Community-based Integrated Care System Research Articles

Challenges and solutions for discharge support of elderly people in the acute care ward: Interviews with community-based integrated care supporters and patients in Tokyo, Japan.

Japan, which has become the country with the longest-living people in the world due to rapid population aging, has an insurer function for each local government and socialized long-term care under a public system. Japan aims to build a Community-based Integrated Care System (CICS) for each municipality with the goal of integrating medical care and long-term care. However, despite the policy and management studies, the challenges and solutions for discharge support by the parties have not yet been clarified. This study aimed to obtain suggestions on challenges and solutions for discharge support in the acute care wards for the elderly for community-based integrated care support providers and patients in Kita Ward, Tokyo. Semi-structured interviews were conducted, and the obtained data were a priori analyzed by a deductive thematic analysis using a conceptual framework for integrated care based on the integrative functions of primary care. The challenges were found to include: i) disparity between medical and lifestyle perspectives, ii) competencies of medical and care workers at homes, iii) discharge support challenges related to the elderly themselves, iv) nursing care dependent on family; and v) the impact of payment of medical service in the health insurance system and payment of long-term care services. The solution that can be applied at the local government level was community connection. While aiming to build a CICS for each local government, there was a contradiction in that the challenges and solutions required examination at the national and prefectural levels.

Helping the Elderly Live Better With Dementia: Recent Developments in Japan’s Adult Guardianship System and Its Role in Geriatric Social Work Practice

With the rapid aging of Japanese society and increasing concerns over the welfare of people with psychiatric disorders, intellectual disability, and dementia, a renewed adult guardianship system based on the notion of respect for self-determination, the practical use of one’s remaining abilities, and re-socialization, has now been in place for 20 years. Japanese adult guardianship practices are understudied in English language literature; thus, this article presents an overview of recent developments in Japan’s adult guardianship system and geriatric social work initiatives adopted in Japan’s adult guardianship practice. The authors found that the guardianship system not only helped the elderly live better with dementia but also contributed to the realization of “ageing in place” in the community-based integrated care system.

Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital.

This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29-8.57) and moderate (OR: 2.46, 95% CI: 1.06-5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51-2.95, p < 0.001], 2.42 [95% CI: 1.79-3.27, p < 0.001], and 2.01 [95% CI: 1.46-2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.

On-scene time delays for epileptic seizures in developed community-based integrated care system regions

BackgroundDelayed on-scene time by emergency medical services (EMS) can have detrimental effects on critical cases for people with epilepsy (PWE). In preparation for a super-aged society, a Community-based Integrated Care System is crucial to manage healthcare costs. However, sufficient coordination irrespective of sociomedical changes among medical providers is challenging. AimThis study aimed to evaluate on-scene time delays in the treatment of PWE, identify factors associated with such delays, and clarify regional differences. The focus was on the volume of acute care beds in regions with a developed Community-based Integrated Care System. MethodsThis population-based observational study evaluated on-scene time delays in the treatment of PWE across six major cities in western Japan between 2017 and 2021. In addition, we also evaluated the association between regional differences focusing on volume of acute care beds (“Reduced region” and “Preserved region”, as cities with numbers of acute care beds per 1,000 people below and above the national average, respectively) along with sociomedical factors associated with on-scene time delays. ResultsThis study included 8,737 PWE transported by EMS, with a mean on-scene time for EMS ranging from 12.9 ± 6.8 min to 21.7 ± 10.6 min. On-scene time delays were evident in Reduced regions, with an increase of 1.45 min (95 % confidence interval 0.86–2.03 min, p < 0.001). A high total EMS call volume independently influenced on-scene time delays during the middle period of the pandemic in Reduced regions. ConclusionOptimal coordination must be facilitated to ensure the effective functioning of the Community-based Integrated Care System, particularly during unusual circumstances.

Categorization using the Dementia Assessment Sheet for Community-Based Integrated Care System 8-items (DASC-8) based on cognitive function and activities of daily living predicts frailty, disability and mortality in older adults.

This longitudinal study aimed to determine whether categorization by the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) is associated with risk of frailty onset, disability, and mortality. We analyzed longitudinal data from outpatients aged 65 years and older evaluated for the DASC-8 at the Frailty Clinic. The outcomes during the 3-year follow-up period were (Study A) frailty onset (Kihon Checklist ≥8) and (Study B) disability (new certification of nursing care needs) or mortality. Multivariate Cox regression analyses were performed to examine independent associations between the DASC-8 category and outcomes, and hazard ratios and 95% confidence intervals (CIs) were calculated after adjustment for age, sex, and the presence or absence of diabetes, hypertension, and dyslipidemia. (Study A) Out of the 216 patients without frailty in Categories I or II at baseline, 40 (20.4%) and 11 (55.0%) developed frailty, respectively. The adjusted hazard ratio was 3.62 (95% CI: 1.69-7.76, P < 0.001). (Study B) Out of the 350 patients who did not require long-term care at baseline, disability or death occurred for 20 (7.3%) in Category I, 14 (23.0%) in Category II, and 9 (56.3%) in Category III. The adjusted hazard ratios were 2.40 (Category I vs. II; 95% CI: 1.13-5.11, P = 0.023) and 5.43 (Category I vs. III; 95% CI: 2.23-13.3, P < 0.001). Categorization according to DASC-8 is associated with the risk of frailty, disability, and mortality in older patients. Geriatr Gerontol Int 2024; 24: 150-155.

The framework for modern community medicine in Japan.

Along with the transition to depopulation and an aging society in Japan, the modification of community medicine and its related systems is required. With this in mind, the Japanese government has recently advocated two major plans: 'Community Healthcare Vision' and 'Community-based Integrated Care System'. This paper proposes a theoretical framework to understand modern community medicine based on the ongoing government plans. The key viewpoints consisting of the framework are 'community and/or region', 'care systematization,' and 'coworking with residents (citizens)'. This is expected to be useful for capturing and monitoring the whole picture of modern community medicine in Japan. Such modeling might aid in the future development of medicine and medical science, as in other developed countries.

End-of-life care management for older adults at home by multidisciplinary professionals in Japan.

Population aging is a global phenomenon, and there is an urgent need to establish community-based integrated care systems for a sustainable society. In particular, the needs of home-dwelling older adults are multifaceted, encompassing areas such as medical care, nursing care, and welfare. Therefore, it is necessary to implement comprehensive care management that utilizes social resources suitable for diverse needs. This study aims to comprehensively describe care management practices by various professionals for home-dwelling older adults in the end-of-life (EOL) period. This study adopted a qualitative analysis method using conventional content analysis. We conducted semi-structured interviews of 20 multidisciplinary professionals from February to March 2020. Multidisciplinary professionals ensured continuity of care by implementing care management as necessary when providing care to older adults who desired to stay at home until the end. Seven categories of EOL care management practices for home-dwelling older adults by multidisciplinary professionals were generated: (1) support to enable discharge to home; (2) decision-making support that captures the intention of the older adult without missing opportunities; (3) building a team system to realize the desired life and EOL; (4) family support for the entirety of the EOL period, (5) symptom control aimed at the realization of wishes; (6) emotional support for acceptance of the EOL period; (7) spiritual support. Multidisciplinary professionals, including care managers, collaborating in a mutually complementary manner by sharing a comprehensive understanding of care management might prevent knowledge fragmentation and ensure that older adults receive home-based EOL care.

Future perspective of psychiatric home-visit nursing provided by nursing stations in Japan.

Psychiatric home-visit nursing supports the lives of people with mental disorders in the community and plays an important role in the "community-based integrated care system" which is rapidly being implemented in Japan. Although the number of responsive home-visit nursing stations (HVNS) is increasing, the current situation of service provision has not yet been clarified. This study aimed to investigate the characteristics and difficulties of psychiatric home-visit nursing provided by HVNS. We further discussed future care provisions and service improvements. We conducted a questionnaire survey of 7,869 member stations of the National Association for Visiting Nurse Service; of this number 2,782 facilities (35.4%) responded. Of the 2,782 facilities, 1,613 (58.0%) provided psychiatric home-visit nursing. The HVNS that provided psychiatric home-visit nursing were diverse, and the percentage of users with mental disorders ranged widely. Majority of the HVNS reported having "difficulty in caring for users/families who refuse care" (56.3%), "difficulty in care for psychiatric symptoms" (54.0%), and "difficulty in assessment of psychiatric symptoms" (49.1%), with differences in difficulty depending on the percentage of psychiatric users. As user needs and HVNS characteristics diversify, it is necessary to take advantage of the characteristics of each station to develop consultation and training systems and collaborative network platforms within each community for future sustainable service provision.

Family caregiver’s concerns and anxiety about unaccompanied out-of-home activities of persons with cognitive impairment

BackgroundAlthough people with cognitive impairment highly value social participation in out-of-home activities, their families typically perceive concerns and experience anxiety over such activities. This study aimed to elucidate the underlying concerns and factors associated with family caregivers’ anxiety over the individual’s unaccompanied out-of-home activities.MethodsIn December 2021, we conducted a cross-sectional e-survey of family caregivers of individuals with early-stage cognitive impairment. Caregivers’ concerns about ten common risks related to out-of-home activities were cross-tabulated by specific anxiety levels to examine trend associations. With the variables of caregivers and their individuals across the five domains, we ran logistic regression analyses to determine explanatory models for anxiety.ResultsThe study participants were 1,322 family caregivers of people whose cognitive function varied from intact to possible mild dementia according to the Dementia Assessment Sheet for Community-based Integrated Care System 8-item. Significant associations were found between the prevalence of concerns and the degree of anxiety, even without actual experience with the issues of concern. Among the five domains, individual dementia characteristics and social behaviors were the predominant factors attributed to caregiver anxiety. Caregivers’ no anxiety state was significantly associated with: younger age (OR 4.43, 95% CI 1.81–10.81), no detectable cognitive decline (OR 3.34, 95% CI 1.97–5.64), free from long-term care (LTC) (OR 3.52, 95% CI 1.72–7.21), no manifestation of behavioral and psychological symptoms of dementia (BPSD) (OR 13.22, 95% CI 3.06–57.01), and not engaging in unaccompanied out-of-home activities (OR 3.15, 95% CI 1.87–5.31). Their severe anxiety was positively associated with being on LTC (OR 3.39, 95% CI 2.43–4.72) and minor BPSD (OR 1.43, 95% CI 1.05–1.95), and negatively associated with engagement in unaccompanied out-of-home activities (OR 0.31, 95% CI 0.23–0.43).ConclusionsThe study found that family caregivers’ anxiety was associated with concerns about behavioral issues, regardless of actual experiences. There were two significant associations in opposite directions between caregivers’ anxiety and the individual’s engagement in out-of-home activities. In the early phase of cognitive impairment, caregivers may intuitively interpret the individual’s behavior and feel anxious. Educational support may provide reassurance and enable caregivers to facilitate out-of-home activities.

Evaluation of Everyday Living Areas for Deinstitutionalized Community-Living People with Mental Illness

Deinstitutionalization of psychiatric care has been associated with increased homelessness, crime, and suicide, partly owing to insufficient, adequate, and accessible community resources. Therefore, appropriate resource placement is a key deinstitutionalization issue. The study’s aim was to identify residential group homes for people with mental illness in Kochi Prefecture, Japan, and the social resources necessary for social reintegration using a geographic information system (GIS). Everyday living areas (ELAs), as defined by the Japanese Community-Based Integrated Care System for People with Mental Illness (CICSM), were assessed using ELA location simulations. We used GIS to determine the spatial distribution of group homes, visiting nursing stations, psychiatric hospitals, daycare centers, and employment support offices. Following the CICSM definition of ELAs, we identified areas that people with mental illness could reach within 30 min on foot/by bicycle and counted the number of social resources in them. The ELA location simulation results suggest that policymakers should avoid uniform distribution of ELAs according to the CICSM definition. Establishing ELAs in suburban areas requires careful consideration of the available community resources, number of people with mental illness, existing support systems, and feasibility of the location.

Association of functional and cognitive impairment severity with discharge to long-term care facilities in older patients admitted to a general acute care hospital from home

BackgroundThe early recognition of hospitalized patients at risk of being discharged to long-term care facilities (LTCFs) may help to identify those who require transitional care programs and interventions that support discharge to home. We examined the association of functional and cognitive impairment severity with discharge to LTCFs among older hospitalized patients. MethodsIn this retrospective cohort study, we used an administrative claims database linked with geriatric assessment data from a general acute care hospital in Japan. We analyzed patients aged ≥65 years discharged between July 2016 and December 2018. The severity of functional and cognitive impairments was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) scale. Based on their DASC-8 scores, patients were designated as Category I (no impairment), Category Ⅱ (mild impairment), or Category III (moderate/severe impairment). We conducted logistic regression analyses to examine the association between the severity of impairments and discharge to LTCFs after adjusting for patient-level factors. ResultsWe analyzed 9,060 patients (mean age: 79.4 years). Among the 112 patients (1.2%) discharged to LTCFs, 62.3%, 18.6%, and 19.2% fell under Category I, Category Ⅱ, and Category III, respectively. Category II was not significantly associated with discharge to LTCFs. However, Category III had a significantly higher odds of discharge to LTCFs than Category I (Adjusted odds ratio: 2.812, 95% confidence interval: 1.452–5.449). ConclusionPatients identified as Category III by the DASC-8 on admission may benefit from enhanced transitional care and interventions that promote discharge to home.

Predicting three categories of Dementia Assessment Sheet for Community-based Integrated Care System 8-items score-based glycemic targets using the number of animal names recalled.

The Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) assesses memory, orientation, instrumental activities of daily living and basic activities of daily living. Category I (DASC-8 score ≤10), category II (11 ≤ DASC-8 score ≤16) and category III (DASC-8 score ≥17) have been defined. Based on these categories, the glycemic targets in diabetes patients aged ≥65 years have been proposed by the Japan Diabetes Society and the Japan Geriatrics Society Joint Committee. DASC-8 is difficult to apply to patients without family members or supportive persons. We propose a verbal fluency test as the screening tool. We enrolled 69 inpatients aged ≥65 years with type 2 diabetes, who were administered the DASC-8 and VF tests, which included recalling animal names and common nouns starting with a specified letter in 1 min. The relationship between DASC-8 and verbal fluency test scores was investigated. Animal fluency correlated with DASC-8 scores after adjustment for patient characteristics. Animal scores correlated with orientation, instrumental activities of daily living and basic activities of daily living scores of DASC-8, and tended to show a relationship with DASC-8 memory scores. An animal score ≥8 predicted category I with a sensitivity of 89% and a specificity of 57%. An animal score ≤6 predicted category III with a sensitivity of 85% and a specificity of 67%. Animal scores would be useful in predicting the categories of DASC-8. Animal fluency could be a screening tool of DASC-8 when a patient's family member or supportive person is absent.

A Nursing Approach Toward Family Caregivers of Older Patients Suffering from Stroke at Home

Older patients who have experienced a stroke often suffer from after-effects and stay at home for long periods of time while undergoing treatment. In order for patients to continue living at home, they need not only appropriate medical nursing care but also support from their families. This study examined nursing approaches for family caregivers to enable older patients who have experienced a stroke to continue living at home while being cared for by their families. The Japanese Ichushi-Web database was searched, and 58 studies were analyzed. Two findings were obtained. The first was that one of the success factors for home care is getting a good grasp of family caregiving ability. This consists of “understanding of the high significance of existence of the family caregivers” and “recognizing the need to maintain and improve good family relationships”. The second was to provide specific support to ensure family caregivers’ abilities that can help with continued home care. This consists of “providing knowledge about illness and disability and teaching appropriate caregiving skills”, “providing emotional support and decision-making support for family caregivers” and “strengthening multidisciplinary cooperation and effective use of social resources”. With the community-based integrated care system underway, the results of this study on securing family caregiving abilities may contribute to improving the quality of life of older patients suffering from stroke living at home. Keywords: older patients with stroke, living at home, family caregiving ability, nursing approach

高齢期の地域居住継続における生活支援ハウスの役割

In order to establish “community-based integrated care systems”, housing for those who find it difficult to remain in their homes should be provided. This study focused on Life Support House (LSH). Based on results, the role of LSH for residents to live continuously in their communities can be properly assessed. Questionnaire surveys of LSH and municipalities and interview survey on 12 LHS were conducted. Responses were analyzed by population scale. In smaller population areas, LHS cover shortage of welfare facilities and senior housing. In larger population areas, LHS provide residences to people in low-income.

Environmental risks to housing and living arrangements among older survivors of the Great East Japan Earthquake and their relationships with housing type: The RIAS Study

Objective Over the course of their lives, people spend most of their time in the home environment. The Community-based Integrated Care System 2018 by the Ministry of Health, Labour and Welfare in Japan declared the importance of "housing" and "living arrangements" as essential elements to enable older adults to live independently and to protect their privacy and dignity in their communities. The present study aims to clarify the relationship between current housing type and "housing" and "living arrangements" among older survivors of the Great East Japan Earthquake (GEJE).Methods We used data obtained from 3,856 participants, aged 65 years or older, in the Research project for prospective Investigation of health problems Among Survivors of the GEJE (RIAS). Housing types were categorized as follows: "same housing," "temporary housing," "disaster public housing," "new housing" (in a different area), and "others." Healthy housing scores were calculated using a housing health checklist from the Nationwide Smart Wellness Housing Survey in Japan. "Living arrangements" were assessed based on residential status, social network, and social capital. To determine the risks associated with each "housing" and "living arrangement" category, we used multivariate logistic and linear regression models.Results The number of participants in each housing type was as follows: 2,531 in "same housing," 146 in "temporary housing," 234 in "disaster public housing," 844 in "new housing," and 101 in "others." Compared with those living in "same housing," those living in "disaster public housing," "new housing," and "others" had a significantly higher healthy housing score, whereas those living in "temporary housing" had a lower score. However, with regards to "living arrangements," the number of residents who were living alone was significantly higher among those in "disaster public housing," and those living in "disaster public housing" as well as "new housing" had low social capital compared with those living in "same housing." The likelihood of having a poor social network was substantially higher for those living in "disaster public housing." Sub-scale analyses indicated that "disaster public housing" was associated with less family support, whereas "new housing" was associated with less support from friends.Conclusion The present results indicate that older survivors-regardless of whether they live in the existing community-find it challenging to establish new social capital and social networks in a new location without the presence of "someone" they knew before the disaster.

Building Relationships Between Community Care Professionals and Convenience Stores in Japan: Community-Based Participatory Research.

Convenience stores play an important role in supporting community-dwelling older adults' lives. We started community-based participatory research (CBPR) in Nerima City, Tokyo Metropolitan area in Japan to develop a collaborative relationship to support older adults in the community-based integrated care system. This study aimed to describe the CBPR process and evaluate building face-to-face relationships between health/social care professionals and the owners/employees of convenience stores. Using CBPR, health/social care professionals in community general support centers (CGSCs) directly approached convenience stores based on the public support agreement between the convenience store chain company and the municipality. To evaluate the face-to-face relationship building between convenience store owners/employees and CGSCs' staff, we administered questionnaire surveys to convenience stores in Nerima City and two control cities from 2017 to 2019, and about 100 convenience stores completed the survey each year. Statistical analyses showed significant improvements in their knowledge for relationships with the CGSCs in Nerima City, including "knowledge of the CGSCs' function" (P = 0.001), "knowing individual professionals in the CGSCs" (P = 0.023), and "knowledge of when to contact the CGSCs" (P = 0.002), compared with control cities. Helping behavior for older adults at convenience stores also increased significantly in Nerima City (P = 0.034). The CGSCs' direct approach based on the public support agreement would effectively promote building relationships at convenience stores, leading to an age-friendly community.

Building Relationships Between Community Care Professionals and Convenience Stores in Japan: Community-Based Participatory Research.

Building Relationships Between Community Care Professionals and Convenience Stores in Japan:Community-Based Participatory Research Ayumi Igarashi, RN, PhD, Hiroshige Matsumoto, RN, PhD, Manami Takaoka, RN, PhD, Haruna Kugai, RN, PhD, Miho Suzuki, RN, PhD, Satoshi Murata, Masakazu Miyahara, and Noriko Yamamoto-Mitani, RN, GNP, PhD What Is the Purpose of this Study? • This study aimed to describe a community-based participatory research process and evaluate the development of collaborative relationships between health/social care professionals and convenience stores in the community. What Is the Problem? • Although it is important to establish collaborations between health/social care professionals in the community and convenience stores, there are obstacles to this. • No previous studies had examined strategies for collaborating with private sector enterprises, such as convenience stores, based on the cultures of enterprises and communities. What Are the Findings? • As a result of approaching convenience stores directly, based on the public support agreement, the relationships between healthcare professionals and convenience stores and helping behaviors improved significantly. Who Should Care Most? • Health/social care providers, who need to collaborate with various community members. • Researchers and municipal government, who aim to construct an effective community-based integrated care system. Recommendations for Action • The two-step strategy to build organizational and individual collaborative relationships, which includes direct approach by health/social care professionals, would effectively promote collaboration and helping behaviors at convenience stores. • The strategy could be applied to build relationships with other private sectors, such as supermarkets, banking services, and newspaper delivery services. [End Page e1] Ayumi Igarashi Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo Hiroshige Matsumoto Department of Community Health Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo Manami Takaoka Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo Haruna Kugai Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo Miho Suzuki Faculty of Nursing and Medical Care, Keio University Satoshi Murata ASNA Co., Ltd. Masakazu Miyahara Community and Cultural Affairs Division, Nerima City, Tokyo, Japan Noriko Yamamoto-Mitani Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo Corresponding author: Ayumi Igarashi, Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: aigarashi-tky@g.ecc.u-tokyo.ac.jp Copyright © 2023 Johns Hopkins University Press

Identifying and Characterizing People with Dementia not Accessing the Japanese Community-Based Integrated Care System using Health Insurance Claims Data.

Objectives In the Japanese Community-Based Integrated Care System (CBICS), access to formal care services is based on voluntary consultations mainly from the families of people with dementia (PWD). The problem is that some people need services but do not consult their municipalities for various reasons. The purpose of this study is to examine the possibility of using health insurance claims data to identify and characterize these PWD. Methods Using health insurance claims data, we selected PWD prescribed with anti-dementia drugs. Of them, excluding those with a usage history of long-term care insurance services or other formal services, facility residents and deaths, we identified PWD not accessing the CBICS. We conducted a visit survey on their status, home care environment and reasons for not accessing services, a proposal for using services and a one-year follow-up. Result Based on the data of 1,809 late-stage elderly who resided in the Tamaki-cho, a town in Mie Prefecture, Japan, for a 2-month period, 16 PWD not accessing the CBICS were identified, and 15 PWD and their families participated in this study. Ten were men and 13 were physically and cognitively relatively independent. All lived with a family caregiver and refused services. Ten families needed but had not accessed the services due to refusal by PWD and other reasons. As a result, seven of these PWD started using long-term care insurance services or dementia prevention services. Conclusions PWD not accessing the CBICS can be identified using health insurance claims data. The results proved that the municipality has a cost-effective way of providing their services to PWD and their families, even if they have never consulted voluntarily.

Transversal Survey of Emergency Medicine Policy and Quality Metrics in Japan's Regional Health Care Plans.

It is essential to establish appropriate medical quality metrics and make improvements to safely and efficiently deliver optimum emergency medical services. The Ministry of Health, Labor and Welfare (MHLW) recommends prefectures to establish numerical quality metrics in their regional healthcare plans (RHCP). The 7th RHCP was issued by the MHLW in 2017 along with a notice of planning in covering the six-year period from 2018 to 2023. In this descriptive study, the emergency medicine policies in the 7th RHCP of each prefecture were analyzed from a quality improvement perspective. The authors examined the chapters on emergency medicine in the RHCPs of 47 prefectural governments for the overall structure, cost-benefits, and connection to community-based integrated care systems. The type and number of clinical measures listed as numerical metrics and their classification methods were emphasized. Regarding the overall plan structure, 40 prefectural governments began their description with an analysis of current surroundings. In total, 24 prefectural governments mentioned community-based integrated care systems but none mentioned cost-benefit analysis. Altogether, only 43 of 47 prefectural governments (91%) indicated numerical metrics. The maximum number of numerical targets for quality measures by prefecture was 19, the minimum was 0, and the median was 4 (IQR: 3-6.5); there were 220 metrics in total, with 82 structural, 96 process, and 42 outcome measures. Additionally, 13 prefectures (28%) classified quality measures according to the MHLW's guidance, 6 (13%) used their own classification manner, while the others did not classify their measures. There were significant differences in emergency medicine policies and quality metrics among the prefectural governments. Further research is needed to develop and establish more comprehensive and appropriate metrics based on a common methodology to improve the quality of emergency medicine.

Measurement of Five Emotions Defined by Traditional Chinese Medicine With a Focus on Preventing Mild Cognitive Impairment.

Objectives: This study aimed to develop a novel Measurement of the Five Emotions (MFE) based on traditional Chinese medicine for assessing cognitive impairment in elderly individuals. Methods: Surveys were collected from 184 participants, over 65years of age, who were residents of Kyoto City, Japan. The surveys included the Measurement of the Five Emotions (MFE) and the Dementia Assessment Sheet for the Community-based Integrated Care System (DASC-21). Item-total reliability and internal consistency reliability were assessed using Spearman's correlation test and Cronbach's alpha coefficient analysis. Factor analysis was conducted to identify the main factors related to the theoretically constructed emotional reaction patterns. Criterion-related validity was examined by investigating the correlation between the scores of the 2 surveys (MFE and DASC-21). Results: The factor analysis revealed that the final version of MFE consisted of 5 factors, which accounted for a cumulative contribution rate of 57.71%. The Cronbach's alpha coefficient reached .71, indicating satisfactory internal consistency. There was a negative correlation between the MFE and DASC-21 scores with a correlation coefficient of -.3149. Furthermore, when comparing participants with lower cognitive function (DASC-21 score >26) to those with higher cognitive function, MFE subscale scores in the emotions of "Sorrow" and "Thought" were significantly lower, suggesting that these particular emotions are related to cognitive impairment. These findings confirmed the reliability and the construct validity of the MFE. Conclusion: The criterion reliability and validity tests provided evidence for the construct validity of the MFE. The negative correlation (coefficient = -.3149) between MFE scores and DASC-21 scores suggested that MFE can serve as a scale for detecting cognitive impairment.