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

在1993年4月至1995年3月的研究期间进行了三次调查(1)通过邮件对大阪府所有医院进行了调查，以探讨建立医疗信息系统的可行性，该系统将在保健中心登记与中风患者有关的数据。共收到421家医院填写的问卷，回复率为72%。这些医院中有89%为中风患者提供住院治疗。70%治疗中风患者的医院表示，他们愿意参与医疗信息系统的建立。2)在大阪市保健中心审查了公共保健护士对中风残疾人进行家访的有关数据。对这些数据进行分析，以确定影响日常生活活动（ADL）变化的因素。研究对象——1149名残疾人——根据生活自理能力的变化分为三组：改善、稳定或恶化。更多的ee因素被发现与ADL恶化相关；年事已高，家庭护理条件差，缺乏体育锻炼。公共卫生护士评估为提供家庭护理条件差的家庭可能具有以下特点：(1)照顾者能力低（一人家庭、白天不在、生病等），(2)住房条件差（没有浴室、日式厕所、小房子等），以及(3)收入水平低（有保障的收入领取者等）。3)对大阪市各保健中心脑卒中患者死亡证明资料进行回顾和分析。主要研究结果如下：(1) 1990年大阪市中风死亡率为每10万人106.3人。(2) 85%的死亡发生在医院，14%发生在家中。(3)在医院死亡中，81%发生在大阪市。(4)卒中后30天内死亡占总死亡人数的53%。根据这些调查的结果，我们讨论(1)建立医疗信息系统的可行性和(2)为脑卒中患者提供社区护理所需的条件。少

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