Factors Associated with Acute Hospitalizations and Mortality of Older Adults in Long-Term Care Facilities and Long-Term Care Hospitals: A Population-Based, Pubic-Insurance Big-Data Analysis

Purpose: This study examined individual, institutional, and regional factors associated with 90-day acute hospitalizations and 1-year mortality among older people admitted to long-term care facilities (LTCFs) and long-term care hospitals (LTCH) in Korea.Methods: We analyzed the National Health Insurance Services (NHIS) Elderly Cohort Database linked with regional statistics. The sample included 13,839 LTCF residents and 23,962 LTCH patients. Multi-level logistic regression analyses were conducted.Results: The risk for 90-day acute hospital admission was positively associated with being male and having comorbidities among both LTCF residents and LTCH patients. Being 80+ years old and having a severe case-mix (LTCF grade 1/LTCH groups A1 & 2) were positively associated with acute hospitalizations among LTCF residents, but the relationships were negative among LTCH patients. People in urban LTCFs and/or those in facilities located in regions with a higher physician supply had lower acute hospitalizations. The risk for 1-year mortality after LTCF or LTCH admission was positively associated with being an old male, having a severe case-mix, and comorbidities. Among institutional factors, public ownership for LTCFs and being a larger size for LTCHs were negatively associated with mortality.Conclusion: This health and long-term care big data analysis showed various factors influenced adverse health outcomes among older Koreans receiving institutionalized long-term care, and the patterns of the relationships were different for LTCFs and LTCHs. Further investigations are needed into the mechanisms underlying the complex dynamics among the multi-level determinants of acute care utilization and mortality by institution type.