Diagnosis Procedure Combination System Research Articles

Oral Biguanide Use Is Associated with Lower Incidence of AKI and Mortality in COVID-19 Patients: A Nationwide Study Using the Diagnosis Procedure Combination System in Japan

Oral Biguanide Use Is Associated with Lower Incidence of AKI and Mortality in COVID-19 Patients: A Nationwide Study Using the Diagnosis Procedure Combination System in Japan

Effects of Rotavirus Vaccination Coverage among Infants on Hospital Admission for Gastroenteritis across All Age Groups, Japan, 2011-2019.

We assessed the effect of rotavirus vaccination coverage on the number of inpatients with gastroenteritis of all ages in Japan. We identified patients admitted with all-cause gastroenteritis during 2011-2019 using data from the Diagnosis Procedure Combination system in Japan. We used generalized estimating equations with a Poisson distribution, using hospital codes as a cluster variable to estimate the impact of rotavirus vaccination coverage by prefecture on monthly numbers of inpatients with all-cause gastroenteritis. We analyzed 294,108 hospitalizations across 569 hospitals. Higher rotavirus vaccination coverage was associated with reduced gastroenteritis hospitalizations compared with the reference category of vaccination coverage <40% (e.g., for coverage >80%, adjusted incidence rate ratio was 0.87 [95% CI 0.83-0.90]). Our results show that achieving higher rotavirus vaccination coverage among infants could benefit the entire population by reducing overall hospitalizations for gastroenteritis for all age groups.

Seasonal variation of surgically treated distal radius fracture in Japan using inpatient database: cross-sectional study.

The purpose of this study was to clarify the relationship between seasonal variation and distal radius fractures using diagnosis procedure combination data in Japan. The participants were hospitalized patients who underwent surgical treatment for distal radius fracture as the primary injury at hospitals that introduced the diagnosis procedure combination system between April 2011 and March 2016. We obtained a summary table of the month of admission, region of residence, age at admission, and sex of the patients from the Ministry of Health, Labour and Welfare and evaluated it by month, region, age group, and sex. The total number of patients for the 5years from 2011 to 2016 was 105,025. There were 29,224 male and 75,801 female participants, with a female-to-male ratio of 2.6. The mean age was 60.2 (standard deviation, 20.8) years. Distal radius fractures occurred more frequently in the winter, especially among female individuals in eastern Japan. Female participants aged ≥ 50years tended to have a higher incidence of distal radius fracture in winter. The incidence of distal radius fracture among male participants aged 0-19years was higher from spring to autumn. Surgically treated distal radius fractures occur frequently during the winter months among female individuals in eastern Japan or those aged ≥ 50years and increase from school age to adolescence, especially in male individuals from spring to autumn. We should be aware of the high incidence of distal radius fractures in winter, especially in regions with snowfall and cold temperatures.

The Evaluation of Hospitalist Care for Patients with Aspiration Pneumonia Using Risk-adjusted Performance Indicators Developed from a Nationwide Inpatient Database.

Background High-quality evidence proving the superiority of hospitalist services is lacking. We developed risk-adjusted performance indicators from a multilevel prediction model using a nationwide inpatient database to evaluate hospitalist medical care for patients with aspiration pneumonia. Methods We extracted cases diagnosed with aspiration pneumonia between 2014 and 2021 from the Diagnosis Procedure Combination (DPC) database. Hospital-level risk-adjusted performance indicators were the observed-to-expected ratio of the following outcomes using a multilevel prediction model containing both patient- and hospital-level variables: death or transfer in poor condition within 30 days (poor outcome), in-hospital death within 30 days, and discharges within the 25th and 50th percentiles for length of stay defined by the DPC system. Using the predicted numbers of each outcome without random intercept as denominators of both indicators, the numerators of Indicator 1 were observed numbers of each outcome, while those in Indicator 2 were "smoothed" predicted numbers of outcomes estimated by the fitted model with random intercept. The ratio of the number of outcomes for each hospital to the mean number of outcomes among participating hospitals was used as a reference. We applied these indicators to Takatsuki General Hospital (TGH) as a working example. Results A total of 526,245 patients were analyzed. Compared with indicator 1, indicator 2 showed greater stability in the mean ratio and bootstrapping confidence interval (CI). Indicator 2 of poor outcome and discharges within the 25th percentile in 2017 at TGH were 1.110 (95% CI 0.784-1.375) and 1.458 (95% CI 1.272-1.597), respectively. Conclusions Utilizing a nationwide inpatient database, we developed risk-adjusted performance indicators using a multilevel prediction model to evaluate hospitalist medical care for patients with aspiration pneumonia. Given the reliable results shown in the working example, these indicators have potential benefits for the accurate evaluation of the quality of medical care.

Study Protocol of Cardiac Rehabilitation for Acute Myocardial Infarction From the JROAD/JROAD-DPC Database - JROAD-CR.

Background: Although cardiac rehabilitation (CR) has been reported to be effective for improving the prognosis of acute myocardial infarction (AMI), more patients must participate in CR during admission and as outpatients. Factors contributing to, and countermeasures against, the low CR participation rate need to be identified. Here we describe the protocol for a study designed to evaluate the effectiveness and problems of CR for AMI from the Japanese Registry of All Cardiac and Vascular Diseases (JROAD) and the JROAD-Japanese Diagnosis Procedure Combination system (JROAD-DPC) database. Methods and Results: This is a multicenter retrospective cohort study that will use the JROAD/JROAD-DPC database to evaluate the effectiveness of CR for AMI (JROAD-CR). Five thousand patients with AMI who were admitted to hospitals registered in the JROAD database in 2014 will be investigated with regard to their baseline characteristics, AMI severity and treatment, examination results, history of CR, and prognosis up to 5 years. We will also investigate the presence, quantity, and quality of CR, and evaluate the effectiveness of CR with respect to cost, exercise tolerance, and prognosis during admission and follow-up. Conclusions: The JROAD-CR study will seek to reveal the effectiveness of CR for AMI in the era of early reperfusion therapy and shortened hospitalization.

Early impact of school closure and social distancing for COVID-19 on the number of inpatients with childhood non-COVID-19 acute infections in Japan.

Many countries have implemented school closures as part of social distancing measures intended to control the spread of coronavirus disease 2019 (COVID-19). The aim of this study was to assess the early impact of nationwide school closure (March–May 2020) and social distancing for COVID-19 on the number of inpatients with major childhood infectious diseases in Japan. Using data from the Diagnosis Procedure Combination system in Japan, we identified patients aged 15 years or younger with admissions for a diagnosis of upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), influenza, gastrointestinal infection (GII), appendicitis, urinary tract infection (UTI), or skin and soft tissue infection (SSTI) between July 2018 and June 2020. Changes in the trend of the weekly number of inpatients between the two periods were assessed using interrupted time-series analysis. A total of 75,053 patients in 210 hospitals were included. The overall weekly number of inpatients was decreased by 52.5%, 77.4%, and by 83.4% in the last week of March, April, and May 2020, respectively, when compared on a year-on-year basis. The estimated impact was a reduction of 581 (standard error 42.9) inpatients per week in the post-school-closure period (p < 0.001). The main part of the reduction was for pre-school children. Remarkable decreases in the number of inpatients with URI, LRTI, and GII were observed, while there were relatively mild changes in the other groups.Conclusion: We confirmed a marked reduction in the number of inpatients with childhood non-COVID-19 acute infections in the post-school-closure period. What is Known:• Most countries have implemented social distancing measures to limit the spread of the novel coronavirus disease 2019 (COVID-19).• A large decrease in pediatric emergency visits has been reported from several countries after the social distancing.What is New:• Based on administrative claims data, a marked reduction in the number of inpatients for childhood non-COVID-19 acute infections was found in the post-school-closure period in Japan.• The magnitude of the reduction was different between the disease groups.

Determining the most important factors in hospital readmission following surgery for lung cancer

With the recent development of novel drugs and the improvement in surgical instruments, the increase in medical care related expenses has become a social issue in several developed countries. Although the present medical oncology is represented by expensive immune- checkpoint inhibitors and robot-assisted surgery, reducing medical expenses is one of the crucial tasks for national health policy. In the field of surgery for lung cancer, one of the most effective ways of reducing medical expenses is preventing postoperative complications. In Japan, for example, the prospective payment system, known as the Diagnosis Procedure Combination (DPC), introduced by the Ministry of Health, Labour and Welfare, has been applied in major medical institutes since 2003 (1). In the DPC system, inpatient medical care-related expenses are calculated based on the diagnosis-related group and not on the actual expenses. In the case of surgical intervention, medical institutes accrue less benefit as postoperative complications occur in this system. It is, thus, important for medical institutes to prevent postoperative complications not only to reduce patient mortality but also to obtain reasonable gain.

Structure and process of dementia care and patient outcomes after hip surgery in elderly people with dementia: A retrospective observational study in Japan

BackgroundJapan introduced the financial incentives for dementia special care at hospitals in the fee schedule in April 2016. ObjectiveTo investigate whether the financial incentives for dementia special care contributed to better patient outcomes after hip surgery for older adults with dementia. DesignRetrospective observational study using the Diagnosis Procedure Combination database and the Reporting on medical functions of hospital beds data. SettingAcute care hospitals adopting the Diagnosis Procedure Combination system in Japan. ParticipantsA total of 20,393 eligible patients aged 65 years or older with dementia who underwent hip surgeries and discharged from 405 hospitals from April 2016 to March 2017. MethodsThere are two levels of dementia care quality categories in the financial incentives for dementia special care as follows: Type 1 requires a multidisciplinary team with geriatric and dementia care expertise and Type 2 requires to assign trained nurses who underwent dementia training at every general ward. The outcomes were in-hospital mortality, readmission within 30 days, and length of hospital stay. We performed generalized estimating equation model or logistic generalized estimating equation models adjusting for individual and hospital characteristics. ResultsAmong the 405 hospitals, the numbers of hospitals without dementia care incentive, those with Type 1, and those with Type 2 were 207, 99, and, 99, respectively. Overall, the prevalence of in-hospital death and readmission within 30 days was 2.01% and 2.70%, respectively. Overall, the mean (standard deviation, SD) length of hospital stay was 32.0 (20.0) days. There were no significant associations between dementia special care and in-hospital mortality in Type 1 (adjusted OR [odds ratio] =0.87, 95% confidence interval [CI] = 0.66–1.16) and Type 2 (adjusted OR = 1.18, 95% CI = 0.92–1.52), and readmission within 30 days in Type 1 (adjusted OR = 1.11, 95% CI = 0.89–1.38) and Type 2 (adjusted OR = 1.03, 95% CI = 0.83–1.29). Length of hospital stay was not significantly different among hospitals with and without incentive, Type 1 (coefficient −0.23, 95% CI = −2.64–2.18.), and Type 2 (coefficient 0.87, 95% CI = −1.54–3.28). An increase in patient-to-nurse ratio was significantly associated with 2.25 days longer length of hospital stay (95% CI 1.00–3.51). ConclusionDementia care incentive was not associated with better outcomes in elderly with dementia who underwent hip surgery in Japan, but the worse nurse workload was associated with longer length of hospital stay. Further long-term assessment is necessary.

Effects of active smoking on postoperative outcomes in hospitalised patients undergoing elective surgery: a retrospective analysis of an administrative claims database in Japan

ObjectivesThe purpose of this study was to investigate the effects of smoking on prognosis after elective surgeries. Incidence of 30-day postoperative complications was compared between propensity score-matched ‘ever-smoker’ and ‘never-smoker’...

Analysis of concordance with antiemetic guidelines in pediatric, adolescent, and young adult patients with cancer using a large-scale administrative database.

ObjectThe appropriate use of antiemetics is important for the prevention of chemotherapy‐induced nausea and vomiting (CINV); however, little is known about the rate of concordance with antiemetic guidelines for CINV in the field of pediatric, adolescent, and young adult.MethodsUsing the Diagnosis Procedure Combination system in Japan, we identified patients <30 years of age who were diagnosed with cancer between July 2010 and March 2016. We have assessed concordance with the ASCO antiemetic guidelines for each emetic risk category of chemotherapeutic drugs. Furthermore, we have assessed the risk factors of discordance with the antiemetic guidelines using a logistic regression.ResultsIn total, 21 106 patients who underwent chemotherapy were included. The rates of concordance with the guidelines in each emetic risk category of chemotherapeutic drugs were 51.1% in high risk, ≥18 years of age; 21.5% in high risk, <18 years of age; 32.1% in moderate risk; 52.0% in low risk; and 51.6% in minimal risk. The main reason for the discordance was underuse of antiemetics, especially steroids. The factors for discordance were younger age, use of moderate and high emetic risk chemotherapeutic drugs, hematological malignancy, and brain tumor.ConclusionThere is substantial scope to improve the antiemetic practice and reduce the risk of discordance with the antiemetic guidelines in pediatric, adolescent, and young adult patients. The risk factors are different from those in adults. Further investigations to evaluate the causes of discordance are warranted.

Impact of Body Mass Index of Japanese Gallbladder Cancer Patients on their Postoperative Outcomes.

We investigated the relationship between body mass index (BMI) and postoperative outcomes in 450 gallbladder cancer patients in Japan. We collected patient information, including sex, age, underlying disease, BMI, stage, surgery method, postoperative time to discharge, and postoperative Medicare fees, from the Japanese administrative database associated with the Diagnosis Procedure Combination system. We classified patient BMIs as underweight (BMI<18.5 kg/m2), normal (BMI≥18.5 kg/m2 and <25 kg/m2) or overweight/obese (BMI≥25 kg/m2), then investigated the relationship between these categories and two postoperative outcomes: time to discharge and postoperative Medicare fees. The median postoperative time to discharge was 12 days in all patients, and 12 days in each of the three weight groups (p=0.62, n.s.). The median postoperative Medicare fees from surgery until discharge were (USD): all patients, $5,002; underweight, $5,875; normal weight, $4,797; and overweight/obese, $5,179 (p=0.146, n.s.). A multivariate analysis with adjustment for competing risk factors revealed that BMI was not associated with increased risk of longer postoperative time to discharge (normal weight: HR 1.17, p=0.29; overweight/obese: HR 1.17, p=0.37) or higher postoperative Medicare fees (OR 0.99, p=0.86, n.s.). Thus, high BMI was not found to be a factor for poor postoperative outcomes in Japanese patients with gallbladder cancer.

Nationwide Increase in Cryptorchidism After the Fukushima Nuclear Accident

To estimate the change of discharge rate after cryptorchidism surgery between pre- and postdisaster in Japan. Cryptorchidism cannot be diagnosed before birth and is not a factor that would influence a woman's decision to seek an abortion. Therefore, this disease is considered suitable for assessing how the Great East Japan Earthquake and the subsequent Fukushima Daiichi nuclear accident (2011) influenced congenital diseases. We obtained cryptorchidism discharge data collected over 6 years from hospitals that were included in an impact assessment survey of the Diagnosis Procedure Combination survey database in Japan and used these data to estimate the discharge rate after cryptorchidism surgery before and after the disaster. The 94 hospitals in Japan that participated in Diagnosis Procedure Combination system and had 10 or more discharges after cryptorchidism surgery within successive 6 years covering pre- and postdisaster period (FY2010-FY2015) were involved. The change in discharge rate between pre- and postdisaster was analyzed using a Bayesian generalized linear mixed model. Nationwide, a 13.4% (95% credible interval 4.7%-23.0%) increase in discharge rates was estimated. The results of all sensitivity analyses were similar to the reported main results. The discharge rate of cryptorchidism was increased nationwide. The rates of low-weight babies or preterm births, risk factors of cryptorchidism, were almost constant during the study period, and age distribution of the surgery was also not changed, which suggested that the other factors that associated with the disaster increased the incidence of cryptorchidism.

Association between outpatient orthopedic surgery costs and healthcare facility characteristics

PurposeThe purpose of this paper is to examine the association between outpatient orthopedic surgery costs and Japan’s healthcare facilities using a large-scale Japanese medical claims database.Design/methodology/approachThe authors obtained reimbursement claims data for 8,588 patients who underwent orthopedic surgery between April 1 and September 30, 2014 at 3,347 Japanese healthcare facilities. Regression analysis, using ordinary least squares, examined the association between outpatient orthopedic surgery costs and healthcare facility characteristics. By using surgical fees as proxy for the surgical costs, the authors defined three dependent variables: surgical cost for each outpatient orthopedic surgery; pre- and post-operative cost one month before and after a surgical operation; and total cost for each patient. The authors also defined five independent variables, which capture healthcare facility characteristics and patient-specific factors: bed count; whether healthcare facilities are reimbursed in a diagnosis procedure combination system; patient’s age; sex; and anatomical surgical sites.FindingsThe authors analyzed 6,456 outpatient orthopedic surgical cases performed at 3,085 healthcare facilities. There were significant differences in the surgical costs for outpatient orthopedic surgery among different healthcare facilities by total beds (p=0.000). Multivariate regression analysis shows that surgical costs for outpatient orthopedic surgery are positively and significantly associated with healthcare facilities classified by total beds after adjusting for patient-specific characteristics (p<0.05).Originality/valueThis is the first research to examine the association between costs for outpatient orthopedic surgery and healthcare facility characteristics in Japan. This study via the multivariate regression method showed that outpatient orthopedic surgery is likely to cost higher as healthcare facility size increased. The average incremental costs for each outpatient orthopedic surgery per 100 beds were calculated at $48.5 for surgery, $40.7 for pre- and post-operative care, and $89.2 total cost.

Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database.

OBJECTIVE Aging of the population may lead to epidemiological changes with respect to chronic subdural hematoma (CSDH). The objectives of this study were to elucidate the current epidemiology and changing trends of CSDH in Japan. The authors analyzed patient information based on reports using a Japanese administrative database associated with the diagnosis procedure combination (DPC) system. METHODS This study included patients with newly diagnosed CSDH who were treated in hospitals participating in the DPC system. The authors collected data from the administrative database on the following clinical and demographic characteristics: patient age, sex, and level of consciousness on admission; treatment procedure; and outcome at discharge. RESULTS A total of 63,358 patients with newly diagnosed CSDH and treated in 1750 DPC participation hospitals were included in this study. Analysis according to patient age showed that the most common age range for these patients was the 9th decade of life (in their 80s). More than half of patients 70 years old or older presented with some kind of disturbance of consciousness. Functional outcomes at discharge were good in 71.6% (modified Rankin Scale [mRS] score 0-2) of cases and poor in 28.4% (mRS score 3-6). The percentage of poor outcomes tended to be higher in elderly patients. Approximately 40% of patients 90 years old or older could not be discharged to home. The overall recurrence rate for CSDH was 13.1%. CONCLUSIONS This study shows a chronological change in the age distribution of CSDH among Japanese patients, which may be affecting the prognosis of this condition. In the aging population of contemporary Japan, patients in their 80s were affected more often than patients in other age categories, and approximately 30% of patients with CSDH required some help at discharge. CSDH thus may no longer have as good a prognosis as had been thought.

S-022 民間病院における小児外科の経済的問題点と対策(小児外科診療の経済的問題点と対策, 第44回日本小児外科学会学術集会)

S-022 民間病院における小児外科の経済的問題点と対策(小児外科診療の経済的問題点と対策, 第44回日本小児外科学会学術集会)

Infectious disease during hospitalization is the major causative factor for prolonged hospitalization: multivariate analysis of diagnosis procedure combination (DPC) data of 20,876 cases in Japan.

This study aimed to evaluate causative factors for prolonged hospitalization based on hospitalization status, type of hospital ward, and comorbidities, specifically diabetes mellitus and infectious diseases, in 20,876 patients hospitalized in Saga University Hospital from April 1, 2012, to February 28, 2015. Prolonged hospitalization was defined as hospital days exceeding period 3 in the diagnosis procedure combination system. Among all factors, causative (risk) factors for prolonged hospitalization were evaluated by multiple logistic regression analysis. Multivariate analysis indicated causative factors for prolonged hospitalization were aging, comorbid diabetes mellitus, time spent in the intensive care unit, and infectious diseases contracted during hospitalization. The risk factors for contracting infectious diseases during hospitalization were aging, male sex, comorbid diabetes mellitus, and increased number of days spent in period 3 in the diagnosis procedure combination code. These data indicated that critical factors for discharge from hospital within an appropriate time frame were prevention of infectious diseases during hospitalization, and a fast and effective therapeutic approach to patients in the intensive care unit.

Examination of the Difference in Medical Treatment Contents According to Major Diagnostic Category of Hospital Group I and Group II Using the Diagnosis Procedure Combination Survey Data

A difference in the medical treatment situation between the first group and the second group of the hospital group in the DPC system was clarified using Diagnosis Procedure Combination (DPC) survey data according to Major Diagnostic Category (MDC). Furthermore, the division between the first group and the second group was examined. DPC survey data collected in 2012 was used. According to MDC, significant differences in the patient ratio of hospitalization, the number of planned hospitalizations, the number of emergency hospitalizations, the number of ambulance conveyances, and the number of treatments were considered. Then, by the Mahalanobis-Taguchi method, distributions of the Mahalanobis distance and item choice according to MDC were considered. Many items according to MDC showed significant differences between the first group and the second group. The Mahalanobis distance was increased by MDC 16 disease when divided by the Mahalanobis distance of 1.0 between the first group and the second group. The item, which contributed to the calculation of the Mahalanobis distance by item choice, varied and showed a difference between the first group and the second group. The second group was authorized by the hospital followed by the first group. However, the results showed significant differences in the number of DPC survey data and the Mahalanobis distance of many items.

Circumstance of endoscopic and laparoscopic treatments for gastric cancer in Japan: A review of epidemiological studies using a national administrative database.

Currently, endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy (LG) have become widely accepted and increasingly play important roles in the treatment of gastric cancer. Data from an administrative database associated with the diagnosis procedure combination (DPC) system have revealed some circumstances of ESD and LG in Japan. Some studies demonstrated that medical costs or length of stay of patients receiving ESD for gastric cancer had become significantly reduced while length of hospitalization and costs were significantly increased in older patients. With respect to LG, some recent reports have shown that this has been a cost-beneficial treatment for patients compared with open gastrectomy while simultaneous LG and cholecystectomy is a safe procedure for patients with both gastric cancer and gallbladder stones. These epidemiological studies using the administrative database in the DPC system closely reflect clinical circumstances of endoscopic and surgical treatment for gastric cancer in Japan. However, DPC database does not contain detailed clinical data such as histological types and lesion size of gastric cancer. The link between the DPC database and another detailed clinical database may be vital for future research into endoscopic and laparoscopic treatments for gastric cancer.

Application of the diagnosis procedure combination (DPC) data to clinical studies

The Diagnosis Procedure Combination (DPC) is a case-mix classification system that is linked with a lump-sum payment system for inpatient care reimbursement. The key objectives of introducing the DPC system are to implement an electronic claim system and to provide transparency of hospital performance. The DPC data include discharge abstract and administrative claims data. The unique advantage of the DPC data is the inclusion of detailed process data and several clinical data that can be applied to clinical studies. In this report, we explain the structure and contents of the DPC database, and discuss the applicability of the DPC data to clinical studies, comparing them with the US Nationwide Inpatient Sample database.

Cost information of chemotherapy for cervical and endometrial cancer in Japan.

Treatment cost is one of the biggest concerns for cancer patients. Providing information to cancer patients about treatment cost and available financial support contributes to high-quality care. The aim of this study was to determine chemotherapy costs and other medical care expenditures for patients with cervical and endometrial cancer. Data from the Diagnosis Procedure Combination system, which is the Japanese version of the Diagnosis-related Group system, were used to identify 179 patients with cervical cancer and 244 patients with endometrial cancer who received chemotherapy from 2008-2010 at a specialized cancer hospital. The costs of chemotherapy per bolus, various protocols, and other medical care expenditures were investigated. The cost per bolus of chemotherapeutic agents varied from ¥13,804-258,906 ($US 173-3236). The total medical cost for each course, including supportive care and treatment for chemotoxic symptoms, ranged ¥22,230-590,140 ($US 278-7377). Fourteen protocols were used in this population. Multiple regression analysis revealed that the factors related to the total medical care cost for cervical cancer were cost of chemotherapeutic agents, laboratory tests, oral medications, number of complications, and age. For endometrial cancer, cost of chemotherapeutic agents, laboratory tests, and oral medications were the factors related to the total medical care costs. The cost of various chemotherapy protocols and the total medical care was determined using the Diagnosis Procedure Combination system. Nurses should give the information about treatment cost and discuss the cost with patients to facilitate high-quality care.