The Japanese Pressure Ulcer Surveillance Study: A Retrospective Cohort Study To Determine Prevalence of Pressure Ulcers in Japan

  • Thu, 9/4/08 - 11:52am
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Author(s): 
Hiromi Sanada, RN, PhD, WOCN;1 Yoshiki Miyachi, MD, PhD;2 Takehiko Ohura, MD, PhD;3 Takahiko Moriguchi, MD, PhD;4 Keiko Tokunaga, RN, ET, PhD;5 Koichi Shido, MD, PhD;6 Gojiro Nakagami, RN, MHS1

The increasing population of elderly people with high medical treatment costs throughout Japan is leading to an escalating financial burden.1 Pressure ulcers (PUs) are one of the most striking conditions affecting medical costs and quality of life among patients, specifically bed-ridden patients.2 In October 2002 a new governmental regulation system related to management of pressure ulcers was introduced in Japan. The Japan Ministry of Health, Labour, and Welfare implemented this regulation in all hospitals covered by the National Medical Insurance system. The regulation included a reduced reimbursement of 50 yen (about 48 cents) per patient for each hospitalized day unless the following 3 requirements were met: 1) establishment of a pressure ulcer specialist team including both physicians and nurses, 2) introduction of the standardized clinical protocol for management of pressure ulcers for each patient starting from the time of admission according to their activities of daily living, and 3) provision of adequate bedding support according to the patients’ medical and nursing requirements. This was the first attempt to reduce the medical expenditures using a penalty system and helped raise awareness among medical professionals concerning the management of pressure ulcers. Whether this system actually reduced PU prevalence was not determined.

Surveillance of pressure ulcer prevalence has been conducted by the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel in the United States and Europe, respectively.3,4 In Japan a study of this proportion has yet to be performed. This is partly due to the lack of social awareness regarding pressure ulcers.5 This particular factor may contribute to the mistaken perception that the PU prevalence was notably low in Japanese hospitals, seeing that only relatively small studies including a limited number of patients at risk for pressure ulcers have been conducted in Japan.

The purpose of this study was to evaluate the governmental regulation system by investigating the PU prevalence using retrospective cohort methods prior to and 1 year after implementation of this regulation. The relationship between the change in prevalence relative to hospital structure and system was also investigated.

References: 

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