Objective: The number of acute care inpatients in Saiseikai Hospitals in the post-COVID period starting May 2023 has not recovered to the level of the pre-COVID period. In order to provide useful findings to make a counteracting plan for the Saiseikai Social Welfare Corporation as a whole, this study aimed at analyzing the DPC data, which are the standardized national claim data for acute care inpatients, to elucidate the difference in acute care inpatients between pre-COVID, COVID-pandemic, and post-COVID periods.

Methods: Refer to body
Results: Among 64 participating hospitals, 49 hospitals (77%) showed a decrease of 10% or more in the average daily number of hospitalized patients in the post-COVID period as compared to the pre-COVID period. Of these 49 hospitals, 34 hospitals (69%) showed a decrease of 10% or more in the average length of hospital stay, and 16 hospitals (33%) showed a decrease of 10% or more in the monthly number of newly admitted patients in the post-COVID period as compared to the pre-COVID period. The decrease in the average length of hospital stay was smaller from the pre-COVID to the COVID-pandemic period when compared with the decrease from the pre-COVID to the post-COVID period. The average length of hospital stay decreased in almost all main disease groups at admission in the post-COVID period as compared to the pre-COVID period, suggesting the decrease in average length of hospital stay was due to comprehensive efforts to decrease it as a hospital as a whole. In many hospitals, the decrease in the monthly number of newly admitted patients was larger than the decrease in the population of local municipalities, thus contributing to the decrease in the average daily number of hospitalized patients together with the decrease in the average length of hospital stay. On the other hand, in hospitals in which the decrease in the average daily number of hospitalized patients was less than 10% or even increasing, the average daily number of hospitalized patients increased from the pre-COVID to the post-COVID period, successfully maintaining the average daily number of hospitalized patients.

Discussion: The reason for the decrease in the average length of hospital stay was presumably due to the upcoming change in the limit of the average length of hospital stay in the 2024 revision of medical fees. If this shortening of the limit of the average length of hospital stay continues, it is necessary to increase the number of newly admitted patients in order to maintain the average daily number of hospitalized patients. In the 2045 population projections for local municipalities from which acute care inpatients come to Saiseikai Hospitals, the population of people aged 15 to 64 is estimated to decrease to 80% of the 2018–2019 population level, whereas the decrease for the population aged 64 to 75 is estimated at 98% and that for ages 75 and over is estimated at 133%. These projections indicate that it will become more important to focus on the acute care of elderly inpatients.

Conclusion: The decrease in the number of acute care inpatients in Saiseikai Hospitals is due to the shortening of the length of hospital stay. There is no easy way to increase the number of newly admitted patients in light of the country’s upcoming population shrinkage. It is necessary to focus more on elderly inpatients, whose population is expected to increase in the future.

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This study clarifies results from surveys of three organizations providing social services in the community (hospitals, welfare facilities, and home service provider offices) regarding the coordination of medical care and welfare.

The results clearly demonstrated that in the integrated provision of “medical care and welfare” and“medical care and nursing care” in the community, collaboration as a social service in the community, i.e., collaboration among key persons in each organization, is necessary. In addition, it was found that efforts to share information,secure professionals, and work toward improvement are required to create a commonunderstanding.

In addition to cultivating cooperation between professionals and institutions, it is also important to understand regional characteristics and needs in order to promote cooperation between medical and welfare services. We would like to conduct further research that can contribute to the practice of promoting cooperation between medical and welfare services that is tailored to local needs.

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From the survey conducted last year, we were able to grasp, to a certain extent, what kind of issues there are with drug treatment and medication administration at Saiseikai facilities for the elderly and how pharmacists at Saiseikai Hospital are involved.
Saiseikai has many facilities for the elderly, and most of the residents continue to receive medication. In the treatment of drugs in the elderly, there is an increase in the complexity of medication administration methods and confirmation of interactions with polypharmacy. In nursing care at facilities for the elderly, it is common practice to crush tablets that are difficult to take and mix them with food and drink, and it is essential to optimize medication administration methods and medication support.
Therefore, as the Saiseikai Pharmacists Association, we decided to cooperate with the Welfare Facility Association to ensure the appropriateness of medication administration for residents, ensure the safety of drug treatment, and avoid undesirable outcomes for residents as much as possible. (1)Regular training sessions on nursing care and medicine, (2)pharmacist visits to the facility to understand the actual situation of the facility, and (3)coordination of drug information between facilities and hospitals.

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"SWS" is the abbreviation for the workshop for medical advisors of postgraduate clinical interns held by Saiseikai (Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc.). Upon completion of the training, physicians are granted a certificate of completion, which is recognized by the Ministry of Health, Labor and Welfare (MHLW), and are qualified to become medical advisors. SWS was launched in 2006. Over the years, however, SWS has evolved from a mere training program for obtaining a medical advisor certification to a training program for "human resource development of Saiseikai physicians" that supports the fundamental principle of "what Saiseikai values most is medical personnel education" as its hidden curriculum.
Therefore, the purpose of Saiseikai organizing SWS training sessions for physicians is twofold. The first is to help participating physicians acquire the desired qualities of clinical advisors, which is the purpose of a training session for medical advisors, i.e., to develop human resources. The second is to provide participating physicians with opportunities to experience the principles of Saiseikai and to grow as high-quality medical professionals. We have been reviewing each SWS immediately after its completion, but we have been inwardly questioning whether we have truly achieved the human resource development we have been striving for. Therefore, with the cooperation of the Saiseikai Institute of Medical Welfare and the Saiseikai Headquarters, we examined the results of all 51 SWSs held in the past, focusing on human resource development.
We asked 10 questions to assess the behavioral changes in the attitudinal domain of the doctors who attended the course.
The completion rate of the SWS and other organizations' training courses for medical advisors is considered equal, since the MHLW grants certification of completion for all similar training courses. In terms of the number of participants, 70% of the physicians attended other training sessions for medical advisors while 30% attended the SWS. This difference can be attributed to the following: (1) The SWS was originally held four times per year, but is now held only twice per year, reducing opportunities for participation; (2) The SWS is held in Osaka and Tokyo (Kaihin-Makuhari, Chiba Prefecture), making it difficult for participants to travel from their places of work; and (3) The SWS is held at a location that is not easily accessible. The results of our study can be summarized in the following three points: (1) Sixty to seventy percent of those who participated in the training sessions for medical advisors, including the SWS, changed their behavior; (2) those who participated in the SWS tended to change their behavior more frequently than those who participated in other training sessions; and (3) SWS participants were more likely to deepen their understanding of the mission and project of Saiseikai, namely "to save lives by providing medicines and treatment to the poor." Doctors have a great influence on the people around them. It is hoped that as many physicians as possible will grow as human beings and change their awareness and habits to desirable ones, which will trigger the development of the hospitals in the various areas that make up the Saiseikai service region.

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[in Japanese]

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[in Japanese]

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