| Project/Area Number |
18K17346
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| Research Category |
Grant-in-Aid for Early-Career Scientists
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| Allocation Type | Multi-year Fund |
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| Review Section |
Basic Section 58010:Medical management and medical sociology-related
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| Research Institution | Ritsumeikan University (2020-2022)
Kyoto University (2018-2019) |
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Principal Investigator |
SAKAI MICHI 立命館大学, 総合科学技術研究機構, 准教授 (10604697)
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| Project Period (FY) |
2018-04-01 – 2023-03-31
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| Project Status |
Completed (Fiscal Year 2022)
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| Budget Amount *help |
¥3,770,000 (Direct Cost: ¥2,900,000、Indirect Cost: ¥870,000)
Fiscal Year 2020: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2019: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2018: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
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| Keywords | 終末期医療 / 高齢者医療 / レセプト / ビックデータ / NDB / 超高齢者 / レセプト情報・特定健診等情報データベー / レセプト情報・特定健診等情報データベース / 終末期高齢者 / 保健医療ビッグデータ / 終末期 / 高齢者 / National Data Base（NDB） |
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| Outline of Final Research Achievements |
1) Validation of Claims Data to Identify Death among Aged Persons: The sensitivity of identifying death from the receipts was 94.3% for inpatient and 47.4% for outpatient, indicating that inpatient death information is highly valid, but the use of death information obtained from outpatient receipts is not recommended.
2) A Time-Trend Analysis from 2012 through 2014 Based on a Nationally Representative SampleUsing NDB: We examined changes over time in medical care for the terminally ill elderly: from H24 to H26, cardiopulmonary resuscitation, ventilation, and ICU admissions in the 7 days before death decreased from 11.0% to 8.3%, 13.1% to 9.8%, and 9.1% to 7.8%, respectively.
3) Regional differences in end-of-life care were examined in a multilevel model using NDB. The subjects were hospitalized patients aged 75 years or older, regional differences in cardiopulmonary resuscitation, ventilation, and ICU admission prior to death were analyzed. (before publication)
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| Academic Significance and Societal Importance of the Research Achievements |
日本医師会は「終末期医療に関する答申」で、形式的な延命は患者の尊厳を侵し、患者の意思、利益に反している場合があるとの認識に立ちながら、何をもって過剰医療かの判断は難しいことから、関係者間の合意形成プロセスの重要性を強調してきた（第XV次生命倫理懇談会答申.2017）。
本研究は「日本の国の高齢者が、先進国に相応しく、等しく、尊厳のある生と死を全うできているのか」という問いに関する議論を深化させ、合意形成の基礎となる情報と共に、診療のばらつきとその要因の解明により、終末期医療のあるべき姿の検討に資する情報となると考える。
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