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

2016 Fiscal Year Final Research Report

• Project/Area Number: 15K15914
• Research Category: Grant-in-Aid for Challenging Exploratory Research
• Allocation Type: Multi-year Fund
• Research Field: Community health nursing
• Research Institution: Hiroshima University
• Principal Investigator: Moriyama Michiko 広島大学, 医歯薬保健学研究院(保), 教授 (80264977)
• Project Period (FY): 2015-04-01 – 2017-03-31
• 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.

Free Research Field

地域看護学