关于增强家庭护理支持诊所的评估，包括急诊家访、住院和临终关怀：日本一城市的回顾性队列研究。

Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan.

机构信息

Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.

Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.

出版信息

BMC Health Serv Res. 2023 Feb 3;23(1):115. doi: 10.1186/s12913-023-09088-1.

DOI:10.1186/s12913-023-09088-1

PMID:36737771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9898920/

Abstract

BACKGROUND

To meet the increasing demand for home healthcare in Japan as the population ages, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012, respectively. This study aimed to evaluate whether enhanced HCSCs fulfilled the expected role in home healthcare.

METHODS

We conducted a retrospective cohort study using linked medical and long-term care claims data from a municipality in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and March 2018, and used either conventional or enhanced HCSCs. Patients were followed up for one year after they started regular home visits or until the month following the end of the regular home visits if they ended within one year. The outcome measures were (i) emergency home visits at all hours and on nights and holidays at least once, respectively, (ii) hospitalization at least once, and (iii) end-of-life care, which was evaluated based on the place of death and whether a physician was present at the time of in-home death. Multivariable logistic regression analyses were conducted for the outcomes of emergency home visits and hospitalizations.

RESULTS

The analysis included 802 patients, including 405 patients in enhanced HCSCs and 397 patients in conventional HCSCs. Enhanced HCSCs had more emergency home visits at all hours than conventional HCSCs (65.7% vs. 49.1%; adjusted odds ratio 1.70, 95% CI [1.26-2.28]), more emergency home visits on nights and holidays (33.6% vs. 16.7%; 2.20 [1.55-3.13]), and fewer hospitalizations (21.5% vs. 32.2%; 0.55 [0.39-0.76]). During the follow-up period, 229 patients (152 patients in enhanced HCSCs and 77 patients in HCSCs) died. Deaths at home were significantly more common in enhanced HCSCs than in conventional HCSCs (80.9% vs. 64.9%; p < .001), and physician-attended deaths among those who died at home were also significantly more common in enhanced HCSCs (99.2% vs. 78.0%; p < .001).

CONCLUSIONS

This study confirms that enhanced HCSCs are more likely to be able to handle emergency home visits and end-of-life care at home, which are important medical functions in home healthcare. Further promotion of enhanced HCSCs would be advantageous.

摘要

背景

为满足日本人口老龄化对家庭医疗保健日益增长的需求，分别于 2006 年和 2012 年引入了家庭护理支持诊所/医院（HCSC）和增强型 HCSC。本研究旨在评估增强型 HCSC 是否在家庭医疗保健中发挥了预期作用。

方法

我们使用日本一个市的医疗和长期护理索赔数据进行了回顾性队列研究。参与者年龄≥65 岁，在 2014 年 7 月至 2018 年 3 月期间开始接受定期家庭访问，并且使用常规 HCSC 或增强型 HCSC。在开始定期家庭访问后的一年或在一年内结束定期家庭访问后的一个月内对患者进行随访。主要结局为（i）至少各进行一次全天和夜间及节假日的紧急家庭访问，（ii）至少住院一次，（iii）根据死亡地点和在家中死亡时是否有医生在场来评估临终关怀。对紧急家庭访问和住院的结局进行多变量逻辑回归分析。

结果

共纳入 802 名患者，其中增强型 HCSC 组 405 名，常规 HCSC 组 397 名。与常规 HCSC 相比，增强型 HCSC 的全天紧急家庭访问（65.7%比 49.1%；调整后的优势比 1.70，95%CI [1.26-2.28]）、夜间和节假日的紧急家庭访问（33.6%比 16.7%；2.20 [1.55-3.13]）更多，住院治疗更少（21.5%比 32.2%；0.55 [0.39-0.76]）。在随访期间，229 名患者（增强型 HCSC 组 152 名，常规 HCSC 组 77 名）死亡。增强型 HCSC 组的家中死亡比例明显高于常规 HCSC 组（80.9%比 64.9%；p<0.001），在家中死亡且有医生在场的比例也明显高于常规 HCSC 组（99.2%比 78.0%；p<0.001）。