Comparison of progression of care-need levels among long-term care recipients with and without advanced care management in a rural municipality of Japan: A population-based observational study
Comparison of progression of care-need levels among long-term care recipients with and without advanced care management in a rural municipality of Japan: A population-based observational study
复制标题
DOI：
10.1016/j.ijnurstu.2020.103804
复制
发表时间：
2021-01-01
影响因子：
8.1
通讯作者：
Tamiya, Nanako
中科院分区：
文献类型：
--
作者：
Itoh, Sakiko;Mori, Takahiro;Tamiya, Nanako
背景：关于先进的护理管理与家庭环境中患者结局之间的关系知之甚少。2009年，日本政府推出了一项财政奖励计划，鼓励至少有一名高级护理管理人员的长期护理机构进行高级护理管理。然而，目前尚不清楚农村地区的先进护理管理是否与接受者的预后改善有关。目的：比较在家庭环境中有和没有先进护理管理的长期护理接受者的护理需求水平的进展。设计：一项以人群为基础的观察性研究。设置：日本农村自治市。参与者：长期护理接受者（n = 2005）.方法：我们使用从农村市政府提供的个人层面的二级数据，这些数据是作为2012年4月至2017年3月期间长期护理福利支出调查和医疗保健索赔记录的一部分收集的。我们用唯一标识符把这两个数据库连接起来。研究受试者的入选标准是：（1）年龄≥ 65岁;（2）新认证为护理需求水平1，2或3;（3）从2012年4月到2017年3月在家中使用长期护理保险服务。我们排除了使用长期护理保险服务不到六个月的个人。最终，我们选择了1722名倾向匹配的接受和不接受高级护理管理的受者，然后进行Kaplan-Meier生存分析和对数秩检验。结果的衡量标准是护理需求水平的进展。在接受和不接受高级护理管理的组中，护理需求1级的受者的5年累积无进展生存率分别为50.3%和42.2（p <0.01），2级护理需求者分别为34.3%和32.3%（p <0.01），3级护理需求者分别为22.3%和24.5%（p > 0.05）。无进展期持续时间的中位数为12（四分位数间距，10-24）个月，护理需求等级为1、14（四分位数间距，11-28）个月，护理需求等级为2级，（四分位数间距，10-24）个月的护理需要3级的收件人。在日本的一个农村城市，在家庭环境中进行高级护理管理的长期护理接受者的护理需求水平进展的概率更高。这一发现表明，政府的政策，提供先进的护理管理的财政奖励可能不会有效地改善长期护理受助人在日本的农村城市的结果。(C)2020爱思唯尔有限公司保留所有权利。
Background: Little is known about the association between advanced care management and patient outcomes in home settings. In 2009, the Japanese government introduced a financial incentive scheme for advanced care management by long-term care agencies with at least one advanced care manager. However, it remains unclear whether advanced care management in rural areas is associated with improved outcomes for recipients.Objective: To compare the progression of care-need levels among long-term care recipients in home settings with and without advanced care management.Design: A population-based observational study.Setting: A rural municipality in Japan.Participants: Recipients of long-term care (n = 2005).Methods: We used individual-level secondary data provided from a rural municipal government that was collected as part of the Survey of Long-Term Care Benefit Expenditures and medical care claim records between April 2012 and March 2017. We linked these two databases using unique identifiers. The inclusion criteria for study subjects were that they: (1) were aged >= 65 years; (2) were newly certified as care-need level 1, 2, or 3; and (3) used long-term care insurance services in home settings from April 2012 through March 2017. We excluded individuals using long-term care insurance services for less than six months. Ultimately, we selected 1722 propensity-matched recipients with and without advanced care management, and then conducted Kaplan-Meier survival analyses and a log-rank test. The outcome measure was progression of care-need levels.Results: The proportions of five-year cumulative progression-free survival in the groups with and without advanced care management were 50.3% and 42.2% for recipients of care-need level 1 (p < .01), 34.3% and 32.3% for recipients of care-need level 2 (p < .01), and 22.3% and 24.5% for recipients of care-need level 3 (p > .05), respectively. The progression-free period lasted a median of 12 (interquartile range, 10-24) months for recipients of care-need level 1, 14 (interquartile range, 11-28) months for recipients of care-need level 2, and 12 (interquartile range, 10-24) months for recipients of care-need level 3.Conclusions: Long-term care recipients with advanced care management in home settings had a higher probability of progression of care-need levels in a rural municipality of Japan. This finding suggests that the governmental policy of providing financial incentive for advanced care management may not be effective in improving the outcome of long-term care recipients in a rural municipality of Japan. (C) 2020 Elsevier Ltd. All rights reserved.