Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan; Health Services Center, Human Resources Group, Sumitomo Heavy Industries, ltd., Tokyo, Japan.
Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
J Am Med Dir Assoc. 2021 Feb;22(2):329-333. doi: 10.1016/j.jamda.2020.09.021. Epub 2020 Nov 5.
To analyze the association of an incentivization program to promote death outside of hospitals with changes in place of death.
A longitudinal observational study using national databases.
Participants comprised Japanese decedents (≥65 years) who had used long-term care insurance services and died between April 2007 and March 2014.
Using a database of Japanese long-term care insurance service claims, subjects were divided into community-dwelling and residential aged care (RAC) facility groups. Based on national death records, change in place of death after the Japanese government initiated incentivization program was observed using logistic regression.
Hospital deaths decreased by 8.7% over time, mainly due to an increase in RAC facility deaths. The incentivization program was more associated with decreased in-hospital deaths for older adults in RAC facilities than community-dwelling older adults.
In Japan, the proportion of in-hospital deaths of frail older adults decreased since the health services system introduced the incentivization program for end-of-life care outside of hospitals. The shift of place of death from hospitals to different locations was more prominent among residents of RAC facilities, where informal care from laymen was required less, than among community residents.
分析旨在鼓励在院外死亡的激励计划与死亡地点变化之间的关联。
使用国家数据库的纵向观察性研究。
研究对象为使用长期护理保险服务且于 2007 年 4 月至 2014 年 3 月间死亡的日本死者（≥65 岁）。
利用日本长期护理保险服务索赔数据库，将受试者分为居住在社区和居住在养老院（RAC）设施两组。根据全国死亡记录，使用逻辑回归观察日本政府启动激励计划后死亡地点的变化。
随着时间的推移，医院死亡人数减少了 8.7%，这主要是由于 RAC 设施死亡人数的增加。激励计划与 RAC 设施中老年人住院死亡人数的减少更为相关，而与社区中老年人的住院死亡人数减少相关性较小。
在日本，自卫生服务系统引入鼓励在医院外进行临终关怀的激励计划以来，体弱老年人的住院死亡比例有所下降。与社区居民相比，RAC 设施居民的死亡地点从医院转移到其他地方的情况更为明显，因为 RAC 设施居民的日常护理需求较少。
