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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家庭长期护理中高级护理管理的结果：基于人群的回顾性观察研究


在以家庭为基础的长期护理中，护理管理旨在促进社区居住的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，并比较了护理管理类型之间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次数据是在 2015 年 5 月至 2019 年 3 月期间收集的。主要结果是日本长期护理保险中证明的护理需求水平的进展。暴露变量是高级护理管理。首先，我们进行倾向得分匹配以调整接受者特征的差异。其次，我们进行了卡普兰-迈耶生存分析和对数秩检验，结果指标是护理需求水平的进展。第三，进行皮尔逊卡方检验，以比较高级护理管理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 名倾向得分匹配的接受者接受高级或传统护理管理。接受高级和传统护理管理组的四年累积无进展生存率分别为 82.2% 和 78.5% (= .69)。使用家庭帮助服务 (< .05) 的高级和传统护理管理群体的比例分别为 17.1% 和 23.8%，使用社区日托服务 (< .05) 的比例分别为 4.0% 和 8.2% 。 与传统护理管理相比，家庭长期护理中的高级护理管理与中等护理需求的老年人的护理需求进展减缓无关。护理服务的使用情况存在显着差异，与传统护理管理组相比，高级护理管理组对家庭帮助服务和社区日托服务的使用率较低。