Abstract
Measuring and improving home care clinic resource volume and geographic allocation are an important public health issue regarding prolonging home care system usage among disabled elderly people. This study examined clinic volume and accessibility’s association with hospitalization duration among disabled elderly people in 13 municipalities in Japan; additionally, this study compared clinic volume and accessibility’s ability to explain hospitalization duration in this population. Home care clinics’ service volume and geographic accessibility were calculated for 17 municipalities using public data and geographic information systems. We analyzed medical claim data from October 2012; the sample included 22,662 persons who were aged ≥75 years, certified as disabled in daily living, and lived in 13 municipalities regarding which data could be obtained for all examined municipality characteristics. Multilevel logistic models with random intercepts were constructed for municipalities and individual- and municipality-level independent variables in order to examine home care clinic volume and accessibility’s correlation with hospitalization duration. Clinic volume ranged from 0 to 9.53 per 10,000 elderly people; clinic accessibility ranged from 0% to 83%. Clinic volume and accessibility were both significantly negatively correlated with hospitalization duration of ≥10 days (odds ratios, 0.944 and 0.713; confidence intervals, 0.914 - 0.974 and 0.553 - 0.921, respectively). Clinics were not homogeneously geographically distributed; clinic accessibility explained hospitalization duration better than clinic volume. Clinic accessibility may more accurately indicate care clinic allocation appropriateness than clinic volume.
Highlights
Prolonging home care system usage is recommended in order to reduce hospital stay duration and medical costs among disabled people
In Japan, public health professionals in local municipalities are responsible for improving home care systems that care for disabled elderly people [1]
In Japan, home care clinics play a significant role in communities: they are differed from general clinic, and provide uninterrupted service to home-dwelling disabled adults
Summary
Prolonging home care system usage is recommended in order to reduce hospital stay duration and medical costs among disabled people. In Japan, public health professionals in local municipalities are responsible for improving home care systems that care for disabled elderly people [1]. Among the most important aspects of home care systems in each municipality is the equitable provision of accessible services. Public health professions in Japanese municipalities are required to assess and improve regional resources accessible to home care services [1]. In Japan, home care clinics play a significant role in communities: they are differed from general clinic, and provide uninterrupted service to home-dwelling disabled adults. Home care clinics are expected to promote home death and the continuity of home dwelling and reduce institutionalization among elderly community members
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