Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study

IF 2.4 3区医学 Q1 NURSING

Journal of Nursing Scholarship Pub Date : 2023-08-29 DOI:10.1111/jnu.12934

Tomomi Sakano MSN, RN, Tatsuhiko Anzai PhD, Kunihiko Takahashi PhD, Sakiko Fukui PhD, RN

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引用次数: 0

Abstract

Introduction

Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life.

Design

This was a retrospective cohort study.

Methods

We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use.

Results

Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001).

Conclusion

Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life.

Clinical relevance

When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.

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老年人在生命最后 3 个月使用上门护理服务对成本的影响：一项回顾性队列研究。

导言：考虑到日本的老龄化社会，预计在家中去世的老年人数量将会增加。在日本，社区居住的老年人在临终时使用和推广家庭访问护理服务面临挑战。我们研究了患者生命末期家庭巡诊护理服务的使用情况，以及有助于降低生命最后 3 个月的医疗护理和长期护理成本（总成本）的建议使用模式（使用情况、开始时间和持续性）：这是一项回顾性队列研究：我们调查了日本的 33 个城市，包括人口稀少地区。分析对象包括 2016 年 9 月至 2018 年 9 月期间死亡的 22927 名 75 岁或以上的老人。我们使用了每月的医疗护理和长期护理保险索赔数据。根据上门护理服务的使用历史，我们将参与者分为五组：（1）早期开始/持续使用；（2）早期开始/中断或片段使用；（3）非早期开始/持续使用；（4）非早期开始/片段使用；（5）未使用。我们进行了单变量和多变量线性回归分析，以研究生命最后 3 个月的总费用与上门护理服务使用模式之间的关联：总体而言，中位年龄为 85 岁，12217 名参与者为男性（53.3%）。在死亡前的最后半年，有 5424 名（23.7%）老年人使用了家庭上门护理服务。对总成本的 log10 变形值进行多变量线性回归分析后发现，与不使用组相比，早期开始/持续使用组在生命最后 3 个月的总成本估计是后者的 0.88 倍（95% 置信区间：0.84, 0.93）（P 结论：早期开始/持续使用组在生命最后 3 个月的总成本估计是后者的 0.88 倍（95% 置信区间：0.84, 0.93）：对于 75 岁或以上的日本老年人来说，在生命即将结束时，尽早开始使用上门护理服务可能有助于降低他们在生命最后 3 个月的总费用：临近生命终点时，许多老年人需要日常生活护理和姑息治疗。日本的政策制定者正在加强对居住在社区的老年人的临终关怀。尽管目前的研究结果并不能证明上门护理服务的有效性，但却为评估上门护理服务的使用情况及其对老年人的影响提供了一个视角。这些研究结果有助于考虑如何在家庭护理环境中为那些希望在家度过最后时光的老年人提供护理服务。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nursing Scholarship 医学-护理

CiteScore

6.30

自引率

5.90%

发文量

审稿时长

6-12 weeks

期刊介绍： This widely read and respected journal features peer-reviewed, thought-provoking articles representing research by some of the world’s leading nurse researchers. Reaching health professionals, faculty and students in 103 countries, the Journal of Nursing Scholarship is focused on health of people throughout the world. It is the official journal of Sigma Theta Tau International and it reflects the society’s dedication to providing the tools necessary to improve nursing care around the world.