Establishment of the outcome based TQM (Total Quality Management ) system for Institutional care for the elderly

参照美国基于MDS数据的养老院质量审核体系，我们在日本一家技术养老院（698张床位）建立了类似的体系。在养老院，MDS数据已经被采集了三年。系统建立后，每个单元可计算出24项质量指标，系统对护理质量的监测效果良好。为了在研究中使用24QI，我们分析了194名连续住在该机构3年的老年人的数据。护理水平的改变，作为结果，QI20（服用抗焦虑药或安眠药）、QI24（压疮）和QI15（脱水）是显著影响因素。这些因素在美国也被定义为关键因素，这些结果表明MDS的QI监测在日本也很有用。对于预防跌倒，我们特别关注，我们分析了三个机构的跌倒记录的详细数据。结果和预防措施各不相同。我们的结论是，分析每个设施与自身环境相关的数据，以及基于这些数据的PDCA循环是重要的。我们也检验了自动断轮轮椅干预的效果。对于三个干预病例，该干预降低了整个跌倒发生率。此外，研究结果还表明，在设施护理TQM（全面质量管理）方面，护理劳动的安全观念和提供的质量都是必要的。最后，本研究结果将于2007年出版机构照护品质管理教材。

Following the US audit check system for the nursing home quality based on MDS data, we established the similar system in one skilled nursing home (698beds) in Japan. In the nursing home, MDS data have been taken for three years. After the system established, they could calculate 24 Quality Indicators by each unit, and the system was effective to monitor quality of care.To utilize the 24QI in the research, we analyzed the data for 194 elderly who lived the institution continuously during 3years. Care-level change, as outcome, the QI20 (took of the antianxiety agent or the sleeping medicine), QI24 (pressure sore), and QI15 (dehydration) were significant affecting factors. These factors are defined as critical factors in US system as well and these results suggested that the QI monitor by MDS be useful in Japan as well.For the fall prevention, we paid special attention to, we analyzed the detail data of fall records in three institutions. The result and prevention were varied. We concluded that the analysis of data on individual each facility related to their own environment, and PDCA cycle based on such data is important. We also examined the effect of auto-break wheel chair intervention. For three intervention cases, the entire fall incidence was reduced by this intervention.Moreover, it was shown that the aspect of both of the concept of safety in the nursing labor and the offered quality was necessary in the aspect of facilities caring TQM (Total Quality Management).Finally, the text book for the quality management in institutional care will be published based on the result of this research in 2007.