【Purpose of research】 In order to continue an independent life in old age, it is necessary to understand the factors related to the deterioration of the degree of care required and take measures against them. In this study, we attempted to clarify the factors related to the deterioration of the degree of long-term care using the accredited questionnaire data, medical insurance and long-term care insurance claim data.

【Materials and methods】 We have created a database that links long-term care insurance certification survey data, long-term care insurance claim data, and medical insurance claim data in one municipality in eastern Japan on an individual basis. From this database, 11,658 home-based subjects who were certified as requiring nursing care level 1 in 2014 were extracted, tracked until 2017, and using the variables related to ADL dependency, injury and illness that can be grasped in the database, and provided long term care insurance services. Factors related to the deterioration of the degree were examined by logistic regression analysis.

【Results】 As a result of the analysis, as ADL dependency status, the following cases showed statistically significant deterioration of dependency degree; those who are not independent in items related to muscle weakness such as turning over, getting up, holding a sitting position, standing on both feet and one foot, walking, transferring, and moving, those who went out less frequently and depended on others for shopping had a worsening level of care, those who use welfare equipment in the medical and long-term care services they are using have deteriorated. This last result can be interpreted as “people who are in a state of using welfare equipment" at high risk. As injuries and illnesses, dependent degree were significantly worse in those with lower limb joint disorders and spinal disorders. Among the medical and long-term care services used, the rate of deterioration was significantly lower for those who used home-visit nursing care for both medical insurance and long-term care insurance.

【Discussion and Conclusion】 As a result of this study, it was suggested that prevention of muscle weakness and continuous care from the viewpoint of nursing are effective in preventing deterioration of the degree of care required.

【Purpose】The purpose of the long-term care insurance system is to support elderly people so that they can maintain an independent life as much as possible even if they are in need of long-term care. This purpose naturally includes increasing the possibility of staying at home as long as possible. In this study, we analyzed the factors related to admission to nursing homes for moderate and severely dependent aged people requiring long-term care at home, using the long-term care insurance accreditation data and the long-term care claim and medical claim data in one municipality in eastern Japan. We examined the conditions for advancing home care.

【Materials and methods】 We have created a database that links long-term care insurance accreditation data, long-term care claim data, and medical claim data in one municipality in eastern Japan on an individual basis. From this database, 6,540 home-based subjects who were certified as requiring long-term care 3 or higher in 2014 were extracted and tracked on a monthly basis until March 2018, and the presence or absence of nursing homes after that was checked from the long-term care claim data. Then, the status of injury and illness and the usage status of medical / long-term care insurance services at the time of the first accreditation during the analysis period were grasped from the medical claim and the long-term care claim data, and the factors related to the admission to nursing home were examined by Cox's proportional hazard model.

【Results】 Regarding factors associated with admission to nursing homes, being a woman, getting older, having dementia, needing assistance in oral cleansing, face washing, and hair washing, and being a user of outpatient care are significant higher hazards. These facotors are items that are closely related to dementia. On the other hand, the low degree of independence in items related to muscle strength such as turning over, getting up, maintaining a sitting position, standing, transferring, and moving resulted in a significant reduction in the hazard ratio of admission to nursing homes. In addition, except for the use of outpatient care, the use of other medical care services significantly reduced the hazard ratio of admission to nursing homes.

【Discussion and Conclusion】 As a result of this analysis, the factors that cause moderately severe elderly people requiring home care to enter nursing homes are elderly people, dementia and dementia related living disorders, and women. On the other hand, elderly people with high medical needs showed a lower risk of admission. This result seems to suggest that moderately severe elderly people requiring medical care may be hospitalized in medical facilities rather than special nursing homes.

【Objective】 In recent years, the number of elderly people hospitalized for pneumonia has been increasing. In particular, attention is focused on the increase in pneumonia in the elderly who are already in need of long term care insurance services, but few studies have analyzed the current situation in detail. The purpose of this study was to analyze the current state of pneumonia in the elderly using medical and long-term care claim data from a local government in western Japan, and to discuss countermeasures.

【Materials and method】 The data used for the analysis are the medical claim (National Health Insurance / Medical care system for the late elderly) and the long-term care insurance (LTCI) claim from April 2012 to March 2017 of one local government in western Japan. We created a database that concatenated these data on an individual basis, and extracted patients who were treated at DPC hospitals for elderly pneumonia (DPC 6 digits = 040080 and 040081), and were hospitalized for the first time. The year and month of the admission were defined as the starting year and month of observation. With this as the starting point (treatment month, elapsed month = 0), the status of medical care service usage and the status of injury and illness before and after that were analyzed.

【Results】 As a result of this analysis, 32.1% of elderly patients admitted to an acute care hospital for pneumonia received some kind of LTCI service for general pneumonia and 53.3% for aspiration pneumonia 6 months before admission. In addition, most of them returned directly to their homes (outpatient / home) after treatment. The cumulative mortality rate for one year after admission was 17.8% for general pneumonia and 31.3% for aspiration pneumonia.

【Discussion】 Given the high cumulative mortality rate for one year, the types of comorbidities, and their high prevalence, pneumonia is an important condition influencing quality of life for the elderly in need of care at the end of life stage. Therefore, in order to maintain QOL at that time, it is important to implement appropriate care management in order to prevent pneumonia.

According to suicide statistics released by WHO, Canada's suicide rate in 2016 was 12.5 per 100,000 population, which is the middle among developed countries. However, the suicide rate among ethnic minorities and immigrants is high, and it has been reported that the suicide rate is more than 20 times the national average, especially in the former. In light of these circumstances, comprehensive suicide countermeasures are being promoted in Quebec, Canada, centered on the Quebec Suicide Prevention Center (Le Center de prévention du suicide de Québec). The center collects and analyzes basic statistics related to suicide, and conducts educational activities and support activities for citizens and high-risk groups (middle-aged men, immigrants, ethnic minorities) based on the analysis results.

In practice, the front lines of mental health are the centers of health and social services (CISSS: centers in tégrés de santé et de services sociaux: equivalent to the health and welfare offices of Japan) and the offices of family doctors. .. It is a characteristic of Quebec that mental health measures are developed within the framework of primary care.

【Objective】 In recent years, the number of elderly people hospitalized due to heart failure has increased. This heart failure pandemic is expected to become a more serious problem as the population ages. Many of these patients are already elderly with multiple chronic illnesses and are presumed to follow the course of the terminal with repeated acute exacerbations of heart failure, but the situation has not always been clarified by objective data. The purpose of this study was to analyze the current state of cardiac failure in the elderly using medical and long-term care claims from a local government in western Japan, and to examine countermeasures.

【Materials and method】 The data used for the analysis are the medical claim (National Health Insurance / Medical care system for the late elderly) and the long-term care insurance (LTCI) claim from April 2012 to March 2017 of one local government in western Japan. We created a database that concatenated these data on an individual basis, and extracted patients who were treated at DPC hospitals for elderly heart failure (DPC first 6 digits = 050130), and were hospitalized for the first time. The year and month of the admission were defined as the starting year and month of observation. With this as the starting point (treatment month, elapsed month = 0), the status of medical care service usage and the status of injury and illness before and after that were analyzed.

【Results】 As a result of this analysis, 32.0% of elderly patients admitted to an acute care hospital for cardiac failure received some kind of long-term care service before admission. In addition, most of them returned directly to their homes (outpatient / home) after treatment. The cumulative mortality rate for one year after admission was 17.9%.

【Discussion】 Given the high cumulative mortality rate for one year, the types of comorbidities and their prevalence, and the high prevalence of heart failure even after discharge, heart failure is an important medical condition that influences the quality of life in end stage for the elderly requiring LTCI services. Therefore, in order to maintain QOL at that time, it is important to firmly position measures to prevent the worsening of heart failure, specifically management of risk factors such as hypertension, diabetes mellitus and inappropriate dietary habits, etc. in care management process.

We developed a logic to generate dummy data for File Format 1 of the DPC data to use for practice of DPC data analysis. We used the results of DPC data aggregation published by the Ministry of Health, Labor and Welfare as a reference in order to get closer to the actual values when the dummy data was aggregated. After developing the logic, we generated two databases of different sizes and tested the difference between the proportions of the two groups for sex. The smaller database showed a significant difference, but the larger one did not show any significant difference from the actual value.

The purpose of this study was to elucidate the causal structure between the use of ICT and management effectiveness in the settings of nursing care services. Recently, the use of ICT has been promoted in the field of nursing care services. In this situation, this study assessed the ability of nursing care services to effectively use ICT in actual settings and it examined the causal structure between the use of ICT and effective management. For this purpose, prior studies were consulted to establish a structure model and an initial hypothesis, and a questionnaire survey was conducted with social welfare service corporations that provided nursing care services. The hypothesis was then tested based on data collected from 102 corporations that provided valid responses, and an exploratory method was incorporated into the consideration of a structure model.