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2019 Fiscal Year Final Research Report

Methidology and Applicaton of Eatimation of Quality Indicator Using Hierarchical Bayesian Models

Research Project

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Project/Area Number 17H04146
Research Category

Grant-in-Aid for Scientific Research (B)

Allocation TypeSingle-year Grants
Section一般
Research Field Medical and hospital managemen
Research InstitutionNational Center of Neurology and Psychiatry

Principal Investigator

Tachimori Histeru  国立研究開発法人国立精神・神経医療研究センター, トランスレーショナル・メディカルセンター, 室長 (60342929)

Co-Investigator(Kenkyū-buntansha) 伊庭 幸人  統計数理研究所, モデリング研究系, 教授 (30213200)
宮田 裕章  慶應義塾大学, 医学部(信濃町), 教授 (70409704)
Project Period (FY) 2017-04-01 – 2020-03-31
Keywords医療の質 / 階層ベイズモデリング / 小児外科 / 循環器外科 / 消化器外科 / 小児先天性心疾患
Outline of Final Research Achievements

The aim of this study was to establish and validate risk models of mortality and morbidity associated with 12 major pediatric surgical procedures using the National Clinical Database-Pediatric (NCD-P) data. Overall, 10 and 21 variables were identified for mortality and morbidity, respectively. C-indices of mortality were 0.940 and 0.924 in the development and validation datasets, respectively. C-indices of morbidity were 0.832 and 0.830 in the development and validation datasets, respectively. Based on the NCD-P data, we developed satisfactory risk models for mortality and morbidity prediction in major pediatric surgeries. Based on the results of this study, we have determined the specifications of a risk calculator for the 12 most difficult pediatric surgery procedures in Japan.Based on this specification, we are developing a web-based system to visualize the risk of death and complications by inputting case information into the system.

Free Research Field

疫学・生物統計学

Academic Significance and Societal Importance of the Research Achievements

施設や地域に,医療の質指標の数値を,全国的な数値とともに報告することで,施設や地域ごとに自らの治療方針を見直し,方針を議論する機会などを提供することを通して医療の質の向上が期待されている。手術リスクを調整した術後の死亡率・罹患率の推定モデルを構築すれば,医療の質を示す指標のひとつとなりうる。本研究では小児外科の12の高難度術式について死亡と主要な合併症のリスクモデルを構築した。それに基づいて,症例の情報を入力することで,死亡と合併症の発生リスクを可視化することが可能となる上のリスクカリキュレータシステムをウェブ上に構築する仕様を決定し実装を進め,小児外科領域の医療の質を高めることに寄与した。

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Published: 2021-02-19  

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