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Development of an extraction and intervention system for patients requiring advanced case management in the community

Research Project

Project/Area Number 15K15914
Research Category

Grant-in-Aid for Challenging Exploratory Research

Allocation TypeMulti-year Fund
Research Field Community health nursing
Research InstitutionHiroshima University

Principal Investigator

Moriyama Michiko  広島大学, 医歯薬保健学研究院(保), 教授 (80264977)

Co-Investigator(Kenkyū-buntansha) 河口 洋行  成城大学, 経済学部, 教授 (40364666)
Project Period (FY) 2015-04-01 – 2017-03-31
Project Status Completed (Fiscal Year 2016)
Budget Amount *help
¥3,640,000 (Direct Cost: ¥2,800,000、Indirect Cost: ¥840,000)
Fiscal Year 2016: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
Fiscal Year 2015: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
Keywords地域看護学 / ケースマネジメント / 地域包括ケア / 疾病管理 / アドバンス・ケア・プラニング
Outline of Final Research Achievements

To establish a sustainable social security system, this research aims to develop an advanced case management model (ACMM) to support the decision-making of patients and families, to implement care management from the local government side, and to promote the optimization of medical and nursing care expenses. The advanced case managers (ACMs) were positioned as the core of the community integrated care system to support the improvement of QOL of patients and families and the End of Life care.
Placed in Kure City, Hiroshima Prefecture, ACMs analyzed the medical and nursing insurance claims data, and extracted persons who spent high medical cost, etc. For the extracted 26 participants, ACMs performed comprehensive assessment, proposal and coordination of service resources. Local government requires the ACMs who can intervene for improving QOL of patients by extracting and analyzing the medical claim data. The effects were observed although it was limited to reduction of medical expenses.

Report

(3 results)
  • 2016 Annual Research Report   Final Research Report ( PDF )
  • 2015 Research-status Report
  • Research Products

    (34 results)

All 2017 2016 2015 Other

All Int'l Joint Research (2 results) Journal Article (16 results) (of which Int'l Joint Research: 3 results,  Peer Reviewed: 6 results,  Open Access: 5 results,  Acknowledgement Compliant: 4 results) Presentation (10 results) (of which Int'l Joint Research: 3 results,  Invited: 4 results) Book (3 results) Remarks (3 results)

  • [Int'l Joint Research] Aalto University/HEMA Institute(Finland)

    • Related Report
      2016 Annual Research Report
  • [Int'l Joint Research] Aalto University(フィンランド)

    • Related Report
      2015 Research-status Report
  • [Journal Article] 糖尿病腎症に対する遠隔面談型セルフマネジメント教育と直接面談型教育の効果の比較:12ヶ月フォローアップ結果2017

    • Author(s)
      尾崎果苗, 加澤佳奈,森山美知子
    • Journal Title

      日本糖尿病教育・看護学会誌

      Volume: 21 Pages: 46-55

    • Related Report
      2016 Annual Research Report
    • Peer Reviewed / Open Access / Acknowledgement Compliant
  • [Journal Article] Health resource utilization and comorbidities in patients with mental dis-orders: analysis based on health insurance claim data2017

    • Author(s)
      Kazawa K, Iwamoto S, Rahman MM, Moriyama M
    • Journal Title

      Health

      Volume: 9 Issue: 04 Pages: 763-777

    • DOI

      10.4236/health.2017.94055

    • Related Report
      2016 Annual Research Report
    • Peer Reviewed / Open Access / Int'l Joint Research / Acknowledgement Compliant
  • [Journal Article] 病床削減政策はなぜ困難なのかー規制変化への対応に関するアンケート調査から2017

    • Author(s)
      河口洋行
    • Journal Title

      社会イノベーション研究

      Volume: 12

    • Related Report
      2016 Annual Research Report
  • [Journal Article] 我が国における後発医薬品普及に関する政策展開と今後の課題2017

    • Author(s)
      河口洋行・吉田俊之
    • Journal Title

      経済研究

      Volume: 215 Pages: 127-156

    • NAID

      120005972364

    • Related Report
      2016 Annual Research Report
  • [Journal Article] 糖尿病患者を透析にしない工夫:データヘルス計画と呉市モデル2016

    • Author(s)
      森山美知子, 加澤佳奈
    • Journal Title

      医工学治療

      Volume: 28 Pages: 123-128

    • Related Report
      2016 Annual Research Report
  • [Journal Article] Development and Testing of the Partnership Scale for Primary Family Caregivers Caring for Patients With Dementia2016

    • Author(s)
      Ayumi Kiriake, Michiko Moriyama
    • Journal Title

      Journal of Family Nursing

      Volume: 1074840716656450 Issue: 3 Pages: 339-367

    • DOI

      10.1177/1074840716656450

    • Related Report
      2016 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] 第4章 Population Health Managementに基づいた地域包括ケアシステムの展開2016

    • Author(s)
      森山美知子
    • Journal Title

      医療・介護に関する研究会報告書(財務総合政策研究所)

      Volume: web

    • Related Report
      2016 Annual Research Report
  • [Journal Article] 第7章 Accountable Care Organizations―日本への示唆2016

    • Author(s)
      森山美知子
    • Journal Title

      医療・介護に関する研究会報告書(財務総合政策研究所)

      Volume: web

    • Related Report
      2016 Annual Research Report
  • [Journal Article] The role of primary health care in incentivising policy outcomes: lessons from the U.K. experience2016

    • Author(s)
      Hiroyuki Kawaguchi, Peter C Smith
    • Journal Title

      Japanese Journal of Health Economics and Policy

      Volume: E3 Pages: 3-16

    • Related Report
      2016 Annual Research Report
    • Int'l Joint Research
  • [Journal Article] Long term care in the Netherlands: Towards managed competition?2016

    • Author(s)
      Richard van Kleef, Hiroyuki Kawaguchi
    • Journal Title

      Japanese Journal of Health Economics and Policy

      Volume: E3 Pages: 26-34

    • Related Report
      2016 Annual Research Report
    • Int'l Joint Research
  • [Journal Article] データヘルス計画:ポピュレーション・ヘルス・マネジメントの展開2015

    • Author(s)
      森山美知子
    • Journal Title

      日本遠隔医療学会雑誌

      Volume: 11(1) Pages: 25-29

    • NAID

      40020514230

    • Related Report
      2015 Research-status Report
    • Peer Reviewed
  • [Journal Article] The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives2015

    • Author(s)
      Takeshita Y, Ikeda M, Sone S, Moriyama M
    • Journal Title

      Health

      Volume: 7(8) Issue: 08 Pages: 934-945

    • DOI

      10.4236/health.2015.78111

    • Related Report
      2015 Research-status Report
    • Peer Reviewed / Open Access / Acknowledgement Compliant
  • [Journal Article] Efficacy and Usability of an E-learning Program for Fostering Qualified Disease Management Nurses2015

    • Author(s)
      Kazawa K, Moriyama M, Oka M, Takahashi S, Kawai M, Nakano M.
    • Journal Title

      Health

      Volume: 7(8) Issue: 08 Pages: 955-964

    • DOI

      10.4236/health.2015.78113

    • Related Report
      2015 Research-status Report
    • Peer Reviewed / Open Access / Acknowledgement Compliant
  • [Journal Article] 高齢化に限らない医療費増の主因2015

    • Author(s)
      河口洋行
    • Journal Title

      週刊東洋経済

      Volume: 10.06号 Pages: 78-79

    • Related Report
      2015 Research-status Report
  • [Journal Article] 判断が曖昧な日本の終末期医療2015

    • Author(s)
      河口洋行
    • Journal Title

      週刊東洋経済

      Volume: 12.15号 Pages: 50-51

    • Related Report
      2015 Research-status Report
  • [Journal Article] 公的医療保険の不透明なリスク調整2015

    • Author(s)
      河口洋行
    • Journal Title

      週刊東洋経済

      Volume: 11.10号 Pages: 48-49

    • Related Report
      2015 Research-status Report
  • [Presentation] 糖尿病腎症重症化予防を目指す保健指導 -看護師の立場から-2017

    • Author(s)
      加澤佳奈
    • Organizer
      第7回日本腎臓リハビリテーション学会学術集会
    • Place of Presentation
      つくば市
    • Related Report
      2016 Annual Research Report
    • Invited
  • [Presentation] 高齢者の疾病構造と死亡前医療の使われ方に関する分析2016

    • Author(s)
      加澤佳奈, 岩本晋, 森山美知子
    • Organizer
      第54回日本医療・病院管理学会学術総会
    • Place of Presentation
      東京都
    • Related Report
      2016 Annual Research Report
  • [Presentation] Utilization of medical receipt information with the aim of data health plan; using data from the Hiroshima Local city2016

    • Author(s)
      Takaaki Shimizu, Tomoichi Yokozeki, Yoshio Utsumi, Susumu Iwamoto, Rie Shimizu, Michiko Moriyama
    • Organizer
      The 18th IFHMA International Congress
    • Place of Presentation
      Tokyo
    • Related Report
      2016 Annual Research Report
    • Int'l Joint Research
  • [Presentation] シンポジウム20:これから学会でプライマリ・ケア看護師をどう養成するか.「日本プライマリ・ケア連合学会プライマリ・ケア看護師養成とプライマリ・ケア看護師に必要な知識と技術」2016

    • Author(s)
      森山美知子
    • Organizer
      第7回日本プライマリ・ケア連合学会学術大会
    • Place of Presentation
      東京都
    • Related Report
      2016 Annual Research Report
    • Invited
  • [Presentation] 地域における医療・介護連携の実践事例(大崎上島町の高齢者ケアの実践)2015

    • Author(s)
      森山美知子
    • Organizer
      第29回日本疾病管理研究会
    • Place of Presentation
      東京都
    • Year and Date
      2015-11-07
    • Related Report
      2015 Research-status Report
    • Invited
  • [Presentation] 高品質な看護サービスと経済的成果-慢性疾患管理ビジネスの実践から-2015

    • Author(s)
      森山美知子
    • Organizer
      第6回看護経済・政策研究学会学術集会
    • Place of Presentation
      東京都
    • Year and Date
      2015-09-12
    • Related Report
      2015 Research-status Report
    • Invited
  • [Presentation] Discussion of the dynamics and action plans for the Japanese healthcare system and the care of elderly people aged 75 years or older.2015

    • Author(s)
      Kazawa K., Kanazawa T., Iwamoto S., Moriyama M.
    • Organizer
      The 6th international conference on community health nursing research
    • Place of Presentation
      Seoul, Korea
    • Year and Date
      2015-08-21
    • Related Report
      2015 Research-status Report
    • Int'l Joint Research
  • [Presentation] 呉市脳梗塞再発予防の仕組みづくりと成果の中間報告‐保険者・医療機関と連携し、発症直後の患者登録・介入を目指す2015

    • Author(s)
      後藤瑞枝, 杉江いづみ,角井紋子,大黒英美,原眞理子,前野尚子,辰巳弥生, 加澤佳奈, 森山美知子
    • Organizer
      第3回日本ニューロサイエンス看護学会学術集会
    • Place of Presentation
      徳島市
    • Year and Date
      2015-07-27
    • Related Report
      2015 Research-status Report
  • [Presentation] Whether Disease Management is Effective for Cost Containment: A New Evidence by Difference in Difference analysis from panel data in Japan2015

    • Author(s)
      Hiroyuki Kawaguchi, Michiko Moriyama, Hideki Hashimoto
    • Organizer
      2015 International Health Economics Association (iHEA)
    • Place of Presentation
      Milan:Italy
    • Year and Date
      2015-07-17
    • Related Report
      2015 Research-status Report
    • Int'l Joint Research
  • [Presentation] プライマリ・ケア看護師養成の夜明け:プライマリ・ケア看護師養成に向けて2015

    • Author(s)
      森山美知子
    • Organizer
      第6回日本プライマリ・ケア連合学会学術大会
    • Place of Presentation
      つくば市
    • Year and Date
      2015-06-13
    • Related Report
      2015 Research-status Report
  • [Book] エビデンスに基づく循環器ケア関連図2017

    • Author(s)
      森山美知子,木原康樹,宇野真理子,中麻規子編集
    • Total Pages
      375
    • Publisher
      中央法規出版
    • Related Report
      2016 Annual Research Report
  • [Book] ADVANCES IN DEA THEORY AND APPLICATIONS: with Extensions to Forecasting Models2017

    • Author(s)
      Hiroyuki Kawaguchi, Kaoru Tone, Miki Tsutsui
    • Total Pages
      576
    • Publisher
      John Wily & Sons, Ltd
    • Related Report
      2016 Annual Research Report
  • [Book] 日本プライマリ・ケア連合学会 プライマリ・ケア看護学 基礎編2016

    • Author(s)
      日本プライマリ・ケア連合学会編(松下明、森山美知子編著)
    • Total Pages
      494
    • Publisher
      南山堂
    • Related Report
      2016 Annual Research Report
  • [Remarks] 広島大学大学院医歯薬保健学研究科 成人看護開発学

    • URL

      http://home.hiroshima-u.ac.jp/seijin/

    • Related Report
      2016 Annual Research Report
  • [Remarks] 広島大学大学院医歯薬保健学研究科 成人看護開発学 慢性疾患マネジメント・プロジェクト研究センター

    • URL

      http://home.hiroshima-u.ac.jp/dmcenter/

    • Related Report
      2016 Annual Research Report
  • [Remarks] 慢性疾患マネジメント・プロジェクト研究センター

    • URL

      http://home.hiroshima-u.ac.jp/dmcenter/

    • Related Report
      2015 Research-status Report

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Published: 2015-04-16   Modified: 2018-03-22  

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