A study of a medical information system and a community care system for the tertiary prevention of stroke in a metropolitan area

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Three surveys were conducted during the study period from April 1993 to March 1995.1) All hospitals in Osaka Prefecture were surveyed by mail to explore the feasibility of establishing a medical information system in which data pertaining to stroke patients would be registered at health centers. Completed questionnaires were received from 421 hospitals (response rate of 72%). Eighty-nine percent of these hospitals offered inpatient care for stroke patients. Seventy percent of hospitals treating stroke patients stated that they were willing to participate in the institution of a medical information system.2) Data pertaining to home visits by public health nurses to persons with disabilities from stroke were reviewed at Osaka City health centers. These data were analyzed to identify the factors influencing changes in activities of daily living (ADL). The subjects-1,149 persons with disabilities-were divided into three groups according to changes in ADL : improved, stable or worsened. Thr … More ee factors were found to be associated with worsened ADL ; advanced age, poor conditions for the provision of home care and lack of physical exercies. The households assessed by public health nurses as providing poor conditions for home care were likely to have the following features : (1) low capacity of care takers (one-person household, absence at day time, sickness, etc.), (2) bad housing conditions (lack of a bath room, Japanese style toilet, small house, etc.), and (3)low levels of income (assured income recipients, etc.).3) Data of death certificates for stroke patients were reviewed and analyzed at Osaka City health centers. The main findings were as follows. (1) The mortality rate from stroke in Osaka City in 1990 was 106.3 per 100,000 popuation. (2) 85% of deaths occurred in hospital, and 14% occurred at home. (3) Among deaths in hospital, 81% occurred in Osaka City. (4) Those who died within thirty days after the onset of stroke accounted for 53% of total deaths.From the results of these surveys, we discuss (1) the feasibility of instituting a medical information system and (2) the conditions necessary for the provision of community care for stroke patients. Less