Administrative Dataを用いたリスク調整と医療の評価手法の開発

2011 Fiscal Year Annual Research Report

• Project/Area Number: 21590556
• Research Institution: Tokyo Medical and Dental University
• Principal Investigator: 伏見 清秀 東京医科歯科大学, 医学部附属病院, 教授 (50270913)
• Keywords: 診断群分類 / 医療データ / 医療サービス研究 / 診療プロセス分析 / 患者リスク調整

Research Abstract

医療の質に対する関心が高まり医療の評価が求められているが、我が国では分析に利用できるデータが乏しく研究は進んでいない。諸外国では患者登録、医療費支払い、厚生統計等のために収集されているAdministrative Data(医療業務データ)を二次的用いた研究が成果を挙げているが、わが国でも急性期医療に関してDPC(Diagnosis Procedure Combination)診断群分類を用いた調査データが収集されるようになり、医療業務データの医療評価研究への応用が可能となってきている。そこで、本研究では、我が国における医療業務データの研究利用を促進するために、我が国の医療業務データの質の評価、医療業務データを用いた分析手法の検討、およびDPC調査データを用いた患者リスク調整の妥当性の検証を行った。DPC調査データ、厚生労働省のDPC調査公表データ、地域医療データ等の医療administrative dataより地域疾病データベースを構築し、以前に報告した方法(Sundararajan et al, Medical Care, 2007)により傷病名情報と診療プロセス情報のアウトカム予測力を、多重ロジスティック解析とC統計値を用いて検討した。傷病構造が異なる我が国のデータを用いた解析から、副傷病の影響をあらわすCharlson係数について,我が国独自の係数を開発する必要性があることが示唆された。本研究結果は、入院患者の日々の診療行為を表す電子的にコード化されたデータを含むわが国の診療プロセス情報の特徴を活かし、医療業務データを用いた医療評価研究の基礎が築かれ、研究データの質の確保とともにさまざまな医療研究への応用に結び付くことが期待される。

Research Products

• [Journal Article] Factors associated with a protracted hospital stay after hip fracture surgery in Japan (2011)
  • Author(s): Takahashi, C., Fushimi, K., Matsuda, S.
  • Journal Title: Geriatrics & Gerontology International Volume: 11(4) Pages: 474-481
  • Peer Reviewed
• [Journal Article] Factors associated with adherence to prophylactic antibiotic therapy for elective general surgeries in Japan (2011)
  • Author(s): Imai-Kamata, S., Fushimi, K.
  • Journal Title: International Journal for Quality in Health Care Volume: 23(2) Pages: 167-172
  • Peer Reviewed
• [Journal Article] Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: World J Surg Volume: 35(11) Pages: 2485-2492
  • Peer Reviewed
• [Journal Article] Early crystalloid fluid volume management in acute pancreatitis : association with mortality and organ failure (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Pancreatology Volume: 11(3) Pages: 351-361
  • DOI: 10.1159/000328965
  • Peer Reviewed
• [Journal Article] Relationships of age, cholecystectomy approach and timing with the surgical and functional outcomes of elderly patients with cholecystitis (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Int J Surg Volume: 9(5) Pages: 392-399
  • DOI: 10.1016/j.ijsu.2011.03.026
  • Peer Reviewed
• [Journal Article] Relationship between hospital volume and outcomes following primary percutaneous coronary intervention in patients with acute myocardial infarction (2011)
  • Author(s): Kuwabara, H., Fushimi, K., Matsuda, S.
  • Journal Title: Circ J Volume: 75(5) Pages: 1107-1112
  • Peer Reviewed
• [Journal Article] Reappraising the Surgical Approach on the Perforated Gastroduodenal Ulcer : Should Gastric Resection Be Abandoned? (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Journal of Clinical Medicine Research Volume: 3(5) Pages: 213-222
  • DOI: 10.4021/jocmr608w
  • Peer Reviewed
• [Journal Article] Quantification of Resource Utilization to Obtain Functional Recovery in Strokes (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Journal of Neurology Research Volume: 1(3) Pages: 96-104
  • DOI: 10.4021/jnr42w
  • Peer Reviewed
• [Journal Article] Re-Justification for Reducing the Length of Hospital Stay Based on Community-Based Appraisal of Functional Recovery of Cerebrovascular Disease Patient (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Journal of Neurology Research Volume: 1(2) Pages: 59-68
  • DOI: 10.4021/jnr18e
  • Peer Reviewed
• [Journal Article] Community-Based Appraisal of the Effects of Parenteral Nutrition Versus Enteral Nutrition on the Quality of Care for Patients With Acute Pancreatitis (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Gastroenterology Research Volume: 4(1) Pages: 1-8
  • DOI: 10.4021/gr289w
  • Peer Reviewed
• [Journal Article] Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries (2011)
  • Author(s): Quan, H., Li, B., Couris, CM., Fushimi, K., Graham, P., Hider, P., Januel, JM., Sundararajan, V.
  • Journal Title: Am J Epidemiol Volume: 173(6) Pages: 676-682
  • Peer Reviewed
• [Journal Article] Quantitative evaluation of age disparities in the quality of geriatric acute medical care in Japan (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: International Journal of Gerontology Volume: 5(3) Pages: 139-145
  • DOI: 10.1016/j.ijge.2011.09.033
  • Peer Reviewed
• [Journal Article] Community-Based Appraisal of Laparoscopic Abdominal Surgery in Japan (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Journal of Surgical Research Volume: 165(1) Pages: e1-e13
  • Peer Reviewed
• [Journal Article] Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K..B., Horiguchi, H., Fujimori, K., Yasunaga, H., Miyata, H.
  • Journal Title: Annals of Surgery Volume: 253(1) Pages: 64-70
  • Peer Reviewed
• [Journal Article] Reconsidering the value of rehabilitation for patients with cerebrovascular disease in Japanese acute health care hospitals (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Fujimori, K.
  • Journal Title: Value in Health Volume: 14(1) Pages: 166-176
  • Peer Reviewed
• [Journal Article] Contribution of case-mix classification to profiling hospital characteristics and productivity (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K.B., Horiguchi, H., Hayashida, K., Fujimori, K.
  • Journal Title: International Journal of Health Planning and Management Volume: 26(3) Pages: e138-e150
  • Peer Reviewed
• [Presentation] The Impact of Comorbid Mental Illness on Costs of Health Care for Inpatients sith Heart Failure (2011)
  • Author(s): Shimizu, S., Ishikawa, KB., Ito, H., Fushimi, K.
  • Organizer: ISPOR 14th Annual European Congress
  • Place of Presentation: Hotel Auditrium Madrid (Madrid, Spain)
  • Year and Date: 2011-11-05
• [Presentation] A look at the use of the Japaneses administrative database and the geographical information system in the management of disaster medicine and regional medical care planning (2011)
  • Author(s): Kuwabara, K., Matsuda, S., Fushimi, K., Ishikawa, K., Horiguchi, H., fujimori, K., Tasaki, T.
  • Organizer: 27th PCS/I Conference
  • Place of Presentation: Le Westin Montreal (Montreal, Quebec, Canada)
  • Year and Date: 2011-10-19
• [Presentation] Application of Agency for Healthcare Research and Quality (AHRQ) patient safety indicators in Japan (2011)
  • Author(s): Ikeda, S., Kobayashi, M., Fushimi, K., Matsuda, S.
  • Organizer: 28th ISQua Conference
  • Place of Presentation: Hong Kong Convention and Exhibition Centre (Hong Kong, China)
  • Year and Date: 2011-09-28
• [Presentation] The Development of clinical Indicators for acute care hospitals in Japan (2011)
  • Author(s): Kobayashi, M., Bito, S., Okada, C., Fushimi, K.
  • Organizer: 28th ISQua Conference
  • Place of Presentation: Hong Kong Convention and Exhibition Centre (Hong Kong, China)
  • Year and Date: 2011-09-28
• [Presentation] 大規模Administrative Databaseより抽出したVancomycin投与症例のTDM実施率がLOS(在院日数)に与える影響 (2011)
  • Author(s): 今井志乃ぶ, 伏見清秀
  • Organizer: 第49回日本医療・病院管理学会学術総会
  • Place of Presentation: 学術総合センター(東京都)
  • Year and Date: 2011-08-20
• [Presentation] 日本における人工股関節置換手術の周術期合併症と施設規模の関係 (2011)
  • Author(s): 金子剛士, 伏見清秀
  • Organizer: 第49回日本医療・病院管理学会学術総会
  • Place of Presentation: 学術総合センター(東京都)
  • Year and Date: 2011-08-20
• [Book] DPCデータの臨床指標・病院指標への活用 (2011)
  • Author(s): 藤森研司、伏見清秀
  • Total Pages: 165
  • Publisher: じほう
• [Book] フランスにおける亜急性期入院医療を対象とした診断群分類の開発 (2011)
  • Author(s): 松田晋哉、伏見清秀
  • Total Pages: 18-25
  • Publisher: 社会保険旬報
• [Book] DPCで見る地域医療の通信簿第1回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第2回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第3回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第4回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第5回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第6回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第7回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第8回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第9回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Japan Medicine
• [Book] DPCで見る地域医療の通信簿第10回 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 1
  • Publisher: Medifax digest
• [Book] DPC包括評価制度の現状とDPC研究班の今までの研究 (2011)
  • Author(s): 伏見清秀
  • Total Pages: 37-43
  • Publisher: 医事業務