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目的 北区版チェックリストを用いた要支援者の要介護状態への移行リスクを予測するための基準設定を導きだすための検討を行った。方法 平成18年度から平成20年度の3年度中に2年度連続して介護予防ケアプランを作成した331人を対象とし,予防給付サービスの利用状況及び北区版チェックリストの点数と介護度悪化防止への影響をx^2検定及びロジスティック回帰分析を用いて算出した。結果 予防通所介護で有意な関連が認められたが、北区版チェックリストとの間では関連は認められなかった。結論 予防通所介護の利用者において介護度悪化防止への有意な影響が認められた。北区版チェックリストの点数の変化は介護度の悪化防止への影響を示唆するものではないと考えられ、利用者の全体像を理解し、生活機能を評価するためのツールとして機能し、その評価を介護予防ケアプランに反映させるための多職種協働でのケアマネジメントのプロセスの重要性が考察された。, Purpose To establish criteria for estimating the risk of a "requirement for long-term care" among persons receiving assistance using a checklist developed by Kita-City, Tokyo. Methods The subjects of this study were 331 elderly people for whom a "care plan for prevention" was developed in two consecutive fiscal years during the period from fiscal years 2006 to 2008. The influence on the utilization of "prevention benefits," as well as on the prevention of worsening of the Kita-Ward checklist score and an increase in the level of long-term care required, were examined by using the chi-squire test and logistic regression analysis. Results A significant relationship was identified with "preventive day care service," but not with "the Kita-City checklist." Conclusion The effect of utilizing the preventive day care service on the prevention of an increase of the care need level was found to be significant in elderly people who used this service. Changes of the Kita-City checklist score were not associated with the prevention of an increase in the level of long-term care required. The results of this study indicate that it is essential to understand the background of users of preventive day care services, to utilize the Kita-City checklist as a tool to assess the daily life functioning of elderly people, and to establish a more appropriate care management process in which a "plan for care prevention" is developed in cooperation with multiple health care professionals based on the outcome of assessment., 首都大学東京, 2012-03-25, 修士（看護学）

Background The German statutory health insurance (GKV) reimburses all health care services that are deemed sufficient, appropriate, and efficient. According to the German Medical Association (BÄK), individual health services (IGeL) are services that are not under liability of the GKV, medically necessary or recommendable or at least justifiable. They have to be explicitly requested by the patient and have to be paid out of pocket. Research questions The following questions regarding IGeL in the outpatient health care of GKV insurants are addressed in the present report: What is the empirical evidence regarding offers, utilization, practice, acceptance, and the relation between physician and patient, as well as the economic relevance of IGeL? What ethical, social, and legal aspects are related to IGeL? For two of the most common IGeL, the screening for glaucoma and the screening for ovarian and endometrial cancer by vaginal ultrasound (VUS), the following questions are addressed: What is the evidence for the clinical effectiveness? Are there sub-populations for whom screening might be beneficial? Methods The evaluation is divided into two parts. For the first part a systematic literature review of primary studies and publications concerning ethical, social and legal aspects is performed. In the second part, rapid assessments of the clinical effectiveness for the two examples, glaucoma and VUS screening, are prepared. Therefore, in a first step, HTA-reports and systematic reviews are searched, followed by a search for original studies published after the end of the research period of the most recent HTA-report included. Results 29 studies were included for the first question. Between 19 and 53% of GKV members receive IGeL offers, of which three-quarters are realised. 16 to 19% of the insurants ask actively for IGeL. Intraocular tension measurement is the most common single IGeL service, accounting for up to 40% of the offers. It is followed by ultrasound assessments with up to 25% of the offers. Cancer screening and blood or laboratory services are also frequent and represent a major proportion of the demand. The ethical, social, and legal aspects discussed in the context of IGeL concern eight subject areas: autonomous patient decisions versus obtrusion, commercialization of medicine, duty of patient information, benefit, evidence, and (quality) control, role and relation of physicians and patients, relation to the GKV, social inequality, formally correct performance. For glaucoma screening, no randomized controlled trial (RCT) is identified that shows a patient relevant benefit. For VUS three RCT are included. However, they do not yet present mortality data concerning screened and non-screened persons. VUS screening shows a high degree of over-diagnosis in turn leading to invasive interventions. To diagnose one invasive carcinoma, 30 to 35 surgical procedures are necessary. Conclusion IGeL are a relevant factor in the German statutory health care system. To provide more transparency, the requests for evidence-based and independent patient information should be considered. Whether official positive and negative-lists could be an appropriate instrument to give guidance to patients and physicians, should be examined. Generally, IGeL must be seen in the broader context of the discussions about the future design and development of the German health care system., GMS Health Technology Assessment; 7:Doc05; ISSN 1861-8863