title: Enhanced Oral Care and Health Outcomes Among Nursing Facility Residents: Analysis Using the National Long-Term Care Database in Japan.
abstract: OBJECTIVE
  Although oral care may have salutary effects among frail elderly people, access to dental care is often limited in long-term care facilities. In 2009, the Japanese long-term care insurance system introduced an additional reimbursement scheme for enhanced oral care supervised by dentists in nursing facilities. The aim of this study was to examine whether enhanced oral care provided by trained nursing facility staff members is sufficient to improve health outcomes among nursing facility residents.
  
  
  METHODS
  This was a quasi-experimental study using a nationwide long-term care database. Using facility-level propensity score matching, we identified 170,874 residents in 742 facilities that provided enhanced oral care and 167,546 residents in 742 control facilities that provided only standard care from 2009 to 2012. We used a resident-level difference-in-differences approach to analyze the impact of enhanced oral care on health outcomes among nursing facility residents.
  
  
  RESULTS
  After controlling for resident characteristics and background time trends, no significant differences were found between residents admitted to the facilities with and without enhanced oral care in the incidence of critical illness, transfer to a hospital, mortality, or costs. Yearly change in the odds of discharge to home was significantly increased for residents with enhanced oral care (odds ratio = 1.07; 95% confidence interval: 1.02-1.12; P = .008).
  
  
  CONCLUSIONS
  The results suggest that enhanced oral care provided by trained nursing facility staff members may improve the general condition of elderly residents in nursing facilities and promote their discharge to home.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan. Electronic address: sachikoono-tky@umin.ac.jp.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Ishimaru
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamana
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Morita
authors.affiliation: Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D016208:Databases, Factual; D003729:Dental Care / Q000592:standards*; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D009909:Oral Health; D017063:Outcome Assessment, Health Care; D057216:Propensity Score
keywords: Oral care; long-term care; nursing home