The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: a retrospective cohort study using health insurance claims data

Abstract

Background Multimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA. Methods We conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007–2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariable Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD. Results Among 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 9.6 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one’s own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one’s home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99–3.60 PWD; HR = 2.81, 95% CI 2.28–3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78–5.55 PWD; HR = 2.81, 95% CI 1.94–4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA. Conclusions The quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed.

Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review

“…Identifying the common predictors of NHA is considered a key factor in delaying the entry into long-term care services [ 2 ] and in enhancing the development and application of preadmission assessments for managing long-term care utilization among older adults [ 6 ]. Furthermore, identifying predictors of NHA among older adults can increase the understanding of modifiers for functional status, dependency, and utilization of health services for older patients [ 7 , 8 ]. As Gauler et al [ 9 ] reported, NHA can be considered as “less of an endpoint and instead as an important transition where associated factors operate to influence outcomes after admission” [ 9 ].…”

The impact of study factors in the association of periodontal disease and cognitive disorders: systematic review and meta-analysis

“…As a result, these studies were at serious risk of confounding. Evidence suggests that PD is associated with multimorbidity [ 40 , 46 ]; multimorbidity is also linked to worse outcomes in older age, including dementia incidence [ 47 ]. We were not able to explore effect of co-morbidities, and future work should account for multimorbidity and seek to make necessary adjustments.…”

Data linkage of German statutory health insurance claims data and care needs assessments preceding a population-based cohort study on nursing home admission

“…The primary outcome of the underlying project is defined as the institutionalisation of care dependent people. Subsequent analyses [10][11][12][13] focus on determinants from health care and the individuals' care arrangement on the risk of nursing home admission after first onset of care dependency. A selection introduced by record linkage may impair the validity of these analyses.…”

“…This article describes the process of linking the two datasets without the presence of a single unique identifier. The aims are to (1) assess the comparability of both datasets, (2) perform and describe the data linkage, (3) assess validity and plausibility of the linkage results with special respect towards the introduction of selection bias into the linked dataset to (4) consequently obtain a dataset allowing to assess institutionalisation of care dependent people in regard to housing and living conditions as well as their received healthcare in subsequent analyses 10–13…”