Restricted accessResearch articleFirst published online 2024-02
The Impact of Continuous Use of Home Health Care Resources on End-of-Life Care at Home in Older Patients with Cancer: A Retrospective Cohort Study in Fukuoka,Japan
This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31–17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86–17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47–13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42–2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92–5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home.
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References
1.
GomesB, HigginsonIJ. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ, 2006; 332:515–521.
2.
Cabanero-MartinezMJ, NolascoA, MelchorI, Fernández-AlcántaraM, Cabrero-GarcíaJ. Place of death and associated factors: a population-based study using death certificate data. Eur J Public Health, 2019; 29:608–615.
3.
AlsirafySA, HammadAM, IbrahimNY, FaragDE, ZakiO. Preferred place of death for patients with incurable cancer and their family caregivers in Egypt. Am J Hosp Palliat Care, 2019; 36:423–428.
4.
Ministry ofHealth, Labour andWelfare. kousei toukei youran (2022) [Compendium of Health and Welfare Statistics]. 2022. https://www.mhlw.go.jp/toukei/youran/index-kousei.html Accessed May23, 2023.
5.
TownsendJ, FrankAO, FermontD, et al.Terminal cancer care and patients' preference for place of death: a prospective study. BMJ, 1990; 301:415–417.
6.
HigginsonIJ, Sen-GuptaGJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med, 2000; 3:287–300.
7.
KhanSA, GomesB, HigginsonIJ. End-of-life care—what do cancer patients want?. Nat Rev Clin Oncol, 2014; 11:100–108.
8.
NilssonJ, BlombergC, HolgerssonG, CarlssonT, BergqvistM, BergströmS. End-of-life care: where do cancer patients want to die? A systematic review. Asia Pac J Clin Oncol, 2017; 13:356–364.
9.
FereidouniA, RassouliM, SalesiM, AshrafizadehH, Vahedian-AzimiA, BarastehS. Preferred place of death in adult cancer patients: a systematic review and meta-analysis. Front Psychol, 2021; 12:704590.
10.
KerrCW, DonohueKA, TangemanJC, et al.Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership. J Palliat Med, 2014; 17:1328–1335.
11.
LustbaderD, MudraM, RomanoC, et al.The impact of a Home-Based Palliative Care Program in an Accountable Care Organization. J Palliat Med, 2017; 20:23–28.
12.
GomesB, CalanzaniN, CurialeV, McCroneP, HigginsonIJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev, 2013; 2013:CD007760.
13.
NatsumeM, WatanabeK, MatsumotoS, et al.Factors influencing cancer patients' choice of end-of-life care place. J Palliat Med, 2018; 21:751–765.
14.
WyeL, LasseterG, PercivalJ, DuncanL, SimmondsB, PurdyS. What works in ‘real life’ to facilitate home deaths and fewer hospital admissions for those at end of life?: results from a realist evaluation of new palliative care services in two English counties. BMC Palliat Care, 2014; 13:37.
15.
Prime Minister of Japan and His Cabinet. Report of the National Council for Social Security Reform. Pathways to pass on reliable social security to future generations. 2013. https://warp.ndl.go.jp/info:ndljp/pid/8295038/www.kantei.go.jp/jp/singi/kokuminkaigi/pdf/houkokusyo.pdf Accessed February27, 2023.
16.
Ministry of Health, Labour and Welfare. Reference materials for the 1st National Conference on home medical care. 2016. https://www.mhlw.go.jp/file/05-Shingikai-10801000-Iseikyoku-Soumuka/0000129546.pdf Accessed February27, 2023.
17.
Ministry of Health, Labour and Welfare. Shinryo hoshu kaitei no gaiyo zaitaku (zaitaku iryo homon kango) [Overview of the revision of medical fees Home (Home health care, home nursing)]. 2022. https://www.mhlw.go.jp/content/12400000/000920430.pdf Accessed May17, 2023.
18.
Ministry of Health, Labour and Welfare. Chuo shakai hoken iryo kyogikai (dai 237 kai) zaitaku iryo ni tsui te (sono 1)[Central Social Insurance Medical Council (237th meeting) on home health care (Part 1)]. 2013. https://www.mhlw.go.jp/stf/shingi/2r9852000002ueo9-att/2r9852000002uvk3_1.pdf Accessed May21, 2023.
19.
Japan Visiting Nursing Foundation. Structure of the Visiting Nursing system in Japan. 2021. https://www.jvnf.or.jp/global/Structure_of_the_Visiting_Nursing_system_in_Japan_EN.pdf Accessed April19, 2023.
20.
KimSA, BabazonoA, JamalA, LiY, LiuN. Comparison of care utilisation and medical institutional death among older adults by home care facility type: a retrospective cohort study in Fukuoka, Japan. BMJ Open, 2021; 11:e041964.
21.
SunY, IwagamiM, KomiyamaJ, et al.Association between types of home healthcare and emergency house calls, hospitalization, and end-of-life care in Japan. J Am Geriatr Soc, 2023; In Press; doi: 10.1111/jgs.18268
22.
Olivares-TiradoP, TamiyaN.Trends and factors in Japan's Long Term Care Insurance System: Japan's 10-year experience. Springer: Dordrecht, The Netherlands; 2014.
23.
SoedaR, MitsuhashiM, OkanoS, et al.Shu matsuki gan kanja no shibo mae 6 shukan no nichijo seikatsu dosa no keiji teki henka [Trajectory of ADL (activities of daily living) for six weeks before death in patients with terminal cancer]. Palliat Care Res, 2020; 15:167–174.
24.
D'HooreW, SicotteC, TilquinC. Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med, 1993; 32:382–387.
25.
MoriokaN, TomioJ, SetoT, YumotoY, OgataY, KobayashiY. Association between local-level resources for home care and home deaths: a nationwide spatial analysis in Japan. PLoS One, 2018; 13:e0201649.
26.
JamalA, BabazonoA, LiY, YoshidaS, FujitaT. Multilevel analysis of hemodialysis-associated infection among end-stage renal disease patients: results of a retrospective cohort study utilizing the insurance claim data of Fukuoka Prefecture, Japan. Medicine (Baltimore), 2020; 99:e19871.
27.
IkedaT, TsuboyaT. Place of death and density of homecare resources: a Nationwide Study in Japan. Ann Geriatr Med Res, 2021; 25:25–32.
28.
AbeK, KawachiI, TaniguchiY, TamiyaN. Municipal characteristics of in-home death among care-dependent older Japanese adults. JAMA Netw Open, 2022; 5:e2142273.
29.
Ministry of Health, Labour and Welfare. 2018. https://www.mhlw.go.jp/file/04-Houdouhappyou-10802000-Iseikyoku-Shidouka/0000197701.pdf Accessed April3, 2023.
30.
AbeK, MiyawakiA, KobayashiY, WatanabeT, TamiyaN. Place of death associated with types of long-term care services near the end-of-life for home-dwelling older people in Japan: a pooled cross-sectional study. BMC Palliat Care, 2020; 19:121.
31.
Japanese Association of Supportive Care in Cancer. Koureisya gan iryou Q&A souron [Cancer Care for the Elderly Q&A General]; 2022. https://jascc.jp/publications/1994/ Accessed February25, 2023.
32.
CostaV, EarleCC, EsplenMJ, et al.The determinants of home and nursing home death: a systematic review and meta-analysis. BMC Palliat Care, 2016; 15:8.
33.
HamanoJ, TachikawaH, TakahashiS, et al.Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey. BMC Res Notes, 2022; 15:238.
34.
Ministry of Health, Labour and Welfare. Shingata koronauirusu kansensho no hoken iryo teikyo taisei kakuho keikaku [Plan for ensuring health and health care delivery systems for new coronavirus infections.]. https://www.mhlw.go.jp/stf/seisakunitsuite/newpage_00056.html Accessed May23, 2023.
35.
Ministry of Health, Labour and Welfare. Dai2kai Zaitakuiryo oyobi iryo kaigo renkei ni kansuru wakingu gurupu shiryo [Second working group on home health care and cooperation between medical and nursing care providers materials.]. 2022. https://www.mhlw.go.jp/stf/newpage_24354.html Accessed February27, 2023.
36.
National Cancer Center Japan. Cancer statistics. 2022. https://ganjoho.jp/reg_stat/statistics/stat/annual.html Accessed April2, 2023.
37.
Ministry of Health, Labour and Welfare. Iryouhino Chiikisa Bunseki [Regional difference analysis of medical expenses.]. 2017. https://www.mhlw.go.jp/content/iryohi_h29.pdf Accessed May21, 2023.
38.
Ministry of Health, Labour and Welfare. Zaitaku iryou ni kakaru tiiki betsu de-ta syuu [Regional data collection on home health care.]. 2023. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000061944.html Accessed May23, 2023.
39.
The National Association for Visiting Nurse Service. Houmon kango akusyon puran 2025–2025 nen wo meza si ta houmon kango [Home care nursing action plan 2025-Home care nursing for 2025.]. https://www.jvnf.or.jp/2017/actionplan2025.pdf Accessed May23, 2023.
40.
Ministry of Health, Labour and Welfare. Dai 93 kai shakai hosho shingi kai iryo bukai shiryo 3-2 iryo no ninaite no kakuho ni tsuite [93rd Session of the Health Care Subcommittee of the Council for Social Security, Document 3-2: securing the medical workforce]. 2022. https://www.mhlw.go.jp/content/12601000/001016975.pdf Accessed May23, 2023.
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