Changes in Home-visit Care Utilization and Outcomes During the Coronavirus Disease 2019 Pandemic: Comparison Between...

The coronavirus disease 2019 (COVID-19) pandemic disrupted access to healthcare for homebound older adults, particularly those with cancer. We compared changes in the initiation and outcomes of physician home-visit care among older Japanese patients with and without cancer during the pandemic.

We conducted a retrospective observational study using national medical claims data of patients aged ≥65 years who began physician home visits between April 2018 and December 2020 in Japan. The proportions of all-cause death, in-home death, and at least one hospitalization within 90 days after the initiation of home-visit care were compared between the pre-pandemic (April 2018 to December 2019) and pandemic periods (January 2020 to December 2020), stratified by cancer diagnosis. Differences between the cancer and non-cancer groups were estimated using linear regression models with an interaction term for cancer status and pandemic period.

Among 509,718 patients (251,311 with cancer), the initiation of home-visit care increased in both groups during the pandemic. All-cause and in-home death rates increased and hospitalization rates decreased in both groups, with greater changes among patients with cancer: 1.6% (95% confidence interval [CI], 1.1-2.1) for all-cause death, 3.8% (95% CI, 3.4-4.3) for in-home death, and -2.9% (95% CI, -3.7 to -2.2) for hospitalization.

During the COVID-19 pandemic, physician home-visit care expanded, and patients with cancer showed a greater shift toward home-based end-of-life care. These findings highlight the need for targeted resource allocation strategies to support home-visit physicians caring for patients with cancer during public health emergencies.