Medical Care for the Elderly at the End of Life; National Big Data Analysis

2022 Fiscal Year Final Research Report

• Project/Area Number: 18K17346
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Ritsumeikan University (2020-2022); Kyoto University (2018-2019)
• Principal Investigator: SAKAI MICHI 立命館大学, 総合科学技術研究機構, 准教授 (10604697)
• Project Period (FY): 2018-04-01 – 2023-03-31
• Keywords: 終末期医療 / 高齢者医療 / レセプト / ビックデータ / NDB

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)

Free Research Field

医療情報学

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。