The study on integrated community based program of health promotion

为了在社区层面实施综合健康促进计划，有必要构建目标人群的筛查体系。在此分析中，我们在九州地区地方政府的协助下构建了这样一个系统。该系统由2002年和2003年6582名助理级老年人的医疗保险索赔和长期护理保险索赔（包括家庭医生评估表）组成。在此基础上，我们构建了基于OLAP的分析系统。以下是主要发现：1)骨骼肌疾病（OMD）、脑血管疾病（CVD）和心脏疾病是导致依赖的三大原因。(2)虽然老年慢性阻塞性肺病的人均医疗支出和长期治疗支出不规律，但由于老年慢性阻塞性肺病的高患病率，其总支出占比最大。3)OMB是女性医疗和LTCI支出以及男性心血管疾病支出的最重要原因。4)人均医疗支出与LTCI支出呈极显著负相关。5)与医疗和LTCI支出增加显著相关的因素是家庭年龄和年龄较高。研究结果表明，综合卫生信息系统对于政策制定的综合分析是非常有用的工具。该系统使筛查高危人群成为可能，同时对卫生项目的有效性进行评估。为了促进这类卫生信息系统的建设，电子索赔的全面实施是必不可少的。

In order to implement an integrated health promotion program at community level, it is necessary to construct the screening system of the target population. In this analysis we have constructed such a system with the assistance of a local government in Kyushu area. The system composes of medical insurance claim and long term care insurance (LTCI) claim (including the evaluation sheet of home doctor) for the 6582 assistant required level elderly persons in 2002 and 2003.Based on this data base, we have constructed the OLAP based analysis system. The followings are major findings ;1)Osteo-muscular diseases (OMD), Cerebro-vascular diseases (CVD) and cardiac diseases are three major causes for dependency.2)Although the per-capita medical and LTCI expenditures of aged with OMD are rather law, the total expenditure due to OMD was the most important because of its high prevalence rate.3)OMB is the most important cause of medical and LTCI expenditures for female, and CVD for male.4)There is very week negative correlation between per capita medical and LTCI expenditures.5)The factors significantly associated with the increase in medical and LTCI expenditures are aged household and higher age.As shown in our study, the integrated health information system is very useful tool for the comprehensive analyses for policy making. This system make it possible to screen the high risk population and at the same time to evaluate the effectiveness of health programs. In order to facilitate the construction of this kind of health information system, the complete implementation of e-claim is indispensable.