Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan
Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan
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DOI：
10.1136/bmjopen-2018-026238
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发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Tamiya, Nanako
中科院分区：
文献类型：
--
作者：
Abe, Kazuhiro;Miyawaki, Atsushi;Tamiya, Nanako
目的评估在患者死亡前接受由非医疗专业人员提供的认证护理员家庭护理服务与患者在家死亡概率之间的关系。设计观察性研究，使用65岁或以上人口中提供家庭护理服务的全职认证护理员人数，以每个市町村的患者死亡前一年为工具变量。设置日本公共长期护理保险（LTCI）制度所覆盖的认证护理人员家庭护理服务。研究对象在65岁以上的LTCI受益人中，共有1613391人去世，除外部死亡原因外，2010年1月至2013年12月期间的死亡均纳入分析。主要结局指标为在家中死亡或在其他地方死亡，包括医院、疗养院和有床位的诊所。在死亡月份前1、2或3个月内，每月使用注册护理员家居照顾服务超过一次的病人数目分别为213 848、176 686及155 716人。这与增加的概率在家里死亡的9.1%点（95%CI 2.9至15.3），10.5%点（3.3至17.6）和11.4%点（3.6至19.2），分别。结论使用认证的护理人员的家庭护理服务死亡前与增加的概率在家里死亡。
Objectives To assess the association between receiving the certified care workers' home care service, which is provided by non-medical professionals prior to a patients' death and the probability of a home death.Design Observational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient's death per municipality as an instrumental variable.Setting The certified care workers' home care service covered by the public long-term care insurance (LTCI) system in Japan.Participants In total, 1613391 LTCI beneficiaries aged 65 or above who passed away, except by an external cause of death, between January 2010 and December 2013 were included in the analysis.Primary outcome measures Death at home or death at other places, including hospitals, nursing homes and clinics with beds.Results Out of all participants, 173498 (10.8%) died at home. The number of patients who used the certified care workers' home care service more than once per each month during 1, 2 or 3months prior to the month of death numbered 213 848, 176686 and 155 716, respectively. This was associated with an increased probability of death at home by 9.1% points (95% CI 2.9 to 15.3), 10.5% points (3.3 to 17.6) and 11.4% points (3.6 to 19.2), respectively.Conclusions The use of the certified care workers' home care service prior to death was associated with the increased probability of a home death.