回避可能な救急搬送・入院を予防する介入の有効性と実行可能性に関する有料老人ホーム施設長の認識

Perceptions of Administrators of Fee-based Homes for the Elderly Regarding the Effect and Feasibility of Interventions to Prevent Potentially Avoidable Emergency Transfers and Hospitalizations

抄録

　高齢者施設から急性期病院への避けられる救急搬送や入院は，入居者のQOL（quality of life；生活の質）の向上や医療資源の効率的活用のために予防することが望ましい．本研究は，回避可能な救急搬送・入院を予防する介入の有効性と実行可能性に関する有料老人ホーム施設長の認識を明らかにすることを目的とした．首都圏A市の有料老人ホーム150施設に自記式質問紙を郵送し，55施設（36.7％）から回答を得た．文献検討から作成した回避可能な救急搬送・入院を予防する介入15項目について有効性は高く認識されていた（67.3〜87.3％）．15項目すべてにおいて実行可能性よりも有効性の方が高く認識されていた．最も有効と認識された項目は，看護師と医師の「情報連携のためのコミュニケーションツール（87.3％）」で，平均要介護度が高い施設でより有効と認識された（p＝0.039）．実行可能性が低いと認識された項目は「高齢者ケアに関する知識や技術のある看護師の雇用（20.0％）」であった．日本の有料老人ホームにおいて回避可能な救急搬送・入院を予防する介入の導入や介入研究の実施のために，介入内容の実行可能性を高める必要性が示唆された．

　Potentially avoidable hospitalizations in acute care hospitals should be prevented to improve the quality of life of residents and to use medical resources in fee-based homes for the elderly efficiently. The purpose of this study is to clarify the perceptions of facility managers of fee-based homes for the elderly regarding the effect and feasibility of initiating interventions to prevent potentially avoidable emergency transfers and hospitalizations. A self-administered questionnaire was mailed to administrators at 150 facilities in a city of the metropolitan area; responses were received from 55 facilities (36.7%). The effectiveness of the interventions developed by the authors based on the literature review was generally highly recognized by the administrators (67.3〜87.3%). All interventions were perceived to be more effective than feasible. The interventions that were recognized as particularly effective were “communication tools for information cooperation between nurses and doctors” (87.3%), which were also recognized as more effective in facilities with a high average level of nursing care (p = 0.039). On the other hand, the intervention that was recognized as being less feasible was “employment of nurses with knowledge and skills in elderly care (20.0%).” These findings suggest that it is necessary to increase the feasibility of introducing interventions and conducting intervention studies in fee-based homes for the elderly in Japan to prevent potentially avoidable emergency transfers and hospitalizations.