The association between advanced practice nurse visiting services and acute healthcare utilization in long-term care residents: A retrospective cohort study with propensity score matching.

BACKGROUND

Residents in long-term care settings have complex medical and functional needs, and the early period following facility admission represents a vulnerable transitional phase. Registered nurses are often not available on-site in institutional long-term care settings, in Korea and globally, limiting the capacity to respond to acute challenges. In 2014, Korea expanded home-visit advanced practice nurse visiting services to cover long-term care residents, enabling advanced practice nurses to deliver skilled nursing interventions within institutional long-term care settings.

OBJECTIVE

This study evaluates the impact of advanced practice nurse visiting services on acute healthcare utilization among long-term care residents with nursing care needs.

DESIGN

Retrospective cohort study using Korean nationwide claims data.

SETTING(S): Institutional long-term care settings.

PARTICIPANTS

32,018 long-term care residents with nursing needs were included, and 1507 were selected through 1:3 propensity score and exact matching.

METHODS

A 1:3 matched cohort was constructed using propensity score matching and exact matching on functional status and clinical severity. Outcomes were emergency department visits, acute hospital admissions, and long-term care hospital admissions within 6 months of Institutional long-term care admission. Left-truncated Cox models estimated hazard ratios with 95% confidence intervals.

RESULTS

Among 1507 matched participants, those who received advanced practice nurse visiting service had significantly lower risks of admission to acute hospitals (hazard ratio 0.62) and long-term care hospitals (hazard ratio 0.52), with no difference in emergency department visits. In subgroup analyses, advanced practice nurse visiting service use was associated with a lower risk of acute hospital admission among residents with long-term care eligibility grades 1 and 2, indicating high functional dependence, with grade 1 reflecting greater dependence than grade 2 (grade 1: hazard ratio 0.56; grade 2: hazard ratio 0.53). A lower risk was also observed among residents with Charlson Comorbidity Index scores of 0-2 (hazard ratio 0.58) and 3-4 (hazard ratio 0.62). For long-term care hospital admission, a significantly lower risk was observed among residents with Charlson Comorbidity Index scores of 3-4 and above (hazard ratio 0.47).

CONCLUSIONS

Advanced practice nurse visiting services were associated with lower risks of acute hospitalization, particularly among residents with high care needs. Furthermore, a lower risk of admission to a long-term care hospital was observed among residents. This suggests the services may help prevent avoidable hospitalizations and enhance continuity of care for high-risk residents in long-term care settings.