Basic Outcome Master (“BOM”) version 3.0 has been published. Its most important feature is its links with the Medical Information System Development Center (“MEDIS-DC”), the Nursing Practice Term Standard Master Nursing Observation (“MEDIS Nursing Master”) and version 10/11 of the Japan Laboratory Code (“JLAC”). These links have dramatically improved standardization among items subject to BOM observation. By aggregating identical structures, representation types (e.g., numerical, enumerative, etc.), result values and results, etc., MEDIS Nursing Master both significantly improves input format accuracy and reduces ambiguities in variance recognition, enabling clean data collection. This structure can be said to form an important element of the Outcome-AssessmentTask (“OAT”) unit—conceived as a basic data unit for use in medical processes. As the daily clinical pathway (hereinafter referred to as the “daily path”) is the collection of OAT units over 24-hour periods, BOM version 3.0 also functions as a safety management tool by improving the user interface of the daily path and adding easy-to-use identification and notification functions when an item under observation strays outside the proper range. The electronic structure of the term master is considered to have a relationship of outcome name-observation item name = 1: n, observation item name-nursing care name = 1:1, thereby smoothing interactions between the clinical path and nursing records. Using BOM version 3.0, it is possible to create a versatile path consisting of a basic OAT unit regardless of the specific nature of the disease or pathological condition, and a minimally required OAT unit according to the specificity of a certain disease or pathological condition. Accumulating big data from this versatile path will contribute to the stratification of complex diseases and pathological conditions.

　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.