Development of quality indicator for adult day services towards promoting the community-based integrated care system in Japan

Abstract

An introduction: From an international point of view, Japan government have promoted integrated care system in the community-based way. Incentives through the long-term care and medical fee system already promoted collaboration between healthcare facilities and community-based long-term care services, and the new reform of the system in 2012 will reinforce this integration of care. On the other hand, in large cities, long-term care benefit cost are increasing with the increasing elderly population ratio. In Japan, long-term care providers are increasing rapidly in which provide services for elderly people whose care levels are low. It is because they can run the business at a relatively small scale and their income is firm. As a result of this situation, among others, there is a problem of extremely increasing number of the providers in cities. We need the control of the number of these providers through the assessment of the quality of the services they provide. In this research, we try to development of quality indicator for adult day Services towards the community-based integrated care system in O-city. These indicators should be associated with transitions of scores such as ADL and QOL and third parties can use it easily. Short description of practice change implemented: We conducted pilot project at O-city. There have already been 278 providers in O-city and 11,439 people have used their services, but even from the point of the city's scale, these numbers are remarkable in Japan. 178 providers (64.0%) participated in this pilot project. In order to create a draft version of the indicators, we made the committee composed of the city workers, the representatives of long-term care providers, and academic experts. The index is composed of categories, staff support, care techniques, awareness of providers, and awareness of community residents, and 25 items. We asked all the providers participated in this project to submit the data concerning ADL/QOL of all their services users in these indicators and at the two points in 2015 (August and February). Key findings: Through the analysis of the collected data, we choose the 5 indicators (1.the rate of the staffs who participate in training courses in the providers, 2.the rate of staffs who participate in training courses outside the providers, 3.the rate of staffs who is qualified to be a certified care worker, 3.the rate of staffs who is qualified to be a rehabilitation specialist, and 5.the rate of demented people in the users) out of 25 items. From the relationship between this index and the evaluation index scores of shift in 6 months and quality of the daily living functional evaluation of 1,517 users in the participating providers, we found that 3 indicators (2,4,5) were related to an improvement of users. Highlights: The O-city continued the project concerning the evaluation of the qualities and announced the result to the citizens. And the O-city prepares making financial incentive to use the quality evaluation by indicators. Besides the city considers including the strength of cooperation between medical services and long-term care in the indicators from the point of constructing a community-based integrated care system. Conclusion: Japan promotes constructions of community-based integrated care system and its means depends on autonomous local governments. The O-city starts to control the long-term care providers through the evaluation of the quality of the day-service providers and verifies whether the control have an effect on a hold-down on medical and care expenses as one of its outcome. This efforts is seems to be advanced practice in Japan, but we need to make it more common in the future.