JP7282867B2 - Regional Comprehensive Care Business System - Google Patents

Description

An embodiment of the present invention relates to a regional comprehensive care business system for executing a regional comprehensive care business including a long-term care insurance business.

In the fields of medical care and nursing care, there is a large amount of computerized data, including receipt data. For example, a national health insurance database (medical and long-term care integrated DB) owned by the Federation of National Health Insurance Organizations exists as a database that integrates insured person qualification information, medical receipt information, nursing care receipt information, and the like. There are information sources that hold information on medical care and nursing care at the same time, and there is a need to promote collaboration between home medical care and nursing care. It was difficult to evaluate such activities.

However, it is known that there are patients, such as patients who are hospitalized in hospitals (especially chronic hospitals), who can expect to be discharged from the hospital due to the enhancement of home medical care services. One of the reasons why it is difficult for people to return home after being discharged from the hospital is that it is unclear whether they can use home medical services at home. In addition, from the perspective of business operators providing home medical care services, there is no way to know whether there is a need in a certain area, so it is difficult to develop services. Conceivable.

For example, at present, home-visit medical care is performed in units of small regions, but even with the quantitative analysis results of this home-visit medical care, it is not possible to grasp the needs of home-visit medical care in the relevant small region. In other words, in areas where there is little or no home care infrastructure, it is thought that potential users of home care services who have needs are hospitalized because they cannot receive medical services at home.

In addition, it is conceivable that some users of nursing care services may be able to maintain or improve their mental and physical conditions by receiving home medical care services. However, when only nursing care services are used, there is no opportunity to contact medical experts who can judge whether medical care is necessary or not, and there are cases where latent needs for home medical care services cannot be recognized.

Although the analysis of the amount of services related to home medical care and long-term care cooperation has been explained above, the analysis of the amount of long-term care insurance services has the same background. In other words, the optimal (ideal) long-term care insurance service based on the user's various attributes (disease, level of long-term care, degree of self-reliance with dementia, degree of self-reliance with disability, mental and physical condition related to other certification survey items, care ability, etc.) Although a combination is assumed, there are many cases in which the combination of services has not actually been achieved. The reason for this is thought to be that local governments do not take into account the provision of optimal service levels according to the various attributes of users living in the area when formulating long-term care insurance business plans. Conventionally, sufficient solutions have not been taken to solve this problem.

JP-A-2002-132947

The aforementioned issues can be resolved by quantitatively grasping the balance between supply and demand for home care services on a regional basis. In this case, there is a possibility of transitioning to home medical service users who are hospitalized and using medical services, and home medical care cooperation who are using nursing care services without recognizing latent needs for home medical care services The number of potential welfare and long-term care users is grasped, and this is used as the demand amount. In addition, the amount of supply is defined as the number of users who use medical services and nursing care services at home, that is, the number of users who realize cooperation between home medical care and nursing care. By grasping the amount of demand and the amount of supply for each sub-region, it is possible to clarify the amount of home medical care and nursing care services that should be provided in which sub-region.

In the above description, services covered by medical insurance are referred to as medical services, and services covered by long-term care insurance are referred to as long-term care services. This notation will be treated uniformly hereafter. In addition, welfare-related in-home care services (home-visit care, outpatient care, short-term admission, home-visit bathing, rental of welfare equipment), welfare-related in-home care services, medical-related in-home care services (home-visit nursing, home-visit rehabilitation, outpatient rehabilitation, home care guidance) is abbreviated as home care, and home care service is abbreviated as home care.

In addition, regarding the issues related to the long-term care insurance business plan mentioned above, various attributes of users in each region It is possible to solve the problem by grasping the apparent amount of supply according to the power, etc.) and the amount of demand required for those attributes.

The present invention uses an integrated medical and nursing care database to quantify the relationship between demand and supply of nursing care services, which could not be quantified until now, and provides a regional integrated care business system that achieves optimal supply of nursing care services. That's what it is.

An integrated community care business system according to an embodiment of the present invention includes an information source provided with an integrated medical and nursing care database having at least insured person information, medical insurance claim information, name of injury and disease information, and certification information requiring long-term care regarding medical care and nursing care; Using the information held by the information source, long-term care insurance users who have multiple preset items of mental and physical conditions , are the attributes of long-term care insurance users, disease, degree of long-term care, degree of independence with dementia, degree of independence with disability, certification survey Items, mental and physical conditions equivalent to care ability , etc. are extracted as subjects, and for each of these extracted subjects, the type of nursing care service that the user actually receives and the amount of this nursing care service by type In addition to calculating the apparent supply amount of services by different mental and physical conditions, etc., for each of the above-mentioned extracted subjects , the combination of the disease, which is the mental and physical condition, the level of care required, the degree of independence from dementia, the degree of independence from disability, and the ability to care Separately, there is a service requirement determination table by mental and physical condition that defines the necessity and required amount of various nursing care services, and nursing care services are divided into home-visit nursing care services, day care services, short office care services, and other services. , and from the nursing care service judgment table that defines which services fall under each category of nursing care service, the type of nursing care service that each subject should originally receive and the amount of each type of nursing care service as the necessary amount of demand for services classified by mental and physical conditions, etc., for each user, and calculating the difference between the apparent supply amount and the necessary demand amount for each type of nursing care service. characterized by

According to the above configuration, it is possible to objectively show the required demand amount, actual supply amount, and demand-supply difference of nursing care services.

It is a figure explaining the information source used for embodiment of this invention. BRIEF DESCRIPTION OF THE DRAWINGS It is a functional block diagram which shows the whole community comprehensive care business system structure which concerns on embodiment of this invention. It is a figure which shows the service necessity determination table|surface classified by psychosomatic condition etc. used for embodiment. It is a figure which shows the care service determination table|surface used for embodiment. FIG. 10 is a diagram for explaining the calculation logic of service usage record amount (actual supply amount) classified by user's physical and mental condition, etc., in the embodiment. FIG. 4 is a diagram for explaining logic for calculating required service amount (required demand amount) for each user's individual mental and physical condition, etc. in the embodiment; FIG. 10 is a diagram for explaining the calculation logic of the supply amount for each sub-region of the sub-region analysis unit in the embodiment; It is a figure explaining the calculation logic of the demand amount classified by subregion of the subregion analysis part in embodiment. FIG. 4 is a diagram for explaining calculation logic of a demand-supply difference for each sub-region by a sub-region analysis unit in the embodiment; It is a figure explaining the subdivided determination table used when subdividing and analyzing the care service in embodiment.

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

FIG. 1 shows the configuration of an information source 1 used in the integrated community care business system according to this embodiment. In FIG. 1, an integrated medical and nursing care database (hereafter referred to as integrated medical and nursing care DB) 1.1, which is one of the information sources 1, includes insured person information 1.1.1, medical receipt information 1.1.2, nursing care receipt information 1.1.3, name of injury or disease information 1.1.4, long-term care requirement certification information 1.1.5, and medical examination information 1.1.6.

In the embodiment of the present invention, a number (symbol) for identifying an individual, an age that can be calculated from the date of birth, and an address code are utilized from the insured person information 1.1.1. In addition, the classification number for recognizing the classification of medical treatment from the medical receipt information 1.1.2 and the nursing care service type code used from the nursing care receipt information 1.1.3 are utilized. Furthermore, the disease information and the classification of the state of need for care are utilized from the injury or disease name information 1.1.4 and the care need certification information 1.1.5. In addition, in order to improve the accuracy of the quantitative analysis, information other than the above in the integrated medical and nursing care DB 1.1 and other information sources 1.2 other than the integrated medical and nursing care DB 1.1 are used.

FIG. 2 shows the overall configuration of the regional comprehensive care business system according to the embodiment of the present invention. This regional comprehensive care business system is constructed as a computer system including the information source 1 shown in FIG. 1, and each functional block described below represents a function executed by this computer system.

The long-term care insurance business plan analysis unit 16, which is the main body of the regional comprehensive care business system in FIG. have

The target person extraction unit 16.1 by long-term care insurance business plan classification uses the medical care integrated DB 1.1 to extract the target person by mental and physical condition, etc. by the extraction unit 16.1.1 of the target person by mental and physical condition, etc. . Here, the mental and physical conditions and the like correspond to various attributes of users of long-term care insurance (disease, level of nursing care required, degree of self-reliance with dementia, degree of self-reliance with disability, certification survey items, care ability, etc.). Subjects classified by mental and physical conditions, etc. are subjects having various attributes set in advance among users of long-term care insurance. The extracting unit 16.1.1 of subjects classified by mental and physical conditions, etc., extracts the insured person information 1.1.1, the medical insurance claim information 1.1.2, the nursing care insurance claim, and the medical care insurance integrated DB 1.1 shown in FIG. The target person mentioned above is extracted using the information 1.1.3 and the long-term care requirement certification information 1.1.5.

The subregion setting section 2.2 defines the relationship between address codes and subregions. That is, the sub-area division determination unit 2.2.1 determines sub-area divisions, and the address code sub-region division association setting unit 2.2.2 converts the results into a tabular format. set.

The sub-region analysis unit 16.2 analyzes the supply and demand of nursing care services, which will be described later, for each sub-region, and the user sub-region identification unit 16.2. to identify a small area. Calculation units 16.2.2 and 16.2.3 also calculate the supply and demand for nursing care services, that is, the actual supply and the required demand for each subregion. Furthermore, from the quantitative value of the demand and supply calculated for each sub-region, the sub-region demand and supply difference calculation unit 16.2.4 calculates the sub-region demand and supply difference.

The actual supply amount is the amount of service actually received by the extracted target person, and the required demand amount is the amount of service that the extracted target person should originally receive.

FIG. 3 shows a determination table (hereinafter referred to as the required service amount determination table 17 for each mental and physical condition) showing the data configuration of the required service amount determination unit 17 for each mental and physical condition. In this mental and physical condition-based service requirement determination table 17, nursing care services are classified into home-visit nursing care services, outpatient nursing care services, and short-term admission nursing care services. Regarding mental and physical conditions (each attribute), each judgment value, that is, disease 1 to 5, care need level condition classification support 1 to care need 5, dementia independence level I to M, disability independence level J, A, B, C, and care force are set to large, small, and the like.

In this mental and physical condition-specific service required amount determination table 17, depending on the combination of the physical and mental condition disease, level of nursing care level, dementia independence level, disability independence level, and care ability, what kind of person is the subject of each mental and physical condition? In order to determine whether or not to receive such care services, it defines the necessity (whether or not there is a white circle) and the required amount (number of units, times (days)) of various care services.

Here, the care ability is assumed to be, for example, living alone (no care ability), living together (with care ability), and living together (no care ability).

In addition to the disease, consider the relationship between the healing status of the disease and the service by combining various test items (blood test results for evaluating the state of the disease, etc.), which are status items related to medical care. becomes possible. Furthermore, in addition to the long-term care status classification, dementia independence, and disability independence, various certification survey items (group 1: ADL, group 2: IADL, group 3: cognitive function, group 4: mental/behavior Disability, etc.) can also be considered based on the correspondence relationship between mental and physical conditions and nursing care services. Furthermore, it is also possible to consider economic capacity (insurance premium level, etc.) in addition to nursing care capacity.

FIG. 4 shows a determination table representing the data configuration of the care service determination unit 18 (hereinafter referred to as the care service determination table 18). In this care service determination table 18, care services are classified, specific service names are listed, and determination as to which service corresponds to various care service classifications is defined. That is, in the care service determination table 18, the care services are classified into visiting care services, outpatient care services, short office care services, and other services.

Home-visit care services include home-visit care, home-visit bathing, home-visit nursing care, home-visit rehabilitation, and home care management guidance. Day care services include day care, day rehabilitation, and the like. Short-term inpatient care services include short-term inpatient life care and short-term inpatient life care (health for the elderly). Other services include facility-based services such as special nursing homes, group homes, living care for residents of specific facilities, and small-scale multi-functional services.

Nursing care service determination table 18 represents each of the above-mentioned nursing care services by a nursing service name (nursing care 1 to nursing care 6), and these nursing care services are home-visit nursing care services, general nursing care services, short-term admission nursing care services, and Which of the other services corresponds is defined with a white circle mark.

Service determination definitions can be changed by updating the above determination table.

The target person extraction unit 16.1 by long-term care insurance business plan classification shown in FIG. Based on 1.1.2, nursing care receipt information 1.1.3, nursing care certification information 1.1.5, and other information in DB 1.2, the subject by mental and physical condition etc. is extracted, but here it is extracted For the selected target person, the actual service usage record (actual supply amount) classified by mental and physical conditions, etc., for each user is extracted, and the service required amount (required demand amount) classified by mental and physical conditions, etc. for each user is extracted. These specific processes will be described with reference to FIGS. 5 and 6. FIG.

As shown in FIG. 5, service usage record (actual supply amount) 19 by user's mental and physical condition is obtained from various record information in medical care integrated DB 1.1 and other DB 1.2 having address codes etc. as information sources. , and is extracted using the care service determination table 18 shown in FIG. At this time, the extracted data is associated with an address code for each user.

In FIG. 5, among the subjects extracted from the various information in the integrated medical and nursing care DB 1.1 and the other DB 1.2, for example, the user with the individual user code [a3692a2] has a disease name [disease 1 ], nursing care level category [need nursing care 3], degree of independence with dementia [I], degree of independence with disability [J2], and care ability [high care ability]. Service name [Nursing care 1], number of units [600], number of times (days) [3], and care service name [Nursing care 3], number of units [800], number of times (days) [5] ], indicating that they do not receive short-term nursing care services.

On the other hand, FIG. 6 shows the service required amount (necessary demand amount) 20 by mental and physical condition, etc. for each user. This necessary demand amount 20 is obtained from the insured person information 1.1.1 of the integrated medical and nursing care DB 1.1 and the other DB 1.2 having address codes, etc. It is extracted using the amount judgment table 17 and the care service judgment table 18 shown in FIG. In this case as well, the extracted data is associated with an address code for each user.

In FIG. 6, the same target person as the user explained in FIG. For the person, the mental and physical condition is the same as the name of disease [disease 1], level of nursing care requirement [3], degree of independence with dementia [I], degree of independence with disability [J2], and care ability [high care ability]. However, the services that should be received are the care service name [care 1], the number of units [900], the number of times (days) [5], and the care service name [care 3]. There are two types, the number of units [1200] and the number of times (days) [8], and no short-term inpatient nursing care service is received.

In this way, there is a difference between the amount of nursing care service that should be received in FIG. 6 and the amount of nursing care service actually received in FIG. is occurring.

Next, these demand and supply quantities are analyzed for each sub-region by the sub-region analysis unit 16.2 shown in FIG. That is, regarding the extraction results of the actual service usage amount (actual supply amount) 19 by user's mental and physical condition, etc. shown in FIGS. , the user subregion identification unit 16.2.1 uses the address code to identify the subregion of the user, and the calculation units 16.2.2 and 16.2.3 determine the actual supply by subregion. Calculate quantity and required quantity. Furthermore, from the quantitative value of the demand and supply calculated for each sub-region, the sub-region demand and supply difference calculation unit 16.2.4 calculates the sub-region demand and supply difference. These will be described in detail below.

First, calculation of the apparent supply amount will be described with reference to FIG. The apparent supply amount calculation unit 16.2.2 for each service type by service type, such as mental and physical conditions by small area, shown in FIG. From the results of other service usage (actual supply amount) 19, the number of people by area is counted to eliminate duplication using the sub-area classification table 11.1 and additional extraction conditions 11.2, and the sum of the number of units and the sum of the number of times is the actual supply An actual supply amount analysis table 21 for each sub-region calculated as an amount is created.

The sub-area division table 11.1 is a table that associates address codes with sub-areas. Further, by setting conditions according to the additional extraction condition 11.2 when calculating the actual supply amount, it is possible to calculate the supply amount in various cases. For example, it is possible to apply extraction conditions that utilize information such as service types and ages. Furthermore, by performing extraction together with state image items related to nursing care and life, it is possible to extract by combining various certified survey items (ADL, IADL, cognitive function, mental/behavioral disorders, etc.).

Next, the calculation of the required amount of demand will be described with reference to FIG. The necessary demand amount calculation unit 16.2.3 for each service type by service type, such as mental and physical conditions by small area shown in FIG. From the separate service required amount (necessary demand amount) 20, the number of people for each small area is counted by removing duplicates using the small area classification table 11.1 and the additional extraction condition 11.2, and the sum of the number of units and the sum of the number of times is calculated as the required demand A necessary demand quantity analysis table 22 for each sub-region calculated as a quantity is created.

In addition, the required amount of units and number of times is based on the values defined in the mental and physical condition etc. service required amount determination table 17, and the demanded amount and supply amount of the number of people are the values calculated from the medical care integrated DB 1.1 be.

The demand and supply difference calculation unit 16.2.4 for each subregion shown in FIG. 2 calculates the demand and supply difference for each subregion from the quantitative values of demand and supply calculated for each subregion as described above. Details will be described below with reference to FIG.

As shown in FIG. 9, the sub-regional demand and supply difference calculation unit 16.2.4 calculates demand for each service category from the aforementioned sub-regional apparent supply analysis table 21 and sub-regional required demand analysis table 22. Calculate the sum of (the number of people, the number of units, the number of times (days)) and the amount of supply (same as the left), and obtain the results shown in Table 23.1 of Analysis of Demand and Supply by Small Area. Furthermore, the ratio of demand to supply is defined by the following equation (2).

Ratio of demand to supply = Necessary demand ÷ Apparent supply (2)
The demand-to-supply ratio of the number of people in the example of FIG. 9 is calculated as follows for each of subregion a, subregion b, and subregion c.

Demand to supply ratio of subregion a = 75/50 = 1.5
Demand to supply ratio of subregion b = 45/30 = 1.5
Demand to supply ratio of subregion c = 15/10 = 1.5
At this time, the adjustment unit 23.2 can adjust the supply amount considering whether the amount of nursing care service provided by the existing nursing care service provider exceeds the capacity or vice versa. Conceivable. Specifically, it is realized by multiplying the supply amount, which is the denominator of the calculation, by the adjustment amount. This is a process for considering the possibility of maintaining a balance between demand and supply without changing the care service provider's system against the difference between supply and demand.

As shown in FIG. 10, the classification of service types can be subdivided. In Figures 3 to 9, three major categories (home-visit care services, outpatient care services, and short-term inpatient care services) were explained, but the same analysis was performed by subdividing into the service types that make up each major category. can be implemented. In other words, home-visit care services are divided into home-visit care, home-visit bathing, home-visit nursing, home-visit rehabilitation, and in-home care management guidance, etc., and outpatient care services are divided into outpatient care, outpatient rehabilitation, etc., and short-term inpatient care. The services may be divided into short-term inpatient life care, short-term inpatient life care (elderly health care), and the like, and aggregate analysis may be performed. At this time, the analysis can be performed by the same method as in the case of the three major classifications.

While several embodiments of the invention have been described, these embodiments have been presented by way of example and are not intended to limit the scope of the invention. These novel embodiments can be embodied in various other forms, and various omissions, replacements, and modifications can be made without departing from the scope of the invention. These embodiments and their modifications are included in the scope and gist of the invention, and are included in the scope of the invention described in the claims and equivalents thereof.

1...Information source 1.1...Integrated medical care database
1.1.1 Insured Person Information 1.1.2 Medical Receipt Information 1.1.3 Nursing Care Receipt Information 1.1.4 Injury or Sickness Name Information 1.1.5 Nursing Care Certification Information 1.1 .6 Health checkup information 1.2 Other information sources (information that can be associated with information in the integrated medical and nursing care DB)
2 Home medical care cooperation analysis part 2.2 Small area setting part 2.2.1 Small area classification determination part 2.2.2 Address code small area classification related setting part 16 Long-term care insurance business plan analysis part 16 16.1...Target person extraction unit by long-term care insurance business plan classification 16.1.1...Target person extraction unit by mental and physical condition, etc. 16.2...Small area analysis unit 16.2.1...User small area identification unit 16.1. 2.2 Calculation unit for actual supply amount by service type by physical and mental condition, etc. by sub-region 16.2.3 Calculation unit for required demand amount by service type by physical and mental condition, etc. by sub-region 16.2.4 Demand by sub-region Supply difference calculation unit 17 -- Service required amount determination table by mental and physical condition, etc. 18 -- Nursing care service determination table 19 -- Actual service usage amount (apparent supply amount) by user, by mental and physical condition, etc.
20 … Required amount of service (necessary amount of demand) according to physical and mental condition, etc., of each user
21... Small area supply analysis table 22. Small area demand analysis table 23.1. Small area demand and supply analysis table 23.2.

Claims (4)

an information source comprising an integrated medical and nursing care database having at least insured person information, claim information, injury or disease name information, and long-term care certification information regarding medical and nursing care;
Using the information held by this information source, long-term care insurance users who have multiple preset items of mental and physical conditions are identified as attributes of long-term care insurance users, such as illness, degree of care required, degree of independence with dementia, degree of independence with disability, and certification. The subjects are extracted according to survey items, mental and physical condition equivalent to care ability , etc., and for each of these extracted subjects, the type of nursing care service actually received and the amount of this nursing service by type are used. In addition to obtaining the apparent supply amount of services by mental and physical conditions, etc. for each person, for each of the extracted subjects, the physical and mental conditions of disease, level of care need, degree of independence with dementia, degree of independence with disability, and care ability For each combination, there is a service requirement judgment table by mental and physical condition that defines the necessity and required amount of various nursing care services, and nursing care services are divided into home-visit nursing care services, day care services, short office care services, and Based on the long-term care service judgment table that categorizes into other services and defines which services fall under each type of long-term care service classification, the type of long-term care service that each subject should originally receive and the amount of each type of long-term care service as the required amount of demand for services by mental and physical condition, etc., for each user, and the difference between the actual supply amount and the required amount of demand is calculated for each type of nursing care service;
A regional comprehensive care business system characterized by comprising: The long-term care insurance business plan analysis department
A target person extraction unit for each mental and physical condition, etc., that obtains the actual supply amount of the service for each mental and physical condition, etc. for each user and the necessary demand amount for the service for each user, for each mental and physical condition, using the information held by the information source. and,
a sub-region setting unit in which a relationship between an address code and determination of a pre-determined sub-region division is set;
Calculate the actual supply and the necessary demand for each sub-region from the actual supply and the necessary demand obtained by the subject person extraction unit by mental and physical condition, etc., and compare the actual supply and the necessary demand. a subregional analysis unit that calculates the difference for each subregion;
The regional comprehensive care business system according to claim 1, characterized by comprising: The apparent supply volume for each sub-region is the number of people receiving the same type of service in the corresponding sub-region, the number of service units, and the number of service times, and the required demand for each sub-region is the same service for the corresponding sub-region. 3. The integrated regional care business system according to claim 2, wherein the type is the number of people who should receive the service, the number of units of service, and the number of service times. 2. The long-term care insurance business plan analysis unit obtains the difference between the actual amount of supply and the required amount of demand as a demand-to-supply ratio obtained by dividing the required amount of demand by the actual amount of supply. The regional comprehensive care business system according to any one of claims 1 to 3.

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