Aging
The effect of regular physician home visits on the prevention of hospitalization among older adults starting long-term care in Japan Yoko Hamasaki* Yoko Hamasaki Masao Iwagami Yuta Taniguchi Jun Komiyama Yuji Ito Taeko Watanabe Naoaki Kuroda Ai Suzuki Nanako Tamiya
Background: Demand for home healthcare is increasing as the population ages. The Japanese healthcare system can reimburse physician home visits.
Aim: We examined whether physician home visits could reduce the risk of hospitalization among older adults starting long-term care, overall and by subgroups, which we identified by a clustering analysis in our previous study.
Methods: This retrospective cohort study included community-dwelling adults aged ≥65 years who started long-term care in City A, Japan, between October 2014 and March 2019. We defined the exposure status of regular physician home visits within 3 months after the care-need certification and followed them from 3 months as a landmark analysis. We excluded participants who were hospitalized or died before the 3-month landmark time point. All-cause hospitalization was assessed using the cumulative incidence function and competing-risk Cox regression. The analysis was conducted for all the participants and also by subgroups of people with (i) mild physical, (ii) mild cognitive, (iii) moderate physical, (iv) moderate multicomponent, and (v) severe multicomponent subtypes, clustered using 74 items on physical and cognitive functions, behavioral problems, and medical procedures in the Japanese standardized survey for care-needs certification.
Results: Of 3,120 participants (median [IQR] age, 83 [77-87] years; female, 60.6%), 6.2% used physician home visits. Median follow-up was 402 (201–730) days, and 1,118 were hospitalized. Overall, physician home visits were associated with fewer hospitalizations (adjusted HR 0.71, 95% CI 0.54-0.93). By subgroup, we observed a lower risk of hospitalization (adjusted HR 0.18, 95% CI 0.07-0.47) only in the severe multicomponent subtype (Figure).
Conclusions: We found physician home visits were associated with a lower risk of hospitalization, driven by the result in the most severe subgroup. These findings inform individualized care decisions and personalized care strategies.
