The Effect of Home Care Support Clinics on Hospital Readmission in Heart Failure Patients in Japan

Yu Sun; Masao Iwagami; Jun Komiyama; Takehiro Sugiyama; Ryota Inokuchi; Nobuo Sakata; Tomoko Ito; Satoru Yoshie; Hiroki Matsui; Keitaro Kume; Masaru Sanuki; Genta Kato; Yukiko Mori; Hiroaki Ueshima; Nanako Tamiya

doi:10.1007/s11606-023-08030-9

The Effect of Home Care Support Clinics on Hospital Readmission in Heart Failure Patients in Japan

J Gen Intern Med. 2023 Jul;38(9):2156-2163. doi: 10.1007/s11606-023-08030-9. Epub 2023 Jan 17.

Authors

Yu Sun^{1

2}, Masao Iwagami^{3

4}, Jun Komiyama^{1

5}, Takehiro Sugiyama^{2

5

6

7}, Ryota Inokuchi^{2

5}, Nobuo Sakata^{2

5

8}, Tomoko Ito², Satoru Yoshie^{2

9

10

11}, Hiroki Matsui¹², Keitaro Kume¹³, Masaru Sanuki¹³, Genta Kato¹⁴, Yukiko Mori¹⁵, Hiroaki Ueshima¹⁶, Nanako Tamiya^{2

5}

Affiliations

¹ Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
² Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
³ Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan. iwagami-tky@umin.ac.jp.
⁴ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan. iwagami-tky@umin.ac.jp.
⁵ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
⁶ Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
⁷ Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
⁸ Heisei Medical Welfare Group Research Institute, Tokyo, Japan.
⁹ Institute of Gerontology, The University of Tokyo, Tokyo, Japan.
¹⁰ Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan.
¹¹ Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
¹² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
¹³ Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
¹⁴ Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan.
¹⁵ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan.
¹⁶ Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan.

PMID: 36650335
PMCID: PMC10361922 (available on 2024-07-01)
DOI: 10.1007/s11606-023-08030-9

Abstract

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.

Keywords: Emergency house calls; Heart failure; Home healthcare services; Readmission.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Heart Failure* / epidemiology
Heart Failure* / therapy
Home Care Services*
Humans
Japan / epidemiology
Patient Discharge
Patient Readmission
Retrospective Studies