JMIR Publications

ABSTRACT

Background:

Care coordination is an essential component for care transitions, such as hospital discharges. Several countries, including Japan, provide financial incentives to standardize care coordination. However, regional variations in hospital conditions may exist, and the impact of care coordination on healthcare outcomes is yet to be determined in Japan.

Objective:

To examine regional differences in accessibility of care coordination, investigate the association between care coordination and healthcare outcomes, explore factors related to regional differences.

Methods:

This is an ecological study conducted nationwide analysis using open-source data for FY 2020. We evaluated accessibility of care coordination by calculating the number of claims on the 47 prefectures and calculated supply-adjusted standardized claim ratios (SCRs) for each prefectures to identify regional differences among regions. The open-source data was extracted from the Seventh National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) (claims from April 2020 to March 2021). Healthcare outcomes included discharge to home, 30-day readmissions, length of hospital stay, and medical expenditures at the prefectural level. Regional differences were evaluated using descriptive statistics, and multivariate negative binomial regression models were used to estimate the association between exposure and outcomes, with adjustments made for socioeconomic factors in the prefecture. Mann–Whitney U tests were used to explore factors explaining regional differences.

Results:

The minimum and maximum supply-adjusted SCRs were 0.015 and 0.174, respectively. The regression models showed that supply-adjusted SCRs were significantly associated with discharge from hospital to home, with a 75.68 (95% CI: 7.28 to 151.60) increase in discharge to home per 10,000 patients discharged from the hospital for one standard deviation increase. Factors related to regional differences were identified: number of nurses per 100 hospital beds, number of offices of care managers per 100 km2 of habitable area, proportion of hospitals providing patients with electronic medical information, proportion of older adults living alone, and average income per capita in the prefecture.

Conclusions:

Care coordination was associated with discharge to home, and Japan has regional disparities in accessibility of care coordination.