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

遵循美国基于MDS数据的养老院质量审核体系，我们在日本的一家技能型养老院(698张床位)建立了类似的体系。在养老院，MDS数据已经采集了三年。系统建立后，每个单位可以计算出24个质量指标，该系统对护理质量的监测是有效的。为了将24QI用于研究，我们分析了194名连续居住3年的老年人的数据。护理水平的变化作为结果，QI20(服用抗焦虑剂或安眠药)、QI24(压疮)和QI15(脱水)是显著的影响因素。这些因素在美国系统中也被定义为关键因素，这些结果表明MDS的QI监测在日本也是有用的。为了预防跌倒，我们特别关注了三个机构的跌倒记录的详细数据。结果和预防各有不同。我们的结论是，分析每个设施与其自身环境有关的数据，以及基于这些数据的PDCA循环是重要的。我们还检查了自动刹车轮椅干预的效果。在3个干预案例中，通过本次干预降低了整体跌倒的发生率。此外，护理人员的安全理念和提供的质量在设施护理TQM(全面质量管理)方面都是必要的。最后，根据本研究的结果，将于2007年出版机构护理质量管理教材。

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.