2022 Fiscal Year Final Research Report

Development of a quantitative evaluation method for medical safety in advanced treatment hospitals and examination of additional medical costs associated with adverse events

Research Project

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Project/Area Number	20K10342
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 58010:Medical management and medical sociology-related
Research Institution	Tokyo Medical and Dental University
Principal Investigator	Toba Mikayo 東京医科歯科大学, 医学部附属病院, 講師 (60463923)
Co-Investigator(Kenkyū-buntansha)	工藤篤東京医科歯科大学, 医学部附属病院, 准教授 (20376734) 森脇睦子東京医科歯科大学, 大学院医歯学総合研究科, 寄附講座准教授 (40437570) 伏見清秀東京医科歯科大学, 大学院医歯学総合研究科, 教授 (50270913)
Project Period (FY)	2020-04-01 – 2023-03-31
Keywords	医療安全管理 / 医療の質管理 / 病院管理 / 有害事象 / 医療事故 / 医療の質指標
Outline of Final Research Achievements	As one of the methods for quantitative evaluation of medical safety, we have developed 98 indicators for evaluating outcome evaluation of adverse event occurrence status and process for occurrence prevention by utilizing DPC data, which is structured data. The incidence of pancreatic fistula requiring invasive procedures after pancreatic surgery, the incidence of postoperative bleeding requiring hemostasis after surgery for breast cancer, and other complications equivalent to Grade III or higher according to the Clavien-Dindo classification, have a sensitivity and specificity of 90%. We were able to create an index of degree. Of these, 22 indicators were analyzed for DPC hospitals other than the specified hospitals. In an analysis of perioperative oral function management, perioperative oral function management was associated with shorter hospital stay and survival to discharge, and was more actively implemented in hospitals other than advanced treatment hospitals.
Free Research Field	医療安全
Academic Significance and Societal Importance of the Research Achievements	DPCデータを用いた医療の質の可視化の取り組みや臨床研究はこれまでも数多くなされてきているが、医療安全管理分野への応用は限定的であった。本研究成果の一部は、研究代表者の施設の医療安全分野における医療の可視化のためのモニタリング指標としての実運用を開始している。また、国立大学附属病院医療安全管理協議会で実施している医療安全指標プロジェクトにもその成果の一部を提供することで、国立大学病院の医療安全の可視化の取り組みも始まったところである。一方で、医療安全の向上に伴う医療経済的インセインティブの評価手法の開発は十分ではなく、引き続き検討を続けていく。