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Open Access Research article

Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

Albert Wong12*, Rianne Elderkamp-de Groot34, Johan Polder23 and Job van Exel45

Author Affiliations

1 Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands

2 Department Tranzo, Faculty of Social and Behavioral Sciences, University of Tilburg, Tilburg, the Netherlands

3 Centre for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, the Netherlands

4 Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, the Netherlands

5 Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, the Netherlands

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BMC Health Services Research 2010, 10:110  doi:10.1186/1472-6963-10-110

Published: 6 May 2010

Abstract

Background

Long-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.

Methods

The 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.

Results

The 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.

Conclusions

These 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.