Outcomes of a financial incentive scheme for dementia care by dementia specialist teams in acute‐care hospitals: A difference‐in‐differences analysis of a nationwide retrospective cohort study in Japan

Objectives The quality of care for dementia in acute‐care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute‐care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short‐term outcomes (in‐hospital mortality and 30‐day readmission). Design and Methods Using a Japanese nationwide inpatient database, we identified older adult patients with moderate‐to‐severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score‐matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient‐level difference‐in‐differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. Results There was no association between a hospital's adoption of the incentive scheme and in‐hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88–1.06; p = 0.48) or 30‐day readmission (aOR: 1.04; 95% CI: 0.95–1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in‐hospital mortality. Conclusions The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in‐hospital mortality. Key points The quality of care for dementia in acute‐care settings has often been criticised. Most dementia care in acute‐care settings has not been evaluated, and the effectiveness of such care on concrete outcomes, including in‐hospital mortality and readmission, has not been confirmed. This nationwide study used difference‐in‐differences analyses to show that a hospital's adoption of the financial incentive scheme under Japan's universal health insurance to provide dementia care by a dementia specialist team was not associated with improvements in in‐hospital mortality or 30‐day readmission. However, the study also found that only 29% of patients in hospitals adopting the scheme received dementia care by a dementia specialist te