担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）  

Home-visit nursing can reduce early readmissions and improve quality of life in older patients with heart failure (HF). In Japan, allocation of home-visit nursing often depends on Long-Term Care Insurance (LTCI) certification, which is determined primarily by functional status within budgets. This study examined whether LTCI certification is associated with the frequency of early home-visit nursing. We retrospectively analyzed 88 patients with HF who initiated home-visit nursing at a single agency between 2014 and 2024. The outcome was the number of visits within the initial 2 weeks comparing patients with and without LTCI. Negative binomial regression estimated incidence rate ratios (IRR), adjusting for age, sex, activities of daily living (ADL), physician-issued special direction, and eligibility under Separate Tables 7 and 8 of the medical insurance system. The median age was 86 years [IQR 82-90], and 74 patients (84.1%) were LTCI-certified. Cross-tabulation showed no significant association between LTCI certification and ADL level (χ² = 6.60, df = 3, P  = .086). LTCI certification was associated with fewer visits (IRR = 0.67, 95% CI 0.49-0.91, P  = .011). Compared with ADL “independent,” the “bed-bound” category received more visits (IRR = 1.99, 95% CI 1.28-3.10, P  = .002). Physician-issued special direction was associated with higher visit frequency (IRR = 3.39, 95% CI 2.59-4.48, P  < .001). These findings suggest that function-based, budget-capped frameworks may under-allocate nursing intensity for medically complex HF patients. Aligning visit planning with medical risk in the early post-discharge period may improve equity and care quality.

DOI： 10.1177/10848223251397543

その他URL： https://journals.sagepub.com/doi/full-xml/10.1177/10848223251397543

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

Background The home-death rate is widely used in Japan as an indicator of community-based end-of-life care; however, this rate includes deaths without professional involvement. This study examines whether the home-death rate reflects medically attended home-based deaths across municipalities. Methods An ecological panel study was conducted using data from 1,741 municipalities obtained in 2017, 2020, and 2023 (5,222 municipality-year observations). National datasets from the Ministry of Health, Labor, and Welfare include data on medical institutions, home-visit nursing services, and clinic-certified home deaths. The dependent variable was the proportion of deaths occurring at home. Explanatory variables included home deaths certified by home-care support clinics and general clinics as well as deaths under home-visit nursing reimbursed by medical or long-term care insurance. Fixed-effects panel regression models with municipality and year effects were applied, using cluster-robust standard errors. Finally, correlations between the model residuals and prefectural rates of coroner-investigated deaths were examined to explore the influence of non-medical deaths. Results Home deaths certified by general clinics and deaths under medical-insurance-reimbursed visiting nursing were significantly associated with higher home-death rates (β=4.06, 95% confidence interval (95%CI), 1.28–6.85; β=31.75, 95%CI 8.14–55.37, respectively). The associations between home-care support clinics and long-term care insurance-reimbursed visiting nursing were not significant. No correlation was found between residuals and prefectural rates of coroner-investigated deaths (r=0.09, 95%CI, –0.20–0.37). Conclusions Japan’s home-death rate partly reflects medically attended home deaths, particularly those involving general clinics and medical-insurance-reimbursed visiting nursing. However, because this rate also includes deaths without professional care, it should be interpreted as a contextual rather than a quality indicator of end-of-life care and complemented by measures capturing care involvement and coordination.

DOI： 10.12688/f1000research.172900.1

その他URL： https://f1000research.com/articles/14-1272/v1/pdf

認知機能や身体機能が低下した80歳代の腹膜透析(PD)を行っている男性患者への訪問看護の支援について報告した。対象患者は40歳代のときにI型糖尿病と診断され、インスリンの自己注射を行っていた。1年前にかかりつけ医より腎機能低下を指摘され、PD導入となった。認知機能障害がみられ、身体的ADLの低下により、セルフケアも家族の支援も困難な状態であった。本人や家族のPD関連手技やインスリン皮下注射が困難であり、訪問看護師が手技の実技を担うこととした。訪問看護導入3ヵ月後、右上肢の脱力が観察され、左中脳動脈領域の脳梗塞を認め入院となり、2ヵ月後自宅退院となった。さらに2ヵ月後より自身での体位変換が困難となり、褥瘡を認め、訪問看護師による褥瘡処置を実施した。訪問看護師がPD手技を全面的に担い、あわせて食事介助などの生活支援を行い治療継続できていたが、1ヵ月後自宅にて死亡した。

掲載種別：研究論文（学術雑誌）  

DOI： 10.35772/ghm.2025.01040

PubMed

CiNii Research

精神科訪問看護に際し患者情報が病院から看護師へ十分に伝達されているか、訪問看護を行う看護師を対象として主観的に評価してもらった。日本全国にわたる訪問看護の事業者、2000団体に対し横断調査を実施し482団体から回答を得、その回答内容が有効であった481団体(回答率8.0%)のデータを解析した。看護師が求めた患者情報に対し、受け取った情報が充足した比を算出してその対数を取ることで患者情報の充足性の指標とした。統計解析の結果、求めた情報と提供された情報の間にみられた落差は、どの項目でも有意な差として検出されたことが明らかになった(p<0.001)。充足度が最も低かった患者情報の項目は、心理検査の結果、精神症状悪化の徴候、精神症状への対処方法(コーピング方略)であった。逆に最も充足度が高かった項目は処方の詳細と診断であった。患者情報の申し送りを向上させるため、充足度が低かった大事な項目が必ず提供情報に含まれるよう、病院は退院時要約を再検討し修正すべきであると結論された。

目的 本研究は,2015年から2021年における全国1,741市町村を対象に訪問看護事業所数の増加が入院医療費および総医療費に与える影響を定量的に検証することを目的とした。方法 本研究は,厚生労働省や政府統計の総合窓口(e-Stat),総務省による公開情報から,2015年から2021年における各市町村の総人口,65歳以上人口,世帯数,病院数,在宅療養支援診療所数,訪問看護事業所数,平均所得割額,入院医療費,総医療費を収集した。目的変数に総医療費および入院医療費,説明変数に訪問看護事業所数,調整変数に人口密度,高齢化率,世帯当たり人口,病院数,在宅療養支援診療所数,平均所得割額を投入したプールドOrdinary Least Squaresモデル,固定効果モデル,変量効果モデルを作成した。作成した3つのモデルから,F検定,Breusch-Paganのラグランジュ乗数検定,ハウスマン検定を用いて,最も適切なモデルを選択した。有意水準は5%と設定した。結果 2015年から2021年にかけて,全国の市町村における訪問看護事業所数,高齢化率,入院医療費,総医療費は全体的に増加傾向を示した。入院医療費,総医療費いずれのモデルにおいても,モデルの比較において固定効果モデルが最も支持された。固定効果モデルの結果より,訪問看護事業所数の係数は入院医療費に対して627.4(95%信頼区間:456.0-798.7,p<0.001),総医療費に対して857.9(95%信頼区間:700.1-1,015.7,p<0.001)であり,訪問看護事業所数の増加が医療費の増加と有意に関連していた。結論 本研究は,訪問看護事業所数の増加が入院医療費および総医療費の増加と有意に関連していることを明らかにした。これらの結果は,訪問看護の供給拡大が短期的な医療費削減に直結しない可能性を示唆している。しかし,訪問看護は患者のQOL向上や在宅療養の継続など,医療費以外にも重要な効果をもたらす可能性があり,その総合的な価値を評価する必要がある。また,予防的な介入は短期的には医療費を増大させるが,長期的には重篤な疾患の進行予防により医療費を是正させる可能性もある。そのため,より長期における訪問看護の効果を検証する必要がある。医療費の適正化と質の高いケアの両立を目指し,訪問看護の質の向上,標準化,質評価の強化,診療報酬制度の見直しなど,多角的な政策対応が求められる。(著者抄録)

担当区分：筆頭著者   掲載種別：研究論文（国際会議プロシーディングス）   国際・国内誌：国際誌  

Accurate prognostic prediction is essential in end-of-life care, particularly in Japan, where cultural values emphasize the importance of being present at the time of death. However, tools that are both accurate and feasible for use in home settings remain limited. Home-visiting nurses are often the primary healthcare professionals most involved during the terminal phase, providing detailed observations through their nursing records. These records may offer valuable insights for prognostic prediction in home-based care. A retrospective analysis was conducted using nursing records from 71 patients who received care from the Nana-r Home-visit Nursing Station between April 2016 and December 2023. Data from the final month before death were analyzed, comprising 1,217 nursing records and 57,884 words of text data. Text mining with KH Coder was used to examine co-occurrence networks and analyze keyword patterns in relation to the number of days until death. The analysis identified themes such as excretion-related activities, distress symptoms, skin and oral health, and consciousness levels. Temporal patterns revealed that terms like "walking" and " eating" were more common earlier, while "consciousness," "breathing," and "urination" appeared closer to death, reflecting systemic decline. These findings suggest that nursing records, particularly their free-text descriptions, provide meaningful insights into the terminal phase. Integrating these observations with quantitative data may support the development of practical tools to improve care strategies for patients receiving end-of-life care in home settings.

DOI： 10.5057/isase.2025-c000006

CiNii Research

担当区分：筆頭著者   国際・国内誌：国内誌  

目的 本研究は，2015年から2021年における全国1,741市町村を対象に訪問看護事業所数の増加が入院医療費および総医療費に与える影響を定量的に検証することを目的とした。
方法 本研究は，厚生労働省や政府統計の総合窓口e-Stat，総務省による公開情報から，2015年から2021年における各市町村の総人口，65歳以上人口，世帯数，病院数，在宅療養支援診療所数，訪問看護事業所数，平均所得割額，入院医療費および総医療費を収集した。目的変数に総医療費および入院医療費，説明変数に訪問看護事業所数，調整変数に人口密度，高齢化率，世帯当たり人口，病院数，在宅療養支援診療所数，平均所得割額を投入したプールドOrdinary Least Squaresモデル，固定効果モデルおよび変量効果モデルを作成した。作成した3つのモデルから，F検定，Breusch-Paganのラグランジュ乗数検定およびハウスマン検定を用いて，最も適切なモデルを選択した。有意水準は5%と設定した。
結果 2015年から2021年にかけて，全国の市町村における訪問看護事業所数，高齢化率，入院医療費および総医療費は全体的に増加傾向を示した。入院医療費，総医療費いずれのモデルにおいても，モデルの比較において固定効果モデルが最も支持された。固定効果モデルの結果より，訪問看護事業所数の係数は入院医療費に対して627.4 (95%信頼区間: 456.0～798.7，p < 0.001)，総医療費に対して857.9 (95%信頼区間: 700.1～1,015.7，p < 0.001) であり，訪問看護事業所数の増加が医療費の増加と有意に関連していた。
結論 本研究は，訪問看護事業所数の増加が入院医療費および総医療費の増加と有意に関連していることを明らかにした。これらの結果は，訪問看護の供給拡大が短期的な医療費削減に直結しない可能性を示唆している。しかし，訪問看護は患者のQOL向上や在宅療養の継続など，医療費以外にも重要な効果をもたらす可能性があり，その総合的な価値を評価する必要がある。また，予防的な介入は短期的には医療費を増大させるが，長期的には重篤な疾患の進行予防により医療費を是正させる可能性もある。そのため，より長期における訪問看護の効果を検証する必要がある。医療費の適正化と質の高いケアの両立を目指し，訪問看護の質の向上，標準化，質評価の強化，診療報酬制度の見直しなど，多角的な政策対応が求められる。

担当区分：筆頭著者   掲載種別：研究論文（その他学術会議資料等）  

This study examined the effects of increasing home-visit nursing agencies and nurses per agency on home death rates in Japan, considering the growing demand for end-of-life care. Publicly available data from 1,741 municipalities from 2016 to 2022 were analyzed using Pooled Ordinary Least Squares, Fixed-Effects, and Random-Effects models. Covariates such as population density, proportion of the older population, household size, number of hospitals, and home clinics were included. The Fixed-Effects model showed that each additional home-visit nursing agency increased the home death rate by 0.06% (p = .010), and each additional nurse per agency increased it by 0.11% (p = .001). Expanding the workforce within existing agencies may have a greater impact on home deaths than merely increasing the number of agencies. Future research should consider factors like family caregiving capacity and regional healthcare practices to improve home-based end-of-life care strategies.

DOI： 10.51094/jxiv.1164

CiNii Research

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.7759/cureus.80878

PubMed

担当区分：筆頭著者  

DOI： 10.17605/OSF.IO/JXS5P

本研究は,訪問看護導入時の訪問看護回数とその後の入院・施設入所との関連を検証した.1訪問看護事業所において2016年4月～2023年12月に訪問看護を終了した65歳以上の利用者468名を対象とした.対象者の入院・施設入所を目的変数,訪問看護開始2週間の訪問回数を説明変数としたロジスティック回帰分析を行った.基本属性や生活自立度などを共変数として調整したロジスティック回帰分析により,入院・施設入所に対する訪問看護開始2週間の訪問回数のオッズ比(95%信頼区間)は,0.93(0.89-0.97)であった.高齢療養者の初期の訪問看護回数が,その後の入院・施設入所に関連することが示唆された.(著者抄録)

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）  

The distribution of home-visit nursing offices in Japan is uneven, with some municipalities facing shortages. Understanding the factors influencing their growth rate is crucial for policy planning. This study developed a machine learning model to predict the growth rate of home-visit nursing offices using municipality-level time-series data from 2015 to 2022. Demographic indicators, healthcare resources, and economic factors were incorporated as predictors. Extreme Gradient Boosting (XGBoost) was employed, integrating one-year and three-year lag variables and a three-year moving average to capture temporal trends. Model performance was assessed using R², and Shapley Additive Explanations (SHAP) analysis was conducted to interpret feature importance. The model demonstrated strong predictive performance, with an average R² of 0.87. The past number of home-visit nursing offices had the highest impact on growth, with the three-year moving average contributing positively and the one-year lag variable indicating potential market saturation. Population density was also positively associated with growth. Although the aging rate had a limited overall influence, a higher aging rate tended to be associated with a lower growth rate of home-visit nursing offices. Economic indicators and the number of hospitals had minor influences. These findings suggest that market conditions and supply-side constraints significantly shape the expansion of home-visit nursing offices. Strategic interventions, such as financial support in underserved areas and sustainability measures in saturated regions, are needed to ensure an optimal distribution of services. Future research should explore additional socioeconomic factors and external shocks to refine predictive models and support data-driven policymaking.

DOI： 10.30574/wjarr.2025.25.2.0602

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1080/2050571X.2024.2403239

担当区分：筆頭著者  

DOI： 10.30574/wjarr.2025.25.1.4043

担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.24546/0100491788

PubMed

精神科における病院から訪問看護への情報伝達の現状と情報に対する訪問看護師の満足感への影響要因を明らかにすることを目的に,精神科訪問看護を行う看護師を対象としたアンケート調査を実施した.483名(回収率8.5%)の回答から.病院からの情報伝達について満足していたのは2割弱に留まった.また,8割以上が情報量の不足を感じ,情報の質は高いと回答した回答者は1割に満たなかった.情報提供への満足感の有無に対する多変量ロジスティック回帰分析によるオッズ比(95%信頼区間)は,情報量:2.7(1.7-4.5),情報の質:3.5(2.0-5.8),看護サマリーの頻度:3.5(1.6-7.9)であった.(著者抄録)

カテコラミン持続点滴を行う心不全患者の転帰と訪問看護介入の影響を調べるため、後ろ向き症例シリーズ研究を行った。心不全のため在宅でカテコール持続点滴を受けており、2016年4月～2024年3月に当訪問看護ステーションでケアを行った40歳代～90歳代の患者8例(男性6例、女性2例、年齢中央値68.5歳)を対象とした。在宅でのカテコラミン持続点滴を要した疾患として最も多かったのは拡張型心筋症であった。カテコラミン持続点滴期間は中央値58.0日、訪問看護の頻度は中央値で週8.4回であった。緊急訪問看護の頻度は週0.7回で、調査期間中に45回発生し、その最も多い理由は点滴装置の故障の管理であった。8例中6例が自宅で死亡し、1例が致死的不整脈により入院し、1例がカテコラミン持続点滴を中止した。

会議種別：口頭発表（一般）  

Accurate prognostic prediction is essential in end-of-life care, particularly in Japan, where cultural values emphasize the importance of being present at the time of death. However, tools that are both accurate and feasible for use in home settings remain limited. Home-visiting nurses are often the primary healthcare professionals most involved during the terminal phase, providing detailed observations through their nursing records. These records may offer valuable insights for prognostic prediction in home-based care. A retrospective analysis was conducted using nursing records from 71 patients who received care from the Nana-r Home-visit Nursing Station between April 2016 and December 2023. Data from the final month before death were analyzed, comprising 1,217 nursing records and 57,884 words of text data. Text mining with KH Coder was used to examine co-occurrence networks and analyze keyword patterns in relation to the number of days until death. The analysis identified themes such as excretion-related activities, distress symptoms, skin and oral health, and consciousness levels. Temporal patterns revealed that terms like "walking" and "eating" were more common earlier, while "consciousness," "breathing," and "urination" appeared closer to death, reflecting systemic decline. These findings suggest that nursing records, particularly their free-text descriptions, provide meaningful insights into the terminal phase. Integrating these observations with quantitative data may support the development of practical tools to improve care strategies for patients receiving end-of-life care in home settings.

会議種別：ポスター発表  

Aims: Japan’s aging population has increased the demand for home-based end-of-life care, and policies have led to a steady increase in home-visit nursing agencies. This study investigates how the number of home-visit nursing agencies and the number of nurses per agency influence home death rates across Japanese municipalities. Methods: Panel data from 1,741 municipalities between 2019 and 2022 were used to analyze the relationship between home death rates and the number of home-visit nursing agencies and nurses per agency. Data were sourced from the Ministry of Health, Labour and Welfare and the Ministry of Internal Affairs. Control variables included population density, aging rate, household numbers, hospital numbers, home clinic numbers and average income tax amount. Statistical models, including fixed effects, random effects, and Pooled Ordinary Least Squares, were applied, with model comparisons based on F-tests, Lagrange Multiplier tests, and Hausman tests. The analysis was conducted using Python (3.11.2) at a 5% significance level. Results: The fixed effects model was selected as the most appropriate. The model demonstrated significant associations between the number of home-visit nursing agencies (β = 0.06, p = 0.010) and nurses per agency (β = 0.11, p = 0.001) with higher home death rates. Conclusions: Both the number of agencies and the number of nurses were significant; however, the strength of association for nurses per agency was larger. This suggests that increasing the scale of existing agencies, by adding more nurses, may be more important than simply increasing the number of agencies to improve home-based end-of-life care.

会議種別：ポスター発表  

会議種別：ポスター発表  

会議種別：ポスター発表