日本572059名使用长期护理服务的老年人的死亡情况，在生命结束时，每天使用家庭护理服务的增加与家庭死亡概率增加3.6%相关。这些结果的政策含义之一是，为了满足患者的临终偏好，不仅需要促进在家中提供医疗服务，而且还需要确保护理人员的充足供应。本研究对日本使用长期护理服务的老年人进行了队列研究，分析了家庭临终护理服务频率与家庭死亡率增加的关系。提供临终关怀是与世界各地人口老龄化相关的一个重要政策问题。然而，目前尚不清楚提供家庭护理服务是否可以让患者在生命结束时选择在家死亡。评估经常使用家居照顾服务能否协助受助人在生命终结时留在家中。这项针对日本长期护理保险制度中老年人的队列研究使用了国家索赔数据。参加者为2015年死亡的65岁及以上长期护理保险受益人，不包括因意外事故等外部原因死亡的人。数据分析于二零二零年十月至十二月进行。从死亡月份前一个月的第一天到死亡日期每周使用家庭护理服务的平均天数。主要结果是老年人是否在家中死亡（或没有）。为了解决缺乏关于个人对死亡地点偏好的信息的问题，我们使用了一种工具变量估计，即2014年市级为每个老年人提供家庭护理服务的全职护理人员数量。在纳入研究的572059例死亡者中，314743例（55.0%）为女性（中位[IQR]年龄为87 [81-91]岁）。在家中死亡的比例为10.5%（60 175名死者），81 675名死者（14.3%）在死亡前至少使用过一次家庭护理服务。普通最小二乘和两阶段最小二乘分析均表明，更频繁地使用家庭护理与更高的家庭死亡概率相关（普通最小二乘估计值，5.0个百分点; 95% CI，4.9-5.1点vs两阶段最小二乘估计值，3.6个百分点; 95% CI，2.3-4.9点）。这项使用工具变量方法的回顾性队列研究表明，在生命结束时更频繁地使用家庭护理服务与更高的家庭死亡概率相关。这些结果的政策含义之一是，为了满足患者的临终偏好，不仅需要促进在家中提供医疗服务，而且还需要确保护理人员的充足供应。
Do in-home care services enable recipients to stay home at the end of life? In this cohort study that examines 572 059 deaths among older adults using long-term care services in Japan, each day of increase in the use of in-home care service at the end of life was associated with a 3.6 percentage point increased probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers. This cohort study of older adults using long-term care services in Japan analyzes the association of the frequency of in-home end-of-life care services with increased in-home death. The provision of end-of-life care is an important policy issue associated with population aging around the world. Yet it is unclear whether the provision of in-home care services can allow patients the option of in-home death at end of life. To assess whether the frequent use of in-home care services can assist recipients to stay at home at the end of life. This cohort study of older adults in Japan’s long-term care insurance system used national claims data. Participants were long-term care insurance beneficiaries aged 65 years or over who died in 2015, excluding those who died due to external causes such as accidents. Data analyses were conducted from October to December 2020. Mean days of in-home care service used per week from the first day of the month before the month of death to the date of death. Primary outcome was whether the older person died at home (or not). To address lack of information on individual preference for place of death, we used an instrumental variable estimation with the full-time equivalent number of care workers providing in-home care services per older population at the municipality level in 2014. Of the 572 059 decedents included in the study, 314 743 (55.0%) were women (median [IQR] age, 87 [81-91] years). The proportion of in-home deaths was 10.5% (60 175 decedents), and 81 675 decedents (14.3%) used in-home care services at least once prior to their death. Ordinary least squares and 2-stage least squares analyses both indicated that more frequent use of in-home care was associated with a higher probability of in-home deaths (ordinary least squares estimate, 5.0 percentage points; 95% CI, 4.9-5.1 points vs 2-stage least squares estimate, 3.6 percentage points; 95% CI, 2.3-4.9 points). This retrospective cohort study using an instrumental variable approach demonstrated that more frequent use of in-home care services at the end of life was associated with a higher probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers.
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影响因子：
3.1
作者：
Gomes B;Calanzani N;Gysels M;Hall S;Higginson IJ
通讯作者：
Higginson IJ
DOI：
10.1111/j.1532-5415.2005.53175.x
发表时间：
2005-03-01
影响因子：
6.3
作者：
Tsutsui, T;Muramatsu, N
通讯作者：
Muramatsu, N
影响因子：
3.7
作者：
Angrist, JD;Imbens, GW;Rubin, DB
通讯作者：
Rubin, DB
影响因子：
4.7
作者：
Patrick, DL;Engelberg, RA;Curtis, JR
通讯作者：
Curtis, JR
影响因子：
2.9
作者：
Abe, Kazuhiro;Miyawaki, Atsushi;Tamiya, Nanako
通讯作者：
Tamiya, Nanako