title: Factors influencing cooperation among healthcare providers in a community-based stroke care system in Japan.
abstract: Community-based stroke care in Japan is currently provided in acute hospitals, convalescent rehabilitation units, general practices, sanatorium-type wards, nursing care facilities, and in-home/commuting care services. We conducted a nationwide survey to identify factors influencing cooperation among the various providers of community-based stroke care. We sent questionnaires to 11,178 facilities and assessed the independent variables of excellent and fair cooperation among the care providers. Of the providers that responded, 66% were engaged in medical practice or long-term care for stroke patients. The following independent variables were inversely associated with excellent or fair cooperation in the community: area with the higher population density among 3 groups divided by tertile threshold (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.41-0.69), facilities covered by long-term care insurance (OR, 0.27; 95% CI, 0.22-0.34), and insufficient communication with local government (OR, 0.19; 95% CI, 0.14-0.24). Positive independent variables of excellent or fair cooperation were the sharing of patient information in the community (OR, 2.53; 95% CI, 1.78-3.66), use of a scale for assessing activities of daily living (OR, 1.93; 95% CI, 1.42-2.63), appropriate utilization of care support managers (OR, 1.91; 95% CI, 1.43-2.55), and adequate comprehension of the long-term care insurance system (OR, 1.54; 95% CI, 1.24-1.92). Our findings suggest that improved communication between healthcare providers and local government, along with appropriate attention to the problems facing providers covered by long-term care insurance, may improve community-based stroke care in Japan.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. koga@hsp.ncvc.go.jp
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Uehara
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yasui
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D016009:Chi-Square Distribution; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D017048:Health Care Costs; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health; D007373:Interinstitutional Relations; D007564:Japan / Q000453:epidemiology; D009111:Local Government; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D058996:Quality Improvement; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome