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The Effect of Home Care Support Clinics on Hospital Readmission in Heart Failure Patients in Japan.
Sun, Yu; Iwagami, Masao; Komiyama, Jun; Sugiyama, Takehiro; Inokuchi, Ryota; Sakata, Nobuo; Ito, Tomoko; Yoshie, Satoru; Matsui, Hiroki; Kume, Keitaro; Sanuki, Masaru; Kato, Genta; Mori, Yukiko; Ueshima, Hiroaki; Tamiya, Nanako.
Afiliação
  • Sun Y; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
  • Iwagami M; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
  • Komiyama J; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan. iwagami-tky@umin.ac.jp.
  • Sugiyama T; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan. iwagami-tky@umin.ac.jp.
  • Inokuchi R; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
  • Sakata N; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
  • Ito T; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
  • Yoshie S; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
  • Matsui H; Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
  • Kume K; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
  • Sanuki M; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
  • Kato G; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
  • Mori Y; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
  • Ueshima H; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
  • Tamiya N; Heisei Medical Welfare Group Research Institute, Tokyo, Japan.
J Gen Intern Med ; 38(9): 2156-2163, 2023 07.
Article em En | MEDLINE | ID: mdl-36650335
BACKGROUND: Heart failure is common and is associated with high rates of hospitalization. Home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in Japan in 2006 and 2012, respectively. OBJECTIVE: This study aimed to examine the effect of post-discharge care by conventional or enhanced HCSCs on readmission, compared with general clinics. DESIGN: Retrospective cohort study using the Japanese nationwide health insurance claims database. PARTICIPANTS: Participants were ≥65 years of age, admitted for heart failure and discharged between July 2014 and August 2015 and received a home visit within a month following the discharge (n=12,393). MAIN MEASURES: The exposure was the type of medical facility that provides post-discharge home healthcare: general clinics, conventional HCSCs, and enhanced HCSCs. The primary outcome was all-cause readmission for 6 months after the first visit; the incidence of emergency house calls was a secondary outcome. We used a competing risk regression using the Fine and Gray method, in which death was regarded as a competing event. KEY RESULTS: At 6 months, readmissions were lower in conventional (38%) or enhanced HCSCs (38%) than general clinics (43%). The adjusted subdistribution hazard ratio (sHR) of readmission was 0.87 (95% CI: 0.78-0.96) for conventional and 0.86 (0.78-0.96) for enhanced HCSCs. Emergency house calls increased with conventional (sHR: 1.77, 95% CI:1.57-2.00) and enhanced HCSCs (sHR: 1.93, 95% CI: 1.71-2.17). CONCLUSIONS: Older Japanese patients with heart failure receiving post-discharge home healthcare by conventional or enhanced HCSCs had lower readmission rates, possibly due to compensation with more emergency house calls. Conventional and enhanced HCSCs may be effective in reducing the risk of rehospitalization. Further studies are necessary to confirm the medical functions performed by HCSCs.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Insuficiência Cardíaca / Serviços de Assistência Domiciliar Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans País/Região como assunto: Asia Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Insuficiência Cardíaca / Serviços de Assistência Domiciliar Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans País/Região como assunto: Asia Idioma: En Ano de publicação: 2023 Tipo de documento: Article