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Association Between In-Hospital Applications for Long-Term Care Services and Hospital Length of Stay Among Older Adults: Ecological Cross-Sectional Study
Naoki Takashi, Joji Onishi, Michiko Fujisawa, Tomoko Ohura, Shosuke Ohtera. JMIR Formative Research, 2025-09-08
Topic: Risk, prevention and care in population studies
The median proportion of in-hospital LTC certification applications was 30.5% (IQR 24.5%-36.1%). The median LOS for older adults was 40 (IQR 37-45.5; range 30-82) days. Prefectures with a higher proportion of in-hospital applications had substantially longer average LOSs. In univariate analysis, the association was statistically significant (β=0.04; P=.003), indicating that a 1% increase in in-hospital applications was associated with an approximately 2-day increase in average LOS. This association remained statistically significant after adjustment for all covariates in multivariate models (β=0.06; P=.04). Findings were consistent across sensitivity analyses. Although initiating LTC certification during hospitalization is essential for supporting timely discharge, our findings indicate a positive association with extended hospital stays. This may reflect systemic delays in the certification process. Even with ideal discharge planning, such delays could extend hospitalization and lead to suboptimal allocation of health care resources. As this study was ecological in design, the findings should be interpreted cautiously. Further individual-level data research is warranted to clarify the mechanisms and inform strategies for improving transitional care efficiency in aging populations.
Key findings
- The median proportion of in-hospital LTC certification applications was 30.5% (IQR 24.5%-36.1%).
- The median LOS for older adults was 40 (IQR 37-45.5; range 30-82) days.
- Prefectures with a higher proportion of in-hospital applications had substantially longer average LOSs.
- In univariate analysis, the association was statistically significant (β=0.04; P=.003), indicating that a 1% increase in in-hospital applications was associated with an approximately 2-day increase in average LOS.
- This association remained statistically significant after adjustment for all covariates in multivariate models (β=0.06; P=.04).
Why it matters
This ecological study found that regions with a higher proportion of in-hospital long-term care certification applications had longer average hospital stays for older adults. The authors caution that the ecological design limits interpretation and that individual-level research is needed.
Study details
- Study designcross-sectional
- Effect size30.5%; 24.5%; 36.1%
- Evidence strengthLow
How this study scored 33/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JMIR Formative Research) |
| Journal's citation record | 0 / 4 | JMIR Formative Research: journal h-index 54 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Shosuke Ohtera: h-index 10 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | National Center for Geriatrics and Gerontology: institution h-index 249 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40921066) |
| Free to read | 2 / 2 | Free to read |
| Total | 33 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Takashi, N., Onishi, J., Fujisawa, M., Ohura, T., & Ohtera, S. (2025). Association Between In-Hospital Applications for Long-Term Care Services and Hospital Length of Stay Among Older Adults: Ecological Cross-Sectional Study. JMIR Formative Research. https://doi.org/10.2196/76782
Vancouver
Takashi N, Onishi J, Fujisawa M, Ohura T, Ohtera S. Association Between In-Hospital Applications for Long-Term Care Services and Hospital Length of Stay Among Older Adults: Ecological Cross-Sectional Study. JMIR Formative Research. 2025. doi:10.2196/76782. PMID: 40921066.
BibTeX
@article{takashi2025-40921066,
author = {Takashi, Naoki and Onishi, Joji and Fujisawa, Michiko and Ohura, Tomoko and Ohtera, Shosuke},
title = {{Association Between In-Hospital Applications for Long-Term Care Services and Hospital Length of Stay Among Older Adults: Ecological Cross-Sectional Study}},
journal = {JMIR Formative Research},
year = {2025},
doi = {10.2196/76782},
pmid = {40921066},
url = {https://doi.org/10.2196/76782}
}
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