JP2002304470A - Formation support system and formation support method for care plan, and formation support program for care plan - Google Patents

Abstract

PROBLEM TO BE SOLVED: To drastically shorten the time required for the whole formation of care plans in a formation support system for care plan for insured persons of nursing care insurance and to perform the formation and maintenance of a proper care according to the state of each insured person regardless of the experience or ability of a care manager forming the care plan. SOLUTION: On the basis of common item data and additional information for each insured person inputted by a user (S1 and S4), and an in-home service plan that is a document drawing the whole care plan of each insured person and a service using form and service providing form for each insured person are formed on the basis of selected problem to be solved, nursing aim, and contents of nursing service (S6, S7, and S9).

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a system for supporting the preparation of a care plan for an insured person who has been recognized as requiring support / nursing care in a care insurance system in a care insurance system, a method for supporting the creation of the care plan, and a care plan. It is about a creation support program.

[0002]

2. Description of the Related Art Conventionally, a care manager interviews each insured person of long-term care insurance and interviews each insured person for assessment items for analyzing a task. Care plans were prepared for each insured in consideration of the degree of need for nursing care and the ability to pay. However, such a care plan creation method has a problem that it takes time to detect a problem group (problem area) that may be a problem for each insured person.
Therefore, there is a care plan creation support system in which the above hearing results are input to a computer, and the problem area for each insured person is automatically extracted by the computer.

[0003]

However, in the above-described conventional care plan creation support system, the extraction of a problem area in the care plan creation process for each insured can be automatically performed. In addition, it is not possible to automatically extract a specific solution task, a care goal, and the contents of a care service suitable for each insured person based on the extracted problem area. Therefore, it is not possible to drastically reduce the time required for creating the entire care plan,
There is a problem in that the content of the care plan created varies depending on the experience and ability of the care manager, and there is a case that an appropriate care plan cannot be created according to the condition of each insured person. In addition, there has been a problem that the created care plan cannot be properly maintained in accordance with the results of implementation and the like.

[0004] The present invention has been made to solve the above-mentioned problems, and can drastically reduce the time required for the entire care plan creation. And regardless of ability
An object of the present invention is to provide a care plan creation support system, a creation support method, and a care plan creation support program that can create and maintain an appropriate care plan according to the condition of each insured person.

[0005]

According to one aspect of the present invention, there is provided a system for supporting the creation of a care plan for each insured person of long-term care insurance using a computer. Master storage means for storing master data including the problem to be obtained, the goals for nursing care and the contents of nursing care services. Based on the common item input means for inputting the item data and the common item data of each insured person input by the common item input means, a problem group which may be a problem for each insured is identified. Detecting means for detecting, and input prompting displaying means for prompting the user to input information to be added to the common item data of each insured based on the detection result by the detecting means Additional information input means for the user to input additional information to the common item data according to the display contents of the input prompting display means, common item data input by the common item input means, and input by the additional information input means Based on the additional information obtained, the solution extraction unit automatically extracts the solution suitable for each insured person from the master data stored in the master storage unit, and the solution problem extraction unit extracts the solution problem. Problem display means for displaying the solved problem, and a care goal suitable for each insured person from the master data stored in the master storage means based on the solution problem displayed on the solution problem display means. Extracting means for automatically extracting the information, the goal displaying means for displaying the nursing care goal extracted by the goal extracting means, and the nursing care goal and solution displayed on the goal displaying means Service content extraction means for automatically extracting contents of a nursing care service suitable for each insured person from master data stored in the master storage means, based on the solution displayed on the title display means, Service content display means for displaying the contents of the nursing care service extracted by the service content extraction means.

[0006] In the above configuration, a problem group which may become a problem for each insured person is detected by the detecting means based on the common item data of each insured person input by the common item inputting means. Based on the detection result, the input prompting display means prompts the user to input information to be added to the common item data of each insured person. Then, when the user inputs additional information to the common item data by the additional information input unit in accordance with the display content, the solution extraction unit stores the additional problem information in the master storage unit based on the additional information and the common item data. A solution problem suitable for each insured person is automatically extracted from the obtained master data, and the solution problem display means displays the solution problem.

Next, based on the solution displayed on the solution display means, the goal extraction means selects a care target suitable for each insured person from the master data stored in the master storage means. It is automatically extracted and the goal display means displays the care goal. Further, the service content extracting means selects each object from the master data stored in the master storage means on the basis of the nursing care goal displayed on the goal display means and the solution problem displayed on the solution problem display means. The contents of the nursing care service suitable for the insurer are automatically extracted, and the service contents display means displays the contents of the nursing care service.

[0008] As described above, the solution problem extracting means, the goal extracting means and the service content extracting means provide the solution problem, the care goal and the content of the care service (hereinafter referred to as "suitable") suitable for each insured person from the master data. , And so on) are automatically extracted, and the solution display unit, the target display unit, and the service content display unit display the extracted solution or the like. Accordingly, it is possible to easily select and determine a solution task or the like according to the state of each insured person. This allows the user to create a care plan for each insured person using this care plan creation support system, and according to the status of each insured person, regardless of the level of experience and ability as a care manager. Can create an appropriate care plan.

The input prompting display means displays a warning on a screen for inputting information by the additional information input means with respect to the task group detected as a potential problem by the detection means, and displays the additional information input means. Will be displayed if the alerted task group is selected by the pointing device.
A list of additional information may be displayed, and information selected by the pointing device from among the displayed information may be input as additional information. This allows
It is possible to easily and reliably input additional information on a problem group (problem area) that may become a problem.

[0010] The solution display means displays the solution extracted by the solution extraction means and the other solution stored in the master storage means separately, and the target extraction means displays the solution problem display means. Based on the solution selected by the user from among the solutions displayed in the above, the care target suitable for each insured person is automatically extracted from the master data stored in the master storage means. , The goal display means displays the care goal extracted by the goal extraction means and the other care goal stored in the master storage means separately, and the service content extraction means displays the goal on the goal display means. Each insured person is selected from the master data stored in the master storage means based on the nursing goal selected by the user from the selected nursing goals and the solution selected by the user. The content of the nursing service suitable for the service is automatically extracted, and the service content displaying means distinguishes the content of the nursing service extracted by the service content extracting means from the content of the other nursing service stored in the master storage means. The common item data of each insured person displayed separately and input by the common item input means, the additional information on each insured person input by the additional information input means, the solutions selected by the user, Based on the goal of and the content of the nursing service selected by the user from the content of the nursing service displayed on the service content display means,
A home service plan, which is a document summarizing the entire care plan of each insured person, a service usage slip, which is a table summarizing the monthly plan and actual use of each nursing care service used by each insured, It may be further provided with a form creation means for creating a service provision form, which is a table in which a monthly plan and usage results of each care service used by a user are divided and summarized for each care service provider. This allows
The care plan creation process including creation of the home service plan, the service usage slip, and the service provision slip can be facilitated.

According to a fourth aspect of the present invention, in the care plan creation support system according to the first aspect, when the end date of the nursing care goal extracted by the goal extracting means arrives, the nursing care goal is displayed. Confirmation display means for displaying a confirmation message regarding at least one of the achievement status, the change in the life needs of the insured person, the change in the state of the insured person, and the implementation status of the care service content extracted by the service content extraction means; Response input means for inputting a response to the content displayed by the confirmation display means, care plan change promotion means for prompting a change of the created care plan according to the content of the response input by the response input means, and change of the care plan According to the contents of the change prompted by the promotion means, the common item data of each insured person and the additional information Additional information inputted by, solve problems extracted solve problems that have been extracted by means of at least one target, and care service contents extracted by the service content extraction means on care extracted by the target extracting means
And changing means for changing the number.

[0012] In this configuration, the user inputs the response status of the achievement status of the care target, the change of the life needs of the insured person, the change of the condition of the insured person, and the implementation status of the contents of the nursing service performed by the response input means. The care plan change promotion means urges the change of the care plan according to the content of the care plan. As a result, the care plan of the insured person can be easily and appropriately changed according to the achievement status of the nursing care target, changes in the life needs of the insured person, changes in the condition of the insured person, and the implementation status of the nursing service contents. can do.

A fifth aspect of the present invention is a method for supporting the preparation of a care plan for each of the care-insured persons by means of a programmed computer. And storing master data including the contents of the care service;
Accepting data on items common to the survey items for certification of long-term care among assessment items for problem analysis of each insured person, and the possibility of a problem for each insured person based on the common item data Detecting a certain problem group; displaying a message prompting the user to input information to be added to the common item data of each insured person based on the detection result; and Receiving the additional information, displaying automatically the appropriate solution for each insured person from the master data according to the common item data and the additional information, and displaying the extracted solution. Automatically extracting a care goal suitable for each insured person from the master data based on the displayed solutions,
A step of displaying the extracted nursing care goals, and automatically extracting the contents of nursing care services suitable for each insured person from the master data based on the displayed nursing care goals and the solutions. And displaying the extracted contents of the nursing care service. According to this method, the same operation as that of the first aspect can be obtained.

Further, in the step of displaying the prompt for inputting the additional information, a warning is displayed on the screen for inputting the additional information regarding the problem group detected to be a problem in the detecting step. In the step of accepting additional information, when the user selects and issues a warning-displayed task group, a list of additional information is displayed, and the information selected and specified by the user from the list-displayed information is added. You may make it receive as information. Thereby, the same operation as described above can be obtained.

[0015] In the step of displaying the solution, the extracted problem and the other solution in the master data are displayed separately, and in the step of automatically extracting the care target, In the step of extracting a care goal suitable for each insured person from the master data based on the solution task selected by the user from the displayed solution tasks, and displaying the care goal, Displaying the extracted nursing goal and the other nursing goal in the master data separately, and automatically extracting the contents of the nursing service, wherein the displayed nursing goal is displayed. Based on the care goals selected by the user from among the above, and the solutions selected by the user, the nursing care service suitable for each insured person from the master data. In the step of extracting the contents of the nursing service and displaying the contents of the nursing service, the contents of the extracted nursing service and the contents of the other nursing services in the master data are distinguished and displayed, and are input by the user. Based on the common item data and the additional information, the solution problem and the care goal selected by the user, and the contents of the care service selected by the user from the contents of the displayed care service. A home service plan which is a document summarizing the entire care plan of the insured person, a service usage slip which is a table summarizing the monthly plan and usage results of each care service used by each insured person, and each insured person To create a service provision form, which is a table that divides the monthly plan and usage results of each nursing care service used by It may alternatively further comprise a flop. Thereby, the same operation as described above can be obtained.

When the end date of the nursing care goal extracted in the step of automatically extracting the nursing care goal arrives, the achievement status of the nursing care goal, a change in life needs of the insured, Displaying a confirmation message regarding at least one of the change of the state of the insurer and the implementation status of the contents of the nursing service extracted by the step of automatically extracting the contents of the nursing service, and inputting a response input from the user to the displayed contents. Receiving the common item data received in the step of receiving, and the step of prompting the user to change the care plan according to the content of the response input, and the step of receiving the common item data in accordance with the content of the prompted change;
Additional information received in the step of accepting additional information, solution issues extracted in the step of automatically extracting solution issues, nursing care goals extracted in the step of automatically extracting nursing care goals, and details of nursing care services Automatically changing at least one of the care service contents extracted by the step of automatically extracting the care service contents. Thus, the above claim 4
The same operation as described above can be obtained.

According to a ninth aspect of the present invention, a computer is provided to support the preparation of a care plan for each insured person of long-term care insurance. Master storage means for storing master data including: and common item input means for inputting data of items common to survey items for certification of need of nursing care among assessment items for analysis of issues of each insured person. Based on the common item data of each insured person input by the common item inputting means, detecting means for detecting a problem group which may be a problem for each insured person, Input prompting display means for prompting the user to input information to be added to the common item data of each insured; and Based on the additional information input means for inputting additional information to the common item data, the common item data input by the common item input means, and the additional information input by the additional information input means. A solution extracting means for automatically extracting a solution suitable for each insured person from the stored master data; a solution displaying means for displaying the solution extracted by the solution extracting means; A target extraction unit for automatically extracting a care target suitable for each insured person from master data stored in the master storage unit based on the solution displayed on the problem display unit; A goal display means for displaying the care goal extracted by the means, and a care goal based on the care goal displayed on the goal display means and the solution task displayed on the solution task display means. A service content extracting means for automatically extracting the contents of the care service suitable for each insured person from the master data stored in the storage means, and the contents of the care service extracted by the service content extracting means; This is a care plan creation support program for functioning as service content display means. In this configuration, by causing the computer to read the care plan creation support program and executing the program on the computer, an operation similar to that of the first aspect can be obtained.

Further, in the above, the input prompting display means displays a warning on the information input screen by the additional information input means with respect to the task group detected as a potential problem by the detection means, The information input means displays a list of additional information when the warning-displayed task group is selected by the pointing device, and uses information selected by the pointing device from the list-displayed information as additional information. You may make it input. Thereby, the same operation as described above can be obtained.

Further, the solution display means displays the solution extracted by the solution extraction means separately from the other solutions stored in the master storage means, and the target extraction means displays the solution problem display means. Based on the solution selected by the user from among the solutions displayed in the above, the care target suitable for each insured person is automatically extracted from the master data stored in the master storage means. , The goal display means displays the care goal extracted by the goal extraction means and the other care goal stored in the master storage means separately, and the service content extraction means displays the goal on the goal display means. Each insured person is selected from the master data stored in the master storage means based on the nursing goal selected by the user from the selected nursing goals and the solution selected by the user. The content of the nursing service suitable for the service is automatically extracted, and the service content displaying means distinguishes the content of the nursing service extracted by the service content extracting means from the content of the other nursing service stored in the master storage means. Separately displayed, the computer in addition to the above means,
Common item data of each insured person input by the common item input means, additional information about each insured person input by the additional information input means, a solution problem and a care goal selected by the user, A home service plan, which is a document summarizing the entire care plan of each insured person, based on the contents of the care service selected by the user from the contents of the care service displayed on the service content display means; The service usage slip, which is a table summarizing the monthly plans and usage results of each care service used by the insured person, and the monthly plans and usage results of each care service used by each insured person, for each care service provider It is desirable to function as a form creation unit for creating a service provision form, which is a table that is divided and compiled. Thereby, the same operation as described above can be obtained.

When the end date of the nursing care goal extracted by the goal extracting means arrives in addition to the above means, the computer is used to monitor the achievement of the nursing care goal and the life needs of the insured. Confirmation display means for displaying a confirmation message relating to at least one of the change, change in the state of the insured person, and the implementation status of the care service content extracted by the service content extraction means, and a response to the content displayed by the confirmation display means A response input means for performing input, a care plan change promoting means for prompting a change of the created care plan according to the content of the response input by the response input means, and a content of the change prompted by the care plan change promoting means. Accordingly, the common item data of each insured person input by the common item input means, the additional information input by the additional information input means, the problem to be solved Solving problems extracted by means output, the target on nursing extracted by the target extracting means, and be made to function as changing means for changing at least one of the nursing service contents extracted by the service content extraction means is desirable. Thereby, the same operation as the above-mentioned claim 4 can be obtained.

[0021]

DESCRIPTION OF THE PREFERRED EMBODIMENTS A care plan creation support system according to one embodiment of the present invention will be described below with reference to the drawings. The configuration of the care plan creation support system (hereinafter, abbreviated as support system) of the present embodiment will be described with reference to FIG. The support system 1 is a system built on a server 2 in a client-server type system. The server 2 includes a server main body 3, a display 4 for displaying various data (input prompting display means, solution problem display means, target display means, service content display means), and a care plan table. From a printer 8 (form creation means) and a keyboard 5 and a mouse 6 (common item input means, additional information input means, change means, response input means) for inputting data for task analysis of each insured person, etc. Become. In addition, the server main body 3 includes a CPU 10 (a detection unit, a solution extraction unit, a target extraction unit, a service content extraction unit,
Form storage means), storage device 11 (master storage means) storing various data including data of various masters 17, CD
A CD-ROM drive 12 for reading data from the ROM 7, and a communication control circuit 13 for transmitting and receiving data to and from each client.

The storage device 11 includes assessment data 15 for analyzing tasks of each insured person, a care plan management DB 16 composed of data such as schedule information and actual information of care services used by each insured person, Various masters 17, CD
A care plan creation support program (hereinafter abbreviated as support program) 18 installed from the ROM 7, a DBMS (Database) which is a database management program
Management System) 19 and the like are stored. The master data stored in the various masters 17 includes a solution problem in a care plan, a long-term / short-term goal (goal for care in claims), service contents (contents of care service in claims), a service type, Service providers are included.

Next, referring to the flowchart of FIG.
A care plan creation process using the care plan creation support system 1 will be described. First, the care manager in charge of each insured person inputs data (hereinafter referred to as “assessment data”) of an assessment item for problem analysis acquired in a visit survey to each insured person from the assessment input screen (S1). The assessment data input from the assessment input screen is limited to the data of the items common to the survey items for the certification of long-term care required by the long-term care insurance among the assessment items for analyzing the tasks of each insured person.

Here, the data input processing from the assessment input screen will be described with reference to FIG. The assessment input screen 20 mainly includes a question area display field 24 for displaying a rough task group (question area) and a question for displaying a question for task analysis belonging to the problem area displayed in the question area display field 24. It comprises a display column 25 and an answer group column 26 comprising a plurality of select buttons 27 displaying the answers to the questions displayed in the question display column 25. Also,
In the upper part of the input screen 20, a user ID input field 21, a name input field 22, and an age input field 2 for inputting a user ID, a name and an age, which are information for identifying each insured person.
Three are arranged.

When the care manager uses the keyboard 5 (see FIG. 1) to input the relevant data of the insured person obtained through a visit survey or the like into the user ID input field 21, the name input field 22, and the age input field 23, The CPU 10 receives a command from the support program 18 and permits the care manager to select and input each of the selection buttons 27. The questions displayed in each question display column 25 and the contents of each answer in the answer group column 26 are both the same as the contents of the survey items for certification of long-term care required by long-term care insurance. For this reason, the care manager easily selects and inputs the selection button 27 suitable for the state of each insured person from the answer group column 26 by referring to the survey result for certification of need for nursing care for each insured person. be able to. The selection input of the selection button 27 is performed by the keyboard 5
Alternatively, this is performed using the mouse 6. When the selection input of the selection button 27 displayed in the screen is completed, the care manager clicks the next screen button 30 with the mouse 6 and performs the selection input of the selection button 27 of the next page.
Although not shown in the figure, the assessment input screen 20 includes, on the insured person, the assessment date, which is the date on which the insured person visited the assessment item, and each of the insured persons obtained during the visit survey. A page having an input column for the degree of care required for the insurer is included. When the care manager wants to return to the screen of the previous page and reconfirm the contents, he clicks the previous screen button 29 with the mouse 6 to display the screen of the previous page.

When the selection input of the selection button 27 for all the answer group columns 26 is completed, the care manager clicks the menu button 28 with the mouse 6 to select it. CPU
When detecting this selection processing, the support program 1
In response to the instruction from the controller 8, the assessment data corresponding to the content selected and input from the assessment input screen 20 is stored in the storage device 11 (see FIG. 1), and the processing of each process in the support system 1 is displayed on the display 4. A menu for selection (hereinafter abbreviated as a process selection menu) is displayed.

When the care manager selects a task to be solved for each insured person (hereinafter referred to as a solution task) from the process selection menu, the CPU 1
No. 0 displays an area examination screen (see FIG. 4), which is a screen for determining a solution subject, on the display 4 in response to a command from the support program 18. When displaying the area review screen, the CPU 10 receives a command from the support program 18 and, based on the assessment data of each insured person input from the assessment input screen 20, discusses a problem with each insured person. An area and a problem group that may become a problem are extracted. Then, returning to the processing of FIG. 2, if there is an area and a problem group that may become a problem (S2
YES), the CPU 10 receives a command from the support program 18 and performs a warning display on the area reviewing screen on the area that may become a problem and the group of solutions, on the area examination screen. The care manager examines the area and the solution problem group displayed on the area examination screen in detail, and determines the specific solution task for each insured person in order to determine a specific solution task and the solution task. Select and enter additional assessment data (additional information in the claims) for the group (S4).

Here, the data input processing from the area examination screen will be described with reference to FIG. Area study screen 31
Is a solution problem group display column 35 for displaying a solution problem group in which some solution problems are systematically collected, and an area display column 3 for displaying an area 34 in which some solution problem groups are systematically collected.
3. A solution field 37 for displaying the solution of each insured person automatically extracted based on the additional assessment data and the like, and a solution addition field for additionally inputting a solution to the solution field 37. 42 etc. The area review screen 31 is composed of a screen of eight pages as a whole. The area display section 33 and the solution group display section 35 of each page include several areas 34 that are mutually related and these areas 34. Is displayed. Also, area review screen 3
1 has a basic information display column 32 on its upper side for displaying information for discrimination and the like for each insured person. On the basic information display column 32, the user ID, name, age, assessment date, and degree of need for nursing care for each insured person input from the assessment input screen 20 (see FIG. 3) are displayed. In addition, a menu button 44, a previous screen button 46, and a next screen button 47 having the same functions as the respective buttons 28 to 30 in FIG. An extraction button 49 for instructing automatic extraction of a solution subject to be solved and a target screen display button 45 for instructing display of a target screen which is a screen for determining a care target of the insured person are arranged. As shown in the figure, an area display column 33 and a solution problem group display column 35
The area 34 and the task group 3 extracted as those that may cause a problem in the determination processing of S2 in FIG.
6 is displayed in a shaded manner (shown by hatching in the figure). Solution problem group display field 35 for each page in area review screen 31
Shows a group of tasks 36 strongly related to the area 34 displayed in the area display section 33, so that the area display section 3 of each page is displayed.
If any area 34 in 3 is displayed as a warning,
Any solution problem group 36 in the solution problem group display field 35 on the same page is displayed as a warning.

The care manager selects and inputs additional assessment data (additional information in the claims) relating to the above-mentioned warning-displayed area 34 and the solution problem group 36, so that a specific solution suitable for each insured person can be obtained. You can know the issues. Specifically, when the care manager clicks and selects the solution task group 36 displayed as a warning on the area examination screen 31 with the mouse 6, the CPU 10 detects this selection process and receives a command from the support program 18. Then, a window 38 for inputting additional data corresponding to the selected solution task group 36 is displayed on the area review screen 31. For example, as shown in the figure, the care manager
When “medical attention” is selected from the solution problem group 36 displayed in the solution problem group display field 35, the CPU
10 displays a window 38 including a list of additional data 48 related to the disease name on the area examination screen 31.

Next, when the care manager clicks and selects with the mouse 6 additional data 48 of the disease name applicable to each insured person from the list displayed in the window 38, the CPU 10 detects this selection processing and provides support. In response to a command from the program 18, a window 39 for inputting additional data corresponding to the selected additional data 48 is displayed on the area review screen 31. Further, when the care manager clicks and selects additional data 48 corresponding to the condition of the insured person from the list displayed in the window 40 by clicking with the mouse 6, the CPU 10 detects this selection process and issues a command from the support program 18. In response, the window 40 for inputting the next additional data corresponding to the selected additional data 48 is displayed on the area examination screen 31.

For example, as shown in the figure, the care manager displays “x. Diabetes” from the list of the additional data 48 displayed in the additional data input window 38 by hatching.
Is selected, the CPU 10 sets the area review screen 31
During this, an additional data input window 39 including a list of additional data 48 for confirming points that are important in caring for a diabetic patient is displayed. Although not shown in the figure, when the care manager presses the help key on the keyboard 5 in this state, a window describing the explanation of diabetes is displayed on the display 4. Next, the care manager operates the additional data input window 39.
Is selected from the list of the additional data 48 displayed in the table, the CPU 10 selects an additional data input window for confirming whether or not the diet restriction is being executed in the area review screen 31. 40 is displayed.
When the care manager selects “dietary restriction not executed” indicated by hatching from the list of the additional data 48 displayed on the window 40, the CPU 10 detects this selection process and receives a command from the support program 18. hand,
Data corresponding to the content selected in each of the windows 38 to 40 is stored as additional data in the assessment data 15 (see FIG. 1) in the storage device 11. Next, when the care manager selects “unstable blood sugar level” from the list of the additional data 48 displayed in the additional data input window 39, the CPU 10 stores the data “unstable blood sugar level” in the assessment data in the storage device 11. The data 15 is stored as additional data. The additional data selectable mark 41 shown in the figure indicates that when the additional data 48 on which the mark 41 is displayed is selected, the next additional data input window is displayed on the right side of the additional data 48. Means.

When the care manager repeats the above selection process, completes the selection and input of the additional data 48 for all the warning-displayed task groups 36 in the displayed page, and clicks the extraction button 49 with the mouse 6. , CPU10
Detects this and receives a command from the support program 18. In accordance with the contents of the command, based on the assessment data 15 stored in the storage device 11 shown in FIG. Identify potential solutions that may be relevant to the insurer's situation. Then, returning to the processing of FIG. 2, when one or more solutions that may be a problem are extracted (YES in S5), the CPU 10 extracts the extracted solution 47 as shown in FIG. It is displayed in the solution field 37 on the screen 31. As a result, if one or more solution issues 47 are displayed on the solution issue field 37, the care manager determines an optimal solution issue in view of the individual situation of the relevant insured person ( S6).

More specifically, if the care manager determines that the solution 47 displayed in the solution field 37 is optimal for the insured in view of the individual situation of the insured, The solution 47 is used as it is. On the other hand, if the care manager determines that the solution is not optimal, the care manager selects the solution 47 on the display 4 with the mouse 6 and presses the delete key on the keyboard 5, so that the corresponding problem is displayed in the solution column 37. Is deleted. Then, the user selects a solution that is most suitable for the individual situation of the insured by clicking with the mouse 6 from among the solutions displayed on the solution problem addition column 42. CPU1
0 detects this selection processing, receives an instruction from the support program 18, and sets a solution 47 according to the selected content.
Is displayed on the solution task field 37. When selecting a task from among the tasks displayed in the additional field 42, the care manager operates the up / down button 43 with the mouse 6 so that the CPU 10 detects this operation.
In response to a command from the support program 18, a solution that is not displayed in the solution addition column 42 at that time is displayed.

When there is no area and a problem group that may cause a problem at the stage of initial display of the area examination screen 31, that is, in the case of NO in the determination processing of S 2 in FIG. 2, the CPU 10 In response to a command from the support program 18, a solution problem group display field 35 on the area examination screen 31 is displayed.
Task group 3 of "person's hope" and "family hope"
6 is displayed as a warning. Then, if there is no request from the person and the family to receive the nursing care service in particular (NO in S3), the care manager selects the task group 36 of “person's wish” and “family wish” by using the mouse 6. ,
As additional data 48 corresponding to these task groups 36, additional data 4 of "there is no particular request from the person and family"
After selecting and inputting only 8, the care plan creation process for the insured person is terminated. On the other hand, if there is a request from the person and his / her family in particular to receive the nursing care service (YES in S3), the care manager performs the same operation as described above and “there is a particular hope from the person and his / her family”. After selecting and inputting the additional data 48 of the insured person, the most appropriate solution to the individual situation of the insured person is selected from among the solutions displayed on the solution addition column 42.

Further, after the additional data 48 is input on the area examination screen 31, there is no solution problem 47 in the solution problem column 37 of any page, and generally, there is a care problem for the corresponding insured person. When it is determined that there is no possibility, that is, when the determination process in S5 in FIG. 2 is NO, the care manager confirms that there is no dissatisfaction with the result from the person and the family. If it is confirmed that there is no dissatisfaction (YES in S12), the care plan creation process for the insured person ends, and if it cannot be confirmed (NO in S12), the addition is performed. Data 4
There is a possibility that the selection method of No. 8 was bad, so S4
Then, the selection of the additional data 48 is performed again.

When the care manager finishes the determination of the solution problem corresponding to the solution problem group 36 for which the warning is displayed on the displayed page, the next screen button 47 is clicked with the mouse 6 to display the next page, and the next page is displayed. Then, a problem to be solved corresponding to the solution problem group 36 for which a warning is displayed is determined. When the care manager finishes the determination of the solution task on all pages and selects the target screen display button 45 with the mouse 6 in this way, the CPU 10 detects this selection process, receives a command from the support program 18, and A goal screen, which is a screen for determining a long-term goal and a short-term goal of the insured person, is displayed.

Next, a method of determining a long-term goal and a short-term goal in the support system 1 will be described with reference to FIG. The target screen 51 includes a solution field 53 and a solution field 53 that display the solution 54 determined in the solution determination process using the above-described area examination screen 31 (see FIG. 4).
Has a long-term goal display field 55 for displaying the long-term goal 56 corresponding to the solution task 54 displayed in the "Solution problem" field, and a short-term goal display field 62 for displaying the short-term goal 63 corresponding to the solution task 54 displayed in the solution task field 53. are doing. Also, the target screen 51
A long-term goal addition screen 57 for adding a long-term goal 56 displayed in the long-term goal display field 55, a long-term goal display field 55
Has a start date input column 59, an end date input column 60, and a period length input column 61 for inputting a period corresponding to the long-term goal 56 displayed in the "." Further, the target screen 51 is used for inputting a short-term target addition screen 64 for adding a short-term target 63 displayed in the short-term target display column 62 and a period corresponding to the short-term target 63 displayed in the short-term target display column 62. Has a start date input field 66, an end date input field 67, and a period length input field 68.

The up / down button 58 provided on the right side of the long-term target addition screen 57 and the up / down movement button 65 provided on the right side of the short-term target addition screen 64 are both provided on the area examination screen 31 (see FIG. 4). This button has the same function as the up / down button 43 in the parentheses. In addition, the target screen 51
Above it, the basic information display column 3 in the area review screen 31
2 has a basic information display field 52 for displaying the same information as
Also, at the bottom, each button 44 in the area review screen 31,
In addition to a menu button 69, a previous screen button 71, and a next screen button 72 having the same functions as those of 46 and 47, a nursing content screen display for instructing the display of a nursing content screen which is a screen for deciding the content of a nursing service. It has a button 70.

The care manager determines the direction of care (short-term goal, long-term goal) of the insured person using the target screen 51, as shown in S7 in FIG. Specifically, the care manager operates the area examination screen 31 (FIG. 4).
When the target screen display button 45 is clicked and selected with the mouse 6 during the referencing), the CPU 10 detects this selection processing. Then, in response to a command from the support program 18, the solution problem 5 determined in the above-described solution problem determination process is performed.
4 is displayed on the solution problem column 53, and based on the solution problem 54, a long-term target 56 and a short-term target 56 The goal 63 is automatically extracted, and the long-term goal 56 and the short-term goal 63 are displayed in a long-term goal display field 55 and a short-term goal display field 62, respectively.

If the care manager determines that the long-term goal 56 is not optimal for the insured in view of the individual situation of the insured, the long-term goal 56 in the long-term goal display field 55 is designated by a mouse. After the selection in step 6, the delete key on the keyboard 5 is pressed. The CPU 10 detects this, receives the instruction from the support program 18, and deletes the corresponding long-term target 56 from the long-term target display column 55. Then, from the long-term goals in the master data displayed on the long-term goal addition screen 57, the long-term goals most suitable for the individual situation of the pertinent insured are selected by clicking with the mouse 6. The CPU 10 detects this selection process and displays a long-term target 56 corresponding to the selected content on the long-term target display column 55. If the care manager determines that the short-term goal 63 is not optimal for the insured person in view of the individual situation of the insured person, the care manager performs the same processing as described above and displays the short-term goal display field. In addition to deleting the short-term goal 63 from the short-term goal 62, the short-term goal most suitable for the individual situation of the insured person is selected from the short-term goals displayed on the short-term goal addition screen 64. Thereby, the CPU 10 displays the short-term target 63 corresponding to the selected content on the short-term target display column 62. In addition, the care manager has a long-term goal display column 5
The start date of the period corresponding to the long-term goal 56 displayed in 5,
Enter the end date and the length of the period in the start date input column 59,
The start date, the end date and the length of the period corresponding to the short-term target 63 displayed in the short-term target display column 62 are input from the end date input column 60 and the period length input column 61, respectively. Field 66, end date input field 67 and period length input field 68 are entered.

When the care manager finishes the determination of the long-term goal 56 and the short-term goal 63 on the displayed page, the next screen button 72 is clicked with the mouse 6 to display the next page.
The long-term goal 56 and the short-term goal 63 corresponding to the solution problem group 54 displayed in the next page are determined. The care manager thus determines the long-term goal 56 and the short-term goal 63 for all pages. Then, if the use request for the nursing care service heard from the person and his / her family at the time of the visit survey is “Yes”, that is, if the determination process of S8 in FIG. The user selects and displays the care content screen, and selectively inputs the content, type, (providing) institution, and frequency of the specific care service of the insured person (S9).

Next, the process of selecting and inputting the contents of the nursing service from the nursing contents screen will be described in detail with reference to FIG. The care content screen 75 displays a solution task column 77 that displays a solution task 78 determined in the processing using the above-described area examination screen 31 (see FIG. 4), and a care service content 80 corresponding to each solution task 78. A service content display column 79 and a type / institution column 8 for selecting and inputting a service type 84 and a service providing organization (hereinafter abbreviated as a service organization) 85 corresponding to each care service content 80.
Three. In the service content display column 79, a list display button 81 for displaying a list of service contents stored in the various masters 17 (see FIG. 1) on the screen, and a service content display column 79 corresponding to each solution 78 An additional button 82 for adding a frame is provided. The type / institution column 83 corresponds to list display buttons 86 and 88 for displaying a list of service types and service institutions stored in the various masters 17 (see FIG. 1), and each care service content 80. An add button 87 for adding a frame of the type / institution column 83 is provided.

On the right side of the type / institution column 83, a frequency column 90 and a period column for inputting a use frequency and a use period of the service corresponding to the service type 84 displayed in the type / institution column 83 are shown. 93 are arranged. Frequency column 90
Is composed of a number-of-times input field 91 for inputting the number of times of use of the service corresponding to each service type 84 for each week, and a use date input field 92 for inputting the service use date.
Further, the period column 93 includes a use period input column 94 and a use period input column 95 for inputting the number of months of use of the service corresponding to the service type 84 displayed in the type / institution column 83. The up / down movement button 96 provided at the right end of the care content screen 75 is a button having the same function as the up / down movement button 43 in the area examination screen 31 (see FIG. 4). The nursing care content screen 75 has a basic information display column 76 for displaying the same information as the basic information display column 32 in the region examination screen 31 at the upper part, and each button 44 in the region examination screen 31 at the lower part. , 46, 47, the target screen 51 (see FIG. 6) in addition to the menu button 98, the previous screen button 100, and the next screen button 101.
Has a target screen display button 99 for instructing the display of. Further, the care content screen 75 has a plan print instruction button 97 for instructing printing of a home service plan, which is a document summarizing the care plan of each insured person, at the lower left thereof.

Next, a description will be given of the process of selecting and inputting the content, type, and provider of the care service using the care content screen 75. When receiving the display instruction of the care content screen 75 from the care manager, the CPU 10 receives the instruction from the support program 18 and determines the solution problem 78 determined in the process using the above-described area examination screen 31 (see FIG. 4). It is displayed in the solution problem column 77. Then, based on the solution task 78 and the long-term goal 56 and the short-term goal 63 selected on the target screen 51 (see FIG. 6), the master data stored in the various masters 17 (see FIG. 1) is read. Automatically extract the care service content 80 suitable for each insured person, and display the care service content 80 in the service content display column 79. If the care manager determines that the nursing service content 80 displayed in the service content display column 79 is not appropriate in view of the individual situation of the insured, the list display button 81 is selected with the mouse 6 and displayed. The user selects a care service content 80 suitable for the individual situation of the insured person from the list of the provided care service contents with the mouse 6. When adding a frame of the service content display column 79 corresponding to each solution problem 78, the user selects the add button 82 with the mouse 6 to display the frame of the additional service content display column 79, The display button 81 is selected with the mouse 6, and the care service content 80 suitable for the insured person is selected and input from the displayed care service content with the mouse 6.

When selecting and inputting the service type 84, the care manager selects the list display button 86 provided in the type / institution column 83 with the mouse 6, and selects each service content from the displayed service types. Service type 84 corresponding to care service content 80 displayed in display column 79
Is selected with the mouse 6. When selecting and inputting the service institution 85, the user selects the list display button 88 provided in the type / institution column 83 with the mouse 6 and corresponds to each service type 84 from the displayed service institution. The mouse | mouth 6 sets the service organization 85 which can provide a service.
To select. Thereafter, the care manager performs input of each input item provided in the frequency column 90 and the period column 93,
The input processing on the care content screen 75 ends. Thereafter, the care manager selects the plan printing instruction button 97 with the mouse 6 and instructs printing of the home service plan. Upon detecting this instruction, the CPU 10 receives an instruction from the support program 18 and, as shown in S10 of FIG. 2, a home service plan (1) (hereinafter referred to as a service plan cover) and a home service plan. (2) Create and output (hereinafter referred to as service plan details).

FIGS. 8 and 9 show the service plan cover and the service plan details. Service plan cover 1
11 is the assessment input screen 20 (see FIG. 3)
And it is edited based on the data input from the area review screen 31 (see FIG. 4). In addition, service plan details 1
21 is edited mainly based on the contents selected and input on the area examination screen 31 (see FIG. 4), the goal screen 51 (see FIG. 6), and the care content screen 75 (see FIG. 7).

Each output item in the service plan description details 121 will be described. Service plan details 121
Includes a solution problem 123 selected and determined in the process on the area examination screen 31 (see FIG. 4), a long-term target 124, a long-term target period 125, and a short-term target selected and determined in the process on the target screen 51 (see FIG. 6). 126 and short-term target period 1
27, the service content 128 selected and determined in the processing on the care content screen 75 (see FIG. 7), and the service type 13
0 and the service institution 131 are displayed. On the right side of the service institution 131, a frequency 132 and a period 133 input in the processing on the care content screen 75 are displayed. Furthermore, a user name 122 input from the name input field 22 on the assessment input screen 20 (see FIG. 3) is displayed above the service plan details 121. The insurance column 1 on the right side of the service content 128
Nothing is displayed on 29. The insurance column 129 indicates whether the care manager, after outputting the service plan details 121, consults with the pertinent insured person and his / her family, and is covered by the nursing care insurance for use of the service corresponding to each service content 128. Enter whether or not.

On the other hand, in the case of NO in S8 in FIG. 2, that is, when there is no request for use of the nursing care service by the insured person and his / her family, the care manager determines the same as above. Carry out operation and care contents screen 7
5 (see FIG. 7), and press the list display button 81 provided in each service content display column 79 to list the service contents stored in the various masters 17 (see FIG. 1) on the screen. indicate. Then, from the displayed service contents, the nursing care contents 80 corresponding to the insured person.
Is selected and input, and the same content is selected and input for the service type 84 as well. Thereafter, the care manager does not select and input the frequency column 90 and the period column 93 in FIG.
As shown in FIG. 3, immediately select the plan print instruction button 97 in FIG. Is completed.

When the creation and output of the service plan cover 111 and the service plan details 121 (care plan table) are completed, the care manager interlocks with the creation of the care plan table as shown in S11 of FIG. The service invoice and the service offer vote of the corresponding insured person are created.

Next, the process of creating the above-mentioned service use form and service provision form will be described in detail with reference to FIG. The care manager specifies the user ID of the insured person from a process selection menu (not shown), and the correction screen 141
In response to the instruction from the support program 18, the CPU 10 displays the service usage schedule and usage results for the insured person in the next month as viewed from the current date. Specifically, the service type 154 according to the content selected and input on the care content screen 75 (see FIG. 7).
And the service institution 155 are displayed in the service type column 147 and the service institution column 148 in the modification screen 141, respectively. The CPU 10 also displays a care content screen 75 (FIG. 7).
(Refer to), (service use) number input field 91, usage date input field 92, usage month input field 94, and usage period input field 95.
The service use schedule and the total number of times of use of the corresponding insured person in accordance with the contents input in step (1) are displayed in the scheduled use column 156 and the scheduled use total number column 159 of the correction screen 141. Furthermore, a service code 153 corresponding to the service type 154 displayed in the service type column 147 from the master data stored in the various masters 17 (see FIG. 1).
Is extracted, and the corresponding service code 153 is displayed in the service code column 146. When the care manager wants to create a service usage slip and a service provision slip for the next two months or later, he inputs the target year input field 143 and the target month input field 144 in the correction screen 141, and presses the return key on the keyboard 5. Press. Upon detecting this, the CPU 10 receives a command from the support program 18 and displays the service use schedule and use results of the corresponding insured person corresponding to the input date.

In principle, the care manager inputs the use start time and use end time of the service corresponding to each service type 154 in the start time input field 151 and the end time input field 152 on the use time zone field 145. , Just select the output button 174 for the service usage / provided form,
It is possible to obtain the service use form and the service provision form of the insured person. However, when correcting the number of service use schedules and the use dates input at the time of creating the care plan table (the service plan cover 111 and the service plan details 121), the schedule column 156 and the total planned use count column 1
Change the contents of 59. At this time, the care manager
By selecting the left / right movement button 158, the schedule column 156
And the contents of the result column 157 can be moved right and left. If the insured person wishes to receive the service corresponding to each service type 154 in a plurality of time zones, the care manager selects the copy button 171 and selects the same service type 154 or service institution. Fifteen
After adding a new frame 173 having 5
The 73 start time input field 151 and the end time input field 152 are corrected. Furthermore, if there is an extra frame 173, the user deletes the frame 173 by selecting the delete button 170 corresponding to the frame 173. The care manager can move the frame 173 displayed on the correction screen 141 up and down by selecting the button 172 for up and down movement. The care manager displays the correction screen 14
When the processing in step 1 is completed, the close button 175
Is selected, and the correction screen 141 is closed.

Next, the service use form and the service provision form which are output when the output button 174 is selected will be described with reference to FIGS. FIG. 11 and FIG.
2 indicates a service use slip 181 and a service offer slip 201, respectively. The service usage slip 181 is a table summarizing the monthly plan and use results of the nursing service used by each insured person, and the service provision slip 201 indicates the monthly plan and usage results of the nursing service used by each insured person. It is a table divided for each care service provider and summarized.

Here, the output items in the service usage slip 181 will be described. Target year column 1 in this usage slip 181
82 and the target month column 183, the correction screen 141 (FIG. 10)
The target year and the target month corresponding to the target year and month entered in (Ref.) Are displayed. In the care insurance certification column 184, the result of whether or not the certification for care required entered on the assessment input screen 20 (see FIG. 3) has been displayed, and in the assessment personal information column 185, the assessment input information is displayed. The personal information of the insured person input on the screen 20 is displayed. Furthermore, the provision time zone column 186, the service content column 187, and the service institution column 18 in the service usage form 181.
8, the contents input on the correction screen 141 (see FIG. 10) are displayed in the scheduled use column 189, the scheduled total use count column 191, the use record column 190, and the use record total count column 192. However, when the service usage slip 181 is output for the first time, there is usually no usage record for the target year and month, so nothing is displayed in the usage record column 190 and the total number of use records column 192.

The contents of the output items in the service provision form 201 are the same as those in the service form 181 described above. However,
In the details 214 in the service provision slip 201, only those belonging to a specific service institution 188 among the details 194 displayed in the service usage slip 181 are displayed.

When the creation of the service use slip 181 and the service offer slip 201 is completed, the care manager
Based on the data collected from each service institution, the results column 157 and the total number of times of use column 160 in the correction screen 141 (see FIG. 10) are entered, and the contents of the schedule column 156 and the total number of times scheduled use 159 are changed. Modify as appropriate.

The data collection from each of the above service organizations is performed using the data collection system 221 shown in FIG. As shown in the figure, the data collection system support system 221 includes the support system 1 constructed on the server 2 arranged in the general care station 222,
It is composed of a client 226 that is distributed to each care service provider and connected to the server 2 via a communication line. As a provider of each care service, a helper station 223 for providing a home care service, and a day service station 22 for providing a day care service are provided.
4. There is a day care station 225 for performing tsusho rehabilitation. In FIG. 13, the printer 8 in FIG. 1 is omitted.

Next, a device for easily maintaining the care plan created by the series of processes shown in FIG. 2 will be described. The support system 1 has a function of supporting monitoring of the execution results of the care plan, changes in life needs of the insured person, and changes in the state of the insured person and family, and care performed by the user based on the monitoring results. It has a function to support plan maintenance. By using the monitoring support function and the maintenance support function, the user can easily prepare the care plan according to the execution result of the care plan, changes in the life needs of the insured, and changes in the condition of the insured and the family. Can be maintained.

Next, referring to FIG. 15 in addition to the flowchart of FIG. 14, a care plan maintenance process using the monitoring support function and the maintenance support function will be described. When one week before the end date input in the short-term target end date input field 67 on the target screen 51 shown in FIG. 6 is reached (YES in S21), the CPU 10 checks the execution plan of the care plan shown in FIG. Is automatically output by the printer 8 shown in FIG. The check list 230 lists check items relating to the execution results of the care plan and the like. Checklist 2 for each insured person in charge
Upon receipt of 30, the insured person checks each check item on the checklist 230 by the end date of the short-term goal, and the insured person for each check item is Write the response result from. Then, when the end date of the short-term goal comes (YES in S23), and each care manager inputs his / her ID and password to use the support system 1, the CPU 10 determines the insured person in charge of each care manager. A monitoring process for a care plan execution result and the like and a care plan maintenance process based on the result of the monitoring process are automatically started (S
24).

Next, the monitoring processing and the maintenance processing shown in S24 will be described in detail with reference to FIG. 17 in addition to the flowchart in FIG. CPU10
Starts this process, as shown in FIG.
A screen 231 for checking whether or not the life needs of the insured person is satisfied is displayed on the display 4 (see FIG. 1).
It is displayed above (S31). The care manager displays the user ID 233, the name 234, and the age 235, which are information for identifying each insured person displayed on the check screen 231.
To check the insured person to be processed. And
With reference to the checklist 230 for the insured person, a confirmation process corresponding to the guidance message 232 is performed based on the answer result from the insured person to the check item (1) in the checklist 230. Specifically, when the answer result from the insured person to the check item of (1) is “Yes”, the care manager clicks the check box 236 with the mouse 6 to check it, and then presses the check button with the mouse 6. Click 238. On the other hand, if the answer to the check item (1) is “No”, the user clicks the check box 237 with the mouse 6 to check it, and then clicks the confirmation button 238 with the mouse 6.

As a result of the above confirmation processing, if the care manager selects the “No” check box 237 (NO in S 31), the CPU 10 is currently provided from the service provider to the relevant insured person. A screen for checking whether there is a problem with the service being provided is displayed on the display 4. This check screen is a screen of the same format as the above-mentioned check screen 231 relating to life needs. Based on the result of the insured person's response to the check item (2) included in the checklist 230 for the insured person, the care manager determines whether there is a problem with the service provided by the service provider. Perform selection input. If the care manager selects and inputs that the provided service has a problem (YES in S32),
The CPU 10 displays a guidance message to the effect that it is necessary to make adjustments with the service providing organization (S33).

The care manager confirms the needs, long-term goals, short-term goals, service contents, and the like of the pertinent insured with the service provider in accordance with the above guidance message. This need includes the demands of the insured and his or her family, as well as the expected risks to the insured. Specifically, the care manager performs the above-described needs confirmation processing as follows. That is, the care manager informs the service provider of the needs of the insured and their family members, and requests that the insured people and their families improve the services provided by the service provider. If so, confirm to the service provider the extent to which the service can be improved, and communicate the result to the insured.

When the care manager responds to the above guidance message by pressing the execution key on the keyboard 5, the CPU 10 checks whether the needs of the insured have changed. Is displayed on the display 4. On this check screen, the care manager selects and inputs whether there is a change in needs based on the result of the insured person's response to the check item (3) in the check list 230. And
If the care manager selects and inputs that the needs of the insured have changed (YES in S34), the CPU 1
0 displays on the display 4 a screen for checking whether a new need has arisen for the pertinent person. On this check screen, the care manager makes a selection input regarding whether or not new needs arise, based on the result of the insured person responding to the check item (4) in the check list 230. Specifically, the care manager will indicate that a new need has arisen when the condition of the medical condition or disability of the insured person changes, or when the condition of the caregiver of the insured person changes. Is input. When detecting the selection input indicating that a new need has been generated (YES in S35), the CPU 10 displays a guidance message indicating that a new solution task needs to be added on the display 4 (S36).

When the care manager responds by pressing the execution key on the keyboard 5 in response to the above guidance message, the CPU 10 displays the area review screen 31 shown in FIG. (S37) The user is prompted to input a new solution task. The care manager adds a new solution task on the area examination screen 31 (S38). Then, on the goal screen 51 shown in FIG. 6 and the nursing content screen 75 shown in FIG. 7, after inputting new short-term goals, long-term goals, service contents, etc. corresponding to the new solution task, the nursing contents screen is displayed. By instructing the output of the service use form / provided form at 75, the care plan and the service use form / provided form of the insured person are changed (S57). When these processes are completed, the CPU 10 informs the service provider that it is necessary to coordinate with the service provider in order to urge the service provider to change the service content according to the content of the service provision sheet after the modification. Display on the display 4 (S58),
This process ends.

As a result of the determination processing in S34 and S35,
Despite the changing needs of the insured (S
34 (YES at 34), when there is no new need for the insured (NO at S35), it means that the existing needs of the insured have disappeared. In this case, the CPU 10 displays on the display 4 a guidance message to the effect that the solution to the existing needs that has disappeared needs to be deleted at the time of creating the next care plan (S40), and the process ends. .

In the determination processing of S34, if the care manager selects and inputs that there is no change in the needs of the corresponding insured (NO in S34), the CPU 10
A screen for checking whether the short-term goal of the insured person has been achieved is displayed on the display 4. On this check screen, the care manager selects and inputs whether or not the short-term goal has been achieved based on the result of the insured person's response to the check item (6) in the check list 230. Then, when the care manager performs a selection input indicating that the short-term goal has been achieved (S4).
(YES at 1), CPU 10 detects this selection input and displays on display 4 a screen for checking whether or not the state of the insured person or his / her family has changed. On this check screen, the care manager selects and inputs whether the state of the insured person or his / her family has changed based on the result of the insured person's response to the check item (7) in the check list 230. I do. Then, when the care manager performs a selection input indicating that the state of the insured person or his / her family has not changed (NO in S42), the CPU 10 executes the short-term goal achievement normal processing (S46).

Next, with reference to the flowchart of FIG. 18, the short-term goal achievement normal processing shown in S46 will be described. When the CPU 10 starts this processing,
A screen for checking whether or not the content of the service (care) has been executed as shown in the service plan details 121 shown in FIG. 9 is displayed on the display 4. In this check screen, the care manager displays checklist 2
Service (care) of the insured person based on the result of the insured person's response to check item (9) in 30
Is selected as to whether or not the contents of the step (a) are executed as described in the service plan details 121. Then, when the care manager performs a selection input indicating that the content of the service has been executed according to the service plan details 121 (YE in S61).
S), the CPU 10 detects this selection input, and
A guidance message indicating that the continuity of the long-term goal and the service (care) content should be examined is displayed on the display 4 (S62).

When the care manager responds by pressing the execution key on the keyboard 5 in response to the above guidance message, the CPU 10 displays the target screen 51 shown in FIG. S63), urge the care manager to delete the short-term goal. The care manager deletes the short-term target on the target screen 51, and deletes the service content corresponding to the deleted short-term target on the care content screen 75 shown in FIG. 7 (S64).

On the other hand, when the care manager performs a selection input indicating that the service content is not executed according to the service plan details 121 (N in S61).
O), the CPU 10 detects this selection input and displays a guidance message on the display 4 to the effect that it is necessary to review the contents of the service (care) of the insured person (S).
65). When the care manager responds by pressing the execution key on the keyboard 5 in response to the above guidance message, the CPU 10 displays the care content screen 75 shown in FIG. 7 on the display 4 (S66). Urges the care manager to change the contents of the service. The care manager reviews whether the service content has been grasped by the service provider, whether the service content is practicable, and the like, and corrects the service content and the like on the care content screen 75 (S67). ).

In the determination process of S42 in FIG. 16, when the care manager performs a selection input indicating that the state of the insured person or his / her family has changed (S4).
(YES in 2), CPU 10 detects this selection input, examines a predicted problem, and displays a guidance message on display 4 indicating that a new short-term goal needs to be set (S43). When the care manager responds by pressing the execution key on the keyboard 5 in response to the above guidance message, the CPU 10
The target screen 51 shown in FIG. 6 is displayed above (S4
4) Encourage the care manager to add short-term goals. The care manager adds a short-term goal on the goal screen 51 (S45), and also displays a care content screen 75 shown in FIG.
In, additional input of service contents etc. corresponding to the added short-term goal is performed.

In the determination processing of S41, if the care manager has made a selection input indicating that the short-term goal of the insured person has not been achieved (NO in S41), C
The PU 10 displays on the display 4 a screen for checking whether the condition of the insured person or his / her family has changed. On this check screen, the care manager selects and inputs whether the state of the insured person or his / her family has changed based on the result of the insured person's response to the check item (7) in the check list 230. I do. When the care manager performs a selection input indicating that the state of the insured person or his / her family has not changed (NO in S47), the CPU 10 determines whether the short-term target of the insured person is appropriate. A screen for checking is displayed on the display 4. The care manager
On this check screen, based on the result of the insured person's response to the check item (10) in the check list 230, a selection input is made as to whether or not the short-term goal of the insured person is appropriate. Then, when the care manager performs a selection input indicating that the short-term goal is not appropriate (S
(NO at 53), the CPU 10 displays a guidance message on the display 4 to the effect that the short-term goal needs to be corrected (S54).

When the care manager gives an acknowledgment by pressing the execution key on the keyboard 5 in response to the above guidance message, the CPU 10 displays the target screen 51 shown in FIG. S55), prompt the care manager to correct the short-term goal. The care manager corrects the short-term target on the target screen 51, and corrects the service content and the like corresponding to the short-term target corrected on the target screen 51 on the care content screen 75 shown in FIG. 7 (S56).

In the determination process of S53, if the care manager has made a selection input indicating that the short-term goal is appropriate (YES in S53), the CPU 10 proceeds to S4.
Perform normal processing when the short-term goal of 6 is achieved.

In the determination process of S47, if the care manager has made a selection input indicating that the condition of the insured person or his / her family has changed (YES in S47), C is determined.
The PU 10 detects this selection input and displays a screen on the display 4 for checking whether or not the change in the condition of the insured person or the family is an overall change. On this check screen, the care manager determines whether the change in the condition of the insured person or his / her family is an overall change based on the result of the insured person's response to the check item (8) in the checklist 230. The user makes a selection input as to whether or not to perform selection. Then, when the care manager performs a selection input indicating that the change is an overall change (YE in S48).
S), the CPU 10 performs re-creation processing of the care plan of the insured person (S49).

Next, the care plan re-creating process shown in S49 will be described with reference to the flowchart of FIG. When starting this process, the CPU 10 displays on the display 4 a guidance message indicating that it is necessary to recreate a care plan for the insured person (S7).
1). When the care manager responds by pressing the execution key on the keyboard 5 in response to the instruction message, the CPU 10 displays the assessment input screen 20 shown in FIG. 3 on the display 4 (S72). Then, re-input of the assessment data is prompted (S73). Then, when the care manager completes re-input of the assessment data on the assessment input screen 20 (S7).
3), the CPU 10 sets the area review screen 31 shown in FIG.
Is displayed on the display 4 to urge the re-creation of the care plan for the insured person (S74). The care manager re-creates the care plan and the service use form / provided form for the insured person using the area review screen 31, the target screen 51 shown in FIG. 6, and the care content screen 75 shown in FIG. Is performed (S75).

In S48 of FIG. 16, when the care manager has made a selection input indicating that the change is not an overall change (NO in S48), the CPU 10 sets a new solution task, a short-term or long-term goal, and a service content. A guidance message to the effect that it is necessary to add an instruction is displayed on the display 4 (S50). When the care manager responds by pressing the execution key on the keyboard 5 in response to the above guidance message, the CPU 10 displays the area examination screen 31 shown in FIG. 4 on the display 4 (S51). Encourage the insured to add new solutions, short- and long-term goals, service content, etc. The care manager uses the area examination screen 31, the goal screen 51 shown in FIG. 6, and the care content screen 75 shown in FIG. 7 to solve the problem, the short-term and long-term goal, and the service content of the insured person. An additional input is performed (S52).

S31, S32, S34 in FIG.
Each of the check screens and the display 4 corresponding to S35, S41, S42, S47, S48, S53 and S61 in FIG. 18 corresponds to a confirmation display unit in claim 4. Also, S33, S36, S40, and S in FIG.
43, S50, S54, each guidance message corresponding to S62, S65 in FIG. 18, and S71 in FIG.
S37, S44, S51, S55 in FIG.
The display of each modification screen shown in S63 and S66 in FIG. 8 and S72 in FIG. 19 corresponds to the care plan change promotion means in claim 4.

As described above, according to the support system 1 according to the present embodiment, a solution problem, a care goal, and the contents of a care service (hereinafter referred to as a solution problem, etc.) suitable for the insured person from the master data. Automatically extracted)
The extracted solution issues and the like are displayed in the solution issue field 37 in the area examination screen 31 (see FIG. 5), the long-term goal display field 55 and the short-term goal display field 62 in the goal screen 51 (see FIG. 6), and the care content screen 75 (see FIG. 7) is displayed in the service content display column 79 or the like. Thus, the user can easily select a solution task or the like according to the state of each insured person according to the display contents.

Further, according to the support system 1 according to the present embodiment, when the end date of the short-term goal comes, the achievement status of the short-term goal, changes in the life needs of the insured, changes in the state of the insured and the family And displays a guidance message prompting the user to change the created care plan in accordance with the contents of the response input from the care manager to the check items in the check screen.
Displayed above. In this way, the status of achievement of short-term goals, changes in the life needs of the insured, changes in the status of the insured, implementation of service content, etc. are appropriately monitored, and care for the insured is taken according to the monitoring results. The plan can be easily and appropriately maintained.

The present invention is not limited to the above embodiment, and various modifications are possible. For example, in the above embodiment, a solution problem suitable for the insured person is automatically extracted from the master data stored in the various masters 17 (see FIG. 1), and only this solution problem is examined in the area. Although the problem is displayed in the solution field 37 in the screen 31 (see FIG. 5), after displaying all the solutions corresponding to the area 34 displayed in the area display field 33 on the solution field 37,
Only the solutions that are appropriate for the insured person may be displayed as a warning. Further, in the above embodiment, the configuration is such that the user can add / change the solution, the short-term goal, the long-term goal, and the service content automatically extracted by the CPU. The service content may be adopted as it is. Furthermore, in the above embodiment, an example in which the present invention is applied to a client-server type system has been described. However, the present invention may be applied to a stand-alone type system.

[0080]

As described above, according to the first, fourth, or seventh aspect of the present invention, a solution, a goal in care, and a care service suitable for each insured are selected from the master data. By automatically extracting the contents (hereinafter referred to as solution issues) and displaying the extracted solution issues, the user can easily respond to the status of each insured person according to the displayed contents. Can be selected. This makes it easier to determine the solution issues and the like that are the core of the care plan, so that the time required for the entire care plan creation is shorter than that of the conventional care plan creation support system that automatically extracts the problem areas. Can be significantly reduced, and the user can create an appropriate care plan according to the condition of each insured person, regardless of the level of experience and ability as a care manager. In addition, as the assessment data used to detect a problem group (problem area) that could be a problem, data on items common to the survey items for certification of long-term care required by long-term care insurance were used. As a result, assessment data necessary only for the creation of a care plan is compared with a conventional care plan creation support system that extracts problem areas based on assessment data interviewed only for the creation of a care plan. Therefore, the user can reduce the number of assessment surveys (hearing surveys on assessment items for problem analysis of each insured person) performed by each user before creating a care plan. it can.

Further, a warning is displayed on the screen for inputting additional information regarding the group of tasks that have been detected as possibly causing a problem.
A problem group that may become a problem by displaying a list of additional information when selected by a device and using the information selected by the pointing device from the displayed information as additional information It is possible to easily and reliably input additional information on (problem area).

Further, based on the input common item data and additional information of each insured person and the selected problem to be solved, goals for nursing care, and contents of nursing care services, a home service plan and a service usage slip are provided. By creating the service provision slip, the entire care plan creation process including the creation of these forms can be facilitated. This makes it possible to drastically reduce the time required for the entire care plan creation process, as compared with the conventional care plan creation support system that automatically performs extraction of a problem area.

When the end date of the nursing care goal arrives, the achievement status of the nursing care goal, changes in the life needs of the insured, changes in the state of the insured, and the implementation status of the contents of the nursing service are performed. A confirmation message regarding at least one of the displayed care messages is displayed, and the user is prompted to change the created care plan according to the content of the response input from the user to the message. In this way, the status of achievement of the goals for nursing care, changes in the life needs of the insured, changes in the status of the insured, and the status of implementation of the nursing care services are reliably monitored, and a care plan is taken according to the monitoring results. Can be easily and appropriately maintained.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of a care plan creation support system according to an embodiment of the present invention.

FIG. 2 is a flowchart showing care plan creation processing in the creation support system.

FIG. 3 is a diagram showing an assessment input screen used for the care plan creation process.

FIG. 4 is a diagram showing a state in which additional data is selected and input on an area examination screen used in the care plan creation processing.

FIG. 5 is a diagram showing a result of selecting and inputting additional data on the area examination screen.

FIG. 6 is a view showing a target screen used in the care plan creation processing.

FIG. 7 is a diagram showing a care content screen used in the care plan creation processing.

FIG. 8 is a diagram showing the contents of the first page of a care plan table (home service plan) created in the care plan creation process.

FIG. 9 is a diagram showing the contents of the second and subsequent pages of the care plan table (home service plan) created in the care plan creation process.

FIG. 10 is a view showing a screen for correcting the contents input when the care plan table is created.

FIG. 11 is a diagram showing a service usage slip created in the care plan creation process.

FIG. 12 is a diagram showing a service provision slip created in the care plan creation process.

FIG. 13 is a diagram showing a configuration example of a data collection system incorporating the creation support system.

FIG. 14 is a diagram showing a maintenance process of a care plan created by the creation support system.

FIG. 15 is a diagram showing a check list of a care plan execution result and the like output during a care plan maintenance process in the creation support system.

FIG. 16 is a diagram showing a monitoring process and a maintenance process in FIG. 14;

FIG. 17 is a view showing a screen for checking whether or not life needs of the insured person used in the monitoring processing and the maintenance processing are satisfied.

FIG. 18 is a diagram showing a normal process when a short-term goal is achieved in FIG. 16;

FIG. 19 is a view showing a care plan re-creating process in FIG. 16;

[Explanation of symbols]

1 care plan creation support system 4 display (input promotion display means, solution problem display means, target display means, service content display means, confirmation display means) 5 keyboard (common item input means, additional information input means, change means) 6 mouse (Common item input means, additional information input means, pointing device, response input means) 8 Printer (form creation means) 10 CPU (detection means, solution problem extraction means, target extraction means, service content extraction means, form creation means) 17 Various masters (master storage means) 18 Care plan creation support program 20 Assessment input screen (common item input means) 31 Area examination screen (additional information input means) 231 Check screen (confirmation display means)

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Masaki Nakamura 164 Ohara Idemachi, Sakyo-ku, Kyoto-shi Medical corporation corporation Inside the corporate corps association (72) Inventor Chiemi Kawasoe 164 Ohara Idemachi, Sakyo-ku, Kyoto-shi Medical corporation association Inside the Goryokkai

Claims (12)

[Claims] 1. A system for supporting the creation of a care plan for each insured person of long-term care insurance by a computer, comprising: master data including a solution problem, a goal in nursing care, and the contents of a nursing care service which can be taken during the care plan. A common item inputting means for inputting data of items common to a survey item for certification of need of nursing care among assessment items for problem analysis of each insured person, and the common item input Detecting means for detecting a problem group that may be a problem for each insured person based on the common item data of each insured person input by the means; Input prompting display means for prompting input of information to be added to the common item data of each insured person, and according to the display contents of the input prompting display means. Additional information input means for a user to input additional information to the common item data; common item data input by the common item input means; and additional information input by the additional information input means. The master stored in the master storage means.
A solution extraction means for automatically extracting a solution suitable for each insured person from data, a solution display means for displaying the solution extracted by the solution extraction means, and a solution display means Target extracting means for automatically extracting a care target suitable for each insured person from the master data stored in the master storage means based on the solution problem displayed in Target display means for displaying the care target extracted by the above, based on the care target displayed on the target display means and the solution displayed on the solution display means, the master storage means Service contents extracting means for automatically extracting contents of a care service suitable for each insured person from the stored master data; and a care service extracted by the service contents extracting means. Care plan creation support system characterized in that a service content display means for displaying the contents of the screws. 2. The input prompting display means performs a warning display on a screen for information input by the additional information input means with respect to a task group detected as a potential problem by the detection means, The additional information input means displays a list of additional information when the task group displayed as a warning is selected by a pointing device, and adds information selected by the pointing device from the displayed information. The care plan creation support system according to claim 1, wherein the information is input as information. 3. The solution display unit displays the solution extracted by the solution extraction unit and the other solution stored in the master storage unit separately, and the target extraction unit includes: Based on the solution selected by the user from among the solutions displayed on the solution display, the care target suitable for each insured person is selected from the master data stored in the master storage. The goal display means distinguishes and displays the care goal extracted by the goal extraction means and the other care goals stored in the master storage means, The content extracting unit is configured to determine the master record based on the care target selected by the user from the care targets displayed on the target display unit and the solution task selected by the user. Master stored in storage means
The contents of the nursing care service suitable for each insured person are automatically extracted from the data. The service contents display means stores the contents of the nursing service extracted by the service contents extracting means and the master storage means. The common item data of each insured person input by the common item input means and the additional information about each insured person input by the additional information input means Based on the information, the solution problem and the care target selected by the user, and the contents of the nursing service selected by the user from the contents of the nursing service displayed on the service content display means, A home service plan, which is a document summarizing the entire care plan of the insurer, and a monthly plan and usage results for each care service used by each insured person Form that creates a service usage form, which is a table, and a service provision form, which is a table that summarizes the monthly plan and usage results of each care service used by each insured person for each care service provider. The care plan creation support system according to claim 1, further comprising a creation unit. 4. When the end date of the nursing care goal extracted by the goal extracting means arrives, the achievement status of the nursing care goal, changes in life needs of the insured, changes in the state of the insured, Confirmation display means for displaying a confirmation message relating to at least one of the implementation statuses of the care service contents extracted by the service content extraction means; and response input means for inputting a response to the contents displayed by the confirmation display means A care plan change promoting means for prompting a change of the created care plan according to the content of the response input by the response input means; and the common item according to the content of the change prompted by the care plan change promoting means Common item data of each insured person input by the input means, additional information input by the additional information input means, A change unit configured to change at least one of the extracted solution, the care target extracted by the target extraction unit, and the care service content extracted by the service content extraction unit. The care plan creation support system according to claim 1, wherein 5. A method for supporting the creation of a care plan for each care-insured person by means of a programmed computer, including a solution problem, a care goal and contents of a care service that can be taken during the care plan. Storing master data; accepting data of items common to the survey items for certification of need of nursing care among assessment items for analysis of issues of each insured person; based on the common item data, A step of detecting a problem group that may be a problem for the insured person; and a step of, based on the detection result, displaying a message prompting the user to input information to be added to the common item data of each insured person. And a step of receiving additional information input by a user according to the display content; and Automatically extracting a solution problem suitable for each insured person from the master data, displaying the extracted solution problem, based on the displayed solution problem, Automatically extracting a care goal suitable for each insured person from the data; displaying the extracted care goal; and the displayed care goal and solution task. On the basis of the,
A step of automatically extracting contents of a nursing service suitable for each insured person from the master data; and a step of displaying the contents of the extracted nursing service. How to help. 6. A display for prompting input of the additional information, a warning display on a screen for inputting the additional information regarding a task group detected as a potential problem in the detecting step. In the step of receiving the additional information, when the task group for which the warning is displayed is instructed to be selected by the user, a list of additional information is displayed, and the user is instructed to select from among the information displayed in the list. 6. The care plan creation support method according to claim 5, wherein said information is received as said additional information. 7. The step of displaying the solution tasks, wherein the extracted solution tasks and other solution tasks in the master data are displayed separately, and the care target is automatically extracted. In, based on the solution problem selected by the user from the displayed solution problem, extracting a care goal suitable for each insured person from the master data, In the displaying step, the extracted nursing care goal and the other nursing care goal in the master data are distinguished and displayed. In the step of automatically extracting the contents of the nursing care service, the displayed nursing care goal is displayed. Based on the nursing goals selected by the user from the nursing goals and the solutions selected by the user, each insured person is selected from the master data. In the step of extracting the contents of the nursing service suitable for, and displaying the contents of the nursing service,
The contents of the extracted nursing care service and the contents of other nursing care services in the master data are displayed separately, common item data and additional information input by the user, and a solution problem selected by the user And a home service plan, which is a document summarizing the entire care plan of each insured person, based on the care target and the contents of the care service selected by the user from the contents of the displayed care service. And a service usage vote that summarizes the monthly plans and usage results of each care service used by each insured person, and the monthly plans and usage results of each care service used by each insured user. 6. The care plan creation support according to claim 5, further comprising a step of creating a service provision slip which is a table divided and provided for each provider. How to help. 8. When the end date of the nursing care goal extracted by the step of automatically extracting the nursing care goal arrives, the achievement status of the nursing care goal, a change in life needs of the insured, Displaying a confirmation message regarding at least one of the change of the state of the insurer and the implementation status of the contents of the nursing service extracted by the step of automatically extracting the contents of the nursing service, and a response input from the user to the displayed contents Receiving the common item data according to the content of the response input; prompting the user to change the care plan according to the content of the response input; and receiving the common item data according to the content of the prompted change. The additional information received in the step of receiving the additional information, the step of automatically extracting the solution problem Changing at least one of the extracted solution problem, the care goal extracted by the step of automatically extracting the care goal, and the care service content extracted by the step of automatically extracting the content of the care service The method according to claim 5, further comprising the step of: 9. A computer for supporting the preparation of a care plan for each care-insured person, storing master data including possible solutions, care goals, and contents of care services during the care plan. Master storage means for inputting, common item input means for inputting data of items in common with the survey items for nursing care recognition among the assessment items for problem analysis of each insured person, and the common item input means Based on the input common item data of each insured person, detecting means for detecting a problem group that may be a problem for each insured person, based on the detection result by the detecting means, Input prompting display means for prompting the user to input information to be added to the insured common item data; and Additional information input means for inputting additional information to the eye data; common item data input by the common item input means; and additional information input by the additional information input means, based on the master storage. Master stored in the means
A solution extraction means for automatically extracting a solution suitable for each insured person from data, a solution display means for displaying the solution extracted by the solution extraction means, and a solution display means Target extracting means for automatically extracting a care target suitable for each insured person from the master data stored in the master storage means based on the solution problem displayed in Target display means for displaying the care target extracted by the above, based on the care target displayed on the target display means and the solution displayed on the solution display means, the master storage means Service contents extracting means for automatically extracting contents of a care service suitable for each insured person from the stored master data; and a care service extracted by the service contents extracting means. Care plan creation support program for functioning as a service content display means for displaying the contents of the screw. 10. The input prompting display means performs a warning display on a screen for information input by the additional information input means with respect to a task group detected as a potential problem by the detection means, The additional information input means displays a list of additional information when the task group displayed as a warning is selected by a pointing device, and adds information selected by the pointing device from the displayed information. The care plan creation support program according to claim 9, wherein the information is input as information. 11. The solution display unit displays the solution extracted by the solution extraction unit and another solution stored in the master storage unit separately, and the target extraction unit includes: Based on the solution selected by the user from among the solutions displayed on the solution display, the care target suitable for each insured person is selected from the master data stored in the master storage. The goal display means distinguishes and displays the care goal extracted by the goal extraction means and the other care goals stored in the master storage means, The content extracting unit is configured to execute the master based on a care target selected by a user from the care targets displayed on the target display unit and a solution task selected by the user. The master stored in the storage means
The contents of the nursing care service suitable for each insured person are automatically extracted from the data, and the service contents display means stores the contents of the nursing care service extracted by the service contents extracting means and the master storage means. The contents of the other nursing care services are displayed in a distinguished manner, and in addition to the above-mentioned units, a computer is provided, and the common item data of each insured person input by the common item input unit and the additional information input unit The additional information about each insured person inputted by the user, the solution task and the care goal selected by the user, and the contents of the care service displayed on the service content display means are selected by the user. A home service plan, which is a document summarizing the entire care plan of each insured person based on the contents of the nursing care service, and each service used by each insured person A service usage vote, which is a table that summarizes the monthly plans and usage results of services, and a table that divides the monthly plan and usage results of each care service used by each insured person for each care service provider and summarizes them 10. A function as a form creation means for creating a certain service provision form.
Care plan creation support program described in. 12. In addition to the above means, a computer is provided. When the end date of the care goal extracted by the goal extraction means comes, the achievement status of the care goal, the life needs of the insured person, Display means for displaying a confirmation message relating to at least one of the following: a change in the status of the insured person, a change in the condition of the insured person, and the implementation status of the care service content extracted by the service content extraction means. A response input unit for inputting a response to the content, a care plan change promotion unit for prompting a change of the created care plan in accordance with the content of the response input by the response input unit, and a care plan change promotion unit. According to the content of the change, the common item data of each insured person input by the common item input means, the additional information input means At least one of the added additional information, the problem to be solved extracted by the problem extracting means, the care target extracted by the goal extracting means, and the care service content extracted by the service content extracting means is changed. The care plan creation support program according to claim 9, wherein the care plan creation support program is caused to function as a change unit that performs the change.