Kayama Mami, Kido Yoshifumi, Setoya Nozomi, Tsunoda Aki, Matsunaga Asami, Kikkawa Takahiro, Fukuda Takashi, Noguchi Masayuki, Mishina Keiko, Nishio Masaaki, Ito Junichiro
BMC Psychiatry. 2014 Nov 18;14:311. doi: 10.1186/s12888-014-0311-y.
Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP.
This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time.
The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families".
These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.
日本仍是世界上精神科患者床位比例最高的国家。2011年，为了减少与门诊医疗服务失去定期联系的患者再次住院的情况，日本厚生劳动省设立了日本外展模式项目（JOMP）。在本研究中，我们将阐述JOMP项目方案，并调查住院率和住院时长、随访期（6个月和12个月）的社会功能损害和问题行为，以及JOMP提供服务的时间。
这项纵向回顾性研究使用了2011年9月至2013年7月期间从日本21个县的32个外展团队收集的调查数据。在基线、6个月和12个月时评估结局变量，以确定参与者是否住院。对162名难以与精神卫生服务保持联系的精神疾病患者的数据进行了分析。重复测量方差分析显示干预随时间有显著效果。
JOMP参与者在6个月时的住院率为24.1%，在12个月随访时为27.2%。基线时和12个月时的平均住院时长为38.7天（标准差84.7）。与基线相比，在6个月和12个月随访后，总体功能评估和社会行为量表的平均得分有显著改善。活动日志显示，JOMP最常提供的服务包括“预防躯体症状加重”和“照顾家庭”。
这些结果表明，与日本公共保险的常规门诊护理相比，JOMP在降低再入院率和住院时长、改善社会功能和问题行为方面具有强大潜力。JOMP团队为家庭提供了长期支持。截至2014年4月，JOMP以有限的方式被纳入国民健康保险计划，因此必须对JOMP团队在再入院方面的保真度进行评估。
