As part of community health care services provided by our hospital, there are regular visits by a nurse and/or a physician to patients in their homes. Durin one year from April 2001 to May 2002, we inadvertently skipped 15 visits. It was feared that if nothing were done, such a failure in duty would occur at least once a month. To find the way out of this situation and to reduce the number of skipped cases to zero, we made concerted efforts, turning to the methodology of Total Quality Management (TQM) activities.We tried to grasp the state of things to begin with, and investigated the root causes of the failure. The causes were analyzed using the fishbone diagram. Based on the results of analysis, preventive measures were adopted. Thanks to this, as of February 2004, there are no cases in which we have been remiss in visiting our patints for care in their homes.
Personal failure ; Patient visit for ; Use of ; Home ; etiology

Physical performance measures, such as gait speed, one-legged stance and hand-grip strength, are known as assessment measures of motor function and predictors for adverse health outcomes, and widely used for assessing motor function in preventive programs for long-term care or screening of frail elderly. However, there is no standard assessment sheet for feedback of the results. In the present study, an assessment sheet on physical performance measures for community-dwelling older adults was developed. A pooled analysis of data from six cohort studies, including urban and rural areas was conducted as part of the Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging. The pooled analysis included cross-sectional data from 4683 nondisabled, community-dwelling adults aged 65 years or older. Quintiles were derived according to age and sex group for six physical performance measures, i.e., hand-grip strength, one-legged stance, and gait speed and step length at both usual and maximum paces. The assessment sheets, which indicated the physical performance level according to age and sex, were developed by fitting third order polynomial curves to the data. The reference values in the present assessment sheet were considered to be derived from better represented community-dwelling older adults by using more large-scale population-based cohort data than that in the previous study. The assessment sheet should be useful for feeding back results on physical performance measures to elderly individuals and help them better understand their own physical performance levels.