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Development of a “Medical Care Quality” Evaluation System Centering on Local Residents
(Subject Adopted from On-Campus Public Invitation in the 2014 Year)
Research Project of the Advanced Research Center for Human Studies
Japan has led the world in crossing into the category of a super-aged society. It is being predicted that the year 2025, in which the baby boom generation will reach the age of 75, will see a breakdown of public finance due to increases in medical care expenses, as well as a deficiency in the supply of and a drop in the quality of medical services, causing Japan’s society to become one in which the elderly will not be able to easily rely on hospitals. In order to overcome the various issues being referred to as the “2025 Problems,” it is now becoming necessary for regional communities to make efforts toward reforming social systems to protect the health, medical care, and welfare of their people.
With severe problems characteristic of a super-aged society, including increasing numbers of elderly living alone and rapidly-growing numbers of people going missing due to dementia, manifesting in rapid succession in Japan, national medical policies have, as if to add insult to injury, set forth guidelines stating that “the last days of the elderly are to be spent not in hospitals, but accompanied by care at home whenever possible.” Immediately after the war, the percentage of people passing away in hospitals was roughly 10%, but due to the subsequent expansion in the medical care system, currently over 80% of people spend the last days of their lives in hospitals or other medical facilities. These guidelines are an attempt to return to the days of the past and of care at home. Even though the traditional issue of enriching services for elderly people dependent on care has not yet been sufficiently resolved, this further enormous challenge of shifting to home care for elderly patients who had previously received attentive care at hospitals will be newly added on top of it.
Inevitably, the change to an elderly society with a low birth rate also brings with it issues involving declines in economic activity, such as reductions in the labor force participation rate and lessened tax revenue. How then should regional communities in a period of low growth face the super-aged society, and secure the quality of health, medical care, and welfare? While taking steps from a wider policy-related viewpoint toward reforming the social systems that support communities, practical research activities constructing systems for support and information sharing via the practical application of IT are being undertaken in a research project by Waseda University’s Advanced Research Center for Human Sciences. Michikazu Ono, from the Faculty of Human Sciences and acting as research representative for the project, was asked for his views.
Professor Michikazu Ono, acting as research representative
Anticipating the “From Hospitals to Homes” Movement
Figure 1: Coordination System of Medical Care, Welfare, and Home Care in a Super-Aged Society
“In anticipation of the 2025 Problems, the basis of our joint research is a problem awareness stating that there is a need for us to think seriously about the condition of regional communities and about how to support the transfer of the medical care and nursing care of the elderly referred to as the ‘from hospitals to homes’ movement. To do this, it is of no use to split apart and discuss separately the issues of the elderly, medical care, and health. Instead, there is a need to look at them while anticipating overall reform of the mechanisms of regional communities from a broad viewpoint that includes concepts such as intergenerational coexistence and participation by citizens. If we were to make the boldest statement, we could say that the larger research objectives we are striving for are the reconstruction of the ‘purpose for living’ that is a key factor in birth, aging, sickness, and death of a super-aged society, the pursuit of ideal models for health, medical care, and welfare in regional communities with low growth, and the establishment of these as social systems while applying IT and other leading-edge technology.” (Professor Ono)
In the 2014 year, the topic “Development of a ‘Medical Care Quality’ Evaluation System Centering on Local Residents” (official title: “Development and Usability Verification of a Medical Quality Support System Evaluation Tool as a System for Voluntary Care Evaluation by Local Residents”) was raised. This is a project developmentally succeeding the 2013 year’s research project “Development of Care Paradigms and Regional Systems for Sharing and Survival to Support a Super-Aged Society with Declining Birth Rate.” In order to effectively apply the limited resources of a super-aged society with declining birth rate and to improve the quality of services, what is required is not a reliance on the policies of municipalities and the government, but for citizens receiving such services to possess their own strong value standards and evaluation criteria, and to make their own efforts to actively select services. This project is a practical study whose goal is to exercise sound market principles while keeping in mind evaluations of medical care and welfare from a user’s viewpoint, and also to create an environment in which each individual citizen can understand the systems of medical care and welfare, and is able to obtain and apply appropriate information and knowledge regarding them.
Figure 2: Research and Development Fields of the Project
Deployment of the Tokorozawa Health Care Project
The field of implementation of this practical study is Tokorozawa City, where the Waseda University Tokorozawa Campus, serving as the educational research base of the Graduate School of Human Sciences, the School of Human Sciences, and the School of Sport Sciences, is located. In conjunction with a series of projects, the “Tokorozawa City Health Care Communication System Joint Development Project (THCP)” was established. Beginning with Tokorozawa City’s Health Promotion Department - Public Health and Medical Treatment Division, Citizen’s Medical Center, and Health Care Center, this project was organized through collaboration among the industrial, academic, government, and private sectors, including relevant municipal organizations and groups, the Tokyo Women’s Medical University, and the Jikei University School of Medicine, and its initial meeting was held in January 2014.
“Using locations like these as platforms, joint studies for Grants-in-Aid for Scientific Research, with individual members acting as research representatives, are being deployed concurrently. From the standpoints of Professor Hiroko Kase’s support program for the elderly with dementia, Professor Shoji Nishimura’s health crisis response training applying e-learning, and my own specialized fields of palliative medicine and clinical thanatology, we are engaging in efforts to face the emotional issues associated with the age of home care head-on. Achieving progress has not been easy, however, even with the campus built in Tokorozawa and even though coordination with the community has been a long-standing task for this university. While of course making regional contributions through research, we are also continuing to build mechanisms that will allow many students to step out into the community in the fields of education and volunteer activities to deepen our relations with the people of the community.” (Professor Ono)
As a part of support efforts for the elderly with dementia, students are also involved in activities to go out and visit elderly citizens to listen to the stories they tell. This is because speaking about their own experiences, or their life history, is understood to be effective in preventing or slowing the progress of dementia. In addition, students are also actively engaging in other activities such as conducting operation tests of information sharing systems in the community using handheld devices and smartphones, and setting up places for citizens from different generations to learn from and speak with each other about living together in a regional community.
Collaborations with Tokorozawa City have already yielded research results, even for projects from the 2013 year. A full-scale study was conducted involving random sampling of 9,099 Tokorozawa City citizens for a questionnaire survey, to investigate each citizen’s specific medical behavior and level of satisfaction. These results are being deployed in research for the 2014 year on “medical care quality” evaluations by citizens.
Figure 3: Conceptual Diagram of Tokorozawa Health Care Communication System
Looking Toward the Cultivation of Specialized Human Resources to Secure the Quality of Medical Care
At the International Student Research Forum “Sustainable Healthy Lifestyles and Societies” at Al-Farabi Kazakh National University (Kazakhstan, September 2012)
Gathered around the President of Semey State Medical University after a debate on nuclear power and health (Kazakhstan, September 2012)
By 2025, it is likely that regional medical care and welfare systems will have gone through drastic and sweeping changes. At that time, continuing to enjoy the benefits of medical services with a high level of satisfaction will require advanced know-how to manage the medical care and welfare systems of the entire regional community. It is believed that there will be a need for the establishment of “quality management” methods for regional medical care, and a need for highly-specialized personnel available for consultation about them.
“With only limited resources, we must search for methods to provide health, medical care, and welfare services to each citizen in the most efficient and effective form possible. I would like to see specialized personnel with their own views on social systems for these purposes to be cultivated and developed at our graduate school. Based on the results of our joint research, we are striving to establish such specialized courses in the near future.” (Professor Ono)
Through educational exchanges with Monash University in Australia, known for being an area advanced in regional medical care, programs are also being deployed for students on both sides of the exchanges to learn from each other. Opportunities such as educational exchanges with Kazakhstan, where the medical care system is underdeveloped, are also being arranged to learn about the current state of Japan through comparisons with other countries, and to participate in discussions with foreign people from younger generations.
“To overcome the 2025 Problems and build regional communities that can ensure the prosperous lifestyles of their citizens, those citizens must become ‘smart patients.’ The first essential step toward this is instilling in these citizens a sense of participation. We perceive our goal to be not simply the investigation of the awareness possessed by citizens, but the process of joining together with them in order to build our future.” (Professor Ono)
Regional communities with low growth in the age of a super-aged society with a declining birth rate are an issue common to every region in Japan, and by extension to every region of every developed country. There are high hopes and expectations for the establishment of models for ideal social systems of health, medical care, and welfare that is the ultimate goal of this project.