Comparison of Care Utilization and Medical Institutional Death among Older Adults by Home Care Facility Type: A Retrospective Cohort Study in Fukuoka, Japan

Objectives We compared the care services use and medical institutional deaths among older adults across four home care facility types. Design This was a retrospective cohort study. Setting We used administrative claims data from April 2014 to March 2017. Participants We included 18,347 residents of Fukuoka Prefecture, Japan, who received home care during the period, and aged ≥75 years with certified care needs of at least level 3. Participants were categorized based on home care facility use (i.e., general clinics, Home Care Support Clinics/Hospitals (HCSCs), enhanced HCSCs with beds, and enhanced HCSCs without beds). Primary and secondary outcome measures We used generalized linear regression models to estimate care utilization and the incidence of medical institutional death, as well as the potential influence of sex, age, care needs level, and Charlson comorbidity index as risk factors. Results The results of generalized linear models showed the inpatient days were 53.3, 67.4, 63.9, and 72.6 for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs, and general clinics, respectively. Correspondingly, the numbers of home care days were 64.0, 51.6, 57.9, and 28.4. Our multivariable logistic regression model estimated medical institutional death rate among participants who died during the study period ( n = 9919) was 2.32 times higher ( P <0.001) for general clinic users than enhanced HCSCs with beds users (relative risks=1.69, P <0.001). Conclusions Participants who used enhanced HCSCs with beds had a relatively low inpatient utilization, medical institutional deaths, and a high utilization of home care and home-based end-of-life care. Findings suggest enhanced HCSCs with beds could reduce hospitalization days and medical institutional deaths. Our study warrants further investigations of home care as part of community-based integrated care. Trial registration This study was approved by the Kyushu University Institutional Review Board for Clinical Research (Approval No. 20209). Strengths and limitations of this study This was a retrospective cohort study including data on 18,347 individuals. This study was designed to suggest the kind of healthcare system that will be needed in the future in aging societies by examining the associations of the type of home care provision system with end-of-life care and place of death for older adults. We calculated the number of years that participants lived during the study period and estimated the annual utilization rates per person-year of observation. This study was conducted using data only on residents of Fukuoka Prefecture in Japan, which limits the generalizability of our findings There were no clinical data for individual participants because this study focused on the types of healthcare facilities that provide home care.