Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)

Takeo Nakayama,Motoko Yanagita,Shingo Fukuma,Tomohiro Kuroda,Shunichi Fukuhara,Hiroshi Tamura,Manabu Muto,Yosuke Yamamoto,Shiro Tanaka,Rei Goto,Yasushi Okuno,Genta Kato,Yuichi Imanaka

doi:10.1186/s12199-017-0644-5

Abstract

As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation.Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues—potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care—will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.

Highlights

As Japan becomes a super-aged society, the question of how medical care for the elderly is provided and the direction of that care are important national issues
There are few research papers which reported the actual situation of medical care in elderly based on a large-scale of data in Japan [14, 15], none of the papers which discuss about evidence-practice gap in elderly in super-aging society based on large-scale of data as NDB can be found currently
Health care data included in hospital databases includes test values, and since a more detailed picture of the patient can be obtained, the two need to be compared in validation as a reference to assess the validity of the health insurance claims disease name

Summary

Introduction

As Japan becomes a super-aged society, the question of how medical care for the elderly is provided and the direction of that care are important national issues. There are few research papers which reported the actual situation of medical care in elderly based on a large-scale of data in Japan [14, 15], none of the papers which discuss about evidence-practice gap in elderly in super-aging society based on large-scale of data as NDB can be found currently.

Results

Conclusion