Abstract
BackgroundLong-term care insurance systems in Japan started a special senior care program overseen by qualified care managers (also known as advanced care managers). However, the relationship between advanced care management and outcomes in long-term care recipients remains unknown.ObjectiveWe aimed to compare the outcome of long-term care recipients using facilities with advanced care management and conventional care management, in terms of care needs level progression.MethodsWe conducted a retrospective cohort study using the Survey of Long-Term Care Benefit Expenditures in Japan. We identified those aged ≥65 years who were newly designated a care need level of 3, and received long-term care services between April 2009 and March 2014 in Tokyo. We compared survival without progression of care needs level between the groups, with and without advanced care management, using the Kaplan-Meier method. Factors affecting the outcomes were determined using a multivariable logistic regression model fitted with a generalized estimating equation.ResultsOf 45,330 eligible persons, 12,903 (28.46%) received long-term care based on advanced care management. The average duration of progression-free survival was 17.4 (SD 10.2) months. The proportions of five-year cumulative progression-free survival were 41.2% and 32.8% in those with and without advanced care management, respectively. The group with advanced care management had significantly lower care needs levels (odds ratio 0.77, 95% CI, 0.72-0.82, P<.001).ConclusionsAdvanced care management was significantly associated with improved care needs levels.
Highlights
In 2000, the Japanese government introduced Long-Term Care Insurance (LTCI) for the elderly, which provides welfare and health care services with comprehensive care management [1-3]
We compared the progression of care needs levels of long-term care recipients with advanced care management and conventional care management, using a national long-term care database in Japan
The study subjects were selected based on the following criteria: (1) persons of ≥65 years; (2) those who were newly designated a care needs level of 3; and (3) using long-term care service plans and care programs that were designed by care managers
Summary
In 2000, the Japanese government introduced Long-Term Care Insurance (LTCI) for the elderly, which provides welfare and health care services with comprehensive care management [1-3]. It remains unclear whether care coordination by advanced care managers is associated with improved outcomes of elderly persons. We compared the progression of care needs levels of long-term care recipients with advanced care management and conventional care management, using a national long-term care database in Japan. Objective: We aimed to compare the outcome of long-term care recipients using facilities with advanced care management and conventional care management, in terms of care needs level progression. We identified those aged ≥65 years who were newly designated a care need level of 3, and received long-term care services between April 2009 and March 2014 in Tokyo. Conclusions: Advanced care management was significantly associated with improved care needs levels
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