居家长期护理中的高级护理管理的结果：一项基于人群的回顾性观察研究。

Outcomes of advanced care management in home-based long-term care: A retrospective population-based observational study.

机构信息

Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Genome Informatics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan.

Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Department of General Internal Medicine, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124, Japan.

出版信息

Int J Nurs Stud. 2024 Oct;158:104862. doi: 10.1016/j.ijnurstu.2024.104862. Epub 2024 Jul 21.

DOI:10.1016/j.ijnurstu.2024.104862

PMID:39098084

Abstract

BACKGROUND

In home-based long-term care, care management aims to facilitate the independence of community-dwelling older adults and mitigate the escalation of their care needs. We examined the association between the types of care management (advanced vs. conventional) and the progression of care needs among recipients with moderate care needs and compared care services offered in care plans between care management types.

METHODS

A retrospective, population-based observational study was conducted in Tsukuba City in Japan. The individual-level secondary data from the suburban municipal government was collected between May 2015 and March 2019. The primary outcome was the progression of care-need levels certificated in Japanese long-term care insurance. The exposure variable was advanced care management. First, we conducted propensity-score matching to adjust for differences in recipient characteristics. Second, we performed Kaplan-Meier survival analyses and log-rank tests, with the outcome measure being the progression of care-need levels. Third, Pearson's chi-square tests were performed to compare care services for recipients of advanced vs. conventional care management.

RESULTS

Of the 1010 long-term care recipients, we selected 856 propensity score-matched recipients receiving advanced or conventional care management. The proportions of four-year cumulative progression-free survival in the groups receiving advanced and conventional care management were 82.2 % and 78.5 %, respectively (p = .69). The proportions of the groups with advanced and conventional care management were 17.1 % and 23.8 % using home-help services (p < .05), and 4.0 % and 8.2 % using community-based day care services (p < .05), respectively.

CONCLUSIONS

Advanced care management in home-based long-term care was not associated with a slowing of the progression of care needs among older adults with moderate care needs compared with conventional care management. There was a notable discrepancy in the use of care services, with the advanced care management group having lower rates of use of home-help services and community-based day care services compared with the conventional care management group.

摘要

背景

在居家长期护理中，护理管理旨在促进社区居住的老年人的独立性，并减轻他们的护理需求的升级。我们研究了不同类型的护理管理（高级与常规）与中度护理需求接受者的护理需求进展之间的关联，并比较了两种护理管理类型的护理计划中提供的护理服务。

方法

这是一项在日本筑波市进行的回顾性、基于人群的观察性研究。该研究于 2015 年 5 月至 2019 年 3 月期间从郊区市政府收集个体层面的二级数据。主要结局是经日本长期护理保险认证的护理需求水平的进展。暴露变量是高级护理管理。首先，我们进行倾向评分匹配以调整接受者特征的差异。其次，我们进行 Kaplan-Meier 生存分析和对数秩检验，以护理需求水平的进展为结局测量。最后，我们进行了 Pearson's chi-square 检验，以比较接受高级和常规护理管理的接受者的护理服务。

结果

在 1010 名长期护理接受者中，我们选择了 856 名接受高级或常规护理管理的倾向评分匹配接受者。接受高级和常规护理管理的组的四年累积无进展生存比例分别为 82.2%和 78.5%（p=0.69）。使用家庭帮助服务的组中，接受高级和常规护理管理的比例分别为 17.1%和 23.8%（p<0.05），使用社区日间护理服务的比例分别为 4.0%和 8.2%（p<0.05）。