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. 2011 Jan;11(Spec 10th Anniversary Ed):e125.
Epub 2011 Sep 23.

Integrated care through disease-oriented clinical care pathways: experience from Japan's regional health planning initiatives

Etsuji Okamoto  1 , Masaki Miyamoto, Kazuhiro Hara, Jun Yoshida, Masaki Muto, Aizan Hirai, Haruyuki Tatsumi, Masaaki Mizuno, Hiroshi Nagata, Daisuke Yamakata, Hiroshi Tanaka
Affiliations

Integrated care through disease-oriented clinical care pathways: experience from Japan's regional health planning initiatives

Etsuji Okamoto et al. Int J Integr Care. 2011 Jan.

Abstract

Introduction: In April 2008, Japan launched a radical reform in regional health planning that emphasized the development of disease-oriented clinical care pathways. These 'inter-provider critical paths' have sought to ensure effective integration of various providers ranging among primary care practitioners, acute care hospitals, rehabilitation hospitals, long-term care facilities and home care.

Description of policy practice: All 47 prefectures in Japan developed their Regional Health Plans pursuant to the guideline requiring that these should include at least four diseases: diabetes, acute myocardial infarction, cerebrovascular accident and cancer. To illustrate the care pathways developed, this paper describes the guideline referring to strokes and provides examples of the new Regional Health Plans as well as examples of disease-oriented inter-provider clinical paths. In particular, the paper examines the development of information sharing through electronic health records (EHR) to enhance effective integration among providers is discussed.

Discussion and conclusion: Japan's reform in 2008 is unique in that the concept of 'disease-oriented regional inter-provider critical paths' was adopted as a national policy and all 47 prefectures developed their Regional Health Plans simultaneously. How much the new regional health planning policy has improved the quality and outcome of care remains to be seen and will be evaluated in 2013 after the five-year planned period of implementation has concluded. Whilst electronic health records appear to be a useful tool in supporting care integration they do not guarantee success in the application of an inter-provider critical path.

Keywords: Japan; care pathways; critical path; disease management; electronic health record; regional health planning.

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Figures

Figure 1
Figure 1
Subregions of Tochigi prefecture RHP.
Figure 2
Figure 2
The front page of the electronic health record for inter-provider critical path for diabetes.
Figure 3
Figure 3
Inter-hospital critical path for strokes (to be shared by different providers).
Figure 4
Figure 4
Inter-hospital critical path for strokes (for paMr./Ms.).
Figure 5
Figure 5
Web page of K-MIX for data input of critical path for diabetes.
See this image and copyright information in PMC

References

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    1. Ministry of Health, Labour and Welfare. Nousocchu jouhou shisutemu moderu jigyou handobukku. [Handbook of the model project of information system for strokes]. Tokyo: Dai-ichi Houki; 1992. [in Japanese]
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