Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan
Abstract Background To meet the increasing demand for home healthcare in Japan as the population ages, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012, respectively. This study aimed to evaluate whether enhanced HCSCs fulfilled the expected role in hom...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-09088-1 |
| _version_ | 1811171750559350784 |
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| author | Yu Sun Masao Iwagami Nobuo Sakata Tomoko Ito Ryota Inokuchi Jun Komiyama Naoaki Kuroda Nanako Tamiya |
| author_facet | Yu Sun Masao Iwagami Nobuo Sakata Tomoko Ito Ryota Inokuchi Jun Komiyama Naoaki Kuroda Nanako Tamiya |
| author_sort | Yu Sun |
| collection | DOAJ |
| description | Abstract Background To meet the increasing demand for home healthcare in Japan as the population ages, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012, respectively. This study aimed to evaluate whether enhanced HCSCs fulfilled the expected role in home healthcare. Methods We conducted a retrospective cohort study using linked medical and long-term care claims data from a municipality in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and March 2018, and used either conventional or enhanced HCSCs. Patients were followed up for one year after they started regular home visits or until the month following the end of the regular home visits if they ended within one year. The outcome measures were (i) emergency home visits at all hours and on nights and holidays at least once, respectively, (ii) hospitalization at least once, and (iii) end-of-life care, which was evaluated based on the place of death and whether a physician was present at the time of in-home death. Multivariable logistic regression analyses were conducted for the outcomes of emergency home visits and hospitalizations. Results The analysis included 802 patients, including 405 patients in enhanced HCSCs and 397 patients in conventional HCSCs. Enhanced HCSCs had more emergency home visits at all hours than conventional HCSCs (65.7% vs. 49.1%; adjusted odds ratio 1.70, 95% CI [1.26–2.28]), more emergency home visits on nights and holidays (33.6% vs. 16.7%; 2.20 [1.55–3.13]), and fewer hospitalizations (21.5% vs. 32.2%; 0.55 [0.39–0.76]). During the follow-up period, 229 patients (152 patients in enhanced HCSCs and 77 patients in HCSCs) died. Deaths at home were significantly more common in enhanced HCSCs than in conventional HCSCs (80.9% vs. 64.9%; p < .001), and physician-attended deaths among those who died at home were also significantly more common in enhanced HCSCs (99.2% vs. 78.0%; p < .001). Conclusions This study confirms that enhanced HCSCs are more likely to be able to handle emergency home visits and end-of-life care at home, which are important medical functions in home healthcare. Further promotion of enhanced HCSCs would be advantageous. |
| first_indexed | 2024-04-10T17:20:21Z |
| format | Article |
| id | doaj.art-4127f6798a62446596ec934a92d7bb93 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-10T17:20:21Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-4127f6798a62446596ec934a92d7bb932023-02-05T12:07:58ZengBMCBMC Health Services Research1472-69632023-02-012311910.1186/s12913-023-09088-1Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of JapanYu Sun0Masao Iwagami1Nobuo Sakata2Tomoko Ito3Ryota Inokuchi4Jun Komiyama5Naoaki Kuroda6Nanako Tamiya7Graduate School of Comprehensive Human Sciences, University of TsukubaHealth Services Research and Development Center, University of TsukubaHealth Services Research and Development Center, University of TsukubaHealth Services Research and Development Center, University of TsukubaHealth Services Research and Development Center, University of TsukubaGraduate School of Comprehensive Human Sciences, University of TsukubaHealth Services Research and Development Center, University of TsukubaHealth Services Research and Development Center, University of TsukubaAbstract Background To meet the increasing demand for home healthcare in Japan as the population ages, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012, respectively. This study aimed to evaluate whether enhanced HCSCs fulfilled the expected role in home healthcare. Methods We conducted a retrospective cohort study using linked medical and long-term care claims data from a municipality in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and March 2018, and used either conventional or enhanced HCSCs. Patients were followed up for one year after they started regular home visits or until the month following the end of the regular home visits if they ended within one year. The outcome measures were (i) emergency home visits at all hours and on nights and holidays at least once, respectively, (ii) hospitalization at least once, and (iii) end-of-life care, which was evaluated based on the place of death and whether a physician was present at the time of in-home death. Multivariable logistic regression analyses were conducted for the outcomes of emergency home visits and hospitalizations. Results The analysis included 802 patients, including 405 patients in enhanced HCSCs and 397 patients in conventional HCSCs. Enhanced HCSCs had more emergency home visits at all hours than conventional HCSCs (65.7% vs. 49.1%; adjusted odds ratio 1.70, 95% CI [1.26–2.28]), more emergency home visits on nights and holidays (33.6% vs. 16.7%; 2.20 [1.55–3.13]), and fewer hospitalizations (21.5% vs. 32.2%; 0.55 [0.39–0.76]). During the follow-up period, 229 patients (152 patients in enhanced HCSCs and 77 patients in HCSCs) died. Deaths at home were significantly more common in enhanced HCSCs than in conventional HCSCs (80.9% vs. 64.9%; p < .001), and physician-attended deaths among those who died at home were also significantly more common in enhanced HCSCs (99.2% vs. 78.0%; p < .001). Conclusions This study confirms that enhanced HCSCs are more likely to be able to handle emergency home visits and end-of-life care at home, which are important medical functions in home healthcare. Further promotion of enhanced HCSCs would be advantageous.https://doi.org/10.1186/s12913-023-09088-1Home healthcare servicesEmergency home visitsTerminal care |
| spellingShingle | Yu Sun Masao Iwagami Nobuo Sakata Tomoko Ito Ryota Inokuchi Jun Komiyama Naoaki Kuroda Nanako Tamiya Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan BMC Health Services Research Home healthcare services Emergency home visits Terminal care |
| title | Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan |
| title_full | Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan |
| title_fullStr | Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan |
| title_full_unstemmed | Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan |
| title_short | Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan |
| title_sort | evaluation of enhanced home care support clinics regarding emergency home visits hospitalization and end of life care a retrospective cohort study in a city of japan |
| topic | Home healthcare services Emergency home visits Terminal care |
| url | https://doi.org/10.1186/s12913-023-09088-1 |
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