The Journal of Japan Society for Health Care Management
Online ISSN : 1884-6807
Print ISSN : 1881-2503
ISSN-L : 1881-2503
Volume 13, Issue 1
Displaying 1-6 of 6 articles from this issue
Original Articles
  • Kunichika Matsumoto, Kayoko Haga, Simpei Hanaoka, Takefumi Kitazawa, T ...
    Article type: Original Articles
    2012 Volume 13 Issue 1 Pages 2-6
    Published: June 01, 2012
    Released on J-STAGE: August 06, 2020
    JOURNAL FREE ACCESS

    Cancer is the leading cause of death in Japan and its social burden is also considerable. In this study we estimated the social burden of 9 major cancers in 1996, 2002 and 2008, using cost of illness (COI) method. The burden of stomach cancer and liver cancer has decreased both relatively and absolutely, but the burden of breast cancer, uterine cancer and lung cancer has increased during this time. Change of length of hospital stay and mean age of death as well as change of number of patients and deaths contributed to the change of burdens. Burden of disease and its trend should be taken into account to establish an appropriate health policy for cancer treatment.

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Case Reports
  • Yumi Ogawa, Mayumi Sato, Koya Kamikawa
    Article type: Case Reports
    2012 Volume 13 Issue 1 Pages 7-10
    Published: June 01, 2012
    Released on J-STAGE: August 06, 2020
    JOURNAL FREE ACCESS

    The objective of this study is to evaluate the outcomes and the variance of the liaison critical pathway in an unselected population of patients operated for displaced hip fractures. It is characteristic of the liaison pathway to classify the patients into three groups by assessing the condition of walking ability and lucidity before injury. These groups are Classification A:able to walk independently outside, Classification B:able to walk with a walking device outdoors and Classification C:unable to walk outdoors alone, or is suffering from various levels of dementia. Records of 86 hips procedures in 22 men and 64 women, aged 28 to 96 (mean, 77) years were studied by variant analysis. The variant proportion of the classification of this study group were:Classification A 47%,Classification B 60% and Classification C 22%. The cause of variance was mainly due to patients' pre-existing conditions such as limited weight-bearing or having pre-existing illness. At discharge, 65% in Classification A acquired walking ability outside, 40% in B and 7% in C. 88% in Classification A were able to go into home care, 84% in B and 63% in C, respectively. This latter number of home care return suggested that people who were unable to acquire walking ability outside can still go home. The importance of social circumstances at the time of discharge in influencing the condition of elderly patients with hip fractures in C pathway has been also shown. Outcomes of hospital stay and walking ability were not sufficient, but the classification with the condition of walking ability and lucidity before injury was useful for medical staff, patients and their families.

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  • Yumi Kamijo, Masaaki Matoba, Kayoko Koichi, Masako Shibata, Noriko Shi ...
    Article type: Case Reports
    2012 Volume 13 Issue 1 Pages 11-16
    Published: June 01, 2012
    Released on J-STAGE: August 06, 2020
    JOURNAL FREE ACCESS

    Incidents and accidents prevention in the hospitals is of utmost importance. Showa University has 7 branch hospitals and 1 clinic in Tokyo and Yokohama area. The risk managers in each hospital collect and analyze incident and accident reports in their hospitals. They work out safeguards against medical errors. However, they have never made a comparative study with other hospitals in the past. In this study, we analyzed the differences of incident and accident reports among branch hospitals in Showa University.

    During the period from January 2010 to December 2010, there were 11,171 cases of incident and accident reports made and we examined in 4 branch hospitals (A, B, C, and D hospital). Each hospital used different incident and accident report forms. The numbers of incident and accident reports were 4,304 cases for A hospital, 1,975 cases for B hospital, 4,331 cases for C hospital, and 562 cases for D hospital during this period. Most cases were not severe cases. According to the incident level of our hospital, more than 80 percent were under or equal to level 2, and more than 90 percent were under or equal to level 3. Miss-administration of medicine or injection, accidental falling, and route/tube trouble took up significant portion of incident and accident reports in all hospitals. More than 80 percent of incident and accident reports were made by nurses, and only 6 percent were made by physicians in all hospitals.

    It is desirable that we use the same basic classification or unify the incident and accident report form in all hospital. We need to share the data and information among hospitals to further prevent medical errors.

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  • Akemi Shimasaki
    Article type: Case Reports
    2012 Volume 13 Issue 1 Pages 17-21
    Published: June 01, 2012
    Released on J-STAGE: August 06, 2020
    JOURNAL FREE ACCESS

    This study aims to identify what can relieve anxiety and dissatisfaction of inpatients in the hospital. The subjects were patients who got out of the hospital with support or had been in the hospital for a long period of time. 423 discharged patients and their families were surveyed with questionnaires (response rate 44.4%). The patient satisfaction during the period for discharge arrangement (discharge satisfaction) and during a whole period of hospitalization (inpatient satisfaction) was separately asked. Most of responding patients and their families had felt anxious about therapy, prognosis and their post-discharge lives, and also had complained about their short length of hospitalization, unsatisfactory effect of therapy, and insufficient explanation by medical staff.

    50.4% of respondents had experienced psychological change where they came to a fuller understanding of their present situations and were relieved from their anxiety by communicating with medical staff. X test showed that the psychological change was significantly related to communication with medical doctors and satisfaction with response of medical staff with whom patients had consulted about their anxiety (response satisfaction). Meanwhile, their consultation with the staff in the discharge support section had no correlation to the psychological change, but to response satisfaction. The psychological change, response satisfaction, inpatient satisfaction and discharge satisfaction had positive correlation to each other. Multiple regression analysis revealed that the discharge satisfaction was related to both patients' psychological change and response satisfaction, and that the inpatient satisfaction was only related to response satisfaction. The psychological change and response satisfaction can be separate factors of inpatient's satisfaction.

    Consequently, it is inferred that a sense of procedural fairness brought by interaction between medical staff and patients should take an important role in patient satisfaction with medical treatment which cannot always give good effects.

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  • −for the restructuring of mutual trust−
    Ritsuko Hayashi
    Article type: Case Reports
    2012 Volume 13 Issue 1 Pages 22-30
    Published: June 01, 2012
    Released on J-STAGE: August 06, 2020
    JOURNAL FREE ACCESS

    To achieve more satisfactory resolutions to complaints and claims in medical care, promotion of medical mediation to reach agreement through dialogues between concerned parties are anticipated. To respond to such a need, an educational approach on the theories and techniques through training has recently been conducted. This training led to the impression that participants had difficulties with the IPI (issue, position and interest) analysis needed for handling complaints and claims. Thus the FACE(Fact・Angry・Claim・Emotion:FACE) sheet was developed as a tool to facilitate this analysis and to be utilized in conflict management. This document, composed of 3 sheets [IPI analysis (Sheet I), visualization of this analysis (Sheet II) and management (Sheet III)], is designed so that the key points and the logic of the conflict management may be followed by observing the work sequence for the items of each sheet. Next, to confirm the efficacy of this document, a survey via questionnaire was conducted immediately after training in medication using 80 nurses who were engaged in management. In evaluating each sheet, positive responses were obtained from 92% for Sheet I, 74% for Sheet II and 77% for Sheet III. The developed document is suggested to be an effective tool in clinical practice for the assessment and handling of complaints and claims.

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Introductory Reports
  • Tomohiko Murase, Shinya Kondo, Tetsuya Kokabu, Nodoka Miyazaki, Yasuyu ...
    Article type: Introductory Reports
    2012 Volume 13 Issue 1 Pages 31-35
    Published: June 01, 2012
    Released on J-STAGE: August 06, 2020
    JOURNAL FREE ACCESS

    Epidural anesthesia is widely performed and numerous benefits have been reported such as blood loss reduction, improved perioperative prognosis, requiring less analgesics and chronic postoperative pain prevention. On the other hand, infrequent crucial complications including epidural hematoma and epidural abscess could occur. In order to evaluate the effectiveness and complications of the epidural anesthesia, we reviewed 423 patients in our department who received epidural anesthesia with epidural catheter between July 2008 and May 2010. A template was designed to record detailed information about the epidural anesthesia of each patient such as performer's information, procedure date, puncture location and complications, and effectiveness was recorded on the electronic medical record. These data were then analyzed with Data Warehouse and three factors;the effectiveness, the incidence of dural puncture and the frequency of repeated puncture were evaluated as the quality indicators. We found that the anesthetic effect was lower and dural puncture or repeated puncture happened more frequently in the group of the young doctors who had less than two years experience in epidural anesthesia compared with the group of senior doctors with longer experience. This suggests that these three factors are useful as the quality indicators. The study indicates our record template would make it possible to compare the quality of the epidural anesthesia between the department of Obstetrics and Gynecology and the department of Anesthesia. In the future, by using these quality indicators between institutions, the safety and effectiveness of the epidural anesthesia could be objectively evaluated.

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