[in Japanese]

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[Objective]
This study aims to predict the annual number of acute-care patients hospitalized at 64 Saiseikai Hospitals in Japan These 64 hospitals reported annually the Diagnosis-Procedure Combination/Per Diem Payment System (DPC) data. The prediction was performed, considering residential areas and sex and 5-year age categories of patients, which were assumed to affect the need for inpatient acute care.
[Method]
First, the catchment area, consisting of a group of cities where at least 80% of each hospital's patients reside, was identified based on hospitalizations from 2018 to 2019. Then, the sex- and 5-year age-specific populations of the catchment area of each hospital were estimated toward the year 2045. Assuming that the sex- and 5-year age-specific hospitalization rates do not change from 2018/2019 to 2045, the annual number of acute-care inpatients was estimated.
[Results]
The population change from 2018/2019 to 2045 was compared between the entire nation and the catchment areas of the 64 hospitals combined: a 71.4% change in the nation versus an 80.8% change in the catchment areas for the 0–14 age group, a 72.3% versus an 81.2% change for the 15–64 age group, a 93.6% versus a 103.8% change for the 65–74 age group, and a 139.5% versus a 147.5% change for the 75 and older age group. Then the change in the annual combined inpatient number of the 64 hospitals was compared between the period 2018/2019 and the year 2045. The change in the total number of patients was found to be small at 103%, but the change differed by age group, with the largest decrease of 50% predicted for the 0–14 age group, followed by an 80% decrease for the 15–64 age group. In contrast, as much as a 133% increase was predicted for the 75 and older age group. The change for the 65–74 age group was slight: 98%. The change in the annual number of inpatients estimated for each hospital differed considerably, ranging from a 59.8% decrease to a 147.2% increase.
[Conclusion]
The annual number of acute-care inpatients in 2045 was predicted with a considerable increase predicted for the 75 and older age group, coupled with decreases in the 0–14 and 15–64 age groups. The need for acute inpatient care was predicted to steadily increase for the elderly, especially those aged 75 years and older. The change in the number of patients was predicted to differ considerably between hospitals, indicating that each hospital should develop its own plan toward 2045 considering its catchment area characteristics.

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For end-of-life care, the family and the medical/care team must discuss and concur on what the resident desires and what is in the resident's best interest.
Based on an interview survey, many facilities identify a key family member who can represent the resident's wishes, including end-of-life care, even before the resident is admitted to the facility. They also have multiple regular interactions with family members.
In cases of family conflicts, relatives who are uninformed of the situation and do not communicate with each other tend to unexpectedly find themselves in situations that go against the wishes of the resident and the key persons who have been identified. These are situations that conflict with the wishes of the family members and key persons. For this reason, staffs suggest that the family and relatives fully discuss and devise ways to provide information about end-of-life care and other materials necessary for decision-making. In some cases, the facility staff is also present. Facilities were also found to be taking measures based on the expertise of their staff, such as social workers and nurses.
This study aims to contribute to on-site end-of-life care by clarifying best practices, including cooperation within and outside the facility, and by considering the training of staff members.

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Abstract
Two surveys were conducted on medication and related issues at Saiseikai elderly welfare facilities and child welfare facilities. The investigation examined how pharmacists at Saiseikai Hospitals are involved. One survey targeted pharmacy departments and the other survey targeted welfare facilities. From these surveys, we identified issues related to the use of drugs in welfare facilities. This can clarify the types of support that can be provided by pharmacists related to the safety and appropriate pharmaceutical management of residents' medications.
1. Survey related to medication administration at Saiseikai welfare facilities for the elderly and child welfare facilities (targeting pharmacy departments).
Purpose: This survey investigates issues related to medication administration in welfare facilities, and clarifies what types of support pharmacists can provide to maximize the safety and appropriate pharmaceutical management of residents' medications.
Method: A questionnaire was conducted with the pharmacy department managers of each hospital focusing on cooperation with welfare facilities.
Target: 82 Saiseikai facilities (81 hospitals, 1 welfare facility)
2. Surveys related to medication administration at Saiseikai welfare facilities for the elderly and child welfare facilities (targeting the welfare facilities)
Purpose: This survey investigates issues related to medication administration in welfare facilities, and clarifies what types of support pharmacists can provide to maximize the safety and appropriate pharmaceutical management of residents' medications.
Method: A questionnaire was conducted with the facility managers of each facility regarding issues related to Target: Long-term healthcare facilities for the elderly, welfare facilities for the elderly, child welfare facilities, welfare facilities for people with disabilities, facilities for children with severe mental and physical disabilities, etc.
This paper describes the following: 1. Surveys related to medication administration at Saiseikai welfare facilities for the elderly and child welfare facilities (targeting pharmacy departments).

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Abstract
Two surveys were conducted examining medication and related issues at Saiseikai elderly welfare facilities and child welfare facilities. The investigation examines how pharmacists at Saiseikai Hospital are involved. One survey targeted pharmacy departments and the other survey targeted welfare facilities. From these surveys, issues related to the use of drugs in welfare facilities were identified. This can clarify the types of support that can be provided by pharmacists related to the safety and appropriate pharmaceutical management of residents' medications.
1. Surveys related to medication administration at Saiseikai welfare facilities for the elderly and child welfare facilities (targeting pharmacy departments).
Purpose: This survey investigates issues related to medication administration in welfare facilities, and clarifies what types of support pharmacists can provide to maximize the safety and appropriate pharmaceutical management of residents' medications.
Method: A questionnaire was conducted with the pharmacy department managers of each hospital regarding cooperation with welfare facilities.
Target: 82 Saiseikai facilities (81 hospitals, 1 welfare facility).
2. Surveys related to medication administration at Saiseikai welfare facilities for the elderly and child welfare facilities (targeting welfare facilities)
Purpose: This survey investigates issues related to medication administration in welfare facilities, and clarifies what types of support pharmacists can provide to maximize the safety and appropriate pharmaceutical management of residents' medications.
Methods: A questionnaire was conducted with the facility managers of each facility regarding issues related to Target: Long-term care health facilities for the elderly, welfare facilities for the elderly, child welfare facilities, welfare facilities for people with disabilities, facilities for children with severe mental and physical disabilities, etc.
This paper describes surveys related to medication administration at Saiseikai welfare facilities for the elderly and child welfare facilities (targeting welfare facilities).　

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Abstract
On 30 September 2021, Japan’s Medical Policy Bureau of the Ministry of Health, Labour and Welfare issued "Promotion of Task Shift Share to the extent that it can be implemented under the current system. " As a result, specific examples of tasks that can be shifted or shared in each occupation were presented. For pharmacists, the Japan Hospital Pharmacists Association, a professional organization, indicated a policy to promote.
The practice of task shifting for non-pharmacists results in task shifting for physicians related to drug therapy. Task shifting with physicians showed that the practice of protocol-based pharmacotherapy management (PBPM) was effective. Specific measures are presented to reform how physicians work with the involvement of pharmacists. Additionally, this initiative will lead to improvements in drug therapy quality and protect patient safety. By investigating and sharing the status of PBPM implementation at Saiseikai Group Hospitals, this study highlights the benefits of the widespread introduction of PBPM.

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Abstract
Since FY 2011, Saiseikai has annually created and published 20 indicators used to evaluate the quality of welfare services, titled Indicators for Ensuring and Improving the Quality of Medical and Welfare Services. In the ten years since the start of the program, the data collected for the creation of the indicators have accumulated.
When items from this large data set were examined for correlation with the level of satisfaction of users of nursing care and welfare facilities and their families, a weak positive correlation was confirmed with the percentage of residents using the low-income burden reduction system and a weak negative correlation was found with labor productivity (value added / annual average number of staff). These findings suggest that proactive acceptance of residents using the low-income burden reduction program and not overly pursuing labor productivity may contribute to increased user satisfaction.
If possible, future research will utilize additional collected data and will develop indicators to evaluate improvement activities that can further increase user satisfaction.

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Abstract
This study examines the current status of training of senior management and the securing and development of human resources at welfare facilities. It conducts questionnaire and interview surveys of welfare facility leaders within the same corporation and examines contributions to the training of management executive staff at these welfare facilities.
Staff shortages at welfare facilities are serious both inside and outside of the focus corporation, and efforts to recruit and retain staff must be emphasized in the development of senior management staff. The training goals of facility managers also include improving staff satisfaction, human relations, and work and organizational culture, and it is believed that an interest in employee retention is the key to achieving these goals. More than 60% of the facilities do not provide in-house training for executives, and it is noted that it is difficult to conduct facility-specific training due to the frequent lack of in-facility executive staff candidates. Thus, it was suggested that it is necessary to follow up with the entire corporation.
Since managers of welfare facilities have a variety of backgrounds and occupations, it is necessary to acquire specific knowledge and skills necessary for managers of welfare facilities while understanding their strengths and weaknesses. Additionally, it is necessary to consider the respective roles of each facility individually as well as the corporation as a whole in terms of human resource development.
In the future, while planning and managing training activities, this corporation would like to develop a corporation-wide system that focuses on areas that are difficult for facilities to do alone while exploring the division of management roles among each facility.

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Introduction
The Joint Seminar for Residents of Saiseikai Hospitals is a training seminar for residents of Saiseikai hospitals throughout Japan that began in 2008. In response to the OSCE (Objective Structured Clinical Examination), which became official in 2023, a recent seminar was held to discuss the true thoughts and feelings of first-year residents during their clinical training and to identify what residents and medical students in their clinical clerkship (i.e., student doctors) really want from their residency training and clinical clerkships. Group work was utilized to identify the targets related to training, practice, and doctors that residents and student doctors really want during their residency training and clinical clerkships. These group work themes were developed and implemented to identify what residents and student-doctors really want to learn, as well as the image of the doctor they want to be and the training and practice they want to have.
Study population and methods
The study population consisted of 263 first-year residents currently training at Saiseikai hospitals across Japan who attended the joint seminar in February 2023. These participants were divided into 33 groups according to their future specialties, and group discussions were held on two themes: GW1 The ideal doctor, and GW2 How to improve residency training in hospitals hosting student doctors. Each group had at least one facilitator and a clinical education manager from each hospital (35 participants in total). The group work products consisted of descriptions on sticky notes in various forms and text written on imitation paper. After the seminar, the residents' products were photographed and stored as raw data for analysis and discussion.
Results
-Please refer to the body-
Conclusion
The ideal doctor, as seen by the residents, could be summarized as a doctor with good skills, a good personality, and a good balance between their public and private life. Using Jifuji Misumi's PM theory, we can conclude that the ideal doctor is a PM-type doctor, i.e., a doctor with excellent skills (large P) and a good caring attitude (large M). Thus, the ideal doctor has not changed in the past or the present.

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[Objective]
It is necessary to respond to population structure changes resulting from the rapid aging of Japan’s population. This study estimates the medical resources that will be needed in the future based on the current regional demographics and demand.
[Method]
Medical claims data created by medical institutions are used to supply information for medical functions. The research period spanned from 2014 to 2022. The current number of patients at medical institutions was expressed as a population ratio of each municipality. The local resident areas were defined as city, town, or village, and the area for those working at a company was defined as Toyama City. The number of daily outpatient visits was calculated using the number of weekdays each year, and the number of patients per hospital bed was calculated using the number of days each year. For future projections, the number of patients was based on 2022, the population was based on 2021, and the current share by region was assumed to be maintained in the future. The number of patients was estimated by calculating the prevalence of each disease by gender, age group, and by using future population projections.
[Results]
Due to the impact of COVID-19, the number of outpatients and inpatients decreased and has not returned to pre-COVID-19 levels. Regarding hospitalizations, the number of beds per day decreased for patients not requiring surgery, and increased for patients requiring surgery. The unit price per day for hospitalization has increased. Future projections for outpatient care show that the number of patients will increase until 2025, but will then decline. There was no projected change in medical expenses per day. Projections for future hospitalizations reveal that the number of patients will continue to increase until 2040. The daily medical costs for patients with surgery were approximately twice as high as those without surgery. Overall, costs were on a downward trend. Due to the increase in the number of hospitalized patients, there will be a shortage of 18 hospital beds in 2025 and 49 beds in 2040.
[Conclusion]
In areas where the population is aging, hospital systems, functions, and future projections have revealed the need to review hospital functions. The number of outpatients remains unchanged from the current situation, but hospitalizations are projected to rise. Since it is unlikely that the number of hospital beds can be increased, we will either shorten the length of hospital stays and increase the number of patients admitted, or we will limit the number of patients by stopping low-incidence diseases. In either case, collaboration and coordination with local hospitals is important. Additionally, as the number of patients who cannot be hospitalized increases, the need for home medical care will increase. Thus, hospitals should consider their role in home medical care. Regarding management, more efficient operations will be needed as the daily unit price will decrease.

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[in Japanese]

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Saiseikai Research Institute Bulletin
Vol.4
March 31st, 2024

Publisher
Social Welfare Organization Saiseikai Imperial Gift Foundation
Director
Shigeru Sumitani

Editor
Saiseikai Research Institute of Health Care and Welfare

Mita-Kokusai Bld.21st floor, 1-4-28, Mita, Minato, Tokyo,
108-0073, Japan

TEL: +81-3-3454-3315
FAX: +81-3-3454-5022
URL: http://soken.saiseikai.or.jp/

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