1
|
Tanaka H, Ishikawa KB, Katanoda K. Geographic Access to Cancer Treatment in Japan: Results From a Combined Dataset of the Patient Survey and the Survey of Medical Institutions in 2011. J Epidemiol 2018; 28:470-475. [PMID: 29760321 PMCID: PMC6192973 DOI: 10.2188/jea.je20170051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background There has been no nationwide analysis of travel time for hospital admission in Japan. Factors associated with travel time are also unknown. This study aimed to describe the distribution of travel time for hospital admission of cancer patients and identify underlying factors. Methods The individual data from the Patient Survey in 2011 were linked to those from the Survey of Medical Institutions in the same year, and GIS data were used to calculate driving travel time between the addresses of medical institutions and the population centers of municipalities where patients lived. Proportions of patients with travel time exceeding versus not exceeding 45 minutes were calculated. To analyze the data with consideration of both individual factors of patients and geographical characteristics of areas where patients lived, multilevel logistic model analysis was performed. Results The analysis included 50,845 cancer inpatients. The majority of the cancer patients (approximately 80%) were admitted to hospitals located less than a 45-minute drive from their residences. The travel time tended to be longer for younger patients. The proportion of patients with travel time ≥45 minutes was lower among those with stomach or colorectal cancer (approximately 15%) than those with cervical cancer or leukemia (approximately 30%). The lack of designated cancer care hospitals in the secondary healthcare service areas was significantly associated with travel time. Conclusions Selection of hospitals by cancer inpatients is affected by age, cancer sites, and availability of designated cancer care hospitals in the secondary healthcare service areas where patients live.
Collapse
Affiliation(s)
- Hirokazu Tanaka
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
| | | | - Kota Katanoda
- Center for Cancer Control and Information Services, National Cancer Center
| |
Collapse
|
2
|
Kamitani S, Nishimura K, Kada A, Sayama T, Nishimura A, Kurogi R, Nakamura F, Onozuka D, Ogasawara K, Shiokawa Y, Miyachi S, Yoshimura S, Toyoda K, Nakagawara J, Matsuda S, Okuchi K, Aruga T, Ono J, Nagata I, Miyamoto Y, Iwata M, Hagihara A, Suzuki A, Kataoka H, Ishikawa KB, Iihara K. Abstract TP323: The Relationships Among Hospital Volume, Processes of Care and Patient Outcome in Ischemic Stroke: J-ASPECT Study. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Higher hospital volumes have been related to better outcomes in previous researches. However, the mechanisms of the volume-outcome relationships in stroke have not been sufficiently figured out. The aim of this study is to uncover the roles of processes in acute phase stroke care among the volume-outcome relationships.
Hypothesis:
Processes of care mediate the volume-outcome relationships in stroke patients.
Methods:
We analyzed 45,598 acute ischemic stroke patients in 267 certified training hospitals in Japan. Data between April 1,2011 and May 31, 2012 was obtained from Japanese Diagnosis Procedure Combination Database. We divided annual hospital case volumes into two groups: high-volume and low-volume. Main outcome was 30-day mortality. We set following process of care as mediators: early initiation of aspirin prescription (less than 24 hours) and early initiation of stroke rehabilitation (less than 3 days). Multilevel mediation models were performed adjusting for age, gender, comorbidities, Charlson comorbidity index to examine the relationships among hospital volume, processes of care and outcome.
Results:
The early initiation of aspirin increased from 19.4% to 24.1%, the early initiation of rehabilitations increased from 59.6% to 65.6% and 30-day mortality decreased from 6.1% to 4.2%, for low-volume and high-volume hospitals. In the multilevel logistic regression analyses, admission to high-volume hospitals had 38% increased odds (OR = 1.38; 95% CI, 1.02-1.88) and 118% increased odds (OR = 2.18; 95% CI, 1.59-2.98) of early aspirin and rehabilitation initiation, compared with low-volume hospitals. Before adjusting for processes of care, admissions to high-volume hospitals had 30% decreased odds of death compared with admission to low-volume hospitals (OR = 0.70; 95% CI, 0.61-0.81). When processes of care were further adjusted, the volume-mortality relationship became non-significant. The early initiation of aspirin and rehabilitation accounted for 71% of the relationship (the regression coefficient was reduced from -0.355 to -0.102 when adjusted for processes of care).
Conclusions:
Processes of care mediated the volume-outcome relationships in stroke patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shinya Matsuda
- Univ of Environmental and Occupational Health, Kita-kyushu, Japan
| | | | | | | | | | | | | | | | - Akifumi Suzuki
- Rsch institute for Brain and Blood Vessels, Akita, Japan
| | | | | | | |
Collapse
|
3
|
Kamitani S, Nishimura K, Kada A, Sayama T, Nishimura A, Kurogi R, Nakamura F, Onozuka D, Ogasawara K, Shiokawa Y, Miyachi S, Yoshimura S, Toyoda K, Nakagawara J, Matsuda S, Okuchi K, Aruga T, Ono J, Nagata I, Miyamoto Y, Iwata M, Hagihara A, Suzuki A, Kataoka H, Ishikawa KB, Iihara K. Abstract WMP33: Effects of Organized Stroke Care on In-hospital Mortality and Morbidity of Patients With Ischemic and Hemorrhagic Stroke: J-ASPECT Study. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wmp33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Organized stroke care is an integrated approach to managing stroke to improve outcomes. However, the effectiveness of organized stroke care on mortality and morbidity remains uncertain. This study aimed to examine whether Organized stroke care index (OCI), which graded 0-3 based on the presence of rehabilitation, stroke team assessment, and admission to a stroke unit, developed to assess the accessibility to stroke care by Saposnik (Neurology 2010) influenced stroke outcomes in a nation wide hospital cohort.
Hypothesis:
OCI influenced mortality and morbidity of patients with ischemic and hemorrhagic stroke.
Methods:
Of the 1369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding comprehensive stroke care capacities. Among the institutions that responded, data on patients hospitalized between April 1, 2010 and March 31, 2014, because of stroke were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality morbidity was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, Charson Score and the number of OCI fulfilled in each component and in total.
Results:
Data from 265 institutions and 220,027 emergency-hospitalized patients were analyzed. Patients fulfilled the criteria for admission to a SCU, stroke team assessment and the presence of rehabilitation were 29.9%, 41.2% and 66.5%, respectively. Mortality adjusted for age, sex, Charson score and level of consciousness was significantly correlated with admission to a SCU (OR=0.83, p<0.001), SCU team assessment (OR=0.84,P<0.001), and rehabilitation (OR=0.36, p=0.031). OCI was significantly associated with decreased mortality (OR=0.45, p<0.001) and the highest OCI score was associated with 89.4% decrease of mortality. (OR=0.104, p<0.001) Modified ranking scale 0 to 2 rate were also associated significantly with SCU admission (p<0.001). These association holds for ischemic stroke and subarachnoid hemorrhage.
Conclusion:
A strong association between organized stroke care and lower mortality was apparent. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shinya Matsuda
- Univ of Environmental and Occupational Health, Kita-kyushu, Japan
| | | | | | | | | | | | | | | | - Akifumi Suzuki
- Rsch Institute for Brain and Blood Vessels Akita, Akita, Japan
| | | | | | | |
Collapse
|
4
|
Shimizu S, Imai S, Ishikawa KB, Ikeda S, Fushimi K. The Impact of Modifications of the Formula for Generic Drug Prescription Rate on the Switch To New Brand-Name Drugs With Similar Therapeutic Uses. Value Health 2014; 17:A499. [PMID: 27201508 DOI: 10.1016/j.jval.2014.08.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Shimizu
- Institute for Health Economics and Policy, minato-ku, Japan
| | - S Imai
- National Hospital Organization, Tokyo, Japan
| | | | - S Ikeda
- International University of Health and Welfare, Ohtawara -City, Japan
| | - K Fushimi
- Tokyo Medical and Dental University Graduate School of Medicine, bunkyo-ku, Tokyo, Japan
| |
Collapse
|
5
|
Kamitani S, Nishimura K, Nakamura F, Kada A, Nakagawara J, Toyoda K, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, Nagata I, Matsuda S, Miyamoto Y, Iwata M, Suzuki A, Ishikawa KB, Kataoka H, Morita K, Kobayashi Y, Iihara K. Consciousness level and off-hour admission affect discharge outcome of acute stroke patients: a J-ASPECT study. J Am Heart Assoc 2014; 3:e001059. [PMID: 25336463 PMCID: PMC4323811 DOI: 10.1161/jaha.114.001059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Poor outcomes have been reported for stroke patients admitted outside of regular working hours. However, few studies have adjusted for case severity. In this nationwide assessment, we examined relationships between hospital admission time and disabilities at discharge while considering case severity. Methods and Results We analyzed 35 685 acute stroke patients admitted to 262 hospitals between April 2010 and May 2011 for ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). The proportion of disabilities/death at discharge as measured by the modified Rankin Scale (mRS) was quantified. We constructed 2 hierarchical logistic regression models to estimate the effect of admission time, one adjusted for age, sex, comorbidities, and number of beds; and the second adjusted for the effect of consciousness levels and the above variables at admission. The percentage of severe disabilities/death at discharge increased for patients admitted outside of regular hours (22.8%, 27.2%, and 28.2% for working‐hour, off‐hour, and nighttime; P<0.001). These tendencies were significant in the bivariate and multivariable models without adjusting for consciousness level. However, the effects of off‐hour or nighttime admissions were negated when adjusted for consciousness levels at admission (adjusted OR, 1.00 and 0.99; 95% CI, 1.00 to 1.13 and 0.89 to 1.10; P=0.067 and 0.851 for off‐hour and nighttime, respectively, versus working‐hour). The same trend was observed when each stroke subtype was stratified. Conclusions The well‐known off‐hour effect might be attributed to the severely ill patient population. Thus, sustained stroke care that is sufficient to treat severely ill patients during off‐hours is important.
Collapse
Affiliation(s)
- Satoru Kamitani
- Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo (S.K., F.N., Y.K.)
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan (K.N., Y.M.)
| | - Fumiaki Nakamura
- Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo (S.K., F.N., Y.K.)
| | - Akiko Kada
- Clinical Research Center, Nagoya Medical Center, Nagoya, Japan (A.K.)
| | - Jyoji Nakagawara
- Department of Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Suita, Japan (J.N.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - Kuniaki Ogasawara
- Department of neurosurgery, Iwate Medical University, Morioka, Japan (K.O.)
| | - Junichi Ono
- Chiba Cardiovascular Center, Chiba, Japan (J.O.)
| | | | - Toru Aruga
- Showa University Hospital, Shinagawa-ku, Japan (T.A.)
| | - Shigeru Miyachi
- Department of Neurosurgery, Nagoya University, Nagoya, Japan (S.M.)
| | | | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, Universityof Occupational and Environmental Health, Kitakyushu, Japan (S.M.)
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan (K.N., Y.M.)
| | - Michiaki Iwata
- Department of Intellectual Asset Management, National Cerebral and Cardiovascular Center, Suita, Japan (M.I.)
| | - Akifumi Suzuki
- Research Institute for Brain and Blood Vessels, Akita, Japan (A.S.)
| | - Koichi B Ishikawa
- Center for Cancer Controland Information Services, National Cancer Center, Chuo-ku, Japan (K.B.I.)
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.K., K.M.)
| | - Kenichi Morita
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.K., K.M.)
| | - Yasuki Kobayashi
- Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo (S.K., F.N., Y.K.)
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.I.)
| |
Collapse
|
6
|
Iihara K, Nishimura K, Kada A, Nakagawara J, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, Nagata I, Toyoda K, Matsuda S, Miyamoto Y, Suzuki A, Ishikawa KB, Kataoka H, Nakamura F, Kamitani S. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study. PLoS One 2014; 9:e96819. [PMID: 24828409 PMCID: PMC4020787 DOI: 10.1371/journal.pone.0096819] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Background The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. Conclusions CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.
Collapse
Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- * E-mail:
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Jyoji Nakagawara
- Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Junichi Ono
- Chiba Cardiovascular Center, Ichihara, Japan
| | | | | | - Shigeru Miyachi
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Nagasaki University, Nagasaki, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kita-Kyushu, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akifumi Suzuki
- Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Koichi B. Ishikawa
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Fumiaki Nakamura
- Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Satoru Kamitani
- Department of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
7
|
Iihara K, Nishimura K, Kada A, Nakagawara J, Toyoda K, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, Nagata I, Matsuda S, Ishikawa KB, Suzuki A, Mori H, Nakamura F. The Impact of Comprehensive Stroke Care Capacity on the Hospital Volume of Stroke Interventions: A Nationwide Study in Japan: J-ASPECT Study. J Stroke Cerebrovasc Dis 2014; 23:1001-18. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/08/2013] [Accepted: 08/21/2013] [Indexed: 11/30/2022] Open
|
8
|
Kunisawa S, Morishima T, Ukawa N, Ikai H, Otsubo T, Ishikawa KB, Yokota C, Minematsu K, Fushimi K, Imanaka Y. Association of geographical factors with administration of tissue plasminogen activator for acute ischemic stroke. J Am Heart Assoc 2013; 2:e000336. [PMID: 24045119 PMCID: PMC3835241 DOI: 10.1161/jaha.113.000336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intravenous tissue plasminogen activator (tPA) is an effective treatment for acute ischemic stroke if administered within a few hours of stroke onset. Because of this time restriction, tPA administration remains infrequent. Ambulance use is an effective strategy for increasing tPA administration but may be influenced by geographical factors. The objectives of this study are to investigate the relationship between tPA administration and ambulance use and to examine how patient travel distance and population density affect tPA utilization. METHODS AND RESULTS We analyzed administrative claims data from 114,194 acute ischemic stroke cases admitted to 603 hospitals between July 2010 and March 2012. Mixed-effects logistic regression models of patients nested within hospitals with a random intercept were generated to analyze possible predictive factors (including patient characteristics, ambulance use, and driving time from home to hospital) of tPA administration for different population density categories to investigate differences in these factors in various regional backgrounds. Approximately 5.1% (5797/114,194) of patients received tPA. The composition of baseline characteristics varied among the population density categories, but adjustment for covariates resulted in all factors having similar associations with tPA administration in every category. The administration of tPA was associated with patient age and severity of stroke symptoms, but driving time showed no association. Ambulance use was significantly associated with tPA administration even after adjustment for covariates. CONCLUSION The association between ambulance use and tPA administration suggests the importance of calling an ambulance for suspected stroke. Promoting ambulance use for acute ischemic stroke patients may increase tPA use.
Collapse
Affiliation(s)
- Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.K., T.M., N.U., H.I., T.O., Y.I.)
| | - Toshitaka Morishima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.K., T.M., N.U., H.I., T.O., Y.I.)
| | - Naoto Ukawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.K., T.M., N.U., H.I., T.O., Y.I.)
| | - Hiroshi Ikai
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.K., T.M., N.U., H.I., T.O., Y.I.)
| | - Tetsuya Otsubo
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.K., T.M., N.U., H.I., T.O., Y.I.)
| | - Koichi B. Ishikawa
- Economics Section, Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan (K.B.I.)
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (C.Y.)
| | - Kazuo Minematsu
- National Cerebral and Cardiovascular Center, Suita, Japan (K.M.)
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan (K.F.)
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan (S.K., T.M., N.U., H.I., T.O., Y.I.)
| |
Collapse
|
9
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Comparative study of functional outcomes of three laparoscopic intestinal surgical procedures. Health Policy and Technology 2013. [DOI: 10.1016/j.hlpt.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
10
|
Kuwabara K, Hagiwara A, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. A community-based comparison of trauma patient outcomes between d- and l-lactate fluids. Am J Emerg Med 2013; 31:206-14. [DOI: 10.1016/j.ajem.2012.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/21/2012] [Accepted: 07/15/2012] [Indexed: 10/27/2022] Open
|
11
|
Okumura Y, Shimizu S, Ishikawa KB, Matsuda S, Fushimi K, Ito H. Characteristics, procedural differences, and costs of inpatients with drug poisoning in acute care hospitals in Japan. Gen Hosp Psychiatry 2012; 34:681-5. [PMID: 22902257 DOI: 10.1016/j.genhosppsych.2012.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/12/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aimed to describe the clinical and procedural characteristics of drug poisoning, to examine procedural differences between drug poisoning repeaters and non-repeaters, and to estimate the costs of drug poisoning. METHODS A retrospective cohort study of a nationally representative sample of 6585 inpatients with drug poisoning was conducted, using the administrative database of the Diagnosis Procedure Combination/Per-Diem Payment System in 2008. RESULTS Although only 3% of patients required surgery and 65% were discharged from the hospitals within 3 days, greater than 30% were admitted to tertiary emergency care (i.e., high-level emergency care) centers that provide care to severely ill and trauma patients who require intensive care. Only 30% of patients received psychiatric consultation during hospitalization. In addition, repeaters were less likely to be admitted to hospitals by ambulance (67% vs. 76%) and more likely to be discharged within 3 days (77% vs. 65%) than non-repeaters. The annual economic burden of drug poisoning in Japan was $66 million (¥7.7 billion), with the population aged 20-39 years accounting for 50% of these costs. CONCLUSION This study highlights the need for optimally allocating resources and improving prevention strategies.
Collapse
Affiliation(s)
- Yasuyuki Okumura
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira 187-8553, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
12
|
Kuwabara K, Fushimi K, Matsuda S, Ishikawa KB, Horiguchi H, Fujimori K. Association of early post-procedure hemodynamic management with the outcomes of subarachnoid hemorrhage patients. J Neurol 2012; 260:820-31. [DOI: 10.1007/s00415-012-6710-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/24/2012] [Accepted: 10/08/2012] [Indexed: 12/14/2022]
|
13
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Contribution of the administrative database and the geographical information system to disaster preparedness and regionalization. Am J Disaster Med 2012; 7:95-103. [PMID: 22916447 DOI: 10.5055/ajdm.2012.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Public health emergencies like earthquakes and tsunamis underscore the need for an evidence-based approach to disaster preparedness. Using the Japanese administrative database and the geographical information system (GIS), the interruption of hospital-based mechanical ventilation administration by a hypothetical disaster in three areas of the southeastern mainland (Tokai, Tonankai, and Nankai) was simulated and the repercussions on ventilator care in the prefectures adjacent to the damaged prefectures was estimated. DESIGN, SETTING, AND PATIENTS Using the database of 2010 including 3,181,847 hospitalized patients among 952 hospitals, the maximum daily ventilator capacity in each hospital was calculated and the number of patients who were administered ventilation on October xx was counted. INTERVENTIONS Using GIS and patient zip code, the straight-line distances among the damaged hospitals, the hospitals in prefectures nearest to damaged prefectures, and ventilated patients' zip codes were measured. The authors simulated that ventilated patients were transferred to the closest hospitals outside damaged prefectures. OUTCOMES The increase in the ventilator operating rates in three areas was aggregated. RESULTS One hundred twenty-four and 236 patients were administered ventilation in the damaged hospitals and in the closest hospitals outside the damaged prefectures of Tokai, 92 and 561 of Tonankai, and 35 and 85 of Nankai, respectively. The increases in the ventilator operating rates among prefectures ranged from 1.04 to 26.33-fold in Tokai; 1.03 to 1.74-fold in Tonankai, and 1.00 to 2.67-fold in Nankai. CONCLUSION Administrative databases and GIS can contribute to evidenced-based disaster preparedness and the determination of appropriate receiving hospitals with available medical resources.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | |
Collapse
|
14
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Associations between the use of critical care procedures and change in functional status at discharge. J Intensive Care Med 2012; 28:296-306. [PMID: 22777898 DOI: 10.1177/0885066612453121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Changes in functional status following ICU care have been studied, but results are inconclusive because of insufficient consideration of the combinations of critical care procedures used. Using the Japanese administrative database including the Barthel Index (BI) at admission and discharge, we measured the changes in functional status among the adult patients and determined whether longer ICU stay or use of various critical care procedures was associated with functional deterioration. Of the 12 502 528 patients admitted to 1206 hospitals over 5 consecutive years from 2006, we analyzed data from patients aged 15 years or older who survived ICU admission in 320 hospitals. Critical care procedures evaluated were ventilation, blood purification (hemodialysis, hemodiafiltration, or hemadsorption), and cardiac support devices (intra-aortic balloon pump or percutaneous cardiopulmonary support system). Functional outcomes were determined by the difference between BI at admission and at discharge and were divided into improvement, no change, or deterioration. We compared patient characteristics, principal diagnosis, comorbidities, timing of surgical procedure, complications, days in ICU, and use of critical care procedures among the 3 categories. Associations between critical care procedures and functional deterioration were identified using multivariate analysis. Of 234 209 patients with complete BI information, 7137 (3.1%) received blood purification, 27 100 (11.7%) received ventilation, 2888 (1.2%) received blood purification and ventilation, 5613 (2.4%) received a cardiac support device, 247 (0.1%) received a cardiac support device and blood purification, 10 444 (4.5%) received a cardiac support device and ventilation, and 1110 (0.5%) received a cardiac support device, ventilation, and blood purification. Longer use of blood purification or ventilation and a longer ICU stay were associated with functional deterioration. Intensivists should be aware of the effects of critical care procedures on functional deterioration and advance the appropriate use of functional support according to each patient's condition.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
| | | | | | | | | | | |
Collapse
|
15
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Comparative Study on the Difference in Functional Outcomes at Discharge between Proximal and Total Gastrectomy. Case Rep Gastroenterol 2012; 6:400-9. [PMID: 22933986 PMCID: PMC3398071 DOI: 10.1159/000339715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy (TG) for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI) at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG), we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | | | | | | | | | | |
Collapse
|
16
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers. World J Surg 2012; 35:2485-92. [PMID: 21915743 DOI: 10.1007/s00268-011-1252-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several studies have advocated laparoscopic simple closure (LSC) as the treatment of choice for perforated peptic ulcer disease (PUD). However, there has been no comprehensive community-based evaluation of the advantages of using LSC over open simple closure (OSC). Using an administrative database, we evaluated LSC versus OSC for patients with perforated ulcers. METHODS From 6,334 patients with perforated ulcers, we identified 2,909 simple closure cases between 2006 and 2010. Study variables were demographics, mortality, co-morbidities, complications, ulcer location, surgical timing, blood transfusion, postoperative ventilation, operating room (OR) time, time to resumption of oral food intake, length of stay (LOS), and total charges. After matching patient baseline variables between OSC and LSC, we performed multivariate analyses to assess the impacts of LSC on mortality, complications, and ventilation administration. RESULTS A total of 2,073 OSC cases and 836 LSC cases were identified in 670 hospitals. Younger age, duodenal ulcer, and pre-existing PUD were indicators for selection of LSC. Matching analysis indicated a correlation between LSC and lower mortality, less frequent postoperative and overall blood transfusion, shorter LOS, earlier return to oral intake, and longer OR time. There was no difference between OSC and LSC in complication rate or mortality. Longer OR time was correlated with a higher complication rate and the need for ventilation, the latter of which was independently associated with an increase in mortality. CONCLUSIONS Because longer OR time was associated with more frequent complications and ventilation, surgeons should obtain the skills and strategies necessary to accomplish LSC without extending OR time improperly.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Okumura Y, Shimizu S, Ishikawa KB, Matsuda S, Fushimi K, Ito H. Comparison of emergency hospital admissions for drug poisoning and major diseases: a retrospective observational study using a nationwide administrative discharge database. BMJ Open 2012; 2:bmjopen-2012-001857. [PMID: 23220778 PMCID: PMC3533045 DOI: 10.1136/bmjopen-2012-001857] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare the clinical and procedural characteristics of emergency hospital admissions for drug poisoning and major diseases. DESIGN Retrospective observational study. SETTING Discharged patients from 855 acute care hospitals from 1 July to 31 December in 2008 in Japan. RESULTS There were a total of 1 157 893 emergency hospital admissions. Among the top 100 causes, drug poisoning was ranked higher in terms of the percentage of patients using ambulance services (74.1%; second) and tertiary emergency medical services (37.8%; first). Despite higher utilisation of emergency care resources, drug poisoning ranked lower in terms of the median length of stay (2 days; 100th), percentage of requirement for surgical procedures (1.7%; 91st) and inhospital mortality ratio (0.3%; 74th). CONCLUSIONS Drug poisoning is unique among the top 100 causes of emergency admissions. Our findings suggest that drug poisoning imposes a greater burden on emergency care resources but has a less severe clinical course than other causes of admissions. Future research should focus on strategies to reduce the burden of drug poisoning on emergency medical systems.
Collapse
Affiliation(s)
- Yasuyuki Okumura
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Sayuri Shimizu
- Research Department, Institute for Health Economics and Policy, Minato-ku, Tokyo, Japan
| | - Koichi B Ishikawa
- Statistics and Cancer Control Division, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroto Ito
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| |
Collapse
|
18
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Reappraising the surgical approach on the perforated gastroduodenal ulcer: should gastric resection be abandoned? J Clin Med Res 2011; 3:213-22. [PMID: 22383908 PMCID: PMC3279482 DOI: 10.4021/jocmr608w] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2011] [Indexed: 12/12/2022] Open
Abstract
Background Advancements in medical care for peptic ulcer disease (PUD) have reduced the need for invasive surgical procedures such as gastric resection (GR). Community-based PUD studies from a large sampling of PUD patients designed to analyze hospital resource use and outcomes after different surgical procedures have been rare. We aimed to exhaustively reappraise the risk factors and patient demographics that affect PUD patient recoveries after GR compared to those after simple closure (SC). Methods We used a Japanese administrative database for 6 consecutive months each year between 2006 and 2010. The database included a total of 68,432 PUD patients; we analyzed 6,334 perforation cases and 3,148 cases of patients who underwent GR or SC. Study variables were demographics, comorbidities, characteristics of PUD, and operative day. Study outcomes that were analyzed included mortality, postoperative complications, ventilation administration, postoperative blood transfusions, length of stay, total charges, operating room (OR) time, and the postoperative fasting period (defined as the day of surgery to the day oral food intake was resumed.) To reduce selection bias in study procedures and to control the variation in hospital practice, a propensity score (PS) matching cohort analysis and a mixed linear regression model were used to assess the effects of GR on the outcomes. Results In 699 hospitals, 322 GRs and 2,826 SCs were observed. Younger age, duodenal ulcers, preexisting anemia and an operative day no more than 24hours were significant associated with the choice of SCs. No significant differences were observed in study outcomes after either GR or SC; more postoperative blood transfusions and longer OR times but shorter postoperative fasting periods were observed after GR. Longer OR times, ventilation and postoperative blood transfusion were significantly associated with mortality. Not GR but longer OR times use of ventilation and complications were the most significant indicators of increased resource use. Conclusions There were no major significant differences in GR when compared to SC with regards to patient recoveries. Surgeons should obtain the skills and establish strategies to optimize either type of surgical procedure including minimizing OR time and establishing the best perioperative critical care. Keywords Peptic ulcer perforation; Simple closure; Gastric resection; Outcome; Resource use
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | | | | | | | | | | |
Collapse
|
19
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Early crystalloid fluid volume management in acute pancreatitis: association with mortality and organ failure. Pancreatology 2011; 11:351-61. [PMID: 21757973 DOI: 10.1159/000328965] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/28/2011] [Indexed: 12/11/2022]
Abstract
AIMS Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and/or critical care. METHODS 9,489 AP patients aged ≥18 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demographics, mortality, comorbidities, complications, AP severity, surgery of the biliary/pancreatic system, and fluid volume (FV) during the initial 48 h (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care process was assessed according to AP severity. RESULTS 1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality. CONCLUSION Since relatively too much or too little early FV is associated with mortality, FV should be continuously monitored and managed according to AP severity. and IAP.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | |
Collapse
|
20
|
Kuwabara K, Matsuda S, Ishikawa KB, Horiguchi H, Fujimori K. Association of operating time and gastrectomy with initiation of postoperative oral food intake. Dig Surg 2011; 28:157-62. [PMID: 21540602 DOI: 10.1159/000323626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 11/30/2010] [Indexed: 01/13/2023]
Abstract
BACKGROUND Fast-track programs optimizing perioperative care have been initiated along with the advancement of laparoscopic colorectal surgery. To clarify that these programs were evidence based for gastrectomy cases, we assessed the effect of operating time and gastrectomy type [open partial (OPG), open total (OTG), laparoscopic partial (LPG) and laparoscopic total (LTG)] on postoperative commencement of oral food intake. METHODS Among 14,465 cases of gastrectomy across 837 hospitals, we examined the demographics, comorbidity, complications, postoperative epidural analgesia, rehabilitation and teaching status. The impact of gastrectomy type and operating time on postoperative fasting period was assessed using mixed regression models to distill off the hospital practice belief. RESULTS We identified 2,775 laparoscopic gastrectomies and 10,064 partial gastrectomies, 2,485 of which were conducted via laparoscopy. Operating time was shortest in OPG and longest in LTG. The fasting period was shortest in LPG and longest in OTG. Longer operating time prolonged the fasting period, except for LTG. Postoperative epidural analgesia and earlier rehabilitation, but not laparoscopic gastrectomy, were associated with a shortened fasting period. CONCLUSION When developing a fast-track program for gastrectomy, clinicians should recognize the impact of longer operating time and perioperative care rather than that of gastrectomy type on oral intake.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kazu228 @ basil.ocn.ne.jp
| | | | | | | | | |
Collapse
|
21
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-Based Appraisal of the Effects of Parenteral Nutrition Versus Enteral Nutrition on the Quality of Care for Patients With Acute Pancreatitis. Gastroenterology Res 2011; 4:1-8. [PMID: 27957005 PMCID: PMC5139793 DOI: 10.4021/gr289w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Enteral nutrition (EN) rather than parenteral nutrition (PN) has been advocated in treatment guidelines for acute pancreatitis (AP) as endorsed in randomized studies or meta-analyses. The findings derived from those studies would recognize the criticism of smaller sample sizes or limited patient case-mixes. To determine the generalizability of those findings, community-based appraisal on the advantages of EN over PN is required. Using a Japanese administrative database between 2006 and 2010, we determine whether EN is superior to PN in the real clinical settings. METHODS A total of 24,913 patients diagnosed with AP at admission in 1,000 hospitals were identified. Among them, we analyzed 1,803 patients of ≥ 15 years who received EN or PN for AP across 480 hospitals. Among three nutrition categories of PN only, EN only and PN with EN, we examined patient characteristics, comorbidities, complications, AP severity score determined by the Ministry of Health, Labor and Welfare, surgical procedures for the biliary/pancreatic system, use of artificially assisted ventilation and hemodialysis proxy of multiple organ failures and hospital teaching status. To identify the variables associated with PN use, a logistic regression model was used and the propensity score (PS) was calculated to control for the selection bias of patient case-mix preferring PN use. Then, we compared mortality, length of hospital stay (LOS), total charges (TC) and commencement day of oral food intake between EN and PN. RESULTS A total of 1,191 PN patients, 330 EN patients and 282 mixed EN and PN patients were identified. EN was indicated for patients with mild AP and procedures for the pancreas. PS matching analysis indicated that PN had a higher mortality compared with EN, and PN significantly increased LOS and TC compared with EN. PN deterred the commencement of oral food intake. CONCLUSIONS Community-based study has shown that EN was employed in the less severe case-mixed. Even though considering that selection bias, EN was still superior to PN in AP. Physicians should be aware of the guidelines for the advocacy of EN and need to carefully consider the indications for EN to optimize the quality of AP care.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University Graduate School of Medical Sciences, Department of Health Care Administration and Management, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shinya Matsuda
- University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku Kitakyushu, Fukuoka 807-8555, Japan
| | - Kiyohide Fushimi
- Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan
| | - Koichi B Ishikawa
- National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Hiromasa Horiguchi
- University of Tokyo Graduate School of Medicine, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kenji Fujimori
- Hokkaido University, 5 Nishi 14 Kita Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| |
Collapse
|
22
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K, Yasunaga H, Miyata H. Quantitative Assessment of the Advantages of Laparoscopic Gastrectomy and the Impact of Volume-Related Hospital Characteristics on Resource Use and Outcomes of Gastrectomy Patients in Japan. Ann Surg 2011; 253:64-70. [DOI: 10.1097/sla.0b013e318204e524] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
23
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Reconsidering the value of rehabilitation for patients with cerebrovascular disease in Japanese acute health care hospitals. Value Health 2011; 14:166-176. [PMID: 21211499 DOI: 10.1016/j.jval.2010.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The 21st century has an increasing elderly population at risk of cerebrovascular disease (CVD). Efficient care for recovering functional status is emphasized among policy makers. We investigated whether rehabilitation and its early initiation provided for CVD patients produced functional recovery in acute care hospitals. METHODS Using a Japanese administrative database during a 4-month interval from 2004 to 2008 in patients ages ≥ 15 years, we measured the demographics, consciousness level at admission, comorbidities, complications, procedures, ventilation administration, initiation day of rehabilitation, and hospital characteristics. Outcomes included total charges (TC) and functional status measured by the Barthel index (BI). Multivariate analysis measured the impact of rehabilitation and its early initiation on outcomes. To reduce the selection bias of rehabilitation and the ecological fallacy, we used propensity score matching and the linear mixed model. RESULTS Excluding 488 deceased patients, we analyzed 45,014 CVD patients. Rehabilitation at a generalized unit produced greater BI improvement than no rehabilitation or at intensive care units. A longer hospitalization, but not a 1-day delay of rehabilitation initiation, resulted in less BI improvement and more TC. A higher patient volume and academic hospitals were associated with more TC but not with BI improvement. CONCLUSIONS Rehabilitation, but not the timing of rehabilitation, might accompany functional recovery in acute care hospitals. Because the hospital mix or medical units can explain the variation in the quality of rehabilitation, policy makers, along with monitoring unnecessary long hospitalizations, should encourage a referral policy for rehabilitation-intensive facilities and develop effective rehabilitation using technology to optimize functional outcomes.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, Fukuoka, Japan.
| | | | | | | | | | | |
Collapse
|
24
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Relationships of age, cholecystectomy approach and timing with the surgical and functional outcomes of elderly patients with cholecystitis. Int J Surg 2011; 9:392-9. [DOI: 10.1016/j.ijsu.2011.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 02/08/2011] [Accepted: 03/16/2011] [Indexed: 01/28/2023]
|
25
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based appraisal of laparoscopic abdominal surgery in Japan. J Surg Res 2010; 165:e1-13. [PMID: 21067779 DOI: 10.1016/j.jss.2010.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 08/08/2010] [Accepted: 09/01/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the prevalence of laparoscopic surgery (LS), community-based appraisal of its benefit over open surgery (OS) has not been performed. This can be measured by increased total charge (TC) spent and decreased length of stay (LOS), which are indicative of greater resource use and opportunistic cost reduction. We prioritized the value of LS for eight abdominal procedures. MATERIALS AND METHODS We used a Japanese administrative database for the 6 mo leading up to December 2007. Study procedures were appendectomy, cholecystectomy, choledocholithotomy, herniorrhaphy, colectomy, partial or total gastrectomy, and small bowel resection (SBR) in adults. We analyzed patient demographics, mortality, comorbidity, complications, use of chemotherapy or postoperative pain control, hospital teaching status, postoperative LOS, and TCs. The impact of LS was determined using multivariate analysis on the propensity-score-matched cohorts of LS and OS. RESULTS Herniorrhaphy was most frequently performed (24,088 cases), whereas SBR was performed least (3404). LS was performed most often in cholecystectomy (81%) and least in herniorrhaphy (3.7%). LS did not increase complications in any procedure. Laparoscopic cholecystectomy and SBR were associated with shorter LOS and lower TC, whereas laparoscopic herniorrhaphy increased LOS and TC. Laparoscopic appendectomy and partial gastrectomy reduced LOS and increased TC. CONCLUSIONS LS safety was confirmed. Laparoscopic cholecystectomy or SBR might have advantages, whereas laparoscopic was no better than open herniorrhaphy and might be decided by patient's preference. Considering the variation in the decremental opportunistic cost produced by incremental medical expenses observed among the procedures, policymakers should determine an appropriate reimbursement schedule.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | |
Collapse
|
26
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Probability of survival, early critical care process, and resource use in trauma patients. Am J Emerg Med 2010; 28:673-81. [PMID: 20637382 DOI: 10.1016/j.ajem.2009.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 01/28/2009] [Accepted: 02/27/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Trauma Injury Severity Score is a frequently used prediction model for mortality. However, few studies have assessed the probability of survival (Ps) and early resource use after trauma. We studied the impact of Ps on early critical care or costs to test its applicability to efficient trauma care. METHODS The relationship between Ps in 8207 trauma patients and patients' demographics, organ injured, comorbidities, use of critical care, and total charges during the initial 48 hours was analyzed using multiple regression analyses. RESULTS Significant differences were observed among study variables across different Ps. A large variability in total charges was observed and explained by critical care, which Ps was significantly associated with. CONCLUSIONS Trauma Injury Severity Score offers a tool for estimating resource use and might improve monitoring of early trauma care quality. Measuring the combined effect of Trauma Injury Severity Score and injured organs would refine the methodology for evaluating the trauma care system.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
| | | | | | | | | | | |
Collapse
|
27
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Impact of timing of bile duct interventions on resource use and clinical outcome of cholecystectomy patients in Japan. J Eval Clin Pract 2010; 16:802-10. [PMID: 20557412 DOI: 10.1111/j.1365-2753.2009.01205.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS Laparoscopic cholecystectomy (LC) is increasingly used for acute cholecystitis, in conjunction with staged bile duct interventions (BDIs). However, few studies have evaluated the impact of BDI timing on costs and clinical outcomes during hospitalization. This study assessed the effects of several types of BDI and their timing on resource utilization and complications. METHODS A total of 13,738 cholecystectomy patients were treated for benign gallbladder diseases in 66 academic and 376 community hospitals in Japan in 2006. Variables analysed included: BDIs including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous gallbladder or common bile duct drainage (external drainage), endoscopic sphincterotomy, clearance of choledocholithiasis (internal drainage); and length of stay (LOS), total charges (TCs), procedure-related complications, and hospital function. Multivariate analysis was used to determine the impact of LC or BDIs on LOS, TCs and complications. RESULTS A total of 11,690 (85.1%) patients underwent LC. Inflammation was diagnosed in 70.7% of open cholecystectomy (OC) and 42.1% of LC patients. Complications were 7.7% in OC and 5.4% in LC patients. LC was associated with reduced LOS and TCs. BDIs were performed in more OC than LC patients. Preoperative was more costly than postoperative ERCP. Postoperative external drainage was significantly associated with LOS, TCs and complications. Advantages of pre- or postoperative internal drainage were not proven. CONCLUSIONS External drainage should be completed preoperatively. Postoperative ERCP may be preferable for bile duct scrutiny alone. Further evaluation of the timing of cholecystectomy will determine precisely the superiority of pre- or postoperative BDIs in terms of quality of care for complicated patients.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, Fukuoka, Japan.
| | | | | | | | | | | | | |
Collapse
|
28
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Contribution of case-mix classification to profiling hospital characteristics and productivity. Int J Health Plann Manage 2010; 26:e138-150. [PMID: 20583315 DOI: 10.1002/hpm.1051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Case-mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case-mix groups at 469 hospitals (1,721,274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case-mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | |
Collapse
|
29
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Quantitative comparison of the difficulty of performing laparoscopic colectomy at different tumor locations. World J Surg 2010; 34:133-9. [PMID: 20020298 DOI: 10.1007/s00268-009-0292-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic approaches of colectomy for colonic cancer are increasingly surpassing the mainstream open colectomy approach. Impact of disease variables, such as tumor location, has not been adequately measured in quality improvement initiatives. Quantitative analysis concerning the difficulty performing these procedures and differences in postoperative care depending on tumor site will contribute to the development of training programs and to the assessment of quality of care strategies. METHODS A total of 3,765 cases received laparoscopic colectomy (LC). Patient demographics, weighted comorbidities, procedure-related complications, stapling devices, operating room (OR) time, postoperative length of hospital stay (LOS), or total charges (TC) were categorized and compared based on tumor location: cecum to ascending, transverse, descending, and sigmoid colon. Multivariate analyses determined the impact of tumor location on postoperative LOS, TC, OR time, and complications. RESULTS Sigmoid colon was the most frequent tumor placement (40.5%). Significant differences in age, gender, frequency of blood transfusion, use of stapling devices, OR time, and postoperative LOS were observed among tumor locations. Transverse colon was the most significant determinant of postoperative LOS and TC, whereas descending colon tumors correlated with increased OR time. Greater OR time was associated with more postoperative resource use and complications. CONCLUSIONS Tumor location, complications, and OR time affected postoperative resource use, whereas greater OR time signified an increased occurrence of complications. Developers of LC training programs or healthcare policy makers should consider the quantitative impact of tumor locations when attempting to improve effective skill training or to survey the quality of LC performance.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan.
| | | | | | | | | | | |
Collapse
|
30
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Effect of Hospital Characteristics on the Quality of Laparoscopic Gastrectomy in Japan. Gastroenterology Res 2010; 3:65-73. [PMID: 27956988 PMCID: PMC5139872 DOI: 10.4021/gr2010.04.189w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2010] [Indexed: 01/18/2023] Open
Abstract
Background Laparoscopic gastrectomy (LG) is becoming more widely indicated, although its application has not been investigated sufficiently in community-based gastrointestinal research because the small number of gastric cancers in western countries might have limited its use. However, concerns have been raised regarding variations in the quality of care with LG. To contribute to improving the efficient utilization of costly surgical innovations, we determined the impact of hospital characteristics on LG care. Methods Among 3,914 LG patients in 58 academic and 200 community hospitals between 2006 and 2008, we examined patient demographics, comorbidity, complications, partial or total gastrectomy, care process, hospital patient volume, hospital ownership and teaching status, and fiscal year. Hospital LG volume was divided into three quintile categories (lower volume, LV; intermediate volume, IV; or higher volume, HV) that consisted of an approximately equal number of patients. Dependent variables were operating time (OT), length of stay (LOS) and total charge (TC). The impact of hospital characteristics on these variables was assessed using multivariate analysis. Results Twenty-seven academic hospitals out of 193 LV hospitals treated 271 (21%) LG patients, 20 of 44 IV hospitals treated 596 (47%), and 11 of 21 HV hospitals treated 748 (55%). Although mortality or complications did not vary significantly between LV, IV and HV hospitals, the latter were associated with longer OT or LOS and more TC. More blood transfusions were required in HV hospitals once indicated. Hospital ownership or teaching status did not explain the variation in complications. Teaching and national hospitals consumed more resources, and municipal and private hospitals reduced OT more than national hospitals. Conclusions A volume-quality relationship was recognized. As intraoperative transfusion prolongs OT and results in more complications, clinical societies or policy makers should introduce this new technique concurrently with quality improvement initiatives that aim to reduce unnecessary OT at targeted institutions. Hospitals varied in terms of LOS and TC, therefore, policy makers should also monitor resource utilization to enhance the efficiency of LG care under restrictive fiscal policies.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University Graduate School of Medical Sciences, Department of Health Care Administration and Management, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan 812-8582
| | - Shinya Matsuda
- University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku Kitakyushu, Fukuoka 807-8555, Japan
| | - Kiyohide Fushimi
- Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan
| | - Koichi B Ishikawa
- National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan
| | - Hiromasa Horiguchi
- University of Tokyo Graduate School of Medicine, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kenji Fujimori
- Hokkaido University, 5 Nishi 14 Kita Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| |
Collapse
|
31
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Contribution of bile duct drainage on resource use and clinical outcome of open or laparoscopic cholecystectomy in Japan. J Eval Clin Pract 2010; 16:31-8. [PMID: 20367813 DOI: 10.1111/j.1365-2753.2008.01109.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS Laparoscopic cholecystectomy (LC) is replacing conventional open cholecystectomy (OC) as a preferred surgical method for treating complicated biliary tract disorders. However, there have been few studies assessing the impact of staged bile duct drainage (BDD) on costs and clinical outcomes for either surgical approach. This study evaluated the impact of surgical technique and BDD on resource utilization and complication rates. METHODS This study included 2778 cholecystectomy patients treated for benign biliary tract diseases in 80 academic and 81 community hospitals. For both OC and LC patients, the following variables were analysed: demographics, clinical data, length of stay (LOS), total charges (TC; US$), procedure-related complications and hospital type. Multivariate analyses were used to determine the impact of BDD on LOS, TC and complication rates. RESULTS Of the 2778 cholecystectomy patients in the study, 2255 (81.2%) underwent LC. Inflammation was diagnosed in 55.6% of OC patients and 36.0% of LC patients. Complication was 9.4% in OC cases and 4.7% in LC cases. BDD was performed in 14.5% of OC cases and in 7.6% of LC cases. Diagnosis of inflammation, presence of co-morbidities and BDD each had a significant impact on LOS and TC. After risk adjustment, LC was associated with a reduction in LOS and TC, while BDD resulted in greater LOS and TC. LC and BDD were significantly associated with complications. CONCLUSIONS The study suggested that BDD utilized more resources and had higher rates of complications. LC remains an appropriate procedure for cholecystectomy patients. Further study will be needed to evaluate the effect of pre-operative or post-operative BDD on quality of care.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, 3-1-1 Maidashi Higashi-ku Fukuoka, 812-8582, Japan.
| | | | | | | | | | | | | |
Collapse
|
32
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Hospital volume and quality of laparoscopic gastrectomy in Japan. Dig Surg 2009; 26:422-9. [PMID: 19923832 DOI: 10.1159/000236904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 08/29/2009] [Indexed: 12/10/2022]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has become the prevailing surgery of choice for gastric cancer, but the impact of hospital volume or operating room (OR) time has not been evaluated. An observational study was conducted to assess the quality of LG based on hospital volume and OR time. METHODS 3,054 LG patients were enrolled in 420 hospitals throughout Japan. Analyzed variables included patient demographics, complications, use of stapling devices or chemotherapy, hospital volume, and teaching status. Hospitals were categorized into high- (>or=4 LG per month), intermediate- (1-3) and low- (<1) volume hospitals. Multivariate analysis was used to measure hospital volume and OR time impact. RESULTS 259 laparoscopic total gastrectomies (LTGs) were performed. Complications were observed in 269 cases (8.8%). High-volume hospitals treated less severe cases. OR time, but not hospital volume, was associated with complications. Hospital volume, teaching status and stapling devices explained variations in OR time. CONCLUSION OR time was a more significant predictor of complications than hospital volume. OR time was consumed more in the employment of stapling devices and LTG. To promote LG efficiency, training curricula highlighting the applicability of these techniques should be considered by clinical experts.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan. kazu228 @ basil.ocn.ne.jp
| | | | | | | | | | | |
Collapse
|
33
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Impact of hospital case volume on the quality of laparoscopic colectomy in Japan. J Gastrointest Surg 2009; 13:1619-26. [PMID: 19582520 DOI: 10.1007/s11605-009-0956-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/12/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The increased use of laparoscopic colectomy for colon cancer requires the evaluation of hospital case volume, quality care, and training systems, considering the difficulty of this surgery for various tumor locations. MATERIALS AND METHODS We assessed the quality of this procedure in Japan, based on hospital case volume and tumor location. A total of 3,765 patients were enrolled across 567 hospitals between July and December 2007. We analyzed patient characteristics, postoperative surgical complications, the administration of stapling devices or chemotherapy, hospital volume and teaching status, postoperative length of stay, total charges, and operating room time. Hospitals were classified into four case-volume categories: high (> or =5 cases per month), intermediate to high (3-4), low to intermediate (1-2), and low (<1). Multivariate analysis was used to test the impact of hospital category and tumor location. RESULTS Ten high-volume hospitals performed 401 cases, while 355 low-volume hospitals did 903. Hospital case volume, operating time, and complications affected postoperative stay and total costs. Longer procedural time was an independent predictor of complications. Tumor location, case volume, and teaching status explained the variations in procedural time individually but not complications. Training systems highlighting the applicability of techniques are important to promote the quality of laparoscopic colectomy.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | | | | | | | | | | |
Collapse
|
34
|
Miyata H, Motomura N, Kondo MJ, Fushimi K, Ishikawa KB, Takamoto S. Toward quality improvement of cardiovascular surgery in Japan: an estimation of regionalization effects from a nationwide survey. Health Policy 2009; 91:246-51. [PMID: 19178975 DOI: 10.1016/j.healthpol.2008.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 11/03/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In this study, we estimate the effects of regionalization for cardiovascular surgery in Japan, accounting for both its advantages and disadvantages. METHODS This study includes 209,221 procedures from nearly 572 hospitals that conducted cardiovascular surgery in Japan between 2001 and 2004. For the regionalization parameter, hospital surgical volume was divided into four categories: under 10, 10-24, 25-49, and 50-74 average cardiovascular surgeries per year. The effects of regionalization on the 30-day patient mortality rate and an additional travel distance for patients were examined. RESULTS The 30-day mortality rate for cardiovascular surgery was 4.62% without regionalization. After regionalization, the estimated rate was 4.40% for annual case volumes under 10, 4.28% for volumes 10-24, 3.78% for volumes 25-49, and 3.12% for volumes 50-74. The average annual number of patients who must travel at least an extra 30 km after regionalization are: 0.8 patients for case volumes under 10 (0.001% of total patients), 12.3 patients for volumes 10-24 (0.02% of total), 88.3 patients for volumes 25-49 (0.2% of total), and 179.3 patients for volumes 50-74 (0.3% of total). CONCLUSION The results indicate that, after regionalization, the 30-day mortality rate did improve for hospitals with 25-49 and 50-74 annual surgeries. While increased travel times may be critical for patients requiring emergency surgery, the results suggest that low-volume hospitals get relatively few such cases. In many regions, improving the transportation system for emergency cases may be more effective than maintaining a low-volume.
Collapse
Affiliation(s)
- Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Kuwabara K, Matsuda S, Anan M, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Difference in resource utilization between patients with acute and chronic heart failure from Japanese administrative database. Int J Cardiol 2009; 141:254-9. [PMID: 19157584 DOI: 10.1016/j.ijcard.2008.11.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 11/30/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many studies have reported economic evaluation of evolving agents or therapies for patients with heart failure (HF). However, little is known whether the disease progression category (acute or chronic HF) would be considered as a risk adjustment in health service research. OBJECTIVES This study profiles the difference in resource use or medical care for acute versus chronic HF. METHODS This study analyzed 17,912 HF patients treated in 62 academic hospitals and 351 community hospitals. Study variables included demographic variables, comorbid status, physical activity or disease progression at admission, procedures and laboratory tests, type and dose of heart-related medications, length of stay (LOS), and total charges (TC; 1 US$= 100 yen) for acute and chronic HF. The independent contributions of disease progression categories on LOS and TC were identified using multivariate analysis. RESULTS We identified 9813 chronic and 8099 acute HF patients. Median LOS was 18 days for both chronic and acute HF, whereas TC was US$5731 and US$6447, respectively. Regression analysis revealed that acute HF was associated with a slightly greater TC, whereas performance of procedures was the most prominent factor. As NYHA class was the next most influential factor, class 3 or 4 resulted in longer LOS or greater TC, than did class 1. CONCLUSIONS This study suggests that acute HF increased resource use slightly, whereas use of some practices indicated in critical care was affected more by the procedures performed. Disease progression category should remain an indicator for appropriateness of medical care.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Kuwabara K, Matsuda S, Fushimi K, Anan M, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Differences in Practice Patterns and Costs between Small Cell and Non-Small Cell Lung Cancer Patients in Japan. TOHOKU J EXP MED 2009; 217:29-35. [DOI: 10.1620/tjem.217.29] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine
| | - Makoto Anan
- Health information management, Kyushu Medical Center
| | | | - Hiromasa Horiguchi
- Health Management and Policy, University of Tokyo, Graduate School of Medicine
| | - Kenshi Hayashida
- Department of Healthcare Economics and Quality Management, Kyoto University, Graduate School of Medicine
| | | |
Collapse
|
37
|
Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K, Hayashida K. Impact of timing of cholecystectomy and bile duct interventions on quality of cholecystitis care. Int J Surg 2009; 7:243-9. [DOI: 10.1016/j.ijsu.2009.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 03/24/2009] [Accepted: 04/05/2009] [Indexed: 10/20/2022]
|
38
|
Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H, Hayashida K, Fujimor K. Cost of open versus laparoscopic appendectomy. Clin Ter 2008; 159:155-163. [PMID: 18594744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS There are several literatures on outcome variations between patients treated with an open appendectomy (OA) and a laparoscopic appendectomy (LA). However, there are no studies assessing differences in cost and outcome that adjust for age and hospital function or region. This study examines the differences in cost and procedure-related complications of OA and LA procedures. MATERIALS AND METHODS This study contains 1703 appendectomy patients treated for appendicitis in 76 academic hospitals and 80 community hospitals. Demographic variables, clinical variables, length of stay (LOS), total charges (TC; US$) and complication rates were analyzed for both OA and LA procedures. The specific contributions of LA to LOS, TC, and complication rate were identified using multivariate analysis. RESULTS 1469 (86.3%) patients underwent OA and 234 (13.7%) underwent LA. Complicated appendicitis was diagnosed in 13.1% of OA cases and 15.4% of LA cases. The complication rates were 3.4% in OA and 2.6% in LA (p=0.504). There were significant differences in LOS and TC by severity of appendicitis and by procedure type. After risk adjustment for the other study variables, LA was associated with a higher TC than OA ($1458, p0.001). However there were no significant differences in LOS or complication rates between the two treatment groups. CONCLUSIONS This study suggests that LA increases cost, but has no significant impact on LOS or complication rates. However, other outcomes such as quality of life or subgroup analysis for obese patients are needed for a more complete economic analysis of OA and LA.
Collapse
Affiliation(s)
- K Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, Kyushu University.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Impact of age and procedure on resource use for patients with ischemic heart disease. Health Policy 2008; 85:196-206. [PMID: 17825454 DOI: 10.1016/j.healthpol.2007.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 07/26/2007] [Accepted: 07/30/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Impact of age on healthcare expenditures should be assessed by targeting on specific diseases and controlling for procedures and severity of illness. Relationship between age and resource use in patients receiving acute care medicine for ischemic heart disease (IHD) was examined. METHODS We analyzed 19,874 IHD patients treated in 82 academic and 92 community hospitals. Length of stay (LOS), total charges (TC), and high outliers of LOS and TC were analyzed for every age group (under 65 years, 65-74 years, 75 years or older). Independent effects of age on LOS, TC, and high outliers of LOS and TC were determined using multivariate analysis. RESULTS 7863 (39.6%) patients were under 65 years, 7181 (36.1%) between 65 years and 74 years, and 4830 (24.3%) aged 75 years or older. Proportion of angina or non-medical treatment was significantly different among three age categories (angina 72%, 75%, 71.4%; non-medical 37.3%, 40.9%, 38.9%, respectively). Significant association with LOS or TC was identified in patients receiving coronary artery bypass graft surgery with percutaneous intracoronary intervention, who were most associated with TC high outlier. CONCLUSIONS Age had a modest impact on resource use, as compared with procedures. Policy makers need to acknowledge the impact of procedures on healthcare spending.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Science, 3-1-1 Maidashi Higashiku, Fukuoka 812-8512, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H. Profiling of resource use variation among six diseases treated at 82 Japanese special functioning hospitals, based on administrative data. Health Policy 2006; 78:306-18. [PMID: 16343686 DOI: 10.1016/j.healthpol.2005.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Profiling treatment in Japanese hospitals has rarely been conducted systematically with an administrative database. The study aims to present descriptive statistics of medical profiling and to examine the sources of variation in resource used for six common diseases. METHODS Administrative records for 266,677 patients were analyzed to examine variation in length of stay (LOS) and total charge (TC) by hierarchical multiple linear regression for cases of ischemic stroke, ischemic heart disease (IHD), great vessel disease (GVD), respiratory neoplasm, gastric neoplasm and colonic neoplasm. RESULTS Average LOS and TC increased with disease severity and invasiveness of surgical procedure. The coefficient of determination of the full model was highest for LOS in IHD (0.432), and for TC that was highest in GVD (0.702). Among various variable sets examined, surgical procedures explained largest variance in resource use. CONCLUSION With a standardized database derived from claims data, wide audience of stakeholders in Japanese healthcare will be able to access the profiling of practice or disease variation concerned.
Collapse
Affiliation(s)
- Kazuaki Kuwabara
- Kyoto University, Graduate School of Medicine, School of Public Health, Department of Healthcare Economics and Quality Management, Yoshida Konoe-chou, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
According to the National Vital Statistics data, age-standardized mortality rates (ASRs) of lung cancer have shown slightly declining trends in Japan for both men and women. In order to evaluate whether this tendency will continue, a Bayesian age-period-cohort (APC) model was applied using the National Vital Statistics data from 1952 to 2001. In the projection, a Gaussian autoregressive prior model was applied to smooth age, period, and cohort effects from its 2 immediate predecessors by extrapolation. Posterior distributions from which we drew inferences on mortality rates were derived from 15,000 iterations using 5000 burn-in iterations. We defined the median of the iterated values as the overall summary mortality rate of the iterated results. Our results suggest that the number of deaths due to lung cancer will double for men and women during the next 3 decades due to the aging of the baby-boomer generation (individuals who were born between 1947 and 1951). Currently declining trends in some age groups will reverse and start to increase again in the next decades. However, for recent birth cohorts, the results of the projection varied according to whether the data set included early age group mortality or not. Lung cancer mortality in the future depends on the risk factors engaged in by today's young people, especially smoking. Strong promotion of anti-smoking measures and careful surveillance for lung cancer are needed.
Collapse
Affiliation(s)
- Satoshi Kaneko
- Cancer Information and Epidemiology Division, National Cancer Center Research Institute, Chuo-ku, Tokyo 104-0045, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Shinkai T, Abe K, Ebihara S, Mizushima H, Wakao F, Ishikawa KB, Yamaguchi N. Cancer information from the National Cancer Center, Japan. Information Committee of the National Cancer Center, Tokyo. Jpn J Clin Oncol 1998; 28:717-20. [PMID: 9879286 DOI: 10.1093/jjco/28.12.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
43
|
Replogle ML, Kasumi W, Ishikawa KB, Yang SF, Juji T, Miki K, Kabat GC, Parsonnet J. Increased risk of Helicobacter pylori associated with birth in wartime and post-war Japan. Int J Epidemiol 1996; 25:210-4. [PMID: 8666492 DOI: 10.1093/ije/25.1.210] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Helicobacter pylori infection is now widely recognized as a cause of stomach cancer. We assessed trends in H. pylori infection in Japan, a population with high rates of gastric malignancy. METHODS Using an enzyme-linked immunosorbent assay (ELISA), we tested sera collected between 1980 and 1993 from Tokyo University Hospital patients for anti-H. pylori IgG. Patients ranged in age from 0 to 94 years. Helicobacter pylori prevalence was then assessed for age and/or birth cohort effects. RESULTS Of 1207 sera, 470 (38.9%) were positive for H. pylori IgG. By univariate analysis, both older age and birth in an earlier decade were associated with an increased risk of infection. Age-specific prevalence of H. pylori by birth cohort suggested increases in infection during the decades from 1900 to 1959, and age-specific decreases since 1960. In multivariate analysis, H. pylori infection increased with age and was most prevalent among those born in the 1940s and 1950s. CONCLUSION Relative to other birth cohorts, people born in the 1940s and 1950s have a higher prevalence of H. pylori. This increased prevalence of infection among those born in wartime Japan likely attests to the impact of compromised living conditions on acquisition of H. pylori, and may portend continued high rates of gastric cancer in forthcoming years.
Collapse
Affiliation(s)
- M L Replogle
- Department of Medicine, Stanford University Medical School, CA, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Miki K, Ichinose M, Ishikawa KB, Yahagi N, Matsushima M, Kakei N, Tsukada S, Kido M, Ishihama S, Shimizu Y. Clinical application of serum pepsinogen I and II levels for mass screening to detect gastric cancer. Jpn J Cancer Res 1993; 84:1086-90. [PMID: 8226283 PMCID: PMC5919064 DOI: 10.1111/j.1349-7006.1993.tb02805.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A considerable number of gastric cancers derive from stomach mucosa where chronic atrophic gastritis is severe and extensive. Based on the fact that the serum pepsinogen levels provide a precise measure of the extent of chronic atrophic gastritis, we have devised a mass screening method involving serum pepsinogen measurement to identify subjects at high risk of gastric cancer. In 1991, we screened 4,647 workers (male: 4,113, female: 534, mean age: 49.0 years) at a Japanese company using this method. Out of 875 subjects (18.8%) with a serum pepsinogen I level of less than 50 micrograms/liter and a pepsinogen I/II ratio of less than 3.0, 676 subjects (14.5%) were selected for further investigation by endoscopy. This led to the detection of four subjects (0.086%) with gastric cancer (three in an early stage) and four subjects with adenoma. The cancer detection rate of this new screening method was comparable, and in some respects superior, to that of the traditional barium X-ray screening. Since the incidence of test-positive subjects was as low as 10% amongst subjects aged less than 40, this screening method appears to be especially useful for screening of younger generations. The new method is less expensive than the traditional barium X-ray and subjects experience little discomfort. Further, many serum samples can be quickly measured simultaneously. The results of this study have indicated that serum pepsinogen screening provides a valuable method for detecting gastric cancers.
Collapse
Affiliation(s)
- K Miki
- First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ishikawa KB, Holt M, Kaihara S, Yoshikawa A, Hopkins DS, Mason M. Performance, characteristics, and case mix in Japanese and American teaching hospitals. Med Care 1993; 31:542-51. [PMID: 8502002 DOI: 10.1097/00005650-199306000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- K B Ishikawa
- Hospital Computer Center, University of Tokyo, Japan
| | | | | | | | | | | |
Collapse
|