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[Outcome based quality-improvement methods in visiting nursing services (VNS) in Japan: practical report and
N Tamiya1, K Shichita, K Takasaki
1Department of Hygiene & Public Health, Teikyo University School of Medicine.
Summary
Quality Improvement (QI) in Japanese visiting nursing services (VNS) is crucial. A modified QI method using "unexpected cessation of home care" as an outcome measure identified avoidable causes and informed future care improvement plans.
Area of Science:
- Healthcare Management
- Nursing Quality Improvement
- Geriatric Care
Background:
- Public long-term care insurance in Japan necessitates robust Quality Improvement (QI) for visiting nursing services (VNS).
- Existing QI methods for VNS primarily focus on structure or process, lacking outcome-based performance data.
- There is a need for practical, outcome-focused QI strategies adaptable to Japanese VNS settings.
Purpose of the Study:
- To implement and evaluate a modified QI method for Japanese VNS, utilizing "unexpected cessation of home care" as a key outcome indicator.
- To identify avoidable causes of home care cessation and develop targeted improvement strategies within VNS institutions.
- To assess the feasibility and limitations of this outcome-based QI approach in real-world VNS settings.
Main Methods:
- Retrospective analysis of "unexpected cessation of home care" cases over one year in three diverse Japanese VNS institutions.
- Blind assessment of cessation cases by nurses to categorize them as "avoidable" or "unavoidable."
- Discussion and implementation of necessary improvements for avoidable cessation cases, adapting to facility capabilities.
Main Results:
- The incidences of unexpected home care cessation were 46%, 40%, and 42% across the three institutions.
- A significant proportion of these cessations were categorized as "avoidable" (47, 39, and 15 cases, respectively).
- Improper nursing assessment of patient condition changes emerged as the primary cause of avoidable home care cessation.
Conclusions:
- The modified QI method effectively identified unique institutional problems and facilitated the creation of specific QI plans to prevent home care cessation.
- Challenges in implementation included lengthy analysis times and difficulties in engaging part-time staff.
- Recommendations for broader adoption include recognizing QI importance, computerization, third-party consignment, and shorter investigation periods.