1
|
Kistler CE, Inoue M, Matsui T, Abe M, Le Donne M, Kiyota A, Lin FC, Yang Y, Hanson LC. Pre-post-evaluation of a dementia-specific advance care planning toolkit for Japanese primary care clinicians. J Am Geriatr Soc 2024. [PMID: 38895937 DOI: 10.1111/jgs.19040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The population of people living with dementia (PLwD) continues to grow in Japan where advance care planning (ACP) for PLwD is relatively new. Our aim was to evaluate the feasibility and cultural acceptability of a dementia-specific ACP communication skills toolkit for Japanese primary care clinicians. METHODS We delivered 13 training sessions in primary care clinics across central Japan and conducted a post-training survey to assess whether the toolkit increased confidence in dementia-specific ACP communication skills and the acceptability of the toolkit with the following four statements: (1) The language in the sessions was clear, (2) The sessions took an appropriate amount of time to complete, (3) The design of the sessions was an effective educational method, and (4) The sessions were culturally appropriate for communication with Japanese patients with dementia and their family members. We asked participants to respond using a 5-point Likert scale from strongly agree to strongly disagree. RESULTS All participants were Japanese and included 80 physicians (mean age 39.8 years), 33 nurses (mean age 45.7 years), and 58 other participants (mean age 42.9 years), who were 30.0%, 87.9%, and 55.2% female, respectively. Most participants practiced in rural settings. In pre- post-comparisons, participant confidence increased in determining capacity, understanding dementia prognosis, goals of care, eliciting surrogates, recommending self-care practices to families, and leading family meetings (all p < 0.001). Most participants strongly agreed or agreed that the toolkit was an effective method (96.9%), took an appropriate amount of time (94.5%), contained clear language (89.8%), and was culturally appropriate (73.6%). CONCLUSIONS Dementia-specific ACP communication skills toolkit can be delivered in Japan. Japanese primary care clinicians generally felt the dementia-specific ACP toolkit increased their confidence in ACP communication skills and was acceptable. The language, time, and design were well received, though further work is needed to improve the cultural appropriateness of the toolkit.
Collapse
Affiliation(s)
- Christine E Kistler
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoko Matsui
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Michiko Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Monique Le Donne
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Ayano Kiyota
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yumei Yang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura C Hanson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
2
|
Murakami N, Kabayama M, Yano T, Nakamura C, Fukata Y, Morioka C, Fang W, Nako Y, Omichi Y, Koujiya E, Godai K, Kido M, Tseng W, Wada T, Nakamura T, Hirotani A, Fukuda T, Tamatani M, Okuda Y, Ikushima M, Baba Y, Nagano M, Nakamura Y, Rakugi H, Kamide K. Actual conditions for returning home after hospitalization among older patients receiving home medical care in Japan: OHCARE Study. Geriatr Gerontol Int 2024; 24 Suppl 1:320-326. [PMID: 38267253 DOI: 10.1111/ggi.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To examine the actual conditions of older patients receiving home medical care after hospitalization over a period of 2 years in Japan. METHODS The study population included 102 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan over a period of 2 years. We investigated the actual conditions for returning home after hospitalization. RESULTS The median age of the 102 participants was 84 years, and 61 (59.8%) were women. In the group that returned home, 42 (55.3%) of the respondents desired to recuperate in a familiar place, as in advanced care planning (ACP). During the 2-year follow-up period, the group that did not return home had significantly more deaths. A multivariate analysis showed the association in the presence of ACP (odds ratio: 4.72, 95% confidence interval: 1.60-13.86) and cardiac disease (odds ratio: 0.25, 95% confidence interval: 0.08-0.76). The lack of ACP in the medical records when the patient was admitted to the hospital may have prevented the return home. CONCLUSION In older patients who had difficulty returning home after hospitalization, the lack of ACP in home medical care may have been an influencing factor. ACP could help continue with home medical care. Geriatr Gerontol Int 2024; 24: 320-326.
Collapse
Affiliation(s)
- Naoko Murakami
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Mai Kabayama
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tomoko Yano
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Chika Nakamura
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuka Fukata
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Chihiro Morioka
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Wen Fang
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yumiko Nako
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuki Omichi
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Eriko Koujiya
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Kayo Godai
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Michiko Kido
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Winston Tseng
- School of Public Health, University of California, Berkeley, California, USA
| | - Taizo Wada
- Osaka Home Medical Care Clinic, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
- Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Osaka, Japan
| | - Kei Kamide
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
- Department of Geriatric and General Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Nakanishi Y, Tsugihashi Y, Hayasaka A, Nishioka Y, Akahane M. Web-based questionnaire survey for exploring engagement characteristics of advance care planning in Japan: a cross-sectional study. BMC Res Notes 2024; 17:47. [PMID: 38331916 PMCID: PMC10854018 DOI: 10.1186/s13104-024-06699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE Definitive promotion of advance care planning (ACP) practices will require policy interventions tailored to the characteristics of the Japanese population and society. However, effective policies for promoting ACP are currently lacking in Japan. This study aimed to explore the characteristics of Japanese people who engaged in ACP activities through a web-based questionnaire survey, which was administered to individuals aged 25-64 years and classified into four occupational categories (non-medical/non-caregiving professionals [general population], physicians, nurses, and caregivers). RESULTS The total sample size was 1,648, with equal occupational category and age group distributions. Respondents in the general population group were less likely to discuss or document ACP than those in the other groups. Stepwise logistic regression analysis showed a significant difference in the adjusted odds ratio (aOR) of the independent variables of "attended cardiopulmonary resuscitation (CPR) training session(s)" (aOR: 1.93; 95% confidence interval [CI]: 1.18-3.15) and "having experience in performing CPR" (aOR: 2.61; 95% CI: 1.51-4.54) for respondents who discussed ACP with their families. A significant difference was observed in the aOR of the independent variable of "having experience in performing CPR" (aOR: 4.58; 95% CI: 2.30-9.13) for respondents who documented a written record of ACP.
Collapse
Affiliation(s)
- Yasuhiro Nakanishi
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, 351-0197, Wako, Saitama, Japan.
| | - Yukio Tsugihashi
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Akira Hayasaka
- Mathematics and Informatics, Osaka Kyoiku University, 4-698-1 Asahigaoka, 582-8582, Kashiwara, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, 351-0197, Wako, Saitama, Japan
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan
| |
Collapse
|
4
|
Miyashita J, Kishino M. Real-world experience implementing Advance Care Planning in the Asia-Pacific: ACP in Japan. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:78-84. [PMID: 37516656 DOI: 10.1016/j.zefq.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 07/31/2023]
Abstract
Promoting Advance Care Planning (ACP) in the super-aged society of Japan has become increasingly important for supporting older adults to continue to live in the community until the end of life. To promote ACP further in Japan, Japanese family-centered decision-making and high-context culture need to be taken into account. Therefore, we describe the environmental and historical backgrounds surrounding ACP in Japan, and based on the results, introduce research and education programs regarding its implementation.
Collapse
Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research, Fukushima Medical University, Fukushima, Japan.
| | | |
Collapse
|
5
|
Association between resilience and advance care planning during the COVID-19 pandemic in Japan: a nationwide cross-sectional study. Sci Rep 2023; 13:1371. [PMID: 36697479 PMCID: PMC9876997 DOI: 10.1038/s41598-023-28663-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Advance care planning (ACP) is essential for end-of-life care, especially during the novel coronavirus disease 2019 (COVID-19) pandemic, and resilience is critical to deal with pandemic-related stressors. Therefore, we investigated the association between resilience ability and ACP discussions during the COVID-19 pandemic. A nationwide web-based survey was conducted in July 2021 in Japan. We analyzed the respondents' ability to bounce back from stress (bouncing-back ability), positive stress coping (e.g., "seeking social support", "planning"), and negative stress coping (e.g., "avoidance", "alcohol and drug use") in relation to ACP discussions using multivariable logistic regression models. In total, 2000 responses (86% participation rate) were received (mean age: 51.8 ± 16.7). Normal and high bouncing-back ability (adjusted odds ratio [AOR]: 1.69, 95% CI: 1.03-2.79; AOR: 2.07, 95% CI: 1.18-3.65, respectively) were significantly associated with the occurrence of ACP discussions. Seeking social support and planning were significantly associated with ACP discussions, whereas avoidance and alcohol and drug use were not. Both bouncing-back ability and positive stress coping were significantly associated with the occurrence of ACP discussions during the COVID-19 pandemic in Japan. These findings could be useful for aiding health-care providers involved in ACP discussions during the COVID-19 pandemic.
Collapse
|
6
|
Miyashita J, Shimizu S, Shiraishi R, Mori M, Okawa K, Aita K, Mitsuoka S, Nishikawa M, Kizawa Y, Morita T, Fukuhara S, Ishibashi Y, Shimada C, Norisue Y, Ogino M, Higuchi N, Yamagishi A, Miura Y, Yamamoto Y. Culturally Adapted Consensus Definition and Action Guideline: Japan's Advance Care Planning. J Pain Symptom Manage 2022; 64:602-613. [PMID: 36115500 DOI: 10.1016/j.jpainsymman.2022.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A conceptual framework for advance care planning is lacking in societies like Japan's valuing family-centered decision-making. OBJECTIVES A consensus definition of advance care planning with action guideline adapted to Japanese society. METHODS We conducted a multidisciplinary modified Delphi study 2020-2022. Thirty physicians, 10 healthcare and bioethics researchers, six nurses, three patient care managers, three medical social workers, three law experts, and a chaplain evaluated, in 7 rounds (including two web-based surveys where the consensus level was defined as ratings by ≥70% of panelists of 7-9 on a nine-point Likert scale), brief sentences delineating the definition, scope, subjects, and action guideline for advance care planning in Japan. RESULTS The resulting 29-item set attained the target consensus level, with 72%-96% of item ratings 7-9. Advance care planning was defined as "an individual's thinking about and discussing with their family and other people close to them, with the support as necessary of healthcare providers who have established a trusting relationship with them, preparations for the future, including the way of life and medical treatment and care that they wish to have in the future." This definition/action guideline specifically included support for individuals hesitant to express opinions to develop and express preparations for the future. CONCLUSION Adaptation of advance care planning to Japanese culture by consciously enhancing and supporting individuals' autonomous decision-making may facilitate its spread and establishment in Japan and other societies with family-centered decision-making cultures.
Collapse
Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University.
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University
| | - Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | | | - Kaoruko Aita
- Uehiro Division for Death & Life Studies and Practical Ethics, The University of Tokyo
| | | | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology
| | | | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Chiho Shimada
- Faculty of Humanities and Social Science, Saku University
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Mieko Ogino
- Department of Neurology, Ichikawa Hospital, International University of Health and Welfare
| | | | - Akemi Yamagishi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
| | - Yasuhiko Miura
- Department of General Medicine, The Jikei University School of Medicine
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
| |
Collapse
|
7
|
Watanabe T, Matsushima M, Kaneko M, Aoki T, Sugiyama Y, Fujinuma Y. Death at home versus other locations in older people receiving physician‐led home visits: A multicenter prospective study in Japan. Geriatr Gerontol Int 2022; 22:1005-1012. [PMID: 36374192 PMCID: PMC10100087 DOI: 10.1111/ggi.14496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Japanese government is promoting physician-led home visits as well as end-of-life care at home. However, the proportion of deaths occurring at home has remained unchanged for the past 20 years. OBJECTIVES To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals. METHODS This was a multicenter prospective cohort study in a primary care setting. We enrolled patients aged ≥65 years who had started to receive regular visits by family physicians from 13 facilities in and around Tokyo between February 1, 2013 and January 31, 2016. Patients were followed-up until January 31, 2017. The primary outcome measures were mortality rate and cumulative incidence of deaths at home. RESULTS We enrolled 762 patients. Of 368 deaths, 133 occurred in the patient's home. The mortality rates at home were 137.6/1000 person-years (95% confidence interval 116.1-163.1). In cumulative incidence function, the longer duration of care at home lowers the likelihood of death at home. Multivariable multinomial logistic models showed that younger age and higher Barthel Index score reduced the likelihood of deaths at home, while receiving oxygen therapy and the presence of a full-time caregiver increased the likelihood of deaths at home relative to deaths at other locations. CONCLUSIONS Of deceased patients, only one-third died in patients' homes. We found several factors associated with deaths at home, which appeared to reflect the readiness of patients and their families for death. Geriatr Gerontol Int 2022; 22: 1005-1012.
Collapse
Affiliation(s)
- Takamasa Watanabe
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Centre for Family Medicine Development Japanese Health and Welfare Co‐operative Federation Tokyo Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Department of Health Data Science Yokohama City University Yokohama Japan
- Division of Community Health and Primary Care Center for Medical Education, The Jikei University School of Medicine Tokyo Japan
| | - Makoto Kaneko
- Department of Health Data Science Yokohama City University Yokohama Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Division of Community Health and Primary Care Center for Medical Education, The Jikei University School of Medicine Tokyo Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development Japanese Health and Welfare Co‐operative Federation Tokyo Japan
| |
Collapse
|
8
|
Goto Y, Miura H, Yamaguchi Y, Onishi J. Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention. Palliat Care 2022; 21:135. [PMID: 35883081 PMCID: PMC9315089 DOI: 10.1186/s12904-022-01019-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We developed a novel training program for health care professionals that incorporated shared decision making (SDM) skills training into an advance care planning (ACP) training course, the first in Japan. This study aimed to assess the training program's impact on health care professionals' knowledge, skill, attitudes, and confidence to initiate ACP. METHODS Using the novel Japanese educational program, we evaluated the effect of 8-month programs conducted eight community training sites of professionals who can practice ACP in a local area in Aichi Prefecture (the Aichi ACP Project). SDM skills training was provided during the workshops conducted in the ACP training course, and the participants' satisfaction and understanding of the training were assessed. After the completion of two workshops, information on SDM skill results from the training and submitted assignments were collected anonymously from the training sites. RESULT A total of 404 participants completed all education programs. After the first workshop, at least 95% of trainees stated that they were satisfied with the training and that it was useful for ACP practice. The evaluation of the results between the first and second workshops indicated improvement in SDM skills on some items of the SDM measures. In the second workshop, at least 90% of participants submitted implementation reports, and after the second workshop, a survey of confidence in ACP practice was administered, with responses indicating improvement. There were high levels of interest in education related to the ACP practices of oneself and others. CONCLUSIONS This educational program can be an effective for developing professionals who can practice ACP with SDM skills.
Collapse
Affiliation(s)
- Yuko Goto
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Nagoya, Japan.
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Nagoya, Japan
| | - Yasuhiro Yamaguchi
- Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Joji Onishi
- Department of Community Health Care and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
9
|
Oami T, Imaeda T, Nakada TA, Abe T, Takahashi N, Yamao Y, Nakagawa S, Ogura H, Shime N, Umemura Y, Matsushima A, Fushimi K. Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database. J Intensive Care 2022; 10:33. [PMID: 35836301 PMCID: PMC9281011 DOI: 10.1186/s40560-022-00624-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/01/2022] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined. Methods We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs. Results Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = − $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = − $1806/year [95% CI − $2432 to − $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs. Conclusions We demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00624-5.
Collapse
Affiliation(s)
- Takehiko Oami
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Taro Imaeda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
| | - Toshikazu Abe
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.,Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Nozomi Takahashi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Yasuo Yamao
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Satoshi Nakagawa
- Department of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Asako Matsushima
- Department of Emergency & Critical Care, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| |
Collapse
|