The effects of special nursing units in nursing homes on healthcare utilization and cost: A case-control study using propensity score matching

Abstract

Background: Most nursing homes in South Korea lack professional nursing services, resulting in transporting residents to hospitals for mild health problems and nursing treatment needs. While the number of nursing homes has increased, the number of registered nurses working in nursing homes has declined. In 2019, the Korean Ministry of Health and Welfare and the National Health Insurance Service launched the Special Nursing Units in Nursing Homes, a pilot nurse-led model, to resolve the lack of health and nursing services in nursing homes by mandating registered nurses' minimum staffing levels and protecting their scope of practice.

Objective: This study explored the effects of the Special Nursing Units model in Nursing Homes on healthcare utilization and cost among nursing home residents.

Design: A comparative effectiveness research design using propensity score matching.

Setting(s): Eighteen nursing homes were selected based on the region and number of beds.

Participants: There were 323 matched-pairs of residents from the case and control groups.

Methods: Nursing homes with more than 30 beds were recruited nationwide, with 18 nursing homes being selected based on the region and number of beds. The case group included 323 older adults receiving professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes for more than six months consecutively in 18 nursing homes between April and December 2019. We matched control participants using propensity score matching with health insurance and long-term care data. We analyzed the differences in healthcare utilization and cost changes between the case and control groups using generalized estimating equations.

Results: The groups were not statistically different in baseline demographic or health-related characteristics. There were 26 (8.1%) and 30 (9.3%) deaths in the case and control groups, respectively, during the six months of the model, which was not statistically different (p = .576). The case group showed statistically significant decreases in healthcare utilization and costs, including hospitalization frequency (p = .008), length of stay (p = .002), and hospitalization costs (p = .003); outpatient visit frequency (p = .003) and costs (p < .001); and home healthcare frequency (p < .001) and cost (p < .001) than the control group.

Conclusions: Professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes decreased healthcare utilization and costs. A nurse-led model in nursing homes, which includes mandating the minimum staffing levels of registered nurses and protecting their scope of practice, promises to improve resident health outcomes.