title: [Comparison of survival under domestic or institutional care: the Hannover morbidity and mortality long-term care study].
abstract: OBJECTIVE
  Empirical data, representative of the total population are necessary for medico-actuarial risk calculations. Our study compares mortalities of long-term care (LTC) patients with regard to age, gender and distribution of care levels when in home or institutional care.
  
  
  METHODS
  The data of 88.575 long-term care patients were analysed longitudinally for ten years, using routine data on the files of the German Federal Health Insurance fund (average observation period 2.5 years, a total of 221.625 observation years). The numbers of LTC patients and their care levels while remaining in home or institutional care were calculated, as were any changes to another care level or discontinuation of long-term care benefits (as a result of the need for care falling below the eligibility criteria for care level I or to death) during 1 - 10 years after the onset of long-term care.
  
  
  RESULTS
  Total mortality was found to increase with age and care level in homecare as well as in institutional settings for both sexes. It is greatly influenced by the first year mortality, which for both genders was lower for care level 1 in home care settings but higher for care level 2 and much higher for care level 3 than in institutional care settings. Follow-up mortality (second to tenth year after the start of LTC) was lower for care level 1 and 2 in home care settings than for institutional care. But for care level 3 the follow-up mortality was conversely higher in home care settings than in institutional care (for both genders). The number of patients returning to an active life after rehabilitation is much higher for home care patients than those who had been in institutional care. The transfer rate from homecare to institutional care increased during the first three years after onset of care, descending thereafter, and was much higher than conversely.
  
  
  CONCLUSIONS
  The slogan "outpatient care before inpatient care" must be differentiated and considered carefully with regard to the character and constellation of diseases, age attained, length of time after onset of care, care level, potential for resuming an active life, as well as level of compensation and number and nature of activities of daily life together with being given the necessary help when choosing between homecare or institutional care. Differentiation between first year and follow-up mortalities is recommended when undertaking medico-actuarial calculations.
authors: Medizinischer Dienst der Krankenversicherung Niedersachsen, Hannover. wolfgang.seger@mdkn.de
authors: W
authors: W
authors: Seger
authors: N-A
authors: NA
authors: Sittaro
authors: R
authors: R
authors: Lohse
authors: J
authors: J
authors: Rabba
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease / Q000145:classification / Q000191:economics / Q000401:mortality* / Q000534:rehabilitation*; D017046:Cost Savings / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D018868:Insurance, Disability / Q000191:economics; D008134:Long-Term Care / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D012737:Sex Factors; D016019:Survival Analysis