Abstract
We applied the hip fracture collaboration clinical pathway (hereinafter abbreviated as “Path”) using Basic Outcome Master (“BOM”) to 34 rehabilitation hospital patients and analyzed the results. The outcomes were divided into four groups: (1) home discharge, (2) nursing home transfer, (3) chronic phase hospital transfer and (4) acute phase hospital transfer. Factors affecting these outcomes were analyzed. Home discharge was the outcome for 56% of patients, nursing home transfer for 32%, chronic hospital transfer for 3% and acute hospital transfer for the remaining 9%. No significant differences in outcome were observed in relation to average age or average length of hospital stay. The dementia comorbidity rate was 47% for home discharge patients, 82% for nursing home transfer patients, 100% for chronic hospital transfer patients and 67% for acute hospital transfer patients.
Wipe and bathing, toilet activities, transfer (bed), transfer (toilet) and movement (walking)—the five motor skills included in the Functional Independence Measure (hereinafter abbreviated as FIM)—recorded lower values in the order from high to low of home discharge, nursing home transfer, chronic phase hospital transfer and acute phase hospital transfer. Lower values were observed in the dementia group than in the non-dementia group. The existence of dementia and the FIM value at the time of a patient’s admission affected the patient’s outcome. Histories of stroke, ischemic heart disease and bone fracture also affected outcomes. It is clear that the collaborative daily clinical pathway using BOM offers an important means of visualizing and analyzing cooperative medical process data on dementia, functional recovery and maintenance, complications and deterioration of comorbidity—factors that influence chronic medical need.
Introducing the daily clinical pathway using BOM to facilities will clarify the relationship between nursing observation and outcome and enable the progress of Activities of Daily Living (abbreviated as ADL) to be easily understood. In the future, adding additional ADL-related data to BOM will be important.
