Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan

The aging world population requires a sustainable and high-quality healthcare system. To examine the efficiency of medical cooperation, medical provider and physician networks were constructed using patient claims data. Previous studies have shown that these networks contain information on medical cooperation. However, the usage patterns of multiple medical providers in a series of medical services have not been considered. In addition, these studies used only general network features to represent medical cooperation, but their expressive ability was low. To overcome these limitations, we analyzed the medical provider network to examine its overall contribution to the quality of healthcare provided by cooperation between medical providers in a series of medical services. This study focused on: i) the method of feature extraction from the network, ii) incorporation of the usage pattern of medical providers, and iii) expressive ability of the statistical model. Femoral neck fractures were selected as the target disease. To build the medical provider networks, we analyzed the patient claims data from a single prefecture in Japan between January 1, 2014 and December 31, 2019. We considered four types of models. Models 1 and 2 use node strength and linear regression, with Model 2 also incorporating patient age as an input. Models 3 and 4 use feature representation by node2vec with linear regression and regression tree ensemble, a machine learning method. The results showed that medical providers with higher levels of cooperation reduce the duration of hospital stay. The overall contribution of the medical cooperation to the duration of hospital stay extracted from the medical provider network using node2vec is approximately 20%, which is approximately 20 times higher than the model using strength

Cost-Effectiveness Analysis of Omalizumab for the Treatment of Severe Asthma in Japan and the Value of Responder Prediction Methods Based on a Multinational Trial

AbstractObjectivesOmalizumab improves health outcomes for patients with severe asthma. The purpose of this study was to conduct a cost-utility analysis of omalizumab from a societal perspective by using the results from a randomized controlled trial in Japan, and explore the efficient use of omalizumab.MethodsWe developed a Markov model to compare omalizumab add-on therapy with standard therapy. Patients transitioned between symptom-free, day-to-day, and exacerbation states. Our model had a lifetime horizon in which 5-year omalizumab add-on therapy was followed by standard therapy. Preference-based utilities were extracted from another study. We estimated the expected value of perfect information for patients' response to omalizumab.ResultsIn the base case, incremental cost-effectiveness ratio (ICER) for omalizumab add-on therapy was US $755,200 (95$614,200–$1,298,500) per quality-adjusted life-year gained, compared with standard therapy alone. One-way sensitivity analyses indicated that the results were sensitive to asthma-related mortality, exacerbation risk, and omalizumab cost. The ICER for a responder subgroup was 22$4100 (95% CI $2500–$6000) and $28 million (95$17 million–$42 million) per year, respectively.ConclusionsWith a willingness-to-pay of$45,000 per quality-adjusted life-year, omalizumab was not cost-effective in Japan. Confining omalizumab therapy to previously predicted responders, however, may be a reasonable strategy to reduce the ICER, as the cost-effectiveness was observed to improve for these patients. Further studies should be conducted to explore responder prediction methods. Decreasing the price of omalizumab would improve cost-effectiveness

Trajectories of end-of-life medical and long-term care expenditures for older adults in Japan: retrospective longitudinal study using a large-scale linked database of medical and long-term care claims

We analyzed trajectories of medical and long-term care expenditures during the 60 months before the date of death. We identified six distinct spending trajectories for the total care expenditures. Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. This finding has implications for improving the quality of end-of-life care and its financial foundation

Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life: a cross-sectional study using claims data in Japan.

[Background] End-of-life (EOL) care imposes heavy economic burdens on patients and health insurers. Little is known about the association between the types of EOL care and healthcare costs for cancer patients across various providers. [Objective] To explore the association of healthcare expenditures with benchmarking indicators of aggressive versus palliative care among terminally ill cancer patients, from the perspective of health insurers. [Design] Cross-sectional retrospective study using health insurance claims data. [Setting/participants] Cancer patients who had died in Kyoto prefecture, Japan, between April 2009 and May 2010. [Main outcome measure] Claims data were analyzed using multilevel generalized linear models to examine whether aggressive care and palliative care were associated with expenditures during the last 3 months of life, after adjusting for patient characteristics, hospital characteristics and other non-indicator procedures. [Results] We analyzed 3143 decedents from 54 hospitals. Median expenditure per patient during the last 3 months was US$13 030. Higher expenditures were associated with the aggressive care indicators of higher mortality at acute-care hospitals and use of chemotherapy in the last month of life, as well as with the palliative care indicators of increased hospice care and opioid use in the last 3 months of life. However, increased physician home care in the last 3 months was associated with lower expenditure. [Conclusions] Indicators of both aggressive and palliative EOL care were associated with higher healthcare expenditures. These results may support the coherent development of measures to optimize aggressive care and reduce the financial burdens of terminal cancer care

Intra-operative autologous blood donation for cardiovascular surgeries in Japan: A retrospective cohort study

心臓外科手術における効果的な輸血戦略を検証 --コロナ禍の献血不足対策として--. 京都大学プレスリリース. 2021-03-16.Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016–2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32, 433 and 4, 267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients

COVID-19 Impact on the Japanese Healthcare System and Comparison of its Countermeasures With South Korea and Taiwan

Since the coronavirus disease 2019 (COVID-19) pandemic has begun, Asian countries/regions, such as Japan, South Korea, and Taiwan, had generally controlled the pandemic better than other countries. In this article, we showed the big impact of the pandemic on acute care hospitals in Japan, where the number of COVID-19 patients has been smaller than in other countries. We also compared the mitigation measures against the COVID-19 pandemic among Japan, South Korea, and Taiwan to study the factors affecting the differences among these relatively well-controlled countries/regions. We analyzed Diagnosis Procedure Combination data from the Quality Indicator/Improvement Project database, in which Japanese hospitals participated voluntarily. During the first declaration of emergency, which was from April 4 to May 25, the numbers of inpatients decreased roughly 20% for adults and 40% for those aged under 18 years compared to those of the same period in the previous year. In the analyses by disease, hospitalizations with acute coronary syndrome, ischemic stroke, cancer, childhood non-COVID-19 acute infections, infant and pediatric asthma decreased in number, whereas those with alcohol-related liver diseases and pancreatitis increased. Comparing selected mitigation measures against COVID-19, such as border control, enforced measures, information governance, and contact tracing, among Japan, South Korea, and Taiwan, the implementation and dissemination of measures were less strict, slower, and less comprehensive in Japan. This might explain why Japan has experienced a comparatively high incidence of COVID-19 and indicate a substantial risk of infection explosion. A change in behavioral compliance could trigger an infection explosion under poor performance in the response set. Further monitoring is warranted to promote the evolution of effective sets of countermeasures to overcome the pandemic

Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure, hospitalization and worsening of diabetes: an observational study using medical, dental and pharmacy claims data in Japan

[Aims] To investigate the effects of regular periodontal management for people with type 2 diabetes on total healthcare expenditure, hospitalization and the introduction of insulin. [Materials and methods] We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. We fitted generalized linear models that had sex, age, comorbidities and the status of periodontal management during the previous two years as predictors. [Results] A total of 16, 583 individuals were enrolled. The annual healthcare expenditure in the third year was 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92–1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82–0.98). The aOR of introducing insulin in the third year for those who had not been prescribed insulin during the previous two years (n = 13, 222) was 0.77 (95% CI: 0.64–0.92) in the group receiving periodontal management every year. [Conclusion] Regular periodontal management for diabetic people was associated with reduced healthcare expenditure, all-cause hospitalization and the introduction of insulin therapy

Impact of the Clinical Trials Act on Noncommercial Clinical Research in Japan: An Interrupted Time-series Analysis

Background: The number of new noncommercial clinical studies conducted in Japan declined within the first year of the implementation of the Clinical Trials Act (CTA) on April 1, 2018. This study aimed to examine the impact of the CTA’s enforcement on the number of new noncommercial clinical studies registered in the Japanese Clinical Trial Registry. Methods: An interrupted time-series design was used in the analysis, which was conducted from April 2015 to March 2019. We collected data for studies registered in the Clinical Trial Registry, managed by the University Hospital Medical Information Network. Results: In total, 35, 811 studies were registered; of these, 16, 455 fulfilled the eligibility criteria. The difference in the trend of monthly number of new studies after CTA enforcement decreased significantly by 15.0 (95% confidence interval [CI], −18.7 to −11.3), and the level decreased by 40.8 (95% CI, −68.2 to −13.3) studies from the pre-enforcement to the post-enforcement period. Multigroup analyses indicated that the act exerted a significant effect on the trend of new clinical studies, particularly those with smaller sample sizes, interventional study designs, and nonprofit funding sponsors. Conclusions: The number of Japanese noncommercial clinical studies declined significantly following implementation of the CTA. It is necessary to establish a system to promote clinical studies in Japan while ensuring transparency and safety

Stages of a Transtheoretical Model as Predictors of the Decline in Estimated Glomerular Filtration Rate: A Retrospective Cohort Study

Background: The transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR). Methods: We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup. Results: We analyzed 239, 755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65–0.91); stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and stage 5 group (HR 0.79; 95% CI, 0.66–0.95). Conclusion: Compared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline