title: Characteristics of visiting nurse agencies with high home death rates: A prefecture-wide study in Japan.
abstract: OBJECTIVE
  The purpose of the present study was to identify characteristics of visiting nurse agencies (VNA) in Japan with high home death rates by a prefecture-wide survey.
  
  
  METHODS
  A cross-sectional study of visiting nurse agencies (n = 101) in Ibaraki Prefecture, Japan, was completed. Data included the basic characteristics of each VNA, the type of services provided, level of coordination with other service providers, total number of VNA patients who died per year and place of death and contractual relationship with home-care supporting clinics providing end-of-life care services in the home 24 h a day. The VNA characteristics were analyzed by logistic regression, using the home death rate per VNA as a dependent variable.
  
  
  RESULTS
  A total 69 agencies, excluding those that did not report number of deaths (n = 14) and those without deaths during the year (n = 6), were analyzed. The median home death rate of the 69 VNA was 29.8%. The results of logistic regression analysis showed that higher home death rate was significantly associated with lack of attachment to a hospital, existence of a contractual relationship with home-care supporting clinics and existence of an interactive information exchange through telephone/face-to-face communication with attending physicians.
  
  
  CONCLUSIONS
  In order to increase the home death rate of people using VNA, policymakers must consider establishing home-based service systems within the community that can provide home end-of-life care services 24 h a day, and support the interactive exchange of information between the visiting nurse and the attending physician.
authors.affiliation: Department of Nursing Management, School of Medicine, Yokohama City University, Yokohama, Japan.|Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Kashiwagi
authors.affiliation: Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.affiliation: Ibaraki Nursing Association, Mito, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Murata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000458:organization & administration*; D064650:Home Health Nursing / Q000458:organization & administration*; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D009026:Mortality / Q000639:trends*; D015999:Multivariate Analysis; D064691:Nurses, Community Health / Q000458:organization & administration*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods
keywords: home care supporting clinic; home death rate; home end-of-life care; home-visiting nursing services; visiting nurse agency