ABSTRACT
Iwate Prefecture has the second largest area and the second lowest population density in Japan, therefore needing a system that can supply medical service efficiently. Although there are nine Secondary Medical Districts (SMD) and fourteen hospitals subject to the Diagnosis Procedure Combination (DPC hospitals) in Iwate, four of the DPC hospitals are concentrated in Morioka SMD, the biggest area and administrative center in Iwate, and the other areas have only a few DPC hospitals. To consider the whole concept of cancer care in Iwate, we analyzed lung, stomach, liver, colon, and breast cancer from DPC data published by the Ministry of Health, Labor and Welfare (MHLW). We analyzed the monthly number of patients and estimated the number of patients that each SMD and DPC hospital was capable of receiving, finding that the trend of consultation is different depending on the type of cancer. We consider that the DPC hospitals should think strategically about their functional compartmentalization, and that the local government should revise the regional health care planning.
Subject(s)
Community Health Services/statistics & numerical data , Data Interpretation, Statistical , Neoplasms/epidemiology , Neoplasms/therapy , Female , Humans , Japan/epidemiology , Male , Neoplasms/classification , Neoplasms/diagnosis , Patient Care Planning/statistics & numerical data , Quality Assurance, Health Care , Time FactorsABSTRACT
The clinical pathway (CP) is a schedule of a standard set of treatments for a particular clinical condition. The horizontal axis of the CP indicates hospitalization days and the vertical axis indicates a set of procedures for each day. Using the CP, medical staff (i.e., physicians and nurses) and patients can have a clear image of the content of treatment and its schedule, and can understand the tests, operation schedules and the aim of the discharge day, and avoid excessive or deficient tests and care. The health care service can function smoothly as a team because it is clear who is responsible for what. However, it requires a considerable amount of time and work for medical staff to evaluate clinical activities based on the established CP, to monitor the appropriateness of the CP, and to modify its content if necessary. Because of this, it is not rare for hospital staff to stop using CPs. In this study, we tried to develop a method to systematically evaluate the appropriate level of CP based on Diagnosis Procedure Combination (DPC) data. Furthermore, we developed a methodology to formulate a new CP based on DPC data. The present study has clarified that management staff can support medical staff in CP - based clinical evaluation and CP development by using the DPC data. This kind of partnership between management and medical staffs should contribute to the standardization and amelioration of clinical quality.
Subject(s)
Critical Pathways , Outcome Assessment, Health Care/methods , Quality of Health Care/standards , Evidence-Based Practice , Humans , Nursing Care/statistics & numerical data , Patient Care TeamABSTRACT
Each prefectural government must formulate a Regional Health Care Plan (RHCP) which will be enforced from 2013 to 2017. During this period, in Health Care Regions (HCRs) where the population is less than 200,000, the inflow rate of inpatients is less than 20%, and the outflow rate of inpatients is more than 20%, each prefecture is required to reconsider the size of any such secondary HCR. They should consider natural conditions such as geographical characteristics, social conditions such as traffic, patient flow of each area, access time to core hospitals, et cetera. In this study, we analyzed the situation of the Kiso secondary HCR of Nagano prefecture, based on the 2010 Diagnosis Procedure Combination (DPC) data that was distributed by the Ministry of Health, Labour and Welfare. According to a Geographic Information System (GIS) analysis, the Kiso HCR is self-sufficient for most emergency care and cancer treatments, even though this area is classified as a rural HCR. As this research indicates, DPC data is a useful resource for HCR planning.
Subject(s)
Diagnosis-Related Groups , Geographic Information Systems , Regional Health Planning/methods , Adolescent , Adult , Aged , Child , Child, Preschool , Humans , Infant , Japan , Middle AgedABSTRACT
In 2006, the Akazawa National Forest was accredited as a base of forest therapy. On the assumption that forest therapy is effective for the prevention of lifestyle-related diseases, we started a project to prove the medical effectivity of forest therapy. We also attempted to find a way to stimulate the local economy using forest therapy. As an application of forest therapy for local economy stimulation, we established a clinic in the Akazawa National Forest and offered medical advice and suggested hiking routes. About 150 people visit this clinic each year. We are also offering forest therapy in combination with a complete medical check up. We measured the concentration of the amylase in the saliva from the group who underwent forest therapy and from another group who carried out the same task in the city as a control. We found a significant difference between the two groups. We also measured the levels of 8-OHdG and HRV before and after the forest therapy. In the people who showed a markedly high oxidative stress before the therapy, we observed a significant decline of oxidative stress. It was difficult to measure the effects of forest therapy objectively. However, through this project, we consider that we will be able to obtain some positive effects that will support the usefulness of forest therapy. We still need to continue our research and collect data to prove its usefulness.
