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Analysis of Hospital Characteristics Affecting the Choice of Management Strategy Types: A Cross-Sectional Survey of Private Hospitals in Japan

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Health 2017年第11期9卷 1494-1508页

作者： Yuji Mitadera Mayumi Watanabe Nobuhiro Sato motoi azumi Kouhei Akazawa Department of Medical Informatics and Statistics Niigata University Graduate School of Medical and Dental Sciences Niiga-ta Japan Department of Medical Informatics Niigata University Medical and Dental Hospital Niigata Japan

The hospital environment in Japan has changed drastically lately. Its unpredictability has increased the need for hospitals to select management strategies to clarify their course. However, research on Japanese hospitals’ management strategies has only recently begun with too few studies in this area. Hence, this study clarifies the management strategies of Japanese private hospitals. It explores the hospital characteristics that affect strategy selection. A questionnaire was mailed to 5682 private medical institutions in 2013, and 459 responses with no missing data were used for analysis. Factor analysis yielded four factors: “bed conversion and downsizing (Factor 1),” “diversification of medical and nursing care (Factor 2),” “expansion in business scale (Factor 3),” and “expansion of income from non-insured medical care (Factor 4)”. Logistic regression analysis revealed that Year Founded (before 1965), Hospital Location (municipalities with populations smaller than 100,000), Hospital Type (psychiatric hospitals and mixed-care hospital), and Hospital Income and Expenditure (deficit) had significant positive impacts on the choice of Factor 1. For Factor 2, Hospital Type (sanatorium ward and mixed-care hospitals) and Hospital Income and Expenditure (constant surplus) had positive impacts. For Factor 3, Hospital Type (general hospital) and Bed Counts (more than 200) had positive impacts. For Factor4, Hospital Type (general hospital) had positive impacts. In other words, older hospitals, hospitals in rural areas, psychiatric hospitals, mixed-care hospitals, and hospitals with deficits tended to choose bed conversion and downsizing. Sanatorium ward hospitals, mixed-care hospitals, and hospitals with a constant surplus tended to choose diversification of medical and nursing care. General hospitals and large hospitals tended to choose expansion in scale, and general hospitals tended to choose expansion into non-insured medical care. The planning of mid- to long-term manag

关键词： Hospital Management Strategies Healthcare Management Planning Hospital Diversification

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A Questionnaire Survey in Kidney Transplant Outpatients: Factors Associated with Good Self-Management

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Health 2015年第5期7卷 589-595页

作者： Minako Shimaya Mayumi Watanabe motoi azumi Kayo Shichiri Chikako Tomiyama Mayumi Tanabe Sachi Sato Kouhei Akazawa Department of Medical Informatics Niigata University Medical and Dental Hospital Niigata Japan Health Administration Center Niigata University Niigata Japan Department of Medical Technology Graduate School of Health Sciences Niigata University Niigata Japan Department of Nursing Niigata University Medical and Dental Hospital Niigata Japan

It is very important for outpatients who have had a kidney transplant to take care of themselves after discharge. However, outpatients have limited access to medical care by hospital staff after discharge;therefore, medical staff are unaware of the patient’s living conditions, and the uncertainties and problems that they encounter related to self-management. We conducted a questionnaire survey among 161 of 200 outpatients who received kidney transplants to investigate their recognition and actual practice of daily self-management. To determine the characteristics of adherent outpatients, we divided patients into two groups (the adherent and non-adherent group) and compared them. The Chi-squared test was conducted to test the equality of proportions among the groups, and then multiple logistic regression analysis was used to explore the factors significantly associated with regularly taking medicine or failing to take medicine. As a result of the logistic regression model using demographic factors as independent factors, the periods after transplantation (2 - 5 and 5 - 10 years) and living-donor kidney transplantation or cadaveric kidney transplantation were selected as significant factors associated with good self-management. As a whole, 68.3% of the 145 patients were correctly predicted using the model. The results of this study suggest that in the short period after transplantation (2 - 5 years), cadaveric kidney transplantation and that the patient has a job are significant factors associated with good self-management. Behind these results, a unique Japanese concept, “amae”, could be found. Therefore, medical knowledge and techniques as well as cultural background should be studied.

关键词： Renal Transplantation Living-Donor Kidney Cadaveric Kidney Amae Multiple Logistic Regression Analysis

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