System- and patient-level determinants of Japan’s discharge planning fee uptake among older patients with cancer: A Shizuoka claims cohort study

Background Japan introduced a “discharge planning and support fee” in 2008 to improve care transitions and enhancing discharge processes, including for older patients with cancer. However, few studies have investigated the factors associated with discharge planning in this population. Here, we aimed to identify factors associated with the discharge planning and support fee in older patients with cancer undergoing anticancer drug treatment. Methods This retrospective analysis used data from 3,932 hospitalized patients aged 65 years or older who received anticancer therapy in Shizuoka Prefecture between 2012 and 2017. The outcome was whether the discharge planning fee was billed in the first month of hospitalization. Factors were classified as individual, hospital, or regional, and a multilevel logistic regression analysis was conducted using a generalized linear mixed model (GLMM). Results Of 3,086 eligible patients, 340 (11.0%) were billed the discharge planning fee. Patients aged 85 years or older, with pancreatic cancer, receiving only oral anticancer therapy, and with prior use of day services were associated with a higher likelihood of billing. Conversely, patients with leukemia were significantly less likely to receive support. At the hospital level, the intraclass correlation coefficient (ICC, 0.241), suggesting that the likelihood of discharge support billing depends on the specific hospital. While regional clustering was negligible, a higher number of visiting nurses per 1,000 population in the residential area was significantly associated with an increased likelihood of billing. Conclusions Our findings suggest that internal coordination systems and collaborative networks with community resources are important for discharge planning and support among older cancer patients.