# The Association Between Home‐Visit Nursing Use and the Incidence of Potentially Avoidable Hospitalisation and Its Duration Among Community‐Dwelling Older People: A 12‐Month Prospective Cohort Study

## TL;DR

Home-visit nursing is linked to fewer avoidable hospitalizations in older people living at home, but not to shorter hospital stays.

## Contribution

This study is one of the few to investigate the association between home-visit nursing use and potentially avoidable hospitalization in older adults.

## Key findings

- Home-visit nursing users had a 37% lower incidence of potentially avoidable hospitalization compared to non-users.
- There was no significant difference in hospitalization duration between home-visit nursing users and non-users.
- Home-visit nursing may help older people remain at home by reducing avoidable hospitalizations.

## Abstract

Preventing potentially avoidable hospitalisation (PAH) and reducing its duration are crucial to allow community‐dwelling older people to age at home. In Japan, homecare services, which include a variety of services such as home help, home‐based rehabilitation and home‐visit nursing, are covered by medical and long‐term care insurance and coordinated by care managers. Although home‐visit nursing is essential in homecare, studies investigating the association between the use of home‐visit nursing and the incidence and duration of PAH remain limited.

To examine the association between home‐visit nursing use and the incidence and duration of PAH among community‐dwelling older people.

This was a 12‐month prospective cohort study.

47 home‐visit nursing agencies and 73 care management offices across Japan.

Older people (≥ 75 years) receiving homecare services.

Using online questionnaires, home‐visit nurses and care managers reported older people's demographics, health status and PAH events over 12 months, as well as the state of using home‐visit nursing (users or non‐users). The incidence of PAH was dichotomised as either ‘none’ or ‘one and more’, due to heavy skewing. To examine PAH days, the rate of observed days was used due to the variability in the total observation period. Poisson regression and multivariate linear regression analyses were applied.

Of the 1450 participants initially recruited, 781 with complete dataset were included in the PAH incidence analysis. Of these, 81.0% were home‐visit nursing users. Mean participant age was 85.3 years (standard deviation: 6.1; range: 75–103), and 58.8% were female. The incidence rate ratio (IRR) of PAH was lower among home‐visit nursing users compared with non‐users (IRR, 0.63; 95% confidence interval [CI]: 0.41–0.95). Among 110 participants with PAH, there was no statistically significant difference in the rate of PAH days between home‐visit nursing users and non‐users (β = −0.65, 95% CI: −8.35–4.50).

These results suggest that home‐visit nursing is associated with a lower incidence of PAH among older people; however, it is not associated with the duration of hospital stay once PAH occurs. For community‐dwelling older people with homecare services, home‐visit nursing may contribute to sustaining lives at home without PAH.

Home‐visit nursing may help support community‐dwelling older people in remaining at home by minimizing the occurrence of PAH.

Home‐visit nursing use was associated with a lower incidence of PAH among community‐dwelling older people who need help from professional caregivers. There was no statistically significant difference in the duration of hospitalisation between home‐visit nursing users and non‐users.

Home‐visit nursing use was associated with a lower incidence of PAH among community‐dwelling older people who need help from professional caregivers. There was no statistically significant difference in the duration of hospitalisation between home‐visit nursing users and non‐users.

It was suggested that home‐visit nursing use contributes to older people's longer, uninterrupted lives at home by preventing PAH.

It was suggested that home‐visit nursing use contributes to older people's longer, uninterrupted lives at home by preventing PAH.

The findings can contribute to future intervention and database studies to explore the causal relationship between home‐visit nursing use and the incidence and duration of PAH. The findings indicated that home‐visit nursing service may be required to accommodate the increasing proportion of older people staying at home with minimum PAH.

The findings can contribute to future intervention and database studies to explore the causal relationship between home‐visit nursing use and the incidence and duration of PAH. The findings indicated that home‐visit nursing service may be required to accommodate the increasing proportion of older people staying at home with minimum PAH.