International Journal of Nursing Studies 113 (2021) 103804 Contents lists available at ScienceDirect International Journal of Nursing Studies j o u r n a l h o me p a g e : www. e l s e v i e r . c o m/ i j n s Comparison of progression of care-need levels among long-term care recipients with and without advanced care management in a rural municipality of Japan: A population-based observational study Sakiko Itoh a,b,1,* , Takahiro Mori b,c , Boyoung Jeon b,d , Noriko Morioka a , Tomoko Ito c , Xueying Jin b , Yasuko Ogata a , Nanako Tamiya b,c a Nursing Career Pathway Center, Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan b Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan c Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan d Division of Health Services Development for Persons with Disabilities, National Rehabilitation Center, Seoul, 58, Samgaksan-ro, Gangbuk-gu, Seoul 01022, Republic of Korea a r t i c l e i n f o Article history: Received 24 April 2020 Received in revised form 6 September 2020 Accepted 15 October 2020 Keywords: Community health services Gerontological nursing Health services for the aged Long-term care Patient care management Patient-centered care a b s t r a c t Background: Little is known about the association between advanced care management and patient out- comes in home settings. In 2009, the Japanese government introduced a financial incentive scheme for advanced care management by long-term care agencies with at least one advanced care manager. How- ever, it remains unclear whether advanced care management in rural areas is associated with improved outcomes for recipients. Objective: To compare the progression of care-need levels among long-term care recipients in home set- tings with and without advanced care management. Design: A population-based observational study. Setting: A rural municipality in Japan. Participants: Recipients of long-term care (n = 2005). Methods: We used individual-level secondary data provided from a rural municipal government that was collected as part of the Survey of Long-Term Care Benefit Expenditures and medical care claim records between April 2012 and March 2017. We linked these two databases using unique identifiers. The in- clusion criteria for study subjects were that they: (1) were aged ≥65 years; (2) were newly certified as care-need level 1, 2, or 3; and (3) used long-term care insurance services in home settings from April 2012 through March 2017. We excluded individuals using long-term care insurance services for less than six months. Ultimately, we selected 1722 propensity-matched recipients with and without advanced care management, and then conducted Kaplan–Meier survival analyses and a log-rank test. The outcome mea- sure was progression of care-need levels. Results: The proportions of five-year cumulative progression-free survival in the groups with and without advanced care management were 50.3% and 42.2% for recipients of care-need level 1 (p < .01), 34.3% and 32.3% for recipients of care-need level 2 (p < .01), and 22.3% and 24.5% for recipients of care-need level 3 (p > .05), respectively. The progression-free period lasted a median of 12 (interquartile range, 10– 24) months for recipients of care-need level 1, 14 (interquartile range, 11–28) months for recipients of care-need level 2, and 12 (interquartile range, 10–24) months for recipients of care-need level 3. Conclusions: Long-term care recipients with advanced care management in home settings had a higher probability of progression of care-need levels in a rural municipality of Japan. This finding suggests that the governmental policy of providing financial incentive for advanced care management may not be ef- fective in improving the outcome of long-term care recipients in a rural municipality of Japan. © 2020 Elsevier Ltd. All rights reserved. * Corresponding author at: Nursing Career Pathway Center, Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. E-mail address: itoh@gi.med.osaka-u.ac.jp (S. Itoh). 1 Present affiliation: Department of Genome Informatics, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita 565-0871, Japan. https://doi.org/10.1016/j.ijnurstu.2020.103804 0020-7489/© 2020 Elsevier Ltd. All rights reserved.