Resident and facility characteristics associated with care‐need level deterioration in long‐term care welfare facilities in Japan

Abstract

Aim: To determine the resident and facility characteristics associated with residents' care-need level deterioration in long-term care welfare facilities in Japan.Methods: A nationally representative sample of 358 886 residents who lived in 3774 long-term care welfare facilities for at least 1 year from October 2012 was obtained from long-term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long-term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow-up to define the resident and facility characteristics associated with resident care-need level deteriorations (lost to follow-up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow-up model).Results: Adjusting for the covariates, at the resident level, older age and lower care-need level at baseline were more likely to show deterioration in the care-need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed-model facilities (partly private room settings) were less likely to experience careneed level deterioration. A higher proportion of registered nurses among all nurses was negatively related to careneed level deterioration only in the model including lost to follow-up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care-need level deterioration only in the model excluding lost to follow-up. Conclusions:The present study could help identify residents who are at risk of care-need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758-766.

Development and validation of gradient boosting decision tree models for predicting care needs using a long-term care database in Japan

“…Insurers can consider and counteract the most important factors that contributed to the increases in care needs in an individual's CNL. 23 Consistent with previous research, 10,[25][26][27][28] this present study identified age as the most important factor related to increases in care needs. Other factors identified as important to the ML model were related to medical service use, excretion ability, daily hygiene, previous CNL, and bedridden Level 8.…”

“…9 Previous studies have categorized the patterns and trajectories of care needs 4 and investigated factors related to changes in care needs. [8][9][10] Most of the studies have applied traditional statistical methods to develop regression models that successfully express factors related to changes in CNLs. However, they have not been able to predict the increasing care needs of each insured.…”

Validating care‐needs level against self‐reported measures of functioning, disability and sarcopenia among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study

“…First, the finding that the LTCI‐CNLs classification, an index of an objective assessment of care burden, has a moderate correlation with WHODAS 2.0 and SARC‐F scores suggests that the LTCI‐CNLs classification can be used as a proxy for determining perceived difficulty functioning in daily life and physical performance in patients who are cognitively functional enough to answer these questions. As the LTCI‐CNLs classification is a standardized index incorporated into the Japanese public long‐term insurance system, the LTCI‐CNLs classification could be used in several ways to improve health policy decision‐making and health service research 1,4,18,19 . For health service research, the LTCI‐CNLs classification could be used for casemix adjustment; 18 for example, to examine the effectiveness of specific medical procedures, such as management of oral hygiene, on mortality among older patients.…”

The use of Japanese long-term care insurance claims in health services research: current status and perspectives

“…Most studies using single LTC claims highlighted the lack of information on detailed medical conditions (11)(12)(13)(14)(15). The reason was the difficulty in investigating the effect of LTC service uses without adjusting for the medical conditions of older people.…”