Benefits of Medical Care and Nursing Roles in Comprehensive Community-Based Care Wards

Fees for comprehensive community-based care (CCC) wards were established as “CCC ward hospitalization fee and CCC hospitalization medical care fees: CCC wards” in the medical service fee revision of 2014. Since then, the number of hospitals submitting claims in this category has rapidly increased, from 114 in May 2014 to 2191 in June 2018. Although establishment of the CCC ward system and operational situation were previously described in featured articles and reports, the specific benefits of medical care provided in these wards remain unclear. In this study, we extracted descriptions from the Japanese literature of the benefits of medical care provided in CCC wards, organized this content using a qualitative approach, and examined the nursing roles revealed. In total, 25 papers were identified with information about the benefits of medical care in CCC wards. This content was abstracted into 50 codes and then grouped into 20 subcategories and 9 categories. These 9 categories were further classified into structure, process, and outcomes of medical care provided in CCC wards according to linguistic criteria developed based on the Donabedian model of health care quality, and the results were used to identify the nursing roles in CCC wards. Nurses appear to have diverse roles in the medical care provided in CCC wards, providing counseling on how to maintain basic service infrastructure (structure), supporting patients and families during their time in the wards (process), strengthening interdisciplinary collaboration (process), and improving nurses’ own professional competence (process). Through their roles in these structural and procedural dimensions, nurses support the intelligent operation of CCC wards and the expansion of community care support systems. Our results suggest that these activities may lead to outcomes in the form of enhanced community health.