comprehensive community care system (point) · comprehensive community care system with hospital...
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Comprehensive Community
Care System
Mitsugi General Hospital
October 2011
(point)
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Mitsugi General Hospital (as of 2011)Philosophy :Establish comprehensive community health/care system
with hospital for community and its citizensSystem : ○ Under public corporation law
○ Directly run by National Health InsuranceBeds : 240Annexed : Comprehensive health/welfare facilities including geriatricfacility health facility) 317 beds
Total 557 bedsDepartments : 22 departmentsPopulation :Approx.. 70,000No. of staffs :637 including temporary staff (No. of MD 29)Features : ○ Regional core hospital with advanced medicine (secondary ER )
○ Rehabilitation ward and palliative care ward○ Comprehensive community care system with hospital and health
and welfare center→ Liaison office for comprehensive community health care
○ Home care with bed-bound free campaign○ Coordination and integration of health, medicine and welfare○ Designated teaching hospital certified by academic societies○ Accredited by JCQHC○ Certified for Ningen Dock and health check ups○ Certified palliative care facility○ Certified comprehensive community health and care facility
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Comprehensive Community Careat Mitsugi General Hospital Today
Acute Medical Care
Comprehensive Health and Medical CareHealth care,Rehabilitation,Palliative care
Home care(Visiting nurse station)
Rehab wards,Integrated health and welfare
facilities(Care facilities)
Comprehensive community support center,
Care prevention center
Health and Welfare Center(Health management center)Care prevention center
(Comprehensive community care
liaison office)
Other institutions
between hospitals
between hospitals and clinics
240 hospital beds, 22 departments, 317 institution beds,catchment area of 70,000 people
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Comprehensive Community Care○ Improves QOL by providing continuous comprehensive medical care in the community, taking social factors into consideration and by assuring that people keep living in their familiar environment
○ Comprehensive care aims at holistic medicine (and care) by providing not only cure but also health service (health promotion), home care, rehabilitation and takes community and normalization into perspectives through coordination of care at home and in the facilities and citizens’ participation.
○ Community is not a simple geographical area but organic area of living.
(by Noboru YAMAGUCHI)
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Comprehensive Community Care System
1)System of collaboration among health, medical and social care
2)System of collaboration between institutional (medical, care and social)
services and home care
○ Collaboration between palliative care ward and home palliative care
○ Collaboration between rehabilitation ward and community (home)
rehabilitation
○ Collaboration between (geriatric health) care facility and home care
3)Network of local government, professionals and citizens
Comprehensive care system involving all community components
three dimensional collaboration
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Comprehensive Community Care System(Integration of health, medical, care and welfare services)
Comprehensive Facilities
Geriatric Health Facility(General Ward, Dementia Ward)
Skilled Nursing Home
Home Care Support Office
Day Service Center
Rehabilitation Center (Clinic)
Regional Rehabilitation
Support Center
Care House (assisted living)
Group Home
Senile Dementia Center
Welfare Human Resource
Center
Aid Facility
National Health Insurance Clinics and Care Facilities
Local GovernmentOmi Regional Office, Hiroshima
Public Health Center
Acute Care Ward(ICU)Sub-acute Care WardPalliative Care WardRehabilitation WardChronic Care Ward
Regional Center for High Level
Brain Functions
Mitsugi General Hospital
Medical and Dental Associations
Other HospitalsSocial Welfare Council
Day Service for the Disabled
Visiting Nurse StationsHome Care SupportOfficeHome Help Station
Citizens
Com
prehensive Com
munity
Support Center
Health Welfare CenterDental Health CenterCare Prevention Center(Exercise, diet, oral care)
Home
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(Institu
tion
)
Local government
Community-based service
Volunteers
Palliative care ward
Care prevention center
Geriatric health facility
Hospitals
Clinics
Skilled nursing home
Visiting care
Day care
Respite care
Wide area community rehab support center
Welfare office
Welfare center
Comprehensive community support center
(Home care support center)
Home care support office
Convalescence ward
Rehabilitationward for recovery
Concept of Comprehensive Community Care(Welfare and care) (Health and medicine)
(Institu
tion
)
(Hom
e)
(Hom
e)
Public healthcenterHealth centerHealth managementcenter
New residential arrangement
Assisted living apartment
Group home
Citizens(Clients)(Home)
Visiting nurse(station)Visiting rehabHome palliative care
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Concept of Comprehensive Community Care System
(Buildings)
(programs)
(System)
Health (welfare) centerHealth management Center(ComprehensiveHealth Facility)
Hospitals
Clinics
Long-term care
insurance facility
Care house etc
Disability welfare facility etc
Primary prevention
Secondary prevention
Tertiary prevention
EmergencyTreatment(primary, secondary, tertiary)Rehabilitation(acute,recovery)(maintenance, community)Home medical care(terminal care)Training of new doctors
Care-Care managementCare prevention (new allowance for prevention,community support business)
Comprehens i ve communi ty care sys tem
Home careCare managementVisiting serviceDay service
Health
(Health Japan 21)(Health Frontier
project)
WelfareMedicineMedical law revisionHealth care system reformHealth care plan
Care Long-term care insurance lawCare insurance system reform etc.
Welfare for the disabled(IndependenceSupport Law)Welfare for the elderlyWelfare for the children etc.
( Citizen participation) ( Citizen participation (Volunteers)
“point” to “line”, “line” to “plane” (Community Collaboration)
Community-wide comprehensive care system(Mitsugi General Hospital)
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C i t i z e n s ( U s e r s )City Health CenterPublic Health Center
Health PromotionPrevention of Life-Style Related DiseaseHealthy Japan 21
GP (Clinic)Hospitals (Different roles)
A Hospital B Hospital C Hospital(Cancer) (Cardiovascular) (Stroke)
Primary Care (Early)
Cure
(Secondary, Tertiary)
Social Welfare CouncilWelfare Office
Acute care Ward
Recovery Ward(Rehab)/Palliative Ward Rehabilitation
Home Medical Care
Home Care
Long-care (Medical)
(Care)
Long-Term Care Insurance Facility
Image of Comprehensive Community Care~ Functions, Roles and Collaboration ~
Visiting Nurse / Help Stations
Citizen Volunteers
Welfare Facility
Health
Medical
Care
Welfare
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HealthMedicine
Life
Welfare Care
Comprehensive Community Care System~ Medicine as a core ~
(by Noboru Yamaguchi)
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[5 elements of comprehensive community care]① Strong collaboration with health care ②Improvement of care service③ Promotion of prevention ④ Advocacy and diverse life support services such as watching, meal on the wheel and shopping ⑤ Development of barrier-free housing forelderly citizens (MLIT)
Care
Prevention
Living support
Housing
Daily life zone(within 30 minutes distance)
Comprehensive Community Care System(MHLW)
Medicine
~ Care as a core ~
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Network of Comprehensive Community Care (System)-System of collaboration, point to line, line to plane-
Citizens(consumers
) CitizensVolunteersHealth and welfarecommitteeHealth guidePrivate /NPOs
HealthMedicineWelfareCare
GovernmentHealth and welfare centerHealth management centerComprehensive community support center
InsurersNational Health InsuranceAssociationInsurers’ Council Professionals
(Facilities)(Collaboration)
L i n e a r C o l l a b o r a t i o nP l a n e r ( O r g a n i c )C o l l a b o r a t i o n
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Comprehensive Community Care Network~ “Point”to“Line”, “Line”to“Plane”~
(Sufficient Multiple“ lines”)
(Medical)
(Medical)
(Medical)
(Care and Welfare)
Citizens' OrganizationsVolunteers
(Government )Health and Welfare CenterComprehensive
Community Support Center
“Point”
“Line”
quasi “Plane”
“ Plane ”
(Medical)
(Medical )
Clinic/hospital, hospital/hospital collaboration
(Hospital)(Clinic) (Clinic)
(Clinic) (Care/welfare)
(Hospital)
(Citizens)
(Noboru Yamaguchi)
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Locally Self-sufficient Comprehensive Community Care System
○ Service provision (buildings and programs) and system
integration of health, medicine, rehabilitation, care and welfare are
in place in the community
○ Service provision appropriate for specific conditions is possible
○ Identification of roles (functions) and collaboration among health care
institutions
○ Collaboration between medical and care facilities
○ Collaboration between institutional care and home care
(home, residential institutions)○ Point to line, line to plane
Network building
○ Health, medicine, care and welfare to meet the needs of citizens in the community
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Types of Comprehensive Community Care System
○ Rural village type (Mountain type)
○ Urban type
○ Mega-city type
○ Housing complex type
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Outcome of CCC SystemHealth promotion(Health project)Bed-bound free campaignHome care(Comprehensive and integrated service provision)Planer collaboration (regional collaboration)Seamless service provision
Health management center (Health/welfare center)(restructuring)Care prevention centerComprehensive health and welfare facilityHospital as a community hub
Know
-how
Facilities
Fewer bed-bound pts.
Slower increase in health
care expenditure
Economic effects
Community vitalization
(Town planning)
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Changes in the number of the elderly staying home and that of those bedridden at home in
Mitsugi Town
year
persons% Bar chart: elderly staying at homeLine chart: ratio of the elderly bedridden at home
Graph1
19801980
19811981
19821982
19831983
19841984
19851985
19861986
19871987
19881988
19891989
19901990
19911991
19921992
19931993
19941994
19951995
19961996
19971997
19981998
19991999
20002000
20012001
20022002
20032003
20042004
20052005
20062006
20072007
20082008
20092009
寝たきり老人の割合
在宅老人数
3.8
1479
3.4
1450
3.3
1484
2.8
1516
1.8
1513
1.1
1564
1
1587
0.9
1625
1.1
1676
0.9
1740
1
1814
0.8
1841
1
1867
1
1965
0.9
2040
0.8
2070
0.6
2136
0.8
2181
1
2209
0.7
2240
0.8
2247
1
2281
1
2301
1
2348
1
2332
1
2343
1.1
2340
1.2
2359
1
2345
1
2325
Sheet1
198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009
寝たきり老人の割合3.83.43.32.81.81.11.00.91.10.91.00.81.01.00.90.80.60.81.00.70.81.01.01.01.01.01.11.21.01.0
在宅老人数1,4791,4501,4841,5161,5131,5641,5871,6251,6761,7401,8141,8411,8671,9652,0402,0702,1362,1812,2092,2402,2472,2812,3012,3482,33223432340235923452325
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(National Health Insurance)Expenditure for an Elderly in Mitsugi Town
(Mitsugi General Hospital)amount
Graph1
19851985
19881988
19911991
19931993
19951995
19971997
19981998
19991999
20002000
20012001
20022002
20032003
20042004
Expenditure in Mitsugi
Average in Hiroshima
562014
523491
557584
590304
610654
638758
653886
680289
668895
699546
676120
733585
660518
740154
714384
760754
631991
725707
642995
732133
628529
704341
647548
714457
664371
737137
Sheet1
1985198819911993199519971998199920002001200220032004
Expenditure in Mitsugi562,014557,584610,654653,886668,895676,120660,518714,384631,991642,995628,529647,548664,371
Average in Hiroshima523,491590,304638,758680,289699,546733,585740,154760,754725,707732,133704,341714,457737,137
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Comprehensive Community Care System: Issues
○ “Human” and “financial "resources
○ Seamless service provision(Collaboration between health and care, institutional care and
home care services)
○ Understanding of and support by mayors
and citizens
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Seamless Health/Care Collaboration(Part 1)
○ Acute medical Primarycare Secondary
Tertiary○ From medical care to social care
rehabilitationMedical home care
long-term rehabilitationinstitutional care (care facility)
○ Planer collaboration + seamless services
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Seamless Health/Care Collaboration (Part 2)
○ Services needed are provided anywhere at any time ○ Planer collaboration with seamles service provision
Government
ProfessionalsInstitutions
Citizens
Seamlessness
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Seamless Health/Care Collaboration(Part 3)
MedicineRehabCare
Home care
Medical care & rehab
RehabCare
Home care
discontinued
ER
Discharge
Medical care and rehab discontinued
(Case of discontinued medical care and rehabilitation)
(Case of seamless service)
ER
Rehabilitation
(acute) CareM
edicine
Collaboration
Maintenance
Recovery
Rehab
Care
Inst.H
ome
Care
Bedbound
CareRehab
(re)started
Continued
Discharge
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Difficulty in MaintainingHuman Resources (inclu. MDs)(1)MD shortage
(2)Nurse shortage
(3)Care staff maintenance
(4)Rehab staff maintenance
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MD Shortage(Report by Japan Economic Training Center)( Medical wave 2009)
○ Approx. 77,000 MDs in short in 2016○ Largest number of MDs per 1,000 pts. in Kyoto (42 MDs)○ Serious problem in Aomori, Mie and Hiroshima○ Increase in patients will surpass increase in doctors in Mie,
Hiroshima, Kagawa and Kumamoto in 2025 and 2030→ Increase in medical students will not be enough
○ Measures with immediate effects needed→ △ Allied professionals to take some MD roles
△ Support female MDs returning to workforce△ Participation of GPs in emergency care
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Factors and Issues of MD shortage ① Long-lasting shortage in rural mountainous areas② Specialization requires more MDs③ Increase in specialists who lack primary care expertise④ Insufficient use of female MDs⑤ Becomes apparent with new residency system⑥ Fewer MDs staying at local universities
→ Fewer MDs wishing to take PhD→ Universities incapable of sending MDs to the field
⑦ Uneven distribution of MDs(Concentration to big cities,specific departments, avoiding high risk associated depts.)
⑧ Increase in GPs and decrease in hospital MDs⑨ Effects of intensive allocation of doctors
→ Lack of support to rural mountainous areas⑩ Geographical discrepancy and uneven distribution among
departments not taken care of→ Free choice of MDs at present
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How to Cope with MD shortage○ Increase number of doctors○ Allocation by geographical areas, departments and working
system→ Quota system(UK, Germany)
○ Compulsory service in rural areas for certain period duringthe first 10 years after MD qualification
○ Training in and establishment (system) of general medicine(Department of General Medicine)
○ Fare and adequate fee structure○ Develop sense of mission among doctors
→ Review of medical school education, retraining of MDs○ Use of allied professionals (advanced practice nurses etc.)for part of MD roles, utilization of midwifery clinic ○ Region-oriented health care plan
→ Different plan for urban cities and rural mountain areas
(Proposal to national government)
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Image of Concentration of Doctors at Hub Hospitals
Cooperating hospital
AB
C
D
Hub Hospital
E
Clinic
Small-scalehospital
Clinic
Cooperating hospital
Cooperating hospital
Cooperating hospital
Cooperating
hospital(community hub)
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Treatment and diagnostics Ⅰ(Buildings)(Facilities / equipment) T & DⅡ(Programs)
PhilosophyHuman resourcesTeam medicine, quality of careInformed consentMedical safetyCollaboration between hospital and clinic or facilities and between hospitalsRehabilitation and palliative medicine
Operation and managementManagementHR evaluationOrdering systemE-chartE-receiptsUtilization of IT’s
Functions to meet local needs
Comprehensive health / welfare facilityHome careCollaboration of health and welfareEstablishment of comprehensive community care system Collaboration with community services and roles of comprehensive community liaison officeNetwork building (two dimensional collaboration)
T&D Ⅲ(Quality of science and clinical service)
Patient service
Improvement of meals, environment and amenity
( Noboru Yamaguchi )
Hospital (Clinic) Functions
※ Challenges:How to secure “human” and “financial "resources
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(%)
Improved educational environment and diverse learning opportunities
Good health, medical and welfare services
Good for the elderly and the disabled
Improved amenity in habitat
Low risk in disaster damages
Good telecommunication infrastructure
Convenient transportation including road system
Environmentally friendly with harmonization with nature
Desirable environment for children to grow
Active town with attractive urban space
Active international tourism and exchange
Vital town with active industries
Active citizen activities
Others
Culture-orientation with active art and cultural exchange
Cultural landscape and beautiful streets
Interview on the town after amalgamation
(Onomichi City・Mitsugi Town and Mukaijima Town)
Graph1
0.7
4
25.2
4.8
7.2
10.9
9.5
10.9
28.7
32.3
14.1
15.2
5.7
19.3
29.9
56
東京
Sheet1
東京0.74.025.24.87.210.99.510.928.732.314.115.25.719.329.956.0
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New System for Doctor Training ( Philosophy of Training )
To nurture good quality and personality as doctors and to let them acquire fundamental clinical competency (attitude, skill and knowledge) for primary care so that they are prepared to respond adequately and appropriately to diseases and pathologies they frequently encounter in their daily practice with accurate recognition of social needs for medicine and healthcare, irrespective of their future specialties.
(MHLW)
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Background for Community Care Training(New training for doctors)
○ Health care trend From Cure to CareFrom Hospital Care to Home Care
○ Change in demographics and advancement in medicine and medical technologies○ Problems of specialization / compartmentalization○ Importance in comprehensive community healthcare○ Distinction and relationship between medicine and care(continuity)
Creation of long-term care insurance system○ Priority in primary care○ Specialist and generalist model(Comprehensive healthcare)○ Experience in specific healthcare settings
emergency medicine, preventive medicine, community health and medicine,perinatal, pediatric and developmental medicine, psychiatry, palliative andend-of-life medicine
○ Healthcare to respond to the people’s needs
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“Town Planning” in the Aging SocietyCollaboration of health, medicine, care and welfare and daily life
○ Environment,Architecture, Education
○ Housing for the Elderly3-generation house
○ Community CenterSchool/Nursery schoolShopping Center
○ Employment
Skilled Nursing HomeNursing Home
○ Assisted LivingGroup HomeNursing Home
○ Social Welfare Council
Citizens’ ParticipationCitizens’ OrganizationHealth and Welfare
Welfare OfficeComprehensive Welfare Center
Citizens’ Participation
・Visiting Nurse Station・Home Care Support Center・Geriatric Health
Facility・Hospice・Comprehensive
Community Support Center
Health Promotion CenterHealth and Welfare Center(Health Management Center)
Public Health Center
Hospital
Clinic
GeneralLong - termPsychiatryTB
Health(Health motion)
Life
Medicine Care/welfare
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○ Health is more than medical treatment○ Necessity of comprehensive medicine○ Bed-bound free campaign○ Establishment of comprehensive community care
→ Collaboration of health, medicine, care and welfare:team health care
○ Science (Knowledge)Art (Skill)Humanity(Holistic health care)
○ From disease (organ) oriented medicine to holistic health care (QOL)○ Care is beyond simple help
→ Holistic care including living environment
Holistic Health and Care(by Noboru Yamaguchi)
スライド番号 1スライド番号 2スライド番号 3スライド番号 4スライド番号 5スライド番号 6スライド番号 7Concept of Comprehensive Community Care Systemスライド番号 9スライド番号 10スライド番号 11Network of Comprehensive Community Care (System) �-System of collaboration, point to line, line to plane-Comprehensive Community Care Network�~ “Point”to“Line”, “Line”to“Plane”~Locally Self-sufficient Comprehensive Community Care Systemスライド番号 15スライド番号 16スライド番号 17(National Health Insurance)�Expenditure for an Elderly in Mitsugi Town� (Mitsugi General Hospital)スライド番号 19スライド番号 20スライド番号 21スライド番号 22スライド番号 23スライド番号 24スライド番号 25スライド番号 26Image of Concentration of Doctors at Hub Hospitalsスライド番号 28スライド番号 29New System for Doctor Training Background for Community Care Training� (New training for doctors)スライド番号 32スライド番号 33