The association between advanced practice nurse visiting services and acute healthcare utilization in long-term care residents: A retrospective cohort study with propensity score matching

Background Residents in long-term care settings have complex medical and functional needs, and the early period following facility admission represents a vulnerable transitional phase. However, registered nurses are often not available on-site in institutional long-term care settings, in Korea and globally, limiting the capacity to respond to acute challenges. In 2014, Korea expanded home-visit advanced practice nurse visiting services to cover long-term care residents, enabling advanced practice nurses to deliver skilled nursing interventions within institutional long-term care settings. Objective This study evaluates the impact of advanced practice nurse visiting services on acute healthcare utilization among long-term care residents with nursing care needs. Design Retrospective cohort study using Korean nationwide claims data. Setting(s) Institutional long-term care settings. Participants 32,018 long-term care residents with nursing needs were included, and 1507 were selected through 1:3 propensity score and exact matching. Methods A 1:3 matched cohort was constructed using propensity score matching and exact matching on functional status and clinical severity. Outcomes were emergency department visits, acute hospital admissions, and long-term care hospital admissions within 6 months of Institutional long-term care admission. Left-truncated Cox models estimated hazard ratios with 95% confidence intervals. Results Among 1507 matched participants, those who received advanced practice nurse visiting service had significantly lower risks of admission to acute hospitals (hazard ratio 0.62) and long-term care hospitals (hazard ratio 0.52), with no difference in emergency department visits. In subgroup analyses, advanced practice nurse visiting service use was associated with a lower risk of acute hospital admission among residents with long-term care eligibility grades 1 and 2, indicating high functional dependence, with grade 1 reflecting greater dependence than grade 2 (grade 1: hazard ratio 0.56; grade 2: hazard ratio 0.53). A lower risk was also observed among residents with Charlson Comorbidity Index scores of 0–2 (hazard ratio 0.58) and 3–4 (hazard ratio 0.62). For long-term care hospital admission, a significantly lower risk was observed among residents with Charlson Comorbidity Index scores of 3–4 and above (hazard ratio 0.47). Conclusions Advanced practice nurse visiting services were associated with lower risks of acute hospitalization, particularly among residents with high care needs. Furthermore, a lower risk of admission to a long-term care hospital was observed among residents. This suggests the services may help prevent avoidable hospitalizations and enhance continuity of care for high-risk residents in long-term care settings.