Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study
Abstract Background Wide variations in facility staffing may lead to differences in care, and consequently, adverse outcomes such as hospitalizations. However, few studies focused on types of occupations. Therefore, we aimed to examine the association between a wide variety of facility staffing and...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-09-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04278-2 |
| _version_ | 1797451570128879616 |
|---|---|
| author | Yoko Hamasaki Nobuo Sakata Xueying Jin Takehiro Sugiyama Kojiro Morita Kazuaki Uda Shinya Matsuda Nanako Tamiya |
| author_facet | Yoko Hamasaki Nobuo Sakata Xueying Jin Takehiro Sugiyama Kojiro Morita Kazuaki Uda Shinya Matsuda Nanako Tamiya |
| author_sort | Yoko Hamasaki |
| collection | DOAJ |
| description | Abstract Background Wide variations in facility staffing may lead to differences in care, and consequently, adverse outcomes such as hospitalizations. However, few studies focused on types of occupations. Therefore, we aimed to examine the association between a wide variety of facility staffing and potentially avoidable hospitalizations of nursing home residents in Japan. Methods In this retrospective cohort study using long-term care and medical insurance claims data in Ibaraki Prefecture from April 2018 to March 2019, we identified individuals aged 65 years and above who were newly admitted to nursing homes. In addition, facility characteristic data were obtained from the long-term care insurance service disclosure system. Subsequently, we conducted a multivariable Cox regression analysis and evaluated the association between facility staffing and potentially avoidable hospitalizations. Results A total of 2909 residents from 235 nursing homes were included. The cumulative incidence of potentially avoidable hospitalizations at 180 days was 14.2% (95% confidence interval [CI] 12.7–15.8). Facilities with full-time physicians (adjusted hazard ratio [HR]: 0.59, 95% CI: 0.37–0.94) and a higher number of dietitians (HR: 0.72, 95% CI: 0.54–0.97) were significantly associated with a lower likelihood of potentially avoidable hospitalizations. In contrast, having nurses or trained caregivers during the night shift (HR: 1.72, 95% CI: 1.25–2.36) and a higher number of care managers (HR: 1.37, 95% CI: 1.03–1.83) were significantly associated with a high probability of potentially avoidable hospitalizations. Conclusions We revealed that variations in facility staffing were associated with potentially avoidable hospitalizations. The results suggest that optimal allocation of human resources, such as dietitians and physicians, may be essential to reduce potentially avoidable hospitalizations. To provide appropriate care to nursing home residents, it is necessary to establish a system to effectively allocate limited resources. Further research is warranted on the causal relationship between staff allocation and unnecessary hospitalizations, considering the confounding factors. |
| first_indexed | 2024-03-09T14:56:31Z |
| format | Article |
| id | doaj.art-cf6b07bf41804f6aa01e3fda29f37db0 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-09T14:56:31Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-cf6b07bf41804f6aa01e3fda29f37db02023-11-26T14:10:56ZengBMCBMC Geriatrics1471-23182023-09-0123111010.1186/s12877-023-04278-2Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort studyYoko Hamasaki0Nobuo Sakata1Xueying Jin2Takehiro Sugiyama3Kojiro Morita4Kazuaki Uda5Shinya Matsuda6Nanako 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 TsukubaGlobal Nursing Research Center, Graduate School of Medicine, University of TokyoHealth Services Research and Development Center, University of TsukubaDepartment of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental HealthHealth Services Research and Development Center, University of TsukubaAbstract Background Wide variations in facility staffing may lead to differences in care, and consequently, adverse outcomes such as hospitalizations. However, few studies focused on types of occupations. Therefore, we aimed to examine the association between a wide variety of facility staffing and potentially avoidable hospitalizations of nursing home residents in Japan. Methods In this retrospective cohort study using long-term care and medical insurance claims data in Ibaraki Prefecture from April 2018 to March 2019, we identified individuals aged 65 years and above who were newly admitted to nursing homes. In addition, facility characteristic data were obtained from the long-term care insurance service disclosure system. Subsequently, we conducted a multivariable Cox regression analysis and evaluated the association between facility staffing and potentially avoidable hospitalizations. Results A total of 2909 residents from 235 nursing homes were included. The cumulative incidence of potentially avoidable hospitalizations at 180 days was 14.2% (95% confidence interval [CI] 12.7–15.8). Facilities with full-time physicians (adjusted hazard ratio [HR]: 0.59, 95% CI: 0.37–0.94) and a higher number of dietitians (HR: 0.72, 95% CI: 0.54–0.97) were significantly associated with a lower likelihood of potentially avoidable hospitalizations. In contrast, having nurses or trained caregivers during the night shift (HR: 1.72, 95% CI: 1.25–2.36) and a higher number of care managers (HR: 1.37, 95% CI: 1.03–1.83) were significantly associated with a high probability of potentially avoidable hospitalizations. Conclusions We revealed that variations in facility staffing were associated with potentially avoidable hospitalizations. The results suggest that optimal allocation of human resources, such as dietitians and physicians, may be essential to reduce potentially avoidable hospitalizations. To provide appropriate care to nursing home residents, it is necessary to establish a system to effectively allocate limited resources. Further research is warranted on the causal relationship between staff allocation and unnecessary hospitalizations, considering the confounding factors.https://doi.org/10.1186/s12877-023-04278-2Potentially avoidable hospitalizationsNursing homesJapanLong-term care |
| spellingShingle | Yoko Hamasaki Nobuo Sakata Xueying Jin Takehiro Sugiyama Kojiro Morita Kazuaki Uda Shinya Matsuda Nanako Tamiya Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study BMC Geriatrics Potentially avoidable hospitalizations Nursing homes Japan Long-term care |
| title | Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study |
| title_full | Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study |
| title_fullStr | Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study |
| title_full_unstemmed | Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study |
| title_short | Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study |
| title_sort | facility staffing associated with potentially avoidable hospitalizations in nursing home residents in japan a retrospective cohort study |
| topic | Potentially avoidable hospitalizations Nursing homes Japan Long-term care |
| url | https://doi.org/10.1186/s12877-023-04278-2 |
| work_keys_str_mv | AT yokohamasaki facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT nobuosakata facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT xueyingjin facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT takehirosugiyama facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT kojiromorita facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT kazuakiuda facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT shinyamatsuda facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy AT nanakotamiya facilitystaffingassociatedwithpotentiallyavoidablehospitalizationsinnursinghomeresidentsinjapanaretrospectivecohortstudy |