title: Integrated care through disease-oriented clinical care pathways: experience from Japan's regional health planning initiatives.
abstract: BACKGROUND
  In April 2008, Japan launched a radical reform in regional health planning that emphasized the development of disease-oriented clinical care pathways. These 'inter-provider critical paths' have sought to ensure effective integration of various providers ranging among primary care practitioners, acute care hospitals, rehabilitation hospitals, long-term care facilities and home care.
  
  
  METHODS
  All 47 prefectures in Japan developed their Regional Health Plans pursuant to the guideline requiring that these should include at least four diseases: diabetes, acute myocardial infarction, cerebrovascular accident and cancer. To illustrate the care pathways developed, this paper describes the guideline referring to strokes and provides examples of the new Regional Health Plans as well as examples of disease-oriented inter-provider clinical paths. In particular, the paper examines the development of information sharing through electronic health records (EHR) to enhance effective integration among providers is discussed.
  
  
  CONCLUSIONS
  Japan's reform in 2008 is unique in that the concept of 'disease-oriented regional inter-provider critical paths' was adopted as a national policy and all 47 prefectures developed their Regional Health Plans simultaneously. How much the new regional health planning policy has improved the quality and outcome of care remains to be seen and will be evaluated in 2013 after the five-year planned period of implementation has concluded. Whilst electronic health records appear to be a useful tool in supporting care integration they do not guarantee success in the application of an inter-provider critical path.
authors: National Institute of Public Health, 2-3-6, Minami, Wako-shi, Saitama 351-0197, Japan.
authors: Etsuji
authors: E
authors: Okamoto
authors: Masaki
authors: M
authors: Miyamoto
authors: Kazuhiro
authors: K
authors: Hara
authors: Jun
authors: J
authors: Yoshida
authors: Masaki
authors: M
authors: Muto
authors: Aizan
authors: A
authors: Hirai
authors: Haruyuki
authors: H
authors: Tatsumi
authors: Masaaki
authors: M
authors: Mizuno
authors: Hiroshi
authors: H
authors: Nagata
authors: Daisuke
authors: D
authors: Yamakata
authors: Hiroshi
authors: H
authors: Tanaka