Examination of B item status of elderly patients admitted to DPC hospitals

• Published in: Review of Japan Society of Health Support Science Vol. 7; pp. 51 - 63
• Main Authors: Hayashida, Kenshi, Murakami, Genki, Matsuda, Shinya
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Health Support Science 2022; 日本ヘルスサポート学会
• Subjects: ADL care; ADL ケア; DPC; elderly; need for medical care; Severity; 医療看護必要度; 重症度; 高齢者
• ISSN: 2188-2924
• DOI: 10.14964/hssanj.7.51

[Purpose] To develop a specific evaluation index for acute medical care patients through grasping patient images related to medium- to long-term hospitalization, targeting all medical functions from acute to chronic and home care. Therefore, we examined the status of B items in elderly patients admitted to DPC hospitals.[Data and methods] Using DPC data in 2018, patients aged 75 years or older who were hospitalized for cerebral infarction, cataract, pneumonia（other than aspiration pneumonia）, aspiration pneumonia, heart failure, and hip fracture were evaluated for general ward use. We analyzed the changes in each item of the B items in the severity of the disease and the need for medical/nursing care. In this analysis,（score at admission - score at discharge）/length of stay× 100 was defined as the amount of change in each item, and the mean value was calculated.[Results] It was clarified that age lowers the level of independence in all B items and acts in the direction of hindering improvement by hospitalization. By type of disease, it was shown that the longer the period of hospitalization, the better the B items in locomotor organ diseases such as hip fractures. On the other hand, in cerebral infarction, pneumonia, and heart failure, longer hospital stays were associated with significantly lower changes.[Discussion and conclusion] From the results of this analysis, it was clarified that higher age lowers the level of independence in all B items and acts in the direction of hindering improvement through hospitalization. In addition, it was shown that the longer the hospitalization period, the better the B items in locomotory diseases such as hip fractures. The reason for this was thought to be the large amount of rehabilitation care provided during the hospitalization period. On the other hand, for ischemic cerebral infarction and heart failure, longer hospital stays were associated with significantly smaller changes. This was thought to suggest a reverse causal relationship, with the length of hospital stay being longer in critically ill elderly patients who are unlikely to improve.In the current system, wards are evaluated based on a combination of severity and medical/nursing need A, B, and C items. While care is time-consuming, there is a possibility that there are few items to be evaluated in A and C items, and the average length of hospital stay is longer, which may affect facility standards in terms of medical fees. Therefore, it is considered appropriate to separately evaluate the patient’s condition image focusing on ADL care using the B item