[Examination of local alliances in clinical path (home parenteral nutrition)].

In revising compensation for medical treatment, shifts in home care systems such as management of lifestyle-related diseases, management of a patient within reach of a daily medical treatment, and an attempt to curtail hospitalization are suggested as concrete means of planning medical expenses to be appropriate. In doing this, it is getting more important that the medical institution pursue its purpose and must select the course of treatment and to solidify a medical cooperation among the institutions because a medical treatment is often not concluded at only one medical institution. Although a revision of compensation for medical treatment is getting more difficult due to three consecutive negative revisions in the past, a new clinical path for a local solidarity of femoral neck fracture has been found. Because of this revision, we think that it is necessary to make a system able to shift medical treatment and to care from hospital to facilities in the district and at home. We studied the clinical path in order to develop an effective and solidified cooperation with people of the district with regard to home parenteral nutrition, which is the most frequent medical treatment in case of a home care shift from that of our hospital's support for patients leaving the hospital.

[Utilization of the screening test for discharge support].

We hand out a list of screening tests for discharge support (the screening) to all patients upon admission, so that they can receive an early discharge. Implementing the screening as a balanced score card (BSC) evaluation index of the work performance by the nursing division, we were able to screen more than 40% of newly admitted patients immediately after the introduction of the screening. When more than two items of the screening questionnaire were checked, a discharge support intervention was introduced. Patients who checked items on the screening questionnaire have tended to request discharge support within a week of admission.