Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial

Abstract

Background and aims: Reducing health care costs through preventive geriatric care has become a high priority in Japan. We analyzed data from a randomized controlled trial to examine the effects of a preventive home visit program on health care costs among ambulatory frail elders.

Methods: Structured preventive home visits by nurses or care managers were provided to the visit group every 6 months over 2 years. The enrolled participants (N = 323) were randomly assigned to either the visit group (N = 161) or the control group (N = 162). We analyzed the health care costs, including the costs for hospitalizations and outpatient clinic utilization for participants who had health care insurance from the local government (N = 307). The visit group included 154 individuals in the visit group and 153 people in the control group.

Results: Total health care costs over the study period were not significantly different between groups, but at most monthly time points costs and those for outpatient clinic utilization in the visit group were lower than those in the control group. Hospitalizations, which accounted for more than ¥ 500,000 JPY per month, were less likely to occur more often among participants in the visit group (N = 71) than in the control group (N = 113) (OR = 0.63; p = 0.002).

Conclusions: These results suggest that a preventive home visit program may reduce monthly health care costs, primarily by reducing hospitalization costs.

Fig. 1

Monthly total health care costs of the groups during the study period (the visit group N = 154; the control group N = 153). (a) Numbers are raw data. (b) The yearly TTS average for 2008 was 1 USD = 104.5 JPY; this average for 2009 was 1 USD = 94.6 JPY. (c) A t test showed significant differences of each health care cost between groups using log-transformed values at 3M (p = 0.03), 11M (p = 0.005), 12M (p = 0.046), 13M (p = 0.01) and 17M (p = 0.049)

Fig. 2

Monthly health care costs for outpatient clinic utilization of the groups during the study period (the visit group N = 154; the control group N = 153). (a) Numbers are raw data. (b) The yearly TTS average for 2008 was 1 USD = 104.5 JPY; this average for 2009 was 1 USD = 94.6 JPY. (c) A t test showed significant differences of each health care cost between groups using log-transformed values at 1M (p = 0.01), 6M (p = 0.01), 7M (p = 0.04), 8M (p = 0.008), 11M (p = 0.02), 12M (p = 0.02), 21M (p = 0.01) and 23M (p = 0.048)

Fig. 3

Distribution of monthly hospital care costs of the groups during the study period (N = 307). (a) The yearly TTS average for 2008 was 1 USD = 104.5 JPY; this average for 2009 was 1 USD = 94.6 JPY. (b) The number of participants who were hospitalized in the visit group were ordered from 1 to 24 months; N = 14, 13, 6, 10, 15, 14, 15, 11, 11, 7, 5, 7, 8, 9, 10, 11, 10, 8, 7, 9, 10, 13, 11, 13. (c) The number of participants who were hospitalized in the control group were ordered from 1 to 24 months; N = 6, 10, 9, 9, 14, 7, 10, 5, 9, 10, 11, 9, 10, 13, 9, 11, 14, 9, 6, 9, 10, 10, 6, 10. (d) Hospitalizations that accounted for more than 500,000 JPY: the visit vs. control group (N = 71 vs. N = 113); OR = 0.63, p = 0.002