| Budget Amount *help |
¥3,770,000 (Direct Cost: ¥2,900,000、Indirect Cost: ¥870,000)
Fiscal Year 2014: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
Fiscal Year 2013: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2012: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
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| Outline of Final Research Achievements |
We conducted action research applying the concept and methodology of Population Health Management in an aging community with a declining population where the medical and long-term care expenditures were increasing. Advanced practice nurses (clinical nurse specialists) analyzed the health indicators of the community, stratified the residents based on their health risks, and planned health strategies with the administrators, medical and caretaking stakeholders in accordance with risk characteristics with a view to entire prevention from the primary to the tertiary.We implemented disease management and disease severity prevention, introducing telemedicine and promotion of advanced care planning. As a result, we observed a significant improvement in the health indicators. The results suggest that this model can contribute to the restoration of medical and long-term care finance and can be a pioneering model of the integrated community care system in Japan.
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