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

AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

OBJECTIVES: In 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 of daily living (ADLs) dysfunction and who require medical care, thereby allowing them to continue living in the community. We aimed to preliminarily analyse the characteristics of first-time users of NSMHC service. DESIGN: This pooled cross-sectional study used the Japanese long-term care insurance (LTCI) claims data from the users' first use of NSMHC (from April 2012 to December 2019). SETTING: NSMHC includes nursing home visits, home care, daycare, overnight stays and medical treatment. PARTICIPANTS: The study population included LTCI beneficiaries who received their first long-term care requirement certification in Japan from April 2012 onwards, died between April 2012 and December 2019, and used any LTCI service at least once. RESULTS: Among the 836 563 individuals who used any LTCI service at least once, 3957 (0.47%) used NSMHC. We analysed 3634 individuals without any missing data regarding long-term care requirement certification. Most individuals were aged 80 years or older, with 64.3% requiring care level 3 or above, indicating complete assistance with ADLs. Regarding ADLs in individuals with dementia, 70.6% were at level 2 or below, indicating they can live almost independently even with dementia. A large proportion of NSMHC users availed the service approximately 6 months before death, with no prior use of any LTCI services; they continued using the service for around 4 months, although some people continued to use NSMHC until their month of death. CONCLUSIONS: Using individual data on nationwide LTCI, we described the characteristics of first-time users of NSMHC among those who died within 7.5 years from the first certification of care needs. Further studies are needed to investigate the effect of NSMHC use on user outcomes.

Literature Review of Studies Using the National Database of the Health Insurance Claims of Japan (NDB): Limitations and Strategies in Using the NDB for Research.

The use of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) for research has increased over time. Researchers need to understand the characteristics of the data to generate quality-assured evidence from the NDB. In this review, we mapped and characterized the limitations and related strategies using the NDB for research based on the descriptions of published NDB studies. To find studies that used Japanese healthcare claims data, we searched MEDLINE, EMBASE, and Ichushi-Web up to June 2023. Additionally, we hand-searched the NDB data publication list from the Ministry of Health, Labour and Welfare (2017-2023). We abstracted data based on the NDB data type, research themes, age of the study sample or population, targeted disease, and the limitations and strategies in the NDB studies. Ultimately, 267 studies were included. Overall, the most common research theme was describing and estimating the prescriptions and treatment patterns (125 studies, 46.8%). There was a variation in the frequency of themes according to the type of NDB data. We identified the following categories of limitations: (1) lack of information on confounders/covariates, outcomes, and other clinical content, (2) limitations regarding patients not included in the NDB, (3) misclassification of data, (4) lack of unique identifiers and register of beneficiaries, and (5) others. Although the included studies noted several limitations of using the NDB for research, they also provided some strategies to address them. Organizing the limitations of NDB in research and the related strategies across research fields can help support high-quality NDB studies.

The relationship between leadership behaviours of ward nurse managers and teamwork competency of nursing staff: A cross-sectional study in Japanese hospitals.

AIMS: The aim of this study was to clarify what kind of leadership behaviours of ward nursing managers are related to the teamwork competency of nursing staff. BACKGROUND: There are two types of leadership behaviours: administrative and emotional intelligence leadership. While emotional intelligence leadership is important for teamwork, it is not clear how it relates to individual teamwork competency. METHODS: This was a cross-sectional study. A questionnaire survey was distributed among 13 hospitals in Japan between May and August 2019. RESULTS: We analysed 960 questionnaires. Multiple regression analyses revealed that two emotional intelligence leadership behaviours (staff nurturing and support, and care for patients) were positively associated with all three teamwork competencies (skill, knowledge and attitude, ß = 0.141-0.318). Regarding administrative leadership behaviours, only human resource management was related to teamwork competency knowledge (ß = 0.182). CONCLUSION: Nurses' teamwork competencies were primarily related to emotional intelligence leadership. Furthermore, their teamwork competency was related more to nurse managers' behaviour towards patients and other staff members rather than towards themselves. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to be role models for nursing staff, recognizing that the way they relate to others influences the teamwork competency of their nursing staff.

Predictors of the highest long-term care expenditures in Japan.

BACKGROUND: In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. METHODS: Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model. RESULTS: The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates. CONCLUSIONS: Beyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of the highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financial sustainability of LTCI from a public insurer perspective in Japan.

Healthcare in the year 2020--practice and policy.

Among the key issues facing the nursing profession as we moves towards the year 2020 are politics, policy and practice. This paper addresses these areas, as well as considering legal challenges and the question of whether nursing will exist as we currently know it. Moves away from hospital-based care towards more community-based and preventative care are considered, together with various scenarios describing possible futures.