Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
J Am Med Dir Assoc. 2017 Mar 1;18(3):277.e1-277.e5. doi: 10.1016/j.jamda.2016.11.024. Epub 2017 Jan 9.
Although oral care may have salutary effects among frail elderly people, access to dental care is often limited in long-term care facilities. In 2009, the Japanese long-term care insurance system introduced an additional reimbursement scheme for enhanced oral care supervised by dentists in nursing facilities. The aim of this study was to examine whether enhanced oral care provided by trained nursing facility staff members is sufficient to improve health outcomes among nursing facility residents.
DESIGN, SETTING, AND PARTICIPANTS: This was a quasi-experimental study using a nationwide long-term care database. Using facility-level propensity score matching, we identified 170,874 residents in 742 facilities that provided enhanced oral care and 167,546 residents in 742 control facilities that provided only standard care from 2009 to 2012. We used a resident-level difference-in-differences approach to analyze the impact of enhanced oral care on health outcomes among nursing facility residents.
After controlling for resident characteristics and background time trends, no significant differences were found between residents admitted to the facilities with and without enhanced oral care in the incidence of critical illness, transfer to a hospital, mortality, or costs. Yearly change in the odds of discharge to home was significantly increased for residents with enhanced oral care (odds ratio = 1.07; 95% confidence interval: 1.02-1.12; P = .008).
The results suggest that enhanced oral care provided by trained nursing facility staff members may improve the general condition of elderly residents in nursing facilities and promote their discharge to home.
虽然口腔护理可能对体弱的老年人有益，但在长期护理机构中，获得牙科护理的机会往往有限。2009 年，日本长期护理保险制度在护理机构中引入了一项额外的报销计划，用于加强由牙医监督的口腔护理。本研究旨在检验由经过培训的护理机构工作人员提供的强化口腔护理是否足以改善护理机构居民的健康结果。
设计、设置和参与者：这是一项使用全国性长期护理数据库的准实验研究。使用设施层面的倾向评分匹配，我们在 2009 年至 2012 年期间从 742 家提供强化口腔护理的设施中确定了 170874 名居民和 742 家提供标准护理的对照设施中的 167546 名居民。我们使用居民层面的差异-差异方法来分析强化口腔护理对护理机构居民健康结果的影响。
在控制居民特征和背景时间趋势后，在入住有或没有强化口腔护理的设施的居民中，重症疾病、转院、死亡率或成本的发生率没有显著差异。接受强化口腔护理的居民出院回家的可能性每年都显著增加（优势比=1.07；95%置信区间：1.02-1.12；P=0.008）。
结果表明，由经过培训的护理机构工作人员提供的强化口腔护理可能会改善护理机构中老年人的整体状况，并促进他们出院回家。
