医療観察法における鑑定入院の質の評価—鑑定入院アウトカム指標の確立を目指して

Evaluating Quality of Hospitalization for Assessment in the Medical Treatment and Supervision Act:For establishing outcome measures of hospitalization for assessment

抄録　医療観察法の鑑定入院制度については，鑑定入院の目標設定が曖昧でアウトカムを事後的に評価する仕組みがない，という問題が指摘されていた。我々は先行研究において，鑑定入院のアウトカムを評価するための指標として139項目を抽出した。本研究ではこれらの項目を試用し，鑑定入院対象者およびその関係者から意見を聴取することを通じて，鑑定入院アウトカム指標の確立を試みた。計20例の対象者にかかわる延べ160人から回答を得た。対象者本人の納得や多職種チームの協働などに関する34項目が，可用性が高く，かつ現時点での達成率が十分でないことが示された。これらの項目が，鑑定入院のアウトカム評価のため有用である可能性が示唆された。

　Medical Treatment and Supervision Act, enforced in 2005 in Japan, was established to properly treat persons who committed serious crime in the state of insanity. In this Act, subjects are to be hospitalized for assessment preceding the judgment. However, the outcome measures of the hospitalization for assessment remain unqualified. We attempted to clarify the elements of the outcome measures through a series of questionnaire surveys to the subjects, their family members, and relevant professionals in each case to examine the 139 candidates of outcome measures established in the preceding study. We gained the answers from a total of 160 people. We identified 34 items from 139 candidates as they had high usability and still challenging from the result of questionnaire. These items will be utilized as measures to evaluate the quality of each hospitalization for assessment. However, this result is preliminary and require further qualification.