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医療の質と医療費と原価との関係の解明-医療の可視化と効率化の推進を目指して-

Research Project

Project/Area Number 13J01335
Research Category

Grant-in-Aid for JSPS Fellows

Allocation TypeSingle-year Grants
Section国内
Research Field Medical sociology
Research InstitutionResearch Institute, Osaka Medical Center for Cancer and Cardiovascular Disaeses (2015)
Kyoto University (2013-2014)

Principal Investigator

森島 敏隆  地方独立行政法人大阪府立病院機構大阪府立成人病センター(研究所), がん予防情報センター企画調査課, 主査

Project Period (FY) 2013-04-01 – 2016-03-31
Project Status Completed (Fiscal Year 2015)
Budget Amount *help
¥3,960,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥660,000)
Fiscal Year 2015: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2014: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2013: ¥1,100,000 (Direct Cost: ¥1,100,000)
Keywords医療政策 / 医療経済 / 医療の質 / データベース研究 / 医療費 / 原価計算 / 組織論 / 医療経営
Outline of Annual Research Achievements

国家財政・医療保険財政が危機的状況になる一方で、国民の医療への期待はますます高まる今日において、わが国の医療介護制度・医療提供体制は変革を迫られている。限られた医療費・医療資源を最適な形に再配分しようとする医療制度の再設計において、わが国は全体的な質の向上と経済性・効率性の向上の両立の実現を目指している。
本研究は、わが国の多施設・広域の大規模・観察データに基づいて、医療・介護に関わるパフォーマンス・質・資源・医療費・原価の実態とその格差の評価法を開発した上で、それら相互の関係と関連要因を明らかにすることを目的とした。
研究に用いたデータは、全国レベルの大規模な医事管理データベースおよび各種質問紙調査を通して得たものである。それらのデータを様々なレベルで統合・連結して統計解析処理した。
具体的には以下のように独創的な学術的成果を上げることができた。様々な評価方法の開発・研究に取り組んだ。病院という組織のパフォーマンスに大きな影響を及ぼすと考えられている組織文化の定量的評価の尺度の開発に成功した。急性期~慢性期の医療・介護資源消費の評価方法を脳梗塞患者集団において吟味・確立した。
またそれらの新規に開発した評価方法と既存の評価方法を用いて、医療のパフォーマンス・質・医療費のそれぞれの間の関係やそれらのばらつき・格差に影響する関連要因を探索した。例えば、医療の質と医療費がどれだけ相関するのかについて脳梗塞患者集団と終末期がん患者集団において明らかにした。心筋梗塞診療と脳梗塞診療の質に関連する様々な要因を解明するとともに、多様な疾患背景を持つ患者のプロセス・アウトカムを評価するときに必須となる手法であるリスク調整方法の開発・吟味に取り組んだ。組織文化の新規開発した定量スケールを用いて、病院の組織としての文化が病院全体のパフォーマンスにどう影響するかを実証した。

Research Progress Status

27年度が最終年度であるため、記入しない。

Strategy for Future Research Activity

27年度が最終年度であるため、記入しない。

Report

(3 results)
  • 2015 Annual Research Report
  • 2014 Annual Research Report
  • 2013 Annual Research Report
  • Research Products

    (20 results)

All 2016 2015 2014 2013 Other

All Int'l Joint Research (1 results) Journal Article (7 results) (of which Peer Reviewed: 7 results,  Open Access: 1 results,  Acknowledgement Compliant: 1 results) Presentation (11 results) (of which Int'l Joint Research: 2 results) Book (1 results)

  • [Int'l Joint Research] Imperial College London(英国)

    • Related Report
      2015 Annual Research Report
  • [Journal Article] Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.2015

    • Author(s)
      Ukawa N, Tanaka M, Morishima T, Imanaka Y.
    • Journal Title

      International Journal for Quality in Health Care

      Volume: 27(1) Issue: 1 Pages: 37-45

    • DOI

      10.1093/intqhc/mzu091

    • Related Report
      2015 Annual Research Report 2014 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] Regional variations in in-hospital mortality, care processes, and spending in acute ischemic stroke patients in Japan.2015

    • Author(s)
      Otsubo T, Goto E, Morishima T, Ikai H, Yokota C, Minematsu K, Imanaka Y.
    • Journal Title

      Journal of Stroke and Cerebrovascular Diseases

      Volume: 24(1) Issue: 1 Pages: 239-251

    • DOI

      10.1016/j.jstrokecerebrovasdis.2014.09.016

    • Related Report
      2015 Annual Research Report 2014 Annual Research Report
    • Peer Reviewed / Acknowledgement Compliant
  • [Journal Article] Visualizing variations in organizational safety culture across an inter-hospital multifaceted workforce.2014

    • Author(s)
      Kobuse H, Morishima T, Tanaka M, Murakami G, Hirose M, Imanaka Y.
    • Journal Title

      Journal of Evaluation in Clinical Practice

      Volume: 20 Issue: 3 Pages: 273-280

    • DOI

      10.1111/jep.12123

    • Related Report
      2014 Annual Research Report 2013 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life : a cross-sectional study using claims data in Japan.2014

    • Author(s)
      Morishima T, Lee J, Otsubo T, Imanaka Y.
    • Journal Title

      International Journal for Quality in Health Care

      Volume: 26(1) Pages: 79-86

    • Related Report
      2013 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Association of geographical factors with administration of tissue plasminogen activator for acute ischemic stroke.2013

    • Author(s)
      Kunisawa S, Morishima T, Ukawa N, Ikai H, Otsubo T, Ishikawa K, Fushimi K, Yokota C, Minematsu K, Imanaka Y.
    • Journal Title

      Journal of the American Heart Association

      Volume: 2(5) Issue: 5

    • DOI

      10.1161/jaha.113.000336

    • Related Report
      2013 Annual Research Report
    • Peer Reviewed
  • [Journal Article] The number of cardiologists, case volume and in-hospital mortality in acute myocardial infarction patients.2013

    • Author(s)
      Park S, Sasaki N, Morishima T, Ikai H, Imanaka Y.
    • Journal Title

      International Journal of Cardiology

      Volume: 168(4) Issue: 4 Pages: 4470-4471

    • DOI

      10.1016/j.ijcard.2013.06.139

    • Related Report
      2013 Annual Research Report
    • Peer Reviewed
  • [Journal Article] The association between health care spending and quality : an analysis of regional variations in stroke patients in Japan.2013

    • Author(s)
      Lee J, Morishima T, Park S, Otsubo T, Ikai H, Imanaka Y.
    • Journal Title

      Journal of Health Services Research & Policy

      Volume: 18(2) Issue: 2 Pages: 77-82

    • DOI

      10.1177/1355819612473454

    • Related Report
      2013 Annual Research Report
    • Peer Reviewed
  • [Presentation] Relationship between the Hospital Standardised Mortality Ratio and measures of safety.2016

    • Author(s)
      Morishima T, Bottle A, Aylin P.
    • Organizer
      Health Services Research Network Symposium 2015
    • Place of Presentation
      ノッティンガム(英国)
    • Year and Date
      2016-07-01
    • Related Report
      2015 Annual Research Report
    • Int'l Joint Research
  • [Presentation] Appropriate follow-up period for upper gastrointestinal cancer patients –5 years or more? (J-CANSIS study).2016

    • Author(s)
      1.Miyashiro I, Ito Y, Nakata K, Morishima T, Hattori M, Matsuura N.
    • Organizer
      The 10th Joint Conference of the American Association for Cancer Research and Japanese Cancer Association
    • Place of Presentation
      マウイ(アメリカ合衆国)
    • Year and Date
      2016-02-16
    • Related Report
      2015 Annual Research Report
    • Int'l Joint Research
  • [Presentation] Relationship between the Hospital Standardised Mortality Ratio and measures of safety2015

    • Author(s)
      Morishima T, Bottle A, Aylin P.
    • Organizer
      Health Services Research Network Symposium 2015
    • Place of Presentation
      ノッティンガム(英国)
    • Year and Date
      2015-07-01 – 2015-07-02
    • Related Report
      2014 Annual Research Report
  • [Presentation] Variation in mechanisms of variation in healthcare quality indicators.2014

    • Author(s)
      Imanaka Y, Sasaki N, Morishima T, Otsubo T, Ikai H.
    • Organizer
      The 5th Annual Conference of the Wennberg International Collaborative
    • Place of Presentation
      ロンドン(英国)
    • Year and Date
      2014-09-18 – 2014-09-19
    • Related Report
      2014 Annual Research Report
  • [Presentation] Multicenter study of organizational culture and efficiency indicators of hospital management.2014

    • Author(s)
      Morishima T, Tanaka M, Ukawa N, Otsubo T, Ikai H, Imanaka Y.
    • Organizer
      The 10th World Congress of the International Health Economics Association
    • Place of Presentation
      ダブリン(アイルランド)
    • Year and Date
      2014-07-13 – 2014-07-16
    • Related Report
      2014 Annual Research Report
  • [Presentation] Organizational culture for efficient hospital management versus patient satisfaction: Multi-institutional, multi-professional analysis.2014

    • Author(s)
      Tanaka M, Morishima T, Ukawa N, Otsubo T, Ikai H, Imanaka Y.
    • Organizer
      The 10th World Congress of the International Health Economics Association
    • Place of Presentation
      ダブリン(アイルランド)
    • Year and Date
      2014-07-13 – 2014-07-16
    • Related Report
      2014 Annual Research Report
  • [Presentation] Organizational culture and its relationship with hospital management : a multicenter questionnaire survey and administrative data2013

    • Author(s)
      森島敏隆, 田中将之, 宇川直人, 猪飼宏, 今中雄一
    • Organizer
      医療経済学会第8回研究大会
    • Place of Presentation
      学習院大学(東京都豊島区)
    • Year and Date
      2013-09-07
    • Related Report
      2013 Annual Research Report
  • [Presentation] The number of cardiologists, case volume and in-hospital mortality for acute myocardial infarction2013

    • Author(s)
      Park S, Sasaki N, Morishima T, Ikai H, Imanaka Y
    • Organizer
      医療経済学会第8回研究大会
    • Place of Presentation
      学習院大学(東京都豊島区)
    • Year and Date
      2013-09-07
    • Related Report
      2013 Annual Research Report
  • [Presentation] 在院日数が短い病院では医療従事者の業務負担感が大きいのか? ―多施設大規模質問紙調査とDPCデータの解析―2013

    • Author(s)
      森島敏隆, 田中将之, 宇川直人, 猪飼宏, 今中雄一
    • Organizer
      第51回日本医療・病院管理学会学術総会
    • Place of Presentation
      京都大学(京都府京都市)
    • Related Report
      2013 Annual Research Report
  • [Presentation] 脳梗塞患者集団における機能別医療・介護資源消費推移の可視化2013

    • Author(s)
      大坪徹也, 國澤進, 森島敏隆, 佐々木典子, 今中雄一
    • Organizer
      第51回日本医療・病院管理学会学術総会
    • Place of Presentation
      京都大学(京都府京都市)
    • Related Report
      2013 Annual Research Report
  • [Presentation] Patient-oriented costing by function tracing : theoretical development and practical application.2013

    • Author(s)
      Tanaka M, Otsubo T, Park S, Morishima T, Lee J, Hayashida K, Imanaka Y
    • Organizer
      The 9th World Congress of the International Health Economics Association
    • Place of Presentation
      オーストラリア・シドニー
    • Related Report
      2013 Annual Research Report
  • [Book] “Variations in healthcare spending and quality among institutions”. In: Johnson A, Stukel T編 Health Services Research Series. Medical Practice Variations.2016

    • Author(s)
      Otsubo T, Imanaka Y, Morishima T, Sasaki N, Park S, Lee J.
    • Total Pages
      24
    • Publisher
      Springer, New York
    • Related Report
      2015 Annual Research Report

URL: 

Published: 2014-01-29   Modified: 2024-03-26  

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