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Development of clinical indicators for drug utilization and its application for quality medical care

Research Project

Project/Area Number 18590490
Research Category

Grant-in-Aid for Scientific Research (C)

Allocation TypeSingle-year Grants
Section一般
Research Field Medical sociology
Research InstitutionKyoto University

Principal Investigator

SEKIMOTO Miho  Kyoto University, Graduate School of Medicine, Lecturer (00244583)

Co-Investigator(Kenkyū-buntansha) IMANAKA Yuichi  Kyoto University, Graduate School of Medicine, Professor (10256919)
ISHIZAKI Tatsuro  Kyoto University, Graduate School of Medicine, Associate Professor (30246045)
HAYASHIDA Kenshi  Kyoto University, Graduate School of Medicine, Instructor (80363050)
Project Period (FY) 2006 – 2007
Project Status Completed (Fiscal Year 2007)
Budget Amount *help
¥3,910,000 (Direct Cost: ¥3,400,000、Indirect Cost: ¥510,000)
Fiscal Year 2007: ¥2,210,000 (Direct Cost: ¥1,700,000、Indirect Cost: ¥510,000)
Fiscal Year 2006: ¥1,700,000 (Direct Cost: ¥1,700,000)
KeywordsClinical database / Practice pattern / Blood products / Cerebral infarction / Clinicalpractice guidelines
Research Abstract

This study is designed to evaluate the appropriateness of drug utilization by the use of administrative data such as Disease Procedure Combination (DPC, the Japanese equivalent of diagnosis-related group) data or claims data For this research, we chose to focus on : 1) drug therapy in the treatment of cerebral infarctions, and 2) the utilization of blood products.
In the first study, we used Japan's administrative (DPC) data, which includes information on tests, medications, procedures, use of intensive, or specialized care, and nursing services itemized by type, quantity, and fees. We analyzed 3,136 patients with acute cerebral infarction from 14 medical institutions. Institutions were divided into three groups according to the distribution of medical costs in the first 2 days, and patient background, treatment process, and outcomes were compared across the groups. As a result of analysis, we observed wide variations in drug utilization patterns across institutions. The differences in … More medical costs for the initial hospitalization period appears to be more influenced by ICU utilization and management policies of institutions than the clinical condition of patients. We observed no significant association between drug utilization and patient outcomes.
In the second study, we identified patients who received a blood transfusion, and conducted a survey regarding the use of blood products and evaluated the appropriateness of their use. Our sample population consisted of two hospitals, in which we first conducted a chart review to survey the clinical situations where blood products were used, and subsequently evaluated the appropriateness of the utilization. We developed algorithms to assess the appropriateness of blood transfusion for each blood product In our survey, appropriate use was observed in 70% of red blood cell (RBC) transfusions, 15% of fresh frozen plasma (FFP) transfusions, 56% of platelet transfusions, and 30% of albumin use. The most common clinical situation where blood transfusion occurred included : acute hemorrhage, chronic anemia, and surgery in RBC transfusions ; coagulopathy, and prophylaxis for bleeding in FFP transfusions ; cardiac surgery, cardiac surgery, hematological diseases, and critical illness in platelet transfusions ; and hemorrhagic shock, cardiac surgery, and liver cirrhosis for use of albumin products.
Using DPC data, we calculated the observed/expected ratio (O/E ratio) of utilization of each blood product, and attempted to identify hospitals or divisions with over-utilization of blood products. Diagnostic groups were used for estimating the expected volume of blood products utilization. Although we observed a large variation in the O/E ratios, the magnitudes of O/E ratios were not necessarily associated with appropriateness of utilization. Less

Report

(3 results)
  • 2007 Annual Research Report   Final Research Report Summary
  • 2006 Annual Research Report
  • Research Products

    (11 results)

All 2008 2006 Other

All Journal Article (9 results) (of which Peer Reviewed: 4 results) Presentation (2 results)

  • [Journal Article] Management patterns and healthcare costs for hospitalized patients with cerebral infarction.2008

    • Author(s)
      Sekimoto M, Kakutani C, Inoue I, Ishizaki T, Hayashida K, Imanaka Y.
    • Journal Title

      Health Policy (In press)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary
    • Peer Reviewed
  • [Journal Article] Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan.2008

    • Author(s)
      Ishizaki T, Imanaka Y, Sekimoto M, Fukuda H, Mihara H; Treat-ment of Subarachnoid Hemo-rrhage Expert Group.
    • Journal Title

      J Eval Clin Pract 14

      Pages: 416-21

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary
    • Peer Reviewed
  • [Journal Article] Treatment of Subarachnoid Hemorrhage Expert Group.Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan2008

    • Author(s)
      Ishizaki, T., Imanaka, Y., Sekimoto, M., Fukuda, H., Mihara, H
    • Journal Title

      J Eval Clin Pract 14

      Pages: 416-21

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      2007 Final Research Report Summary
  • [Journal Article] Management patterns and healthcare costs for hospitalized patients with cerebral infarction.2008

    • Author(s)
      Sekimoto M, Kakutani C, Inoue I, Ishizaki T, Hayashida K, Imanaka
    • Journal Title

      Health Policy (In press)

    • Related Report
      2007 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Impact of hospital accreditation on infection control programs in teaching hospitals in Japan.2008

    • Author(s)
      Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H,
    • Journal Title

      Am J Infect Control 36

      Pages: 212-9

    • Related Report
      2007 Annual Research Report
    • Peer Reviewed
  • [Journal Article] Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan.2008

    • Author(s)
      Ishizaki T, Imanaka Y, Sekimoto M, Fukuda H, Mihara H; Treatment of Subarachnoid Hemorrhage Expert Group.
    • Journal Title

      J Eval Clin Pract (In press)

    • Related Report
      2006 Annual Research Report
  • [Journal Article] Evaluation of acute myocardial infarction in-hospital mortality by risk ad justment based on Japanese administrativedata.2008

    • Author(s)
      Hayashida K, Imanaka Y, Sekimoto M, Kobuse H, Fukuda H.
    • Journal Title

      The Journal of International Medical Research (In press)

    • Related Report
      2006 Annual Research Report
  • [Journal Article] Association between patient age and hospitalization resourceuse in a teaching hospital in Japan.2008

    • Author(s)
      Ishizaki T, Imanaka Y, Oh EH, Sekimoto M, Hayashida K, Kobuse H.
    • Journal Title

      Health Policy (In press)

    • Related Report
      2006 Annual Research Report
  • [Journal Article] Management patterns and healthcare costs for hospitalized patients with cerebral infarction

    • Author(s)
      Sekimoto, M., Kakutani, C., Inoue, I., Ishizaki, T., Hayashida, K., Imanaka, Y
    • Journal Title

      Health Policy (In press)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      2007 Final Research Report Summary
  • [Presentation] 卵巣癌入院TJ療法における診療プロセスの施設間比較2006

    • Author(s)
      白井貴子, 関本美穂, 石崎達郎, 今中雄一, QIP Ovarian Cancer Expert Group
    • Organizer
      第44回日本癌治療学会
    • Place of Presentation
      東京
    • Year and Date
      2006-10-19
    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      2007 Final Research Report Summary
  • [Presentation] QIP Ovarian Cancer Expert Group. Primary chemotherapy patterns for ovarian cancer treatment in Japan2006

    • Author(s)
      Shirai, T., Sekimoto, M., Ishizaki, T., Imanaka, Y
    • Organizer
      The 44th Annual Meeting of the Japan Society of Clinical Oncology
    • Place of Presentation
      Tokyo
    • Year and Date
      2006-10-19
    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      2007 Final Research Report Summary

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Published: 2006-04-01   Modified: 2016-04-21  

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