Long-term Care Insurance Claims Research Articles

Health-economic evaluation of orthogeriatric co-management for patients with pelvic or vertebral fragility fractures

BackgroundOrthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures.MethodsIn this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014–2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.ResultsWe included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5–5.9% of the pelvic and 31.8–33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained.ConclusionWe did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM.

Last year of life care transitions between long-term care insurance services in Japan: Analysis of long-term care insurance claims data.

We determined the number of care transitions in the year before death among older adults requiring long-term care (LTC) and those receiving public LTC insurance (LTCI) services in Japan, along with care transition pathways and factors associated with the number of care transitions. This study used data from the Japanese LTCI claims, which store national information on certification of needed LTC and LTCI claims data. Services received in the year before death were classified as in-home, facility, mixture of in-home and facility, and not using LTCI services. The transition count is presented, and Sankey diagrams are produced to visualize care transition pathways. We used a multivariable analysis to identify factors associated with the number of care transitions. Of the participants, 276 896 (65.2%) experienced at least one transition in LTCI care settings in the year before death. Further, 72.0% of those requiring mild LTC underwent one or more transitions. Participants who were 75-84 years old (vs. 65-74 years old), male, without medical care needs, with symptoms of dementia, and with changes in LTC needs in the year before death were more likely to require care transitions. Moreover, participants with higher baseline LTC needs were less likely to require transitions. Over half the participants requiring LTC underwent one or more care transitions in the year before death. Policy deliberations regarding enhancing care under the LTCI system at the end of life and optimizing care transitions are necessary. Geriatr Gerontol Int 2024; ••: ••-••.

Characteristics of first-time users of the nursing small-scale multifunctional home care service: a pooled cross-sectional study using Japanese long-term care insurance claims data from 2012 to 2019

ObjectivesIn April 2012, the Japanese government launched a new nursing service called the nursing small-scale multifunctional home care (NSMHC) to meet the nursing care demands of individuals with moderate-to-severe activities...

Implementation status of postoperative rehabilitation for older patients with hip fracture in Kyoto City, Japan: A population-based study using medical and long-term care insurance claims data.

Continuing rehabilitation after hip fractures is recommended to improve physical function and quality of life. However, the long-term implementation status of postoperative rehabilitation is unclear. This study aims to investigate the implementation status of postoperative rehabilitation for older patients with hip fractures and the factors associated with continuing rehabilitation. A retrospective cohort study evaluated medical and long-term care insurance claims data of patients aged 75 years or older in Kyoto City, Japan, who underwent hip fracture surgeries from April 2013 to October 2018. We used logistic regression analysis to examine factors associated with six-month rehabilitation continuation. Of the 8,108 participants, 8,037 (99%) underwent rehabilitation the first month after surgery, but only 1,755 (22%) continued for six months. The following variables were positively associated with continuing rehabilitation for six months: males (adjusted odds ratio: 1.41 [95% confidence interval: 1.23-1.62]), an intermediate frailty risk (1.50 [1.24-1.82]), high frailty risk (2.09 [1.69-2.58]) estimated using the hospital frailty risk scores, and preoperative care dependency levels: support level 1 (1.69 [1.28-2.23]), support level 2 (2.34 [1.88-2.90]), care-need level 1 (2.04 [1.68-2.49]), care-need level 2 (2.42 [2.04-2.89]), care-need level 3 (1.45 [1.19-1.76]), care-need level 4 (1.40 [1.12-1.75]), and care-need level 5 (1.31 [0.93-1.85]). In contrast, dementia was cited as a disincentive (0.53 [0.45-0.59]). Less than 30% of older patients continued rehabilitation for six months after surgery. Factors associated with continuing rehabilitation were male sex, higher frailty risk, care dependency before hip fracture surgeries, and non-dementia.

Atrial fibrillation and mortality after ischemic stroke: An observational study using an insurance claim database

ObjectivesIn this study, we aimed to examine the association between atrial fibrillation and mortality after ischemic stroke and evaluate the use of anticoagulation therapy for atrial fibrillation before stroke onset in patients who experienced stroke. MethodsIn this retrospective observational study, we used a combined database of medical and long-term care insurance claims data from one prefecture in Japan. The data of 25,352 patients aged ≥ 65 years who were hospitalized in acute care hospitals with a diagnosis of ischemic stroke between April 2012 and March 2015 were extracted. Cox proportional hazard modeling, with adjustment for age, sex, comorbidities, and long-term care dependency level (based on the activities of daily living), was performed to evaluate the relationship between mortality and atrial fibrillation. ResultsThe prevalence of atrial fibrillation was 21.8% in the study population. A significant association was noted between mortality and atrial fibrillation (adjusted hazard ratio: 1.28, 95% confidence interval: 1.16–1.41, p < 0.001). Anticoagulant drugs were used in 32.2% of the patients with atrial fibrillation. ConclusionsThese results indicate that atrial fibrillation is associated with mortality after stroke; however, the use of anticoagulation therapy for atrial fibrillation is unsatisfactory. Efforts to improve the use of atrial fibrillation therapy are required in Japan.

Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study.

Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life. This was a retrospective cohort study. We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use. Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.

Associations between long-term care-service use and service- or care-need level progression: a nationwide cohort study using the Japanese Long-Term Care Insurance Claims database

BackgroundThe effectiveness of the long-term care service in Japan has been unclear, and most of the relevant studies of this service have been limited to a single region and relatively small samples, necessitating large-scale studies. We examined the associations between long-term care service use and the service/care-need level progression at the national scale in Japan.MethodsWe conducted a nationwide retrospective cohort study using data from the Japanese Long-Term Care Insurance Claims database. Individuals aged ≥ 65 years and newly certified as being at the support-need level 1 or 2 or the care-need level 1 between April 2012 and March 2013 were included. We first conducted 1:1 propensity score matching and then examined the associations between service use and the progression in support-need or care-need levels by using Kaplan–Meier survival curves and log-rank tests.ResultsThe final sample consisted of 332,766 individuals. We observed that service use was associated with a faster decline in the support/care-need level, although the differences in the subjects' survival rate diminished; the log-rank test showed significance (p < 0.001). When stratified for urban–rural classifications or regions of Japan, the results were similar to the primary analysis in all of the stratified groups, and no clear regional variations were observed.ConclusionWe did not observe a clear beneficial effect of receiving long-term care in Japan. Our results suggest that Japan's current long-term care service may not be effective for the recipients of these services. Considering that the system is becoming a financial burden, a re-examination of the service to provide more cost-effective care may be advisable.

Regional disparities in Dementia-free Life Expectancy in Japan: An ecological study, using the Japanese long-term care insurance claims database.

The number of people with dementia increases in an aging society; therefore, promoting policies for dementia throughout the community is crucial to creating a dementia-friendly society. Understanding the status of older adults with dementia in each region of Japan will be a helpful indicator. We calculated Dementia-free Life Expectancy and aimed to examine regional disparities and their associated factors. We calculated Dementia-free Life Expectancy and Life Expectancy with Dementia for each secondary medical area in Japan based on the Degree of Independence in Daily Living for the Demented Elderly, using data extracted from the Japanese long-term care insurance claims database. We then conducted a partial least squares regression analysis, the objective variables being Dementia-free Life Expectancy and Life Expectancy with Dementia for both sexes at age 65, and explanatory regional-level variables included demographic, socioeconomic, and healthcare resources variables. The mean estimated regional-level Dementia-free Life Expectancy at age 65 was 17.33 years (95% confidence interval [CI] 17.27-17.38) for males and 20.05 years (95% CI 19.99-20.11) for females. Three latent components identified by partial least squares regression analysis represented urbanicity, socioeconomic conditions, and health services-related factors of the secondary medical areas. The second component explained the most variation in Dementia-free Life Expectancy of the three, indicating that higher socioeconomic status was associated with longer Dementia-free Life Expectancy. There were regional disparities in secondary medical area level Dementia-free Life Expectancy. Our results suggest that socioeconomic conditions are more related to Dementia-free Life Expectancy than urbanicity and health services-related factors.

Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model

BackgroundOlder adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults.ObjectiveThe purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home.MethodsThis was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance.ResultsEducation and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support).ConclusionsThe present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.

Increased care-need in older long-term care insurance users after the 2018 Japan Floods: a retrospective cohort study based on the Japanese long-term care insurance claims.

Level of care-need (LOC) is an indicator of elderly person's disability level and is officially used to determine the care services provided in Japan's long-term care insurance (LTCI) system. The 2018 Japan Floods, which struck western Japan in July 2018, were the country's second largest water disaster. This study determined the extent to which the disaster affected the LOC of victims and compared it with that of non-victims. This is a retrospective cohort study, based on the Japanese long-term care insurance claims from two months before (May 2018) to five months after the disaster (December 2018) in Hiroshima, Okayama, and Ehime prefectures, which were the most severely damaged areas in the country. A code indicating victim status, certified by a residential municipality, was used to distinguish between victims and non-victims. Those aged 64 years or younger, those who had the most severe LOC before the disaster, and those whose LOC increased even before the disaster were excluded. The primary endpoint was the augmentation of pre-disaster LOC after the disaster, which was evaluated using the survival time analysis. Age, gender, and type of care service were used as covariates. Of the total 193,723 participants, 1,407 (0.7%) were certified disaster victims. Five months after the disaster, 135 (9.6%) of victims and 14,817 (7.7%) of non-victims experienced the rise of LOC. The victim group was significantly more likely to experience an augmentation of LOC than the non-victim group (adjusted hazard ratio 1.24; 95% confidence interval 1.06-1.45). Older people who were affected by the disaster needed more care than before and the degree of care-need increase was substantially more than non-victims. The result suggests that natural disasters generate more demand for care services among the older people, and incur more resources and cost for society than before.

노인장기요양시설에서의 미사용 의약품 발생에 영향을 미치는 요인

As the number of elderly living in long-term care facilities increases, unused medicines are also increasing. This study investigated the status of unused medicines in long-term care facilities and the factors affecting it. Using National Health Insurance Claims Database(NHICB) and Long-term Care Insurance Claims Database(LTCHCD), 137,309 people who lived only in long-term care facilities and took prescription drugs in 2019 were analyzed in this study. Most of them were prescribed by the clinic (41%), and the days per prescription were 25 days in average. Only 1.8% of prescriptions were from tertiary general hospitals, but the days per prescription reached 85 days, accounting for 67% of prescriptions for more than 60 days. The average age of long-term care facility residents was 84.8 years, and 22.6% of them deceased in 2019. 33.7% of the subjects had unused medicines. The days of unused medicines due to duplication in pharmacologically equivalent groups were 13 days in average. The average days of unused medicine due to death were comparatively longer, which was 75.5 days. Unused medicine costs were about 0.9% of the total pharmaceutical expenditures and 77.8% of the costs was caused by death. Unused medicines increased as the number of outpatient visits increased (Relative Risk (RR): 1.14) or when the days per prescription were long (RR: 1.16). Older adults who died were 15 times more likely to have unused medicines than those who were alive. The amount of unused medicines in long-term care facilities is substantial, so it is necessary to establish appropriate policies to reduce it.

FORECASTING THE REGIONAL DISTRIBUTION OF HOME CARE PATIENTS USING BIG DATA OF INSURANCE CLAIMS IN JAPAN: 2015 TO 2045

Abstract Regional distribution of home care patients and future demand in Japan are unknown. This study aimed to reveal the actual situation of home care patients by region and forecast demand up to 2045. Linked complete health and long-term care insurance claims data on Nara Prefecture (around 1% of the total population and area of Japan) patients aged 75 years or older who received planned and/or urgent medical treatment by physician home visit between April 2015 and March 2016 were extracted and analyzed by sex, age group, and municipality. We calculated the proportion of home medical care utilization and projected the number of home care patients for every five-year period up to 2045 across five administrative areas of the medical service in Nara Prefecture. Data on 12,656 patients, including 1,455 aged 75–79 years, 2,753 aged 80–84, 3,854 aged 85–89, and 4,594 aged 90 years or older, were extracted. The current proportion of patients receiving home medical care (unadjusted for age) by medical service administrative area showed a difference of up to 1.6 times for those aged 90 years or older. Results of forecasting showed a marked increase in the number of patients aged 90 years or older, with overall numbers continuing to increase up to 2040, reaching a maximum of around 25,759 then decreasing thereafter. The future increase in home care patient numbers could vary by age and area, and our findings suggest that public health policy based on the future demand in each area will be required.

Association of disability level with polypharmacy and potentially inappropriate medication in community dwelling older people

AimsTo investigate the influence of disability severity level on polypharmacy and the prescription of potentially inappropriate medication (PIM) using health insurance and long-term care (LTC) insurance claim data. MethodsData were obtained from a health-care insurance and long-term care insurance claims database of citizens of Kure city, Japan, in April 2017. Data including age, sex, and drug profile were obtained, and the level of LTC needs was used to measure disability level. Factors associated with polypharmacy (≥5 prescribed drugs) and PIM prescription (≥1 PIM) defined by STOPP-J were analyzed statistically. ResultsAmong 67,169 people aged ≥65 (mean age 77.2 ± 7.9, male 40.7%), the frequency of polypharmacy increased with age until 85–89 (male 58.3%, female 57.6%) in both genders, and polypharmacy was most prevalent in those at the mildest LTC level (support level: male 68.9%, female 73.7%). PIM prescriptions was also frequent in those with LTC needs. On multiple logistic regression analysis, polypharmacy was significantly associated with older age and LTC needs, and PIM prescription was associated with older age and higher LTC level, suggesting that there is a large difference in prescription according to the person's age and disability level. ConclusionPolypharmacy was prevalent especially in older persons which peaked at the age of 85–89 or at mild disability level, and PIM prescription was prevalent in those with older age and higher care levels. When optimizing polypharmacy or PIM prescription in older patients, healthcare providers should focus on not only age but also disability level.

Association between care rehabilitation and the risk of fracture hospitalization in people with Parkinson's disease.

This study examined whether there is an association between continuous care rehabilitation (CR) and the risk of fracture hospitalization among people with Parkinson's disease (PwP) aged >75 years with mild-to-moderate care needs level. A retrospective study design based on the merging of medical claims and long-term care insurance claims data was used. Before propensity score matching, of the 2177 participants, 222 received continuous CR, whereas 1955 did not. After matching using a 1:4 ratio, we identified 222 patients in the CR group and 888 patients in the non-CR groups. We carried out a survival analysis to clarify the association between CR and the risk of fracture hospitalization. After matching, there was a significant difference between the CR and non-CR groups in 3 years (stratified log-rank test by age P=0.036) and in 4 years (stratified log-rank test by age P=0.011). The CR group was significantly associated with delays of hospital admission due to fracture within 3 years (hazard ratio 0.54; 95% confidence interval 0.29-0.99; P=0.047) and within 4 years (hazard ratio 0.52; 95% confidence interval 0.30-0.88; P=0.010). Our study showed that older people with Parkinson's disease who continuously received CR had a lower risk of fracture hospitalization in 3 and 4 years than those who did not receive CR or received interrupted CR. Considering our participants with a mild-to-moderate care needs level, a sustainable CR service might benefit people with Parkinson's disease from an early time when their activities of daily living are still intact and cognitive function has not deteriorated. Geriatr Gerontol Int 2022; 22: 628-634.

Implementation and costs of housing adaptations among older adults with different functional limitations in Japan

BackgroundAccessible housing is crucial to maintain a good quality of life for older adults with functional limitations, and housing adaptations are instrumental in resolving accessibility problems. It is unclear to what extent older adults, who have a high risk of further functional decline, use housing adaptation grants acquired through the long-term care (LTC) insurance systems. This study aimed to examine the utilization of housing adaptation grants in terms of implementation and costs, for older adults with different types of functional limitations related to accessibility problems.MethodsThe study sample included individuals from a suburban city in the Tokyo metropolitan area who were certified for care support levels (indicative of the need for preventive care) for the first time between 2010 and 2018 (N = 10,372). We followed the study participants over 12 months since the care needs certification. We matched and utilized three datasets containing the same individual’s data: 1) care needs certification for LTC insurance, 2) insurance premium levels, and 3) LTC insurance claims. We conducted a multivariable logistic regression analysis to estimate the likelihood of individuals with different functional limitations of having housing adaptations implemented. Afterward, we conducted a subgroup analysis of only older adults implementing housing adaptation grants to compare costs between groups with different functional limitations using the Mann–Whitney U and Kruskal–Wallis tests.ResultsHousing adaptations were implemented among 15.6% (n = 1,622) of the study sample, and the median cost per individual was 1,287 USD. Individuals with lower extremity impairment or poor balance were more likely to implement housing adaptations (adjusted odds ratio (AOR) = 1.290 to AOR = 2.176), while those with visual impairment or lower cognitive function were less likely to implement housing adaptations (AOR = 0.553 to AOR = 0.861). Costs were significantly lower for individuals with visual impairment (1,180 USD) compared to others (1,300 USD).ConclusionOlder adults with visual or cognitive limitations may not receive appropriate housing adaptations, despite their high risk of accessibility problems. Housing adaptation grants should include various types of services that meet the needs of older people with different disabilities, and the results indicate there may be a need to improve the system.

Using Machine Learning to Better Model Long-Term Care Insurance Claims

Long-term care insurance (LTCI) should be an essential part of a family financial plan. It could protect assets from the expensive and relatively common risk of needing disability assistance, and LTCI purchase rates are lower than expected. Though there are multiple reasons for this trend, it is partially due to the difficultly insurers have in operating profitably as LTCI providers. If LTCI providers were better able to forecast claim rates, they would have less difficulty maintaining profitability. In this article, we develop several models to improve upon those used by insurers to forecast claim rates. We find that standard logistic regression is outperformed by tree-based and neural network models. More modest improvements can be found by using a neighbor-based model. Of all of our tested models, the random forest models were the consistent top performers. Additionally, simple sampling techniques influence the performance of each of the models. This is especially true for the deep neural network, which improves drastically under oversampling. The effects of the sampling vary depending on the size of the available data. To better understand this relationship, we thoroughly examine three states with various amounts of available data as case studies.

Analysis of the risk factors of mortality in elderly patients with hip fracture using a combined database of medical and long-term care insurance claims data

BackgroundThe present study evaluated the risk of mortality in elderly hip fracture, focusing on comorbidities and nursing care levels. MethodsThe present study was an observational cohort study that used a combined database of medical and long-term care insurance (LTCI) claims data from one prefecture in Japan between 2011 and 2016. In total, 6125 patients aged 65 years and older were selected from acute care hospitals with a diagnosis of “hip fracture” between March 2011 and March 2012. The impact of long-term care insurance claim evaluation levels and comorbidities at recruitment time was investigated using this dataset. These patients were followed up monthly until March 2016. Based on this person-month dataset, survival analysis was performed with death as the endpoint. Cases in which receipt data were missing during the middle of the observation period and cases in which the patient survived at the end of the observation period were censored. ResultsThe number of deaths during the observation period was 635 (10.4%). The impact of comorbidities and nursing care level on mortality were both significant as follows: high nursing care level before the fracture (hazard ratio: 1.09, P < 0.001), comorbidities of malignant diseases (HR: 1.45, P < 0.001), heart disease (hazard ratio: 1.20, P = 0.037), pneumonia (hazard ratio: 1.27, P < 0.001), chronic obstructive pulmonary disease (hazard ratio: 1.28, P = 0.026), renal failure (hazard ratio: 1.44, P < 0.001), and dementia (hazard ratio: 1.27, P = 0.013). ConclusionThe results of this study showed that a high level of nursing care and presence of comorbidities such as malignant diseases, heart diseases, pneumonia, chronic obstructive pulmonary disease, renal failure, and dementia increased mortality in elderly patients with hip fracture. Furthermore, this study showed the usefulness of a combined database of medical and LTCI claims data for clinical and health service-related research in the field of orthopedics.

Effects of Early Postdischarge Rehabilitation Services on Care Needs–Level Deterioration in Older Adults With Functional Impairment: A Propensity Score–Matched Study

ObjectiveTo examine the effects of early postdischarge rehabilitation on care needs–level deterioration in older Japanese patients. DesignPropensity score–matched retrospective cohort study. SettingA secondary data analysis was conducted using medical and long-term care insurance claims data from a suburban city in Japan. ParticipantsWe analyzed patients (N=2746) aged 65 years or older who were discharged from hospital to home between April 2012 and March 2014 and had care needs certification indicating functional impairment. InterventionsThe provision of early rehabilitation services by rehabilitation therapists within 1 month of discharge. Propensity score matching was used to control for differences in characteristics between patients with and without early rehabilitation services. Main Outcome MeasuresAny deterioration in care needs level during the 12-month period after discharge. Cox proportional hazards analyses were conducted to identify the association between the exposure and outcome variables after matching. ResultsAmong 2746 patients, 573 (20.9%) used early rehabilitation services. Care needs–level deterioration occurred in 508 patients (incidence: 18.3 per 1000 person-months), of which 76 used early rehabilitation services (12.3 per 1000 person-months) and 432 did not use early rehabilitation services (20.0 per 1000 person-months). One-to-one propensity score matching produced 566 matched pairs that adjusted for the differences in all covariables. In these matched pairs, the hazard of care needs–level deterioration was significantly lower among patients who used early rehabilitation services (hazard ratio=0.712, 95% CI, 0.529-0.958). A Kaplan-Meier survival analysis showed similar results (log-rank: P=.023). ConclusionsEarly rehabilitation services provided by rehabilitation therapists after hospital discharge appeared effective in preventing care needs–level deterioration, and involving rehabilitation therapists in transitional care may aid the optimization of health care for older Japanese adults with functional impairment.

Predicting demand for long-term care using Japanese healthcare insurance claims data.

Driven by the rapid aging of the population, Japan introduced public long-term care insurance to reinforce healthcare services for the elderly in 2000. Precisely predicting future demand for long-term care services helps authorities to plan and manage their healthcare resources and citizens to prevent their health status deterioration. This paper presents our novel study for developing an effective model to predict individual-level future long-term care demand using previous healthcare insurance claims data. We designed two discriminative models and subsequently trained and validated the models using three learning algorithms with medical and long-term care insurance claims and enrollment records, which were provided by 170 regional public insurers in Gifu, Japan. The prediction model based on multiclass classification and gradient-boosting decision tree achieved practically high accuracy (weighted average of Precision, 0.872; Recall, 0.878; and F-measure, 0.873) for up to 12 months after the previous claims. The top important feature variables were indicators of current health status (e.g., current eligibility levels and age), risk factors to worsen future healthcare status (e.g., dementia), and preventive care services for improving future healthcare status (e.g., training and rehabilitation). The intensive validation tests have indicated that the developed prediction method holds high robustness, even though it yields relatively lower accuracy for specific patient groups with health conditions that are hard to distinguish.

Factors Associated with Outpatient Cardiac Rehabilitation Participation in Older Patients: A Population-Based Study Using Claims Data from Two Cities in Japan.

Although outpatient cardiac rehabilitation has been shown to be effective, the participation status of older cardiac patients is unclear in real-world settings. We investigated the proportion and associated factors of outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention. We analyzed data from medical and long-term care insurance claims data from two municipalities in Japan. The data coverage period was between April 2014 and March 2019 in City A and between April 2012 and November 2016 in City B. We identified patients aged ≥65 years with post-operative acute myocardial infarction, angina pectoris, or heart valve disease. We estimated the proportion of cardiac rehabilitation participation and conducted logistic regression to identify factors (age, sex, type of cardiac disease, open-heart surgery, Charlson comorbidity index, long-term care need level, catecholamine use, inpatient cardiac rehabilitation, and hospital volume for cardiac rehabilitation) associated with outpatient cardiac rehabilitation participation. A total of 690 patients were included in this study. The proportion of patients receiving outpatient cardiac rehabilitation was 9.0% overall. Multivariable logistic regression analysis suggested that men (adjusted OR 3.98; 95% CI 1.69-9.37), acute myocardial infarction (adjusted OR 2.76; 95% CI 1.20-6.36; reference angina pectoris), inpatient cardiac rehabilitation (adjusted OR 17.01; 95% CI 5.33-54.24), and "hospital volume" for cardiac rehabilitation (adjusted OR 4.35; 95% CI 1.14-16.57 for high-volume hospitals; reference low-volume hospital) were independently associated with outpatient cardiac rehabilitation. The participation rate of outpatient cardiac rehabilitation among older post-operative cardiac patients was suboptimal. Further studies are warranted to examine its generalizability and whether a targeted approach to a group of patients who are less likely to receive outpatient cardiac rehabilitation could improve the participation rate.