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Association Between Long-Term Care Insurance Certification and Early Home-Visit Nursing Frequency in Older Patients With Heart Failure in Japan
Takemasa Ishikawa. Home Health Care Management & Practice, 2025-11-23
Topic: Risk, prevention and care in population studies
Home-visit nursing can reduce early readmissions and improve quality of life in older patients with heart failure (HF). In Japan, allocation of home-visit nursing often depends on Long-Term Care Insurance (LTCI) certification, which is determined primarily by functional status within budgets. This study examined whether LTCI certification is associated with the frequency of early home-visit nursing. We retrospectively analyzed 88 patients with HF who initiated home-visit nursing at a single agency between 2014 and 2024. The outcome was the number of visits within the initial 2 weeks comparing patients with and without LTCI. Negative binomial regression estimated incidence rate ratios (IRR), adjusting for age, sex, activities of daily living (ADL), physician-issued special direction, and eligibility under Separate Tables 7 and 8 of the medical insurance system. The median age was 86 years [IQR 82-90], and 74 patients (84.1%) were LTCI-certified. Cross-tabulation showed no significant association between LTCI certification and ADL level (χ² = 6.60, df = 3, P = .086). LTCI certification was associated with fewer visits (IRR = 0.67, 95% CI 0.49-0.91, P = .011). Compared with ADL “independent,” the “bed-bound” category received more visits (IRR = 1.99, 95% CI 1.28-3.10, P = .002). Physician-issued special direction was associated with higher visit frequency (IRR = 3.39, 95% CI 2.59-4.48, P < .001). These findings suggest that function-based, budget-capped frameworks may under-allocate nursing intensity for medically complex HF patients. Aligning visit planning with medical risk in the early post-discharge period may improve equity and care quality.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Ishikawa, T. (2025). Association Between Long-Term Care Insurance Certification and Early Home-Visit Nursing Frequency in Older Patients With Heart Failure in Japan. Home Health Care Management & Practice. https://doi.org/10.1177/10848223251397543
Vancouver
Ishikawa T. Association Between Long-Term Care Insurance Certification and Early Home-Visit Nursing Frequency in Older Patients With Heart Failure in Japan. Home Health Care Management & Practice. 2025. doi:10.1177/10848223251397543.
BibTeX
@article{ishikawa2025-bb3f77fe,
author = {Ishikawa, Takemasa},
title = {{Association Between Long-Term Care Insurance Certification and Early Home-Visit Nursing Frequency in Older Patients With Heart Failure in Japan}},
journal = {Home Health Care Management \& Practice},
year = {2025},
doi = {10.1177/10848223251397543},
url = {https://doi.org/10.1177/10848223251397543}
}
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.
Key findings
- This study examined whether LTCI certification is associated with the frequency of early home-visit nursing.
- Cross-tabulation showed no significant association between LTCI certification and ADL level (χ² = 6.60, df = 3, P = .086).
- LTCI certification was associated with fewer visits (IRR = 0.67, 95% CI 0.49-0.91, P = .011).
- Compared with ADL “independent,” the “bed-bound” category received more visits (IRR = 1.99, 95% CI 1.28-3.10, P = .002).
- Physician-issued special direction was associated with higher visit frequency (IRR = 3.39, 95% CI 2.59-4.48, P < .001).
Why it matters
In this retrospective study of 88 patients with heart failure in Japan, Long-Term Care Insurance certification was associated with fewer early home-visit nursing visits. There was no significant association between certification and activities of daily living level.
Study details
- Participants88
- Effect size84.1%; RR = 0.67; RR = 1.99
- Evidence strengthLow
How this study scored 32/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Home Health Care Management & Practice) |
| Journal's citation record | 0 / 4 | Home Health Care Management & Practice: journal h-index 38 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| 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 | 1 / 4 | 88 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 1 / 6 | Cited 0.6× 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 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 0 / 4 | Last-listed author Takemasa Ishikawa: h-index 3 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Osaka Science Museum: institution h-index 43 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 32 / 100 | — |
What each of these 20 components measures, and what this score is not →
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