Takashi Naoki, Fujisawa Misaki, Ohtera Shosuke
Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan.
JMIR Form Res. 2024 Dec 12;8:e56091. doi: 10.2196/56091.
Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear.
This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors.
This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups.
The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102).
The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms.
有效的出院计划对于成功的护理过渡、缩短住院时间和降低再入院率至关重要。日本提供经济激励措施，以加强对有复杂需求患者的出院后护理计划的协调。然而，这种激励措施对全国的影响尚不清楚。
本研究旨在（1）评估作为出院后护理计划提供指标的出院计划索赔数量与关键医疗保健结果之间的关联，这些结果包括在日本县级层面的回家出院、30天再入院、住院时间和医疗支出，以及（2）描述出院后护理计划提供方面的区域差异并探索相关因素。
这项生态学研究使用了2020财年的县级数据。提交的出院计划索赔用作提供出院后护理计划的指标。使用来自第七次全国健康保险索赔数据库的数据计算供应调整后的标准化索赔比率（SCR），以评估和比较日本47个县的索赔数量，同时考虑人口结构差异。关键结果包括回家出院、30天再入院、住院时间和医疗支出。多变量负二项回归模型评估SCR与结果之间的关联，并对社会经济协变量进行调整。此外，使用曼-惠特尼U检验分析出院后护理计划提供方面的区域差异和相关因素。根据每个因素的三分位数将县分为3组（低、中、高），并比较这些组之间的供应调整后的SCR。
最小供应调整后的SCR与最大供应调整后的SCR之比为10.63，突出了显著的区域差异。供应调整后的SCR越高，表明出院后护理计划提供越频繁，每增加1个标准差的供应调整后的SCR，每1000名患者回家出院的人数增加9.68（95%CI 0.98-18.47）。有几个因素导致了出院后护理计划供应调整后的SCR存在区域差异。供应调整后的SCR较高与每100张医院床位的护士数量较多显著相关（低、中、高组的中位数SCR分别为0.055、0.101和0.103）；每100平方公里可居住面积的护理经理办公室数量较多（0.088、0.082和0.116）；向患者提供电子医疗信息的医院比例较高（0.083、0.095和0.11）；独居老年人比例较低（0.116；0.092；0.071）；以及人均收入较高（0.078、0.102和0.102）。
出院后护理计划的提供与回家出院的可能性增加相关，强调了其在护理过渡中的重要性。然而，护理协调方面存在显著的区域差异。解决这些差异对于实现公平的医疗保健结果至关重要。需要进一步研究以阐明因果机制。
