Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65 Report as inadecuate

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BMC Health Services Research

, 10:110

First Online: 06 May 2010Received: 26 June 2009Accepted: 06 May 2010DOI: 10.1186-1472-6963-10-110

Cite this article as: Wong, A., Elderkamp-de Groot, R., Polder, J. et al. BMC Health Serv Res 2010 10: 110. doi:10.1186-1472-6963-10-110


BackgroundLong-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home.

MethodsThe data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care reference category, discharge to home with home care, admission to a nursing home and admission to a home for the elderly.

ResultsThe study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases relative risk ratio RRR = 11.5 were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg RRR = 6.1 were strong determinants of admission to a home for the elderly. Lung cancer RRR = 4.9 was the strongest determinant of discharge to the home with home care.

ConclusionsThese results emphasize the impact of age, absence-presence of a spouse and disease on long-term care utilization. In an era of demographic and epidemiological changes, not only will hospital use change, but also the need for long-term care following hospital discharge. The results of this study can be used by policy-makers for planning health care utilization services and anticipating future health care needs.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-10-110 contains supplementary material, which is available to authorized users.

Albert Wong, Rianne Elderkamp-de Groot contributed equally to this work.

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Author: Albert Wong - Rianne Elderkamp-de Groot - Johan Polder - Job van Exel


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