In home-based long-term care, care management aims to facilitate the independence of community-dwelling older adults and mitigate the escalation of their care needs. We examined the association between the types of care management (advanced vs. conventional) and the progression of care needs among recipients with moderate care needs and compared care services offered in care plans between care management types. A retrospective, population-based observational study was conducted in Tsukuba City in Japan. The individual-level secondary data from the suburban municipal government was collected between May 2015 and March 2019. The primary outcome was the progression of care-need levels certificated in Japanese long-term care insurance. The exposure variable was advanced care management. First, we conducted propensity-score matching to adjust for differences in recipient characteristics. Second, we performed Kaplan–Meier survival analyses and log-rank tests, with the outcome measure being the progression of care-need levels. Third, Pearson's chi-square tests were performed to compare care services for recipients of advanced vs. conventional care management. Of the 1010 long-term care recipients, we selected 856 propensity score-matched recipients receiving advanced or conventional care management. The proportions of four-year cumulative progression-free survival in the groups receiving advanced and conventional care management were 82.2 % and 78.5 %, respectively ( = .69). The proportions of the groups with advanced and conventional care management were 17.1 % and 23.8 % using home-help services ( < .05), and 4.0 % and 8.2 % using community-based day care services ( < .05), respectively. Advanced care management in home-based long-term care was not associated with a slowing of the progression of care needs among older adults with moderate care needs compared with conventional care management. There was a notable discrepancy in the use of care services, with the advanced care management group having lower rates of use of home-help services and community-based day care services compared with the conventional care management group.

中文翻译：

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家庭长期护理高级护理管理的结果：一项基于人群的回顾性观察性研究


在以家庭为基础的长期护理中，护理管理旨在促进社区老年人的独立性，并减轻他们护理需求的升级。我们研究了护理管理类型（高级与传统）与具有中等护理需求接受者的护理需求进展之间的关联，并比较了不同护理管理类型的护理计划中提供的护理服务。在日本筑波市进行了一项基于人群的回顾性观察研究。郊区市政府的个人层面二手数据是在 2015 年 5 月至 2019 年 3 月期间收集的。主要结局是日本长期护理保险中认证的护理需求水平的进展。暴露变量是高级护理管理。首先，我们进行了倾向得分匹配，以调整收件人特征的差异。其次，我们进行了 Kaplan-Meier 生存分析和对数秩检验，结果测量是护理需求水平的进展。第三，进行 Pearson 卡方检验，以比较高级护理管理接受者与传统护理管理接受者的护理服务。在 1010 名长期护理接受者中，我们选择了 856 名接受高级或常规护理管理的倾向评分匹配的接受者。接受高级护理管理和常规护理管理的组四年累积无进展生存期的比例分别为 82.2% 和 78.5% （ = .69）。使用家庭护理服务的高级和传统护理管理的组别比例分别为 17.1 % 和 23.8% （ < .05），以及 4.0 % 和 8.2 % 使用社区日间护理服务 （ < .05）。 与传统护理管理相比，家庭长期护理中的高级护理管理与具有中等护理需求的老年人护理需求进展的减慢无关。在护理服务的使用方面存在显著差异，与传统护理管理组相比，高级护理管理组对家庭护理服务和社区日间护理服务的使用率较低。