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論文一覧
福田 治久 （ふくだはるひさ）
准教授
医学研究院
附属総合コホートセンター
医療経営・管理学講座
データ更新日：2024.06.03
原著論文准教授
医学研究院
附属総合コホートセンター
医療経営・管理学講座
データ更新日：2024.06.03
| 1. | Tsuzuki S, Murata F, Maeda M, Asai Y, Koizumi R, Ohmagari N, Fukuda H, The association between seasonal influenza vaccination and antimicrobial use in Japan from the 2015-2016 to 2020-2021 seasons: from the VENUS study., Journal of Antimicrobial Chemotherapy, in press, 2023.10. |
| 2. | Mimura W, Ishiguro C, Terada-Hirashima J, Matsunaga N, Maeda M, Murata F, Fukuda H, Bivalent vaccine effectiveness among older adults aged ≥65 years during the BA.5 predominant period in Japan: the VENUS Study., Open Forum Infectious Diseases, 10, 10, ofad475, 2023.10. |
| 3. | Okita Y, Kitamura T, Komukai S, Zha L, Komatsu M, Narii N, Murata F, Maeda M, Gon Y, Kimura Y, Kiyohara K, Sobue T, Fukuda H, Association of anticholinergic drug exposure with the risk of dementia among older adults in Japan: the LIFE study., International Journal of Geriatric Psychiatry, in press, 2023.11. |
| 4. | Miyano T, Ayukawa Y, Anada T, Takahashi I, Furuhashi H, Tokunaga S, Hirata A, Nakashima N, Kato K, Fukuda H, Association between reduced posterior occlusal contact and Alzheimer’s disease onset in older Japanese adults: results from the LIFE Study., Journal of Alzheimer's Disease., in press, 2023.11. |
| 5. | Tamada Y, Kusama T, Maeda M, Murata F, Osaka K, Fukuda H, Takeuchi K, Validity of Claims-based Definition of Number of Remaining Teeth in Japan: Results from the Longevity Improvement and Fair Evidence Study., Plos One, in press, 2024.02. |
| 6. | Maeda M, Murata F, Fukuda H, The Age-Specific Impact of COVID-19 Vaccination on Medical Expenditures and Hospitalization Duration After Breakthrough Infection: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study., Vaccine, 42, 7, 1542-1548, 2024.01. |
| 7. | Yamada N, Nakatsuka K, Tezuka M, Murata F, Maeda M, Akisue T, Fukuda H, Ono R, Pneumococcal vaccination coverage and vaccination-related factors among older adults in Japan: LIFE Study., Vaccine, in press, 2024.01. |
| 8. | Sagara K, Goto K, Maeda M, Murata F, Fukuda H, Medication Adherence and Associated Factors in Newly Diagnosed Hypertensive Patients in Japan: The LIFE Study., Journal of Hypertension, 42, 4, 718-726, 2024.01. |
| 9. | Yamaguchi Y, Murata F, Maeda M, Fukuda H, Investigating the Epidemiology and Outbreaks of Scabies in Japanese Households, Residential Care Facilities, and Hospitals Using Claims Data: The LIFE Study., IJID Regions, in press, 2024.03. |
| 10. | Murata F, Maeda M, Murayama K, Nakao T, Fukuda H, Incidence of post-COVID psychiatric disorders according to the periods of SARS-CoV-2 variant dominance: The LIFE Study., Journal of Psychiatric Research, 174, 12-18, 2024.04. |
| 11. | Kim S, Maeda M, Murata F, Fujii T, Ueda E, Ono R, Fukuda H, Impact of Concurrent Visual and Hearing Impairment on Incident Alzheimer’s Disease: The LIFE Study., Journal of Alzheimer’s Disease, 98, 1, 197-207, 2024.01. |
| 12. | Sato S, Katsuta T, Kawazoe Y, Takahashi M, Murata F, Maeda M, Fukuda H, Kamidani S, Immune thrombocytopenic purpura and Guillain-Barré syndrome after 23-valent pneumococcal polysaccharide vaccination in Japan: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study., Vaccine, in press, 2024.01. |
| 13. | Kusama T, Tamada Y, Kiuchi S, Maeda M, Murata F, Osaka K, Fukuda H, Takeuchi K, Changes in the utilization of outpatient and visiting dental care and per-attendance care cost by age groups during COVID-19 pandemic waves in Japan: A time-series analysis from LIFE study., Journal of Epidemiology, in press, 2024.03. |
| 14. | Tamada Y, Takeuchi K, Kusama T, Maeda M, Murata F, Osaka K, Fukuda H, Bivalent mRNA Vaccine Effectiveness and Hybrid Immunity against COVID-19 among Older Adults in Japan: A Test-negative Study from the VENUS Study., BMC Infectious Diseases, 10.1186/s12879-024-09035-3, 24, 1, 135, 2024.01. |
| 15. | Murata F, Maeda M, Ono R, Fukuda H, Association Between Regular Physical Activity and Pneumonia-Related Hospitalization According to Pneumococcal Vaccination Status: The VENUS Study., Vaccine, 42, 6, 1268-1274, 2024.01. |
| 16. | 山田 直輝, 中塚 清将, 手塚 真斗, 村田 典子, 前田 恵, 福田 治久, 秋末 敏宏, 小野 玲, 高齢者肺炎球菌ワクチンの接種率および接種関連要因の検討 LIFE Study, 日本公衆衛生学会総会抄録集, 81回, 234-234, 2022.09. |
| 17. | 手塚 真斗, 小野 玲, 中塚 清将, 山田 直輝, 秋末 敏宏, 村田 典子, 前田 恵, 福田 治久, 高齢者肺炎球菌ワクチン接種が要介護認定に及ぼす影響 LIFE study, 日本公衆衛生学会総会抄録集, 81回, 230-230, 2022.09. |
| 18. | Chieko Ishiguro, Wataru Mimura, Yukari Uemura, Megumi Maeda, Fumiko Murata, Haruhisa Fukuda, Multiregional population-based cohort study for evaluation of the association between herpes zoster and mRNA vaccinations for SARS-CoV-2: the VENUS Study, Open Forum Infectious Diseases, 10.1093/ofid/ofad274, 2023.05. |
| 19. | Tamada Y, Takeuchi K, Kusama T, Maeda M, Murata F, Osaka K, Fukuda H, Effectiveness of COVID-19 Vaccines against Infection in Japan: A Test-Negative Study from the VENUS Study., Vaccine, in press, 2023.07. |
| 20. | Mimura W, Ishiguro C, Terada-Hirashima J, Matsunaga N, Sato S, Kawazoe Y, Maeda M, Murata F, Fukuda H, Effectiveness of BNT162b2 against infection, symptomatic infection, and hospitalization among older adults aged ≥65 years during the Delta variant predominance in Japan: The VENUS Study., Journal of Epidemiology, in press, 2023.09. |
| 21. | Megumi Maeda, Fumiko Murata, Haruhisa Fukuda, Effect of COVID-19 vaccination on household transmission of SARS-CoV-2 in the Omicron era: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study., International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 10.1016/j.ijid.2023.06.017, 134, 200-206, 2023.09, OBJECTIVES: To evaluate the effectiveness of vaccination on reducing household transmission of SARS-CoV-2 among common household types in Japan during the Omicron variant wave. METHODS: This retrospective study was conducted using vaccination records, COVID-19 infection data, and resident registry data from two Japanese municipalities. Households that experienced their first COVID-19 case between January and April 2022 were categorized into two groups according to the presence/absence of children aged ≤11 years. We constructed multivariable logistic regression models with generalized estimating equations to calculate the odds ratios (ORs) and 95% confidence intervals for household transmission according to the vaccination statuses of primary cases and household contacts. RESULTS: We analyzed 7326 households with 17,586 contacts. In all households, the OR for household transmission was |
| 22. | Fukuda H, Kanzaki H, Murata F, Maeda M, Ikeda M, Disease burden and progression in patients with new-onset mild cognitive impairment and Alzheimer’s disease identified from Japanese claims data: Evidence from the LIFE Study., Journal of Alzheimer's Disease, in press, 2023.07. |
| 23. | Haruhisa Fukuda, Fumiko Murata, Sachie Azuma, Masahiro Fujimoto, Shoma Kudo, Yoshiyuki Kobayashi, Kenshi Saho, Kazumi Nakahara, Rei Ono, Development of a data platform for monitoring personal health records in Japan: The Sustaining Health by Integrating Next-generation Ecosystems (SHINE) Study, PLOS ONE, 10.1371/journal.pone.0281512, 18, 2, e0281512-e0281512, 2023.02, Background The Sustaining Health by Integrating Next-generation Ecosystems (SHINE) Study was developed as a data platform that incorporates personal health records (PHRs) into health-related data at the municipal level in Japan. This platform allows analyses of the associations between PHRs and future health statuses, and supports the production of evidence for developing preventive care interventions. Herein, we introduce the SHINE Study’s profile and describe its use in preliminary analyses. Methods The SHINE Study involves the collection of participants’ health measurements and their addition to various health-related data from the Longevity Improvement & Fair Evidence (LIFE) Study. With cooperation from municipal governments, measurements can be acquired from persons enrolled in government-led long-term care prevention classes and health checkups who consent to participate in the SHINE Study. For preliminary analyses, we collected salivary test measurements, lifelog measurements, and gait measurements; these were linked with the LIFE Study’s database. We analyzed the correlations between these measurements and the previous year’s health care expenditures. Results We successfully linked PHR data of 33 participants for salivary test measurements, 44 participants for lifelog measurements, and 32 participants for gait measurements. Only mean torso speed in the gait measurements was significantly correlated with health care expenditures (r = -0.387, P = 0.029). Conclusion The SHINE Study was developed as a data platform to collect and link PHRs with the LIFE Study’s database. The analyses undertaken with this platform are expected to contribute to the development of preventive care tools and promote health in Japan.. |
| 24. | Nakatsuka K, Ono R, Murata S, Akisue T, Fukuda H, Claimed-based frailty index in Japanese older adults: a cohort study using LIFE Study., Journal of Epidemiology, in press, 2023.01. |
| 25. | Nakamura J, Nakatsuka K, Uchida K, Akisue T, Fukuda H, Ono R, Analysis of post-extraction bleeding in antithrombotic therapy patients: The Longevity Improvement and Fair Evidence Study., Gerodontology, in press, 2023.06. |
| 26. | Maeda M, Murata F, Fukuda H, Effect of COVID-19 Vaccination on Household Transmission of SARS-CoV-2 in the Omicron Era: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study., International Journal of Infectious Diseases, 134, 200-206, 2023.07. |
| 27. | Onizuka H, Fukuda H, Associations between income changes and the risk of herpes zoster: LIFE Study., Social Science & Medicine, in press, 2023.05. |
| 28. | Ishiguro C, Mimura W, Uemura Y, Maeda M, Murata F, Fukuda H, Multiregional population-based cohort study for evaluation of the association between herpes zoster and mRNA vaccinations for SARS-CoV-2: the VENUS Study., Open Forum Infectious Diseases, 10, 7, ofad274, 2023.07. |
| 29. | Kawabata J, Morikane K, Fukuda H, Effect of participation in a surgical site infection surveillance program on hospital performance in Japan: a retrospective study., Journal of Hospital Infection, in press, 2023.04. |
| 30. | Nobuhiro Narii, Tetsuhisa Kitamura, Sho Komukai, Ling Zha, Masayo Komatsu, Fumiko Murata, Megumi Maeda, Kosuke Kiyohara, Tomotaka Sobue, Haruhisa Fukuda, Association of pneumococcal vaccination with cardiovascular diseases in older adults: The vaccine effectiveness, networking, and universal safety (VENUS) study., Vaccine, 10.1016/j.vaccine.2023.02.077, 41, 13, 2307-2313, 2023.03, The protective effect of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against cardiovascular disease has been investigated in the United States and Europe; however, its effect has not been fully established. This study aimed to investigate the protective effect of PPSV23 on cardiovascular events in adults aged ≥ 65 years. This population-based nested case-control study was conducted using the claims data and vaccine records between April 2015 and March 2020 from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study. PPSV23 vaccination was identified using vaccination records in each municipality. The primary outcome was acute myocardial infarction (AMI) or stroke. The adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for PPSV23 vaccination were calculated using conditional logistic regression. Among 383,781 individuals aged ≥ 65 years, 5,356 and 25,730 individuals with AMI or stroke were matched with 26,753 and 128,397 event-free controls, respectively. Individuals who were PPSV23 vaccinated, compared with the unvaccinated individuals, had significantly lower odds of AMI or stroke events (aOR, 0.70 [95% CI, 0.62-0.80] and aOR, 0.81 [95% CI, 0.77-0.86], respectively). More recent PPSV23 vaccination was associated with lower odds ratios (AMI, aOR 0.55 [95% CI, 0.42-0.72] for 1-180 days and aOR 1.11 [95% CI, 0.84-1.47] for 720 days or longer; stroke, aOR 0.83 [95% CI, 0.74-0.93] for 1-180 days and aOR 0.90 [95% CI, 0.78-1.03] for 720 days or longer). Among Japanese older adults, individuals who were PPSV23 vaccinated, compared with unvaccinated individuals, had significantly lower odds of AMI or stroke events.. |
| 31. | Kiyomasa Nakatsuka, Rei Ono, Shunsuke Murata, Toshihiro Akisue, Haruhisa Fukuda, Claimed-based frailty index in Japanese older adults: a cohort study using LIFE Study., Journal of epidemiology, 10.2188/jea.JE20220310, 2023.03, BACKGROUNDS: We aimed to assess whether the U.S. developed claimed-based frailty index (CFI) can be implemented in Japanese older adults using claim data. METHODS: We used the monthly claims data and certification of long-term care (LTC) insurance data of residents from 12 municipalities from April 2014 to March 2019. The 12 months from first recording was defined as the "baseline period," and the time thereafter as "follow-up period". Participants aged ≥65 years and those with no certified LTC insurance or who died at baseline were included. New certification of LTC insurance and all-cause mortality during the follow-up period were defined as outcome events. CFI categorization consisted of three steps including: 1) using 12 months deficit-accumulation approach that assigned different weights to each of the 52 items; 2) the accumulated score to derive the CFI; and 3) categorizing the CFI as "robust" ( |
| 32. | Fukuda H, Maeda M, Murata F, Development of a COVID-19 vaccine effectiveness and safety assessment system in Japan: The VENUS Study., Vaccine, in press, 2023.03, これまで，日本には，ワクチン接種者と非接種者のその後の健康状態をモニタリングできるワクチン評価システムがなかった．本研究では，COVID-19ワクチンの有効性と安全性を評価可能なシステムを日本で初めて開発した．本研究は，VENUS Studyと命名され，各自治体に居住する住民の住基台帳，VRS（ワクチン接種記録システム），HER-SYS（感染症法発生届情報），医療レセプトデータ4種類のデータを連携する多元的データベースとして開発された．4自治体からデータ収集し，個々の対象者は氏名，生年月日，性別を基にした5つのマッチングアルゴリズムを使用してデータ間で名寄し連携し，連携後は匿名化した．VENUS StudyのデータベースがCOVID-19ワクチン研究に有用かどうかを確認するために，COVID-19のワクチン接種率，COVID-19の症例数，PCR検査数の傾向を調査し，4データ間の突合率も評価した．その結果，この多元的なデータベースは，COVID-19のワクチン接種数、COVID-19の症例数、PCR検査数をモニタリングできることが明らかになった．また，5つのアルゴリズムを使用して，各データ間が高い精度で突合できることも明らかになった．各データソースの特性を理解した上で適切に使用すれば，VENUS Studyは，日本におけるCOVID-19ワクチンの有効性と安全性に関する住民ベースの研究のための比較分析とモニタリングを促進する実用的なデータプラットフォームを提供できる．したがって，この研究は，ワクチン接種者と非接種者の両方を監視できる日本初のCOVID-19ワクチン評価システムの開発に向けた重要な一歩をもたらすものである．. |
| 33. | Kawabata J, Fukuda H, Effects of a financial incentive scheme for dementia care on medical and long-term care expenditures: A propensity score-matched analysis using LIFE Study data., Plos One, 18, 3, e0282965, 2023.03. |
| 34. | Nakao T, Murayama K, Fukuda H, Eto N, Fujita K, Igata R, Ishikawa K, Isomura S, Kawaguchi T, Maeda M, Mitsuyasu H, Murata F, Nakamura T, Nishihara T, Ohashi A, Sato M, Yoshida Y, Kawasaki H, Ozone M, Yoshimura R, Tatebatashi H, Survey of psychiatric symptoms among inpatients with COVID-19 using the Diagnosis Procedure Combination data and medical records in Japan., Brain, Behavior, & Immunity - Health, in press, 2023.03. |
| 35. | Fukuda H, Murata F, Azuma S, Fujimoto M, Kudo S, Kobayashi Y, Saho K, Nakahara K, Ono R, Development of a Data Platform for Monitoring Personal Health Records in Japan: The Sustaining Health by Integrating Next-generation Ecosystems (SHINE) Study, Plos One, 18, 2, e0281512, 2023.02. |
| 36. | Moriyama S, Hieda M, Kisanuki M, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, AkashiK, Fukuda H, Both new-onset and pre-existing hypertension are favorable indicators of clinical outcomes in patients treated with vascular endothelial growth factor inhibitors., Circulation Journal, in press, 2023.01. |
| 37. | Nishimura N, Fukuda H, Risk of cardiovascular events leading to hospitalization after Streptococcus pneumoniae infection: A retrospective cohort LIFE study., BMJ Open, 12, 11, e059713, 2022.12. |
| 38. | Moriyama S, Hieda M, Kisanuki M, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, Akashi K, Fukuda H, The Effect of renin-angiotensin system inhibitors in cancer patients treated with anti-VEGF therapy., Open Heart, 9, 2, e002135., 2022.12. |
| 39. | Murata F, Maeda M, Fukuda H, Association between metabolic syndrome and participation in colorectal cancer screening in Japan: A retrospective cohort analysis using LIFE Study data., Cancer Epidemiology, 83, 102335, 2023.01. |
| 40. | 谷 直道, 竹内 研時, 福田 治久, 地域住民の成人歯科健診における歯周ポケット検査と糖尿病発症の関連性: LIFE Study, 日本公衆衛生雑誌, 10.11236/jph.22-038, 70, 1, 39-47, 2023.01. |
| 41. | Wataru Mimura, Chieko Ishiguro, Megumi Maeda, Fumiko Murata, Haruhisa Fukuda, Effectiveness of messenger RNA vaccines against infection with SARS-CoV-2 during the periods of Delta and Omicron variant predominance in Japan: the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study, International Journal of Infectious Diseases, 10.1016/j.ijid.2022.10.001, 125, 58-60, 2022.12. |
| 42. | Wataru Mimura, Chieko Ishiguro, Megumi Maeda, Fumiko Murata, Haruhisa Fukuda, Effectiveness of a Third Dose of COVID-19 mRNA Vaccine During the Omicron BA.1- and BA.2-Predominant Periods in Japan: The VENUS Study., Open forum infectious diseases, 10.1093/ofid/ofac636, 9, 12, ofac636, 2022.12, BACKGROUND: Vaccine effectiveness against the severe acute respiratory syndrome coronavirus 2 Omicron BA.2 sublineage in Japan is unknown. We assessed the effectiveness of a third dose of COVID-19 mRNA vaccine compared with that of 2 doses. METHODS: We performed a population-based cohort study using a municipality database located in the Chubu region of Japan during the Omicron BA.1- and BA.2-predominant periods (January 1-March 31, 2022 and April 1-27, 2022, respectively). We included residents aged ≥16 years who received a second vaccine dose at ≥14 days before the start of each period, regardless of the third dose. We compared the data at 14 days after the second and third dose and at 2-week intervals from 14 days to 10 weeks after the third dose using a Cox regression model. Vaccine effectiveness was defined as (1 - hazard ratio) × 100 (%). RESULTS: In total, 295 705 and 288 184 individuals were included in the BA.1- and BA.2-predominant periods, respectively. The effectiveness of a third dose against infection was 62.4% and 48.1% in the BA.1- and BA.2-predominant periods, respectively. Vaccine effectiveness at 2-3 weeks and ≥10 weeks after the third dose decreased from 63.6% (95% confidence interval [CI], 56.4-69.5%) to 52.9% (95% CI, 41.1-62.3%) and from 54.5% (95% CI, 3.0-78.7%) to 40.1% (95% CI, 15.1-57.7%) in the BA.1- and BA.2-predominant periods, respectively. CONCLUSIONS: A third dose was moderately effective against BA.1 and BA.2 sublineages, but its effectiveness decreased by approximately 10% age points from 2-3 weeks to ≥10 weeks after the third vaccination.. |
| 43. | Mimura W, Ishiguro C, Fukuda H., Influenza vaccine effectiveness against hospitalization during the 2018/2019 season among older persons aged ≥75 years in Japan: LIFE-VENUS Study., Vaccine, 40, 34, 5023-5029, 2022.11. |
| 44. | Ishiguro C, Mimura W, Murata F, Fukuda H., Development and Application of a Japanese Vaccine Database for Comparative Assessments in the Post-Authorization Phase: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study., Vaccine, 40, 42, 6179-6186, 2022.11. |
| 45. | Adomi M, Maeda M, Murata F, Fukuda H., Comparative risk of fracture in community-dwelling older adults initiating suvorexant versus Z-drugs: Results from LIFE Study., Journal of the American Geriatrics Society, 10.1111/jgs.18068, in press, 2022.11. |
| 46. | Fukuda H, Maeda M, Murata F, Murata Y., Anti-Dementia Drug Persistence Following Donepezil Initiation Among Alzheimer's Disease Patients in Japan: LIFE Study., Journal of Alzheimer's Disease, 10.3233/JAD-220200, in press, 2022.11. |
| 47. | Mimura W, Ishiguro C, Maeda M, Murata F, Fukuda H., Effectiveness of mRNA vaccines against SARS-CoV-2 infections during the periods of Delta and Omicron variant predominance in Japan: The VENUS Study., International Journal of Infectious Disease, 10.1016/j.ijid.2022.10.001, in press, 2022.11. |
| 48. | Nishimura N, Fukuda H., Risk of cardiovascular events leading to hospitalization after Streptococcus pneumoniae infection: A retrospective cohort LIFE study. BMJ Open, BMJ Open, in press, 2022.11. |
| 49. | Haruhisa Fukuda, Megumi Maeda, Fumiko Murata, Yutaka Murata, Anti-Dementia Drug Persistence Following Donepezil Initiation Among Alzheimer’s Disease Patients in Japan: LIFE Study, Journal of Alzheimer's Disease, 10.3233/jad-220200, 90, 3, 1177-1186, 2022.11, Background: Donepezil is frequently used to treat Alzheimer’s disease (AD) symptoms but is associated with early discontinuation. Determining the persistence rates of anti-dementia drug use after donepezil initiation may inform the development and improvement of treatment strategies, but there is little evidence from Japan. Objective: To determine anti-dementia drug persistence following donepezil initiation among AD patients in Japan using insurance claims data. Methods: Insurance claims data for AD patients with newly prescribed donepezil were obtained from 17 municipalities between April 2014 and October 2021. Anti-dementia drug persistence was defined as a gap of ≤60 days between the last donepezil prescription and a subsequent prescription of donepezil, another cholinesterase inhibitor, or memantine. Cox proportional hazards models were used to analyze the association between care needs levels and discontinuation. Results: We analyzed 20,474 AD patients (mean age±standard deviation: 82.2±6.3 years, women: 65.7%). The persistence rates were 89.1% at 30 days, 79.4% at 90 days, 72.6% at 180 days, 64.5% at 360 days, and 58.3% at 540 days after initiation. Among the care needs levels, the hazard ratio (95% confidence interval) for discontinuation was 1.01 (0.94–1.07) for patients with support needs, 1.12 (1.06–1.18) for patients with low long-term care needs, and 1.31 (1.21–1.40) for patients with moderate-to-high long-term care needs relative to independent patients. Conclusion: Japanese AD patients demonstrated low anti-dementia drug persistence rates that were similar to those of other countries. Higher long-term care needs were associated with discontinuation. Further measures are needed to improve drug persistence in AD patients.. |
| 50. | Motohiko Adomi, Megumi Maeda, Fumiko Murata, Haruhisa Fukuda, Comparative risk of fracture in community‐dwelling older adults initiating suvorexant versus Z‐drugs: results from LIFE study, Journal of the American Geriatrics Society, 10.1111/jgs.18068, 71, 1, 109-120, 2023.01. |
| 51. | Chieko Ishiguro, Wataru Mimura, Fumiko Murata, Haruhisa Fukuda, Development and application of a Japanese vaccine database for comparative assessments in the post-authorization phase: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study., Vaccine, 10.1016/j.vaccine.2022.08.069, 2022.09. |
| 52. | Wataru Mimura, Chieko Ishiguro, Haruhisa Fukuda, Influenza vaccine effectiveness against hospitalization during the 2018/2019 season among older persons aged ≥ 75 years in Japan: The LIFE-VENUS Study., Vaccine, 10.1016/j.vaccine.2022.07.002, 40, 34, 5023-5029, 2022.08. |
| 53. | Naomichi Tani, Haruhisa Fukuda, Medical visits and health-care expenditures of patients attending orthopedic clinics during the COVID-19 pandemic in Japan: LIFE Study, International Journal for Quality in Health Care, 10.1093/intqhc/mzac056, 34, 3, 2022.07. |
| 54. | Fumiko Murata, Megumi Maeda, Chieko Ishiguro, Haruhisa Fukuda, Acute and delayed psychiatric sequelae among patients hospitalised with COVID-19: a cohort study using LIFE study data., General psychiatry, 10.1136/gpsych-2022-100802, 35, 3, e100802, 2022.06, Background: Characterising the psychiatric sequelae of coronavirus disease 2019 (COVID-19) can inform the development of long-term treatment strategies. However, few studies have examined these sequelae at different time points after COVID-19 infection. Aims: The study aimed to investigate the incidences and risks of acute and delayed psychiatric sequelae in patients hospitalised with COVID-19 in Japan. Methods: This retrospective cohort study was conducted using a database comprising healthcare claims data from public health insurance enrollees residing in a Japanese city. We analysed a primary cohort comprising patients hospitalised with COVID-19 between March 2020 and July 2021 and two control cohorts comprising patients hospitalised with influenza or other respiratory tract infections (RTI) during the same period. We calculated the incidences of acute (1-3 months after infection) and delayed (4-6 months after infection) psychiatric sequelae. These sequelae were identified using diagnosis codes and categorised as mood/anxiety/psychotic disorder, mood disorder, anxiety disorder, psychotic disorder or insomnia. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of psychiatric sequelae occurrence after COVID-19 infection compared with influenza and other RTI. Results: The study population with acute psychiatric sequela consisted of 662 patients with COVID-19, 644 patients with influenza, and 7369 patients with RTI who could be followed for 3 months; the study population with delayed psychiatric sequelae consisted of 371 patients with COVID-19, 546 patients with influenza, and 5397 patients with RTI who could be followed for 6 months. In the analysis of acute psychiatric sequelae, COVID-19 had significantly higher odds of mood/anxiety/psychotic disorder (OR: 1.39, p=0.026), psychotic disorder (OR: 2.13, p |
| 55. | Shoji T, Sato N, Fukuda H, Muraki Y, Kawata K, Akazawa M, Clinical implication of the relationship between antimicrobial resistance and infection control activities in Japanese hospitals: a principal component analysis-based cluster analysis., Antibiotics, 2022.04. |
| 56. | Fukuda H, Onizuka H, Murata F, Medical expenditures for community-acquired pneumococcal disease in Japan., Journal of National Institute of Public Health, 72, 1, 2022.03. |
| 57. | Fukuda H, Ishiguro C, Ono R, Kiyohara K, The Longevity Improvement & Fair Evidence (LIFE) Study: Overview of the Study Design and Baseline Participant Profile., Journal of Epidemiology, 2022.03. |
| 58. | Fukuda H, Onizuka H, Nishimura N, Kiyohara K, Risk factors for pneumococcal disease in persons with chronic medical conditions: Results from the LIFE Study., International Journal of Infectious Diseases, 2022.02. |
| 59. | Tomokazu Shoji, Natsu Sato, Haruhisa Fukuda, Yuichi Muraki, Keishi Kawata, Manabu Akazawa, Clinical Implication of the Relationship between Antimicrobial Resistance and Infection Control Activities in Japanese Hospitals: A Principal Component Analysis-Based Cluster Analysis., Antibiotics (Basel, Switzerland), 10.3390/antibiotics11020229, 11, 2, 2022.02, There are few multicenter investigations regarding the relationship between antimicrobial resistance (AMR) and infection-control activities in Japanese hospitals. Hence, we aimed to identify Japanese hospital subgroups based on facility characteristics and infection-control activities. Moreover, we evaluated the relationship between AMR and hospital subgroups. We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in 124 hospitals from April 2016 to March 2017. Hospitals were classified using cluster analysis based the principal component analysis-transformed data. We assessed the relationship between each cluster and AMR using analysis of variance. Ten variables were selected and transformed into four principal components, and five clusters were identified. Cluster 5 had high infection control activity. Cluster 2 had partially lower activity of infection control than the other clusters. Clusters 3 and 4 had a higher rate of surgeries than Cluster 1. The methicillin-resistant Staphylococcus aureus (MRSA)/S. aureus detection rate was lowest in Cluster 1, followed, respectively, by Clusters 5, 2, 4, and 3. The MRSA/S. aureus detection rate differed significantly between Clusters 4 and 5 (p = 0.0046). Our findings suggest that aggressive examination practices are associated with low AMR whereas surgeries, an infection risk factor, are associated with high AMR.. |
| 60. | Rei Ono, Kazuaki Uchida, Kiyomasa Nakatsuka, Maeda Megumi, Haruhisa Fukuda, Economic Status and Mortality in Patients with Alzheimer's Disease in Japan: The Longevity Improvement and Fair Evidence Study, 10.1016/j.jamda.2021.08.025, 23, 1, 161-164, 2022.01. |
| 61. | Maeda M, Fukuda H, Matsuo R, Ago T, Kitazono T, Kamouchi M, Regional Disparity of Reperfusion Therapy for Acute Ischemic Stroke in Japan: A Retrospective Analysis of Nationwide Claims Data from 2010 to 2015., J Am Heart Assoc, 2021.12. |
| 62. | Rei Ono, Kiyomasa Nakatsuka, Kazuaki Uchida, Haruhisa Fukuda, Healthcare expenditure attributable to dementia with Lewy bodies in Japan: LIFE Study, Alzheimer's & Dementia, 10.1002/alz.053750, 17, S10, 2021.12. |
| 63. | Fukuda H, Ono R, Maeda M, Murata F, Medical care and long-term care expenditures attributable to Alzheimer's disease onset: Results from the LIFE Study., Journal of Alzheimer's Disease, 10.3233/JAD-201508, 84, 2, 807-817, 2021.11. |
| 64. | 小野 玲, 中塚 清将, 内田 一彰, 福田 治久, アルツハイマー型認知症とレビー小体型認知症の診断後月別医療費推移 LIFE Study, Dementia Japan, 35, 4, 644-644, 2021.10. |
| 65. | Fukuda H, Changes to hospital inpatient volume after newspaper reporting of medical errors., Journal of Patient Safety, 17, 5, e401-e405, 2021.08, [URL]. |
| 66. | Tomotaka Sobue, Haruhisa Fukuda, Tetsuya Matsumoto, Bennett Lee, Shuhei Ito, Satoshi Iwata, The background occurrence of selected clinical conditions prior to the start of an extensive national vaccination program in Japan, 10.1371/journal.pone.0256379, 16, 8, e0256379-e0256379, 2021.08. |
| 67. | Kusama Y, Ito K, Fukuda H, Matsunaga N, Ohmagari N, National database study of trends in bacteraemia aetiology among children and adults in Japan: a longitudinal observational study., BMJ Open, in press, 2021.04. |
| 68. | Maeda M, Fukuda H, Kiyohara K, Miki R, Kitamura T, Changes in percutaneous coronary intervention practice in Japan during the COVID-19 outbreak: LIFE Study., Acute Medicine & Surgery, 2021.02. |
| 69. | 小田太史, 福田治久, 病床機能報告制度を用いた日常生活動作とリハビリテーション提供時間の関係., 日本公衆衛生雑誌, 68, 1, 3-11, 2021.01. |
| 70. | Maeda M, Fukuda H, Matsuo R, Kiyuna F, Ago T, Kitazono T, Kamouchi M, Nationwide temporal trend analysis of reperfusion therapy utilization and mortality in acute ischemic stroke patients in Japan., Medicine, 2021.01. |
| 71. | 山田絵理佳, 松浦江美, 福田治久., 病院における感染対策製品の使用状況とMRSA検出率との関連., 保健学研究, 34, 31-38, 2021.01. |
| 72. | Haruhisa Fukuda, Kosuke Kiyohara, Daisuke Sato, Tetsuhisa Kitamura, Satoshi Kodera, A Real-World Comparison of 1-Year Survival and Expenditures for Transcatheter Aortic Valve Replacements: SAPIEN 3 Versus CoreValve Versus Evolut R, Value in Health, 10.1016/j.jval.2020.10.022, 24, 4, 497-504, 2020.12, OBJECTIVES: New versions of balloon-expandable and self-expandable valves for transcatheter aortic valve replacement (TAVR) have been developed, but few studies have examined the outcomes associated with these devices using national-level data. This study aimed to elucidate the clinical and economic outcomes of TAVR for aortic stenosis in Japan through an analysis of real-world data. METHODS: This retrospective cohort study was performed using data from patients with aortic stenosis who had undergone transfemoral TAVR with Edwards SAPIEN 3, Medtronic CoreValve, or Medtronic Evolut R valves throughout Japan from April 2016 to March 2018. Pacemaker implantation, mortality, and health expenditure were examined for each valve type during hospitalization and at 1 month, 3 months, 6 months, and 1 year. Generalized linear regression models and Cox proportional hazards models were used to examine the associations between the valve types and outcomes. RESULTS: We analyzed 7244 TAVR cases (SAPIEN 3: 5276, CoreValve: 418, and Evolut R: 1550) across 145 hospitals. The adjusted 1-year expenditures for SAPIEN 3, CoreValve, and Evolut R were $79 402, $76 125, and $75 527, respectively; SAPIEN 3 was significantly more expensive than the other valves (P |
| 73. | Fukuda H, Sato D, Iwamoto T, Yamada K, Matsushita K, Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections., Scientific Reports, 2020.10. |
| 74. | Fukuda H, Kiyohara K, Sato D, Kitamura T, Kodera S, A Real-World Comparison of 1-year Survival and Expenditures for Transcatheter Aortic Valve Replacements: SAPIEN 3 versus CoreValve versus Evolut R., Value in Health, 2020.10. |
| 75. | Jingushi S, Fukuda H, Low-intensity pulsed ultrasound is frequently used to treat fractures after osteosynthesis in elderly patients: A study using open data from the National Database of Health Insurance Claims of Japan., 2020.09. |
| 76. | Shigemichi Takito, Yoshiki Kusama, Haruhisa Fukuda, Satoshi Kutsuna, Pharmacist-supported antimicrobial stewardship in a retirement home, Journal of Infection and Chemotherapy, 10.1016/j.jiac.2020.04.008, 26, 8, 858-861, 2020.08, [URL], In an 80-bed fee-based retirement home with nursing care, the dispatched-pharmacist has provided prescription recommendations to visiting physicians based on pathogen identification using Gram staining as part of an antimicrobial stewardship program. Thus, we evaluated the effects of pharmacist-supported antimicrobial stewardship. We calculated the total number of all antimicrobials and macrolides, fluoroquinolones, and cephalosporins prescriptions per 100 residents per month at the retirement home from January 2013 to December 2017. Using log-transformed monthly resident numbers with an offset before and after the intervention, we performed Poisson regression analyses that adjusted for monthly mean age. Interrupted time series analyses (ITSA) were conducted to examine the changes in the incidence rate ratios for the baseline and slope before and after the intervention. The total number of all antimicrobial prescriptions per 100 residents per month from 2013 to 2017 was 14.10, 18.51, 10.59, 5.41, and 3.90, respectively. Although there was a significant pre-intervention increase in the total number of all antimicrobial prescriptions, the intervention was followed by a significant decrease. There was also a significant reduction in the slope. ITSA of the changes in the prescription of macrolides and fluoroquinolones showed that there were significant pre-intervention increase and followed by a significant post-intervention decrease in the slope. There was no significant change in cephalosporin prescriptions by the intervention. Our study shows that pharmacist-supported AS can reduce antimicrobial prescriptions in a retirement home. Nevertheless, further studies are needed to collect and analyse more data on similar interventions.. |
| 77. | Haruhisa Fukuda, Daisuke Sato, Kensuke Moriwaki, Haku Ishida, Differences in healthcare expenditure estimates according to statistical approach: A nationwide claims database study on patients with hepatocellular carcinoma, PLOS ONE, 10.1371/journal.pone.0237316, 15, 8, e0237316-e0237316, 2020.08. |
| 78. | Yugo Soga, Fumiko Murata, Megumi Maeda, Haruhisa Fukuda, The effects of raising the long‐term care insurance co‐payment rate on the utilization of long‐term care services, Geriatrics Gerontology International, 10.1111/ggi.13935, 20, 7, 685-690, 2020.07. |
| 79. | Haruhisa Fukuda, Daisuke Sato, Yoriko Kato, Wataro Tsuruta, Masahiro Katsumata, Hisayuki Hosoo, Yuji Matsumaru, Tetsuya Yamamoto, Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database, Neurosurgery, 10.1093/neuros/nyz377, 87, 1, 63-70, 2020.07, [URL]. |
| 80. | Yugo Soga, Fumiko Murata, Megumi Maeda, Haruhisa Fukuda, The effects of raising the long-term care insurance co-payment rate on the utilization of long-term care services, Geriatrics and Gerontology International, 10.1111/ggi.13935, 20, 7, 685-690, 2020.07, [URL], Aim: The effect of raising insurance co-payment rates on healthcare service utilization in Japan remains unclear. In this study, we utilized patient-level long-term care (LTC) insurance claims data to analyze these effects. Methods: Claims data were obtained on individuals certified as requiring LTC in City A and City B, Fukuoka Prefecture, Japan during August 2014–July 2016. Individuals whose LTC insurance co-payment rate increased from 10% to 20% in August 2015 were regarded as high-income individuals; individuals whose co-payment rate remained at 10% were regarded as non–high-income individuals. We examined the changes in LTC service utilization between high-income individuals and non–high-income individuals during the study period. Monthly LTC insurance charges were analyzed to evaluate service utilization. We created monthly panel data for the study participants, and quantified the differences in LTC service utilization before and after August 2015 between the high-income and non–high-income groups. Care needs levels and age were included as covariates in a fixed-effects model. Results: The sample comprised 7711 individuals (1000 high-income individuals and 6711 non–high-income individuals) in City A and 647 individuals (84 high-income individuals and 563 non–high-income individuals) in City B. After adjusting for care needs levels and age, the co-payment rate increase was associated with reductions in monthly LTC insurance charges of $34.3 (P |
| 81. | Shigemichi Takito, Yoshiki Kusama, Haruhisa Fukuda, Satoshi Kutsuna, Pharmacist-supported antimicrobial stewardship in a retirement home., Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 10.1016/j.jiac.2020.04.008, 26, 8, 858-861, 2020.04, In an 80-bed fee-based retirement home with nursing care, the dispatched-pharmacist has provided prescription recommendations to visiting physicians based on pathogen identification using Gram staining as part of an antimicrobial stewardship program. Thus, we evaluated the effects of pharmacist-supported antimicrobial stewardship. We calculated the total number of all antimicrobials and macrolides, fluoroquinolones, and cephalosporins prescriptions per 100 residents per month at the retirement home from January 2013 to December 2017. Using log-transformed monthly resident numbers with an offset before and after the intervention, we performed Poisson regression analyses that adjusted for monthly mean age. Interrupted time series analyses (ITSA) were conducted to examine the changes in the incidence rate ratios for the baseline and slope before and after the intervention. The total number of all antimicrobial prescriptions per 100 residents per month from 2013 to 2017 was 14.10, 18.51, 10.59, 5.41, and 3.90, respectively. Although there was a significant pre-intervention increase in the total number of all antimicrobial prescriptions, the intervention was followed by a significant decrease. There was also a significant reduction in the slope. ITSA of the changes in the prescription of macrolides and fluoroquinolones showed that there were significant pre-intervention increase and followed by a significant post-intervention decrease in the slope. There was no significant change in cephalosporin prescriptions by the intervention. Our study shows that pharmacist-supported AS can reduce antimicrobial prescriptions in a retirement home. Nevertheless, further studies are needed to collect and analyse more data on similar interventions.. |
| 82. | Fumiko Murata, Akira Babazono, Haruhisa Fukuda, Effect of income on length of stay in a hospital or long-term care facility among older adults with dementia in Japan., International journal of geriatric psychiatry, 10.1002/gps.5248, 35, 3, 302-311, 2020.03, [URL], OBJECTIVE: We aimed to ascertain the degree of influence of income disparity among older people with newly developed dementia on the probability and duration of stay in a hospital or long-term care facility and the degree of influence on medical expenses for hospitalization and care costs. METHODS: This was a retrospective cohort study. Study participants included 12 829 individuals aged 75 years or older not diagnosed with dementia between April 2012 and March 2013 but newly diagnosed with dementia between April 2013 and March 2014. Participants were categorized according to income. We evaluated the associations of income with the probability and duration of stay in a hospital or long-term care facility and the costs for hospitalization and care. RESULTS: In the adjusted analyses, high-income individuals had a lower probability of admission to a hospital or long-term care facility than middle- and high-income individuals. In all hospitals, low-income individuals had the longest duration of stay, but in long-term care facilities, income categories varied by facility type. Medical expenses for hospitalization and care costs were highest in the low-income group. CONCLUSION: Income category affects the probability and duration of stay in the hospital or a long-term care facility, as well as expenses for hospitalization and care. It is necessary to consider a policy to enable low-income older patients with dementia to continue living at home.. |
| 83. | Haruhisa Fukuda, Yoshihiko Yano, Daisuke Sato, Sachiko Ohde, Shinichi Noto, Ryo Watanabe, Osamu Takahashi, Healthcare Expenditures for the Treatment of Patients Infected with Hepatitis C Virus in Japan., PharmacoEconomics, 10.1007/s40273-019-00861-x, 38, 3, 297-306, 2020.03, [URL], AIM: The recently developed direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infections are costly. Cost-effectiveness analyses of DAAs require accurate healthcare expenditure estimates for the various HCV disease states, but few studies have produced such estimates using national-level data. This study utilized nationally representative data to estimate the healthcare expenditure for each HCV disease state. METHODS: We identified all patients infected with HCV between April 2010 and March 2018 from a nationwide administrative claims database in Japan. Monthly patient-level healthcare expenditures were calculated for the following disease states: chronic hepatitis C (CHC), compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC). The expenditures for the CHC and CC states were also compared before DAA treatment and after sustained virologic response (SVR) was achieved. A longitudinal two-part model was employed to estimate the healthcare expenditures for each state. RESULTS: During the study period, 1,564,043 patients with 146,488,137 patient-months of data met the inclusion criteria. The year of valuation was 2017. The mean monthly healthcare expenditures per patient (95% confidence intervals) for the pre-DAA CHC, CC, DC, and HCC states were US$267 (US$267-268), US$428 (US$427-429), US$666 (US$663-669), and US$969 (US$966-972), respectively. The mean monthly healthcare expenditures per patient for the post-SVR (≥ 2 years) CHC and CC states were US$176 (US$176-177) and US$238 (US$236-240), respectively. Healthcare expenditure increased with increasing age in all disease states (P |
| 84. | Yoshiki Kusama, Kumiko Suzuk, Yoshiaki Gu, Haruhisa Fukuda, Masahiro Ishikane, Kayoko Hayakawa, Norio Ohmagari, Obstacles to antimicrobial use surveillance using claims data in elderly care facilities in Japan, Japanese Journal of Chemotherapy, 68, 2, 210-215, 2020.03, © 2020 Japan Society of Chemotherapy. All rights reserved. Antimicrobial use (AMU) is positively correlated with the occurrence of antimicrobial resistance (AMR). Inappropriate use of antimicrobials in elderly care facilities may promote and spread AMR to surrounding communities through intercommunication between these facilities and hospitals. Therefore, AMU surveillance in elderly care facilities is important The Ministry of Health, Labour, and Welfare of Japan developed the National Insurance Claims Database (NDB), and this database is open to any researchers who pass its qualification exam. Although the NDB was previously used to estimate the state of national and prefectural AMU surveillance, it is unknown to what extent it can be used for AMU surveillance in elderly care facilities. Therefore, we evaluated the usefulness of the NDB for AMU surveillance in elderly care facilities. For us to be able to extract their AMU data from the NDB. elderly care facilities needed to meet both the following conditions: (1) they needed to have specified that their data could be extracted from the NDB; and (2) the medical fees of their patients were paid by medical insurance, not nursing insurance. Only two of the four kinds of elderly care facilities, namely, beds for long-term care in hospitals and intensive care home for elderly patients, met these conditions. However, AMU in beds for long-term care in hospitals could not be estimated using the NDB, because the detailed treatment information is unavailable in this database due to their comprehensive medicine system, in which all medical costs are paid as admission fees. The only situation in which AMU could be estimated using the NDB was in the case where the drugs were prescribed in intensive care home for elderly patients by visiting doctors; prescriptions could not be extracted from the NDB when they were prescribed in clinics or hospitals. In conclusion. AMU surveillance in elderly care facilities using the NDB is possible only for a very limited set of elderly care facilities at present However, introduction of a system of mandatory reporting of detailed treatment information in long-term care hospitals, and/or of combining medical insurance and nursing insurance data, is currently planned. Therefore, the situation could change in the near future. An AMU surveillance system may also be widely applicable to the surveillance of other dnigs. As society faces challenges from the rapidly aging population, we should continue to develop drug Use surveillance systems for elderly care facilities using the NDB to solve issues related to polypharmacy or inappropriate drug use, including the use of antibiotics.. |
| 85. | Wataru Mimura, Haruhisa Fukuda, Manabu Akazawa, Antimicrobial Utilization and Antimicrobial Resistance in Patients With Haematological Malignancies in Japan: A Multi-Centre Cross-Sectional Study, Ann Clin Microbiol Antimicrob, 10.1186/s12941-020-00348-0, 19, 1, 7-7, 2020.02, [URL], BACKGROUND: Infection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. METHODS: We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance. RESULTS: In total, 8064 patients were included. Non-Hodgkin lymphoma (50.0%) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4%), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6%) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare. CONCLUSIONS: Broad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases.. |
| 86. | Yuki Kimura, Haruhisa Fukuda, Kayoko Hayakawa, Satoshi Ide, Masayuki Ota, Sho Saito, Masahiro Ishikane, Yoshiki Kusama, Nobuaki Matsunaga, Norio Ohmagari, Longitudinal trends of and factors associated with inappropriate antibiotic prescribing for non-bacterial acute respiratory tract infection in Japan: A retrospective claims database study, 2012–2017, 10.1371/journal.pone.0223835, 14, 10, e0223835-e0223835, 2019.10, [URL]. |
| 87. | 日馬由貴, 鈴木久美子, 具芳明, 福田治久, 石金正裕, 早川佳代子, 大曲貴夫, 日本の高齢者施設におけるレセプト情報を利用した抗菌薬使用量調査の問題点, 日本化学療法学会雑誌, 68, 2, 210-215, 2019.10. |
| 88. | Tsubasa Akazawa, Yoshiki Kusama, Haruhisa Fukuda, Kayoko Hayakawa, Satoshi Kutsuna, Yuki Moriyama, Hirotake Ohashi, Saeko Tamura, Kei Yamamoto, Ryohei Hara, Ayako Shigeno, Masayuki Ota, Masahiro Ishikane, Shunichiro Tokita, Hiroyuki Terakado, Norio Omagari, Eight-Year Experience of Antimicrobial Stewardship Program and the Trend of Carbapenem Use at a Tertiary Acute-Care Hospital in Japan-The Impact of Postprescription Review and Feedback, Open Forum Infect Dis, 6, 10, ofz389, 2019.09, [URL]. |
| 89. | Chie Teramoto, Tatsuro Ishizaki, Seigo Mitsutake, Haruhisa Fukuda, Takashi Naruse, Sayuri Shimizu, Hideki Ito, Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo: A retrospective study., Health & social care in the community, 10.1111/hsc.12707, 27, 4, 899-906, 2019.07, [URL], As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January-February, February-March, March-April, and April-May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March-April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p |
| 90. | 福田治久, 佐藤大介, 福田敬, レセプトデータを用いた医療費分析における診療報酬改定の補正方法, 保健医療科学, 68, 2, 2019.05. |
| 91. | 福田治久, 佐藤大介, 白岩健, 福田敬, NDB解析用データセットテーブルの開発, 保健医療科学, 68, 2, 2019.05, 目的 2011年度より第三者提供が開始されたレセプト情報・特定健診等情報データベース（NDB）の研究利用が不十分な状況にある．学術研究を加速化させ，エビデンスに基づいた医療政策を推進するためには，NDBの活用可能性を高めていく必要がある．本研究の目的は，臨床疫学研究および医療経済研究を行うのに有用性が高く，かつ，データ容量の効率性が高いNDB解析用データセットを構築することである． 方法 2009年4月から2016年12月の間の医科入院レセプトおよびDPCレセプトにおいて1度でも出現したことのある解析用患者IDを全データから無作為に25%分を抽出し，当該解析用患者IDの全期間における全診療行為情報を含む全レセプトデータを格納したNDBを用いた．臨床疫学研究および医療経済研究を行うのに有用性の高い解析用データセットテーブルに必要な変数について検討した．また，医科レセプトにおいては退院年月日情報が含まれていないことから，レセプトデータを用いた補完的な退院年月日を付加する方法について検討した．本検討では，退院年月日情報が含まれるDPCレセプトを用いて，入院年月日と診療実日数を用いる場合と，診療行為発生日を用いる場合のそれぞれの方法で退院年月日を算出し，実際のDPCレセプトに記載されている退院年月日との一致状況について検証した． 結果 NDBに含まれるレコード識別情報を有機的に連結させた解析用データセットテーブルとして，以下の11テーブルを開発した：患者（KAN），レセプト（REC），傷病名（SYO），診療行為（SIN），薬剤（IYA），特定器材（TOK），調剤（TYO），調剤加算料等（TKA），DPC診断群分類（BUD），医療機関（IRK），入院（ADM）．医療機関（IRK）を除く各テーブルは解析用患者IDによって相互に突合することができる．また，医科レセプトにおける補完退院年月日は，診療行為（SI），医薬品（IY），特定器材（TO），コーディングデータ（CD）の各レコードにおける診療行為年月日の最終日情報を用いることで，99.83%の入院症例において正しい退院年月日を付加することができた． 結論 本研究において開発した解析用データセットテーブルを用いることで，NDBを用いた臨床疫学研究および医療経済研究を即座に実施可能な環境をもたらすことができる． . |
| 92. | M. Maeda, H. Fukuda, S. Shimizu, T. Ishizaki, A comparative analysis of treatment costs for home-based care and hospital-based care in enteral nutrition patients: A retrospective analysis of claims data, Health Policy, 10.1016/j.healthpol.2018.12.006, 123, 4, 367-372, 2019.04, [URL]. |
| 93. | K. Moriwaki, H. Fukuda, Cost-effectiveness of implementing guidelines for the treatment of glucocorticoid-induced osteoporosis in Japan, Osteoporosis International, 10.1007/s00198-018-4798-9, 30, 2, 299-310, 2019.02, [URL]. |
| 94. | 大谷泰史, 福田治久, 公立病院再編による経営改善効果に関する研究, 日本医療・病院管理学会誌, 56, 1, 17-27, 2019.01. |
| 95. | Fukuda H, Yano T, Shimono N, Inpatient expenditures attributable to hospital-onset Clostridium difficile infection: a nationwide case-control study in Japan., PharmacoEconomics, 36, 11, 1367-1376, 2018.11, [URL]. |
| 96. | Hirose Masahiro, Nishimura Nobuhiro, Kumakura Shiyunichi, Telloyan John Arthur, Igawa Mikio, Fukuda Haruhisa, Imanaka Yuichi, Do pharmacists have the most potential for patient safety in Japan? Learning from a 2010 nationwide survey, Journal of Hospital Administration, 7, 3, 40-48, 2018.04, Background: Unlike in many other countries, patient safety (PS) in Japan has been promoted under the social insurance medical fee schedule, with the implementation of preferential medical fee paid to medical institutions as incentives. Meanwhile, many hospitals do not assign a full-time physician as PS manager at PS division due to the shortage of physicians.Objective: The Health Ministry in Japan has been promoting PS by utilizing the preferential patient safety countermeasure fee (PPSCF) since 2006. This study aims to address the potential of pharmacists for PS at hospitals implementing the PPSCF.Methods: A nationwide questionnaire survey targeting 2,674 hospitals with the PPSCF was performed from 2010 to 2011. Of the 669 hospitals that responded, 627 hospitals were eligible for analysis, including 178 hospitals implementing PPSCF 1 with 400 beds or more (group A), 286 hospitals implementing PPSCF 1 with 399 beds or fewer (group B), and 163 hospitals implementing PPSCF 2 (group C).Results: Although the mean values of PS activities for nurses were the highest among physicians, nurses, and pharmacists, the values per person recalculated for pharmacists were the highest, and the ranges of the values per person for pharmacists were narrowest across the three professional groups. For example, the number per person of incident reports filed in group A was 2.37 ± 0.30 for pharmacists, 1.14 ± 0.11 for physicians, and 2.09 ± 0.31 for nurses (p = .002). For pharmacists, those values were 2.37 ± 0.30 in group A, 2.43 ± 0.14 in group B and 2.35 ± 0.19 in group C (p = .802).Conclusions: Across health professionals, pharmacists may have the most potential for PS under the social insurance medical fee schedule in Japan.. |
| 97. | Yumi Hurst, Haruhisa Fukuda, Effects of changes in eating speed on obesity in patients with diabetes: a secondary analysis of longitudinal health check-up data, BMJ Open, 10.1136/bmjopen-2017-019589, 8, 1, e019589-e019589, 2018.01, [URL]. |
| 98. | Koki Kato, Haruhisa Fukuda, Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients, GERIATRICS & GERONTOLOGY INTERNATIONAL, 10.1111/ggi.12977, 17, 11, 2247-2254, 2017.11, [URL], AimTo quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. MethodsWe carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. ResultsThe case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. ConclusionsDespite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254.. |
| 99. | Tatsuro Ishizaki, Masaya Shimmei, Haruhisa Fukuda, Eun-Hwan Oh, Chiho Shimada, Tomoko Wakui, Hiroko Mori, Ryutaro Takahashi, Cumulative number of hospital bed days among older adults in the last year of life: A retrospective cohort study, GERIATRICS & GERONTOLOGY INTERNATIONAL, 10.1111/ggi.12777, 17, 5, 737-743, 2017.05, [URL], Aim: To determine whether age, proximity to death and long-term care insurance certification are related to receiving hospital inpatient care; the number of hospital bed days (HBD) among older Japanese adults in the last year of life; and to estimate the total number of HBD. Methods: Using health insurance claims and death certificate data, the present retrospective cohort study examined the HBD of city residents aged >= 65 years who died between September 2006 and October 2009 in Soma City, Japan. Using a two-part model, factors associated with receiving hospital inpatient care and the total number of HBD in each quarter in the last year of life were examined. Results: The total number of HBD in the last year of life varied widely; 13% had no admission, and 27% stayed >= 90 days. Younger age, approaching death and having long-term care insurance certification were significantly associated with being more likely to receive hospital inpatient care during each quarterly period in the last year of life. In contrast, having long-term care insurance certification and the last 3-month period before death, compared with the first 3-month period, were significantly associated with a fewer number of HBD. Conclusions: The present study showed that older age was associated with being less likely to receive hospital inpatient care. The findings regarding the risk of inpatient care and total number of HBD in the last year of life help to understand resource use among older dying adults, and to develop evidence-based healthcare policies within aging societies.. |
| 100. | Haruhisa Fukuda, Miki Mizobe, Impact of nonadherence on complication risks and healthcare costs in patients newly-diagnosed with, DIABETES RESEARCH AND CLINICAL PRACTICE, 10.1016/j.diabres.2016.11.007, 123, 55-62, 2017.01, [URL], Aims: To investigate the association between nonadherence to diabetes treatment and the occurrence of diabetes complications. Methods: Our study retrospectively identified adherence and nonadherence to diabetes treatment in patients during the first year of observation after new diagnoses of type 2 diabetes enrolled in commercial database from 52 health insurers in Japan. Participants were insurance enrollees with type 2 diabetes who received healthcare between 2005 and 2013, and who could be tracked for more than 12 months from the initiation of diabetes treatment. We compared the occurrence of diabetes-related complications (retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion) and all-cause healthcare expenditure during the second to eighth years. Results: We identified 1784 nonadherent patients and 9547 adherent patients. Cox proportional hazard models showed that the occurrence of microvascular complications was significantly higher in the nonadherent group: the hazard ratios (95% confidence intervals) for retinopathy, nephropathy, and neuropathy were 2.04 (1.57-2.66), 1.91 (1.35-2.72), and 1.83 (1.02-3.27), respectively. However, no significant differences were observed between the adherent and nonadherent groups for the macrovascular complications (ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion). In addition, the nonadherent group had a significantly higher cumulative healthcare expenditure than the adherent group during the second-to-fifth-year period (p = 0.029) and the second-to-sixth-year period (p = 0.009) after treatment initiation. Conclusions: Nonadherence in the first year of diabetes may increase the incidence of complications and result in higher expenditures for patients and payers. (C) 2016 Elsevier Ireland Ltd. All rights reserved.. |
| 101. | 山中直子, 今村陽子, 福田治久, 抗菌薬適正使用評価のための分析フレームワークの構築., 日本環境感染学会誌, in press, 2016.12. |
| 102. | Haruhisa Fukuda, Shunya Ikeda, Takeru Shiroiwa, Takashi Fukuda, The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan, PHARMACOECONOMICS, 10.1007/s40273-016-0402-3, 34, 10, 1005-1014, 2016.10, [URL], Background Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses. Objectives The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates. Research design Monthly panel data analysis of Japanese claims data. Subjects The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013. Measures Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models. Results The average follow-up period per patient ranged from 49.4 to 52.3 months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US$180 [95 % confidence interval (CI) 178-181] to US$223 (95 % CI 221-224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US$13,595; 95 % CI 13,568-13,622), neuropathy/extremity disease with surgery (US$4594; 95 % CI 3979-5208), and diabetic nephropathy with dialysis (US$3689; 95 % CI 3667-3711). Conclusions Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.. |
| 103. | Haruhisa Fukuda, Kensuke Moriwaki, Cost-Effectiveness Analysis of Safety-Engineered Devices, INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 10.1017/ice.2016.110, 37, 9, 1012-1021, 2016.09, [URL], OBJECTIVE. To estimate the cost-effectiveness of safety-engineered devices (SEDs) relative to non-SEDs for winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles. DESIGN. Decision analysis modeling. PARTICIPANTS. Hypothetical cohort of healthcare workers who utilized needle devices. METHODS. We developed a decision-analytic model to estimate and compare the life-cycle costs and benefits for SED and non-SED needle devices. For this cost-effectiveness analysis, we quantified the total direct medical cost per needlestick injury, number of needlestick injuries avoided, and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the robustness of the base-case analysis. RESULTS. In the base-case analysis, we calculated the incremental cost-effectiveness ratios of SED winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles to be $2,633, $13,943, $1,792, and $1,269 per needlestick injury avoided, respectively. Sensitivity analyses showed that the calculated incremental cost-effectiveness ratio values for using SEDs did not fall below zero even after adjusting the values of each parameter. CONCLUSION. The use of SED needle devices would not produce cost savings for hospitals. Government intervention may be needed to systematically protect healthcare workers in Japan from the risk of bloodborne pathogen infections.. |
| 104. | Kazunori Toyoda, Ken Okumura, Yoichiro Hashimoto, Takanori Ikeda, Takashi Komatsu, Teruyuki Hirano, Haruhisa Fukuda, Kazuo Matsumoto, Masahiro Yasaka, Identification of Covert Atrial Fibrillation in Cryptogenic Ischemic Stroke: Current Clinical Practice in Japan, JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 10.1016/j.jstrokecerebrovasdis.2016.05.012, 25, 8, 1829-1837, 2016.08, [URL], Background and aim: A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device. Methods, results, and conclusion: The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30% of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance with current medical practice in Japan.. |
| 105. | H. Fukuda, Patient-related risk factors for surgical site infection following eight types of gastrointestinal surgery, JOURNAL OF HOSPITAL INFECTION, 10.1016/j.jhin.2016.04.005, 93, 4, 347-354, 2016.08, [URL], Objective: To identify patient-related risk factors for surgical site infection (SSI) following eight types of gastrointestinal surgery that could be collected as part of infection surveillance efforts. Design: Record linkage from existing datasets comprising the Japan Nosocomial Infections Surveillance (JANIS) and Diagnosis Procedure Combination (DPC) programmes. Methods: Patient data from 35 hospitals were retrieved using JANIS and DPC from 2007 to 2011. Patient-related factors and the incidence of SSI were recorded and analysed. Risk factors associated with SSI were examined using multi-level mixed-effects logistic regression models. Results: In total, 2074 appendectomies; 2084 bile duct, liver or pancreatic procedures; 3460 cholecystectomies; 7273 colonic procedures; 482 oesophageal procedures; 4748 gastric procedures; 2762 rectal procedures and 1202 small bowel procedures were analysed. Using multi-variate analyses, intra-operative blood transfusion was found to be a risk factor for SSI following all types of gastrointestinal surgery, except appendectomy and small bowel surgery. In addition, diabetes was found to be a risk factor for SSI following colon surgery [odds ratio (OR) 1.23, P = 0.028] and gastric surgery (OR 1.70, P Conclusions: Intra-operative blood transfusion, diabetes and use of steroids are risk factors for SSI following gastrointestinal surgery, and should be included as part of SSI surveillance for these procedures. (C) 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.. |
| 106. | 高木康文, 福田治久, MRSA感染症における追加的医療資源の推計., 日本環境感染学会誌, 10.4058/jsei.31.173, 31, 3, 173-180, 2016.05, 本研究の目的は，MRSA感染症における追加的医療資源(入院日数・出来高換算医療費)の推計である． 対象は調査病院を2012年12月～2014年12月に退院した患者で，解析手法はMRSA感染有無を目的変数にしたロジスティック回帰によって推定される傾向スコアによるマッチング法を用いた．傾向スコア推定後，DPC10桁が同一でスコアが近似するMRSA感染者と非感染者を1対1でマッチングした．また，時間依存バイアスに対処したマッチング法も併せて行った．両者の医療資源の差異の平均から追加医療資源を算出し有意差の検定は対応のあるt検定を用いた． 解析対象症例数は24,538例で，感染者数は47名であった．MRSA感染症による入院日数の延長は時間依存バイアスに対処した場合：13.1日(95%信頼区間3.7日–22.4日，p=0.008)および医療費の増加は107.0万円(31.7万円–182.2万円，p=0.007)であり，時間依存バイアスに対処しない場合：21.2日(95%信頼区間11.7日–30.8日，p 本研究は，傾向スコアを用い時間依存バイアスに対処したマッチング法でMRSA感染症による追加的医療費を推計した．結果，時間依存バイアスに対処しなければ結果を過大評価することが明らかとなった．本推計値は感染制御における費用対効果を計る資料として活用できる． . |
| 107. | 豊田一則, 奥村謙, 橋本洋一郎, 池田隆徳, 小松隆, 平野照之, 福田治久, 松本万夫, 矢坂正弘, 潜因性脳梗塞と塞栓源不明脳塞栓症：わが国における臨床的意義と潜在性心房細動検出の重要性., 脳卒中, 10.3995/jstroke.10416, 38, 2, 77-85, 2016.04, 発症原因を特定できない潜因性脳梗塞は，病型分類法によって診断基準が異なり，脳梗塞全体に占める頻度も16～39％と研究間で差が大きい．この中に塞栓症が多く含まれると考えられ，塞栓源不明脳塞栓症という概念も提唱された．とくに潜在性心房細動が注目され，植込み型心電図記録計を用いた長期間の観察では3 割の患者に心房細動が同定された．次世代型植込み型心電図記録計は小型で遠隔監視が可能であり，海外では潜在性心房細動の検出目的に用いられている．心房細動を同定できれば，確立した再発予防法として抗凝固薬を使用でき，脳梗塞再発予防に利するであろう．次世代型植込み型記録計を国内で潜在性心房細動検出目的に用いることを日本脳卒中学会から厚生労働省に要望している．使用が承認された場合は，わが国の診療事情に合わせて頭部MRIを含めたより詳細な診断に基づいて，検査に相応しい患者を抽出すべきと考え，その基準を提案する．. |
| 108. | Haruhisa Fukuda, Cost-effectiveness analysis for diabetes care, Nippon rinsho. Japanese journal of clinical medicine, 74, 707-712, 2016.04. |
| 109. | Haruhisa Fukuda, Manabu Kuroki, The Development of Statistical Models for Predicting Surgical Site Infections in Japan: Toward a Statistical Model-Based Standardized Infection Ratio, INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 10.1017/ice.2015.302, 37, 3, 260-271, 2016.03, [URL], OBJECTIVE. To develop and internally validate a surgical site infection (SSI) prediction model for Japan. DESIGN. Retrospective observational cohort study. METHODS. We analyzed surveillance data submitted to the Japan Nosocomial Infections Surveillance system for patients who had undergone target surgical procedures from January 1, 2010, through December 31, 2012. Logistic regression analyses were used to develop statistical models for predicting SSIs. An SSI prediction model was constructed for each of the procedure categories by statistically selecting the appropriate risk factors from among the collected surveillance data and determining their optimal categorization. Standard bootstrapping techniques were applied to assess potential overfitting. The C-index was used to compare the predictive performances of the new statistical models with those of models based on conventional risk index variables. RESULTS. The study sample comprised 349,987 cases from 428 participant hospitals throughout Japan, and the overall SSI incidence was 7.0%. The C-indices of the new statistical models were significantly higher than those of the conventional risk index models in 21 (67.7%) of the 31 procedure categories (P<.05 no significant overfitting was detected.>CONCLUSIONS. Japan-specific SSI prediction models were shown to generally have higher accuracy than conventional risk index models. These new models may have applications in assessing hospital performance and identifying high-risk patients in specific procedure categories.. |
| 110. | H. Fukuda, N. Yamanaka, Reducing needlestick injuries through safety-engineered devices: results of a Japanese multi-centre study, JOURNAL OF HOSPITAL INFECTION, 10.1016/j.jhin.2015.09.019, 92, 2, 147-153, 2016.02, [URL], Background: Quantitative information on the effectiveness of safety-engineered devices (SEDs) is needed to support decisions regarding their implementation. Aim: To elucidate the effects of SED use in winged steel needles, intravenous (IV) catheter stylets and suture needles on needlestick injury (NSI) incidence rates in Japan. Methods: Japan EPINet survey data and device utilization data for conventional devices and SEDs were collected from 26 participating hospitals between 1 April 2009 and 31 March 2014. The NSI incidence rate for every 100,000 devices was calculated according to hospital, year and SED use for winged steel needles, IV catheter stylets and suture needles. Weighted means and 95% confidence intervals (CI) were used to calculate overall NSI incidence rates. Findings: In total, there were 236 NSIs for winged steel needles, 152 NSIs for IV catheter stylets and 180 NSIs for suture needles. The weighted NSI incidence rates per 100,000 devices for SEDs and non-SEDs were as follows: winged steel needles, 2.10 (95% CI 1.66-2.54) and 14.95 (95% CI 2.46-27.43), respectively; IV catheter stylets, 0.95 (95% CI 0.60-1.29) and 6.39 (95% CI 3.56-9.23), respectively; and suture needles, 1.47 (95% CI -1.14-4.09) and 16.50 (95% CI 4.15-28.86), respectively. All devices showed a significant reduction in the NSI incidence rate with SED use (P Conclusion: SED use substantially reduces the incidence of NSIs, and is therefore recommended as a means to prevent occupational infections in healthcare workers and improve healthcare safety. (C) 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.. |
| 111. | Haruhisa Fukuda, Sayuri Shimizu, Tatsuro Ishizaki, Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients, PLOS ONE, 10.1371/journal.pone.0133694, 10, 7, e0133694, 2015.07, [URL], Objectives To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Design Retrospective cohort study. Setting Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Participants Patients aged 65 years and above who had undergone hip fracture surgery. Measurements Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. Results The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Conclusion Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.. |
| 112. | 小原 仁, 齋藤 潤栄, 福田 治久, ペニシリン耐性肺炎球菌感染による追加的医療資源：JANIS全入院患者部門データを用いた推定., 日本環境感染学会誌, 10.4058/jsei.30.165, 30, 3, 165-173, 2015.06, 耐性菌感染による重症化と治療期間の延伸は，追加的な医療資源量の増加をもたらす．これは逼迫する医療費の適正化に向けた施策の障害にもなっている．本研究では，Japan Nosocomial Infection Surveillance全入院患者部門データ(以下，JANISデータ)において判定されているペニシリン耐性肺炎球菌(penicillin-resistant Streptococcus pneumoniae: PRSP)感染症例をもとに耐性菌感染による追加的医療資源量の推計を行った．解析対象となるデータは，調査協力を得られた1病院から直接収集したJANISデータと診断群分類別包括評価(Diagnosis Procedure Combination/Per-Diem Payment System)データを用いた．PRSP感染者と非感染者の判定はJANISデータに基づいた．すべての対象症例を病名と術式行為が一致する層別に分類し，各層からプロペンシティスコアをもとにPRSP感染有無に関するマッチングを行った．このマッチングされたペア差の平均値から追加的医療資源となる在院日数と入院医療費を推定した． すべてのペアを対象にしたPRSP感染による在院日数の増加は2.79日であった．また年齢区分5歳未満では在院日数2.08日，入院医療費110,634円の増加が認められた．本研究では，PRSP感染によって生じる追加的医療資源量を推計した．この耐性菌感染によって在院日数の増大と5歳未満においては在院日数と入院医療費の増大が明らかとなった．本研究成果は，感染制御に関する費用対効果を踏まえた技術評価の側面を支える基礎資料として，広く貢献できるものと考える．耐性菌感染の抑制に向けた包括的な感染制御の発展が期待される． . |
| 113. | 福田 治久, 医療材料を対象とした臨床試験データの費用効果分析への利活用可能性の検討, レギュラトリーサイエンス学会誌, 10.14982/rsmp.5.1, 5, 1, 1-12, 2015.02. |
| 114. | 小原 仁, 福田 治久, 外来患者の逆紹介がその後の入院率に与える効果., 日本医療・病院管理学会誌, 10.11303/jsha.52.19, 52, 1, 19-26, 2015.02, 医療連携を主体とした機能分化の推進が期待されている。しかしながら，機能分化を可能とする病院の外来縮小は進んでいない。本研究は，機能分化に向けた逆紹介の課題要因を明らかにするとともに，外来縮小の方針決定に影響を与えると考えられた逆紹介とその後の入院率との関連を明らかにすることを目的とした。南風病院呼吸器内科に外来受診をした慢性閉塞性肺疾患（COPD）と喘息疾患の再診患者を対象にロジスティック回帰分析を行った。入院率の比較については傾向スコアマッチングを用いた生存時間分析を実施した。解析の結果，長期処方実績や複数科外来受診などの要因が逆紹介と関連していた。また生存時間分析による入院率の比較では，外来患者の逆紹介とその後の入院率の減少に関連は認められなかった。一般外来の縮小に向けた外来患者の逆紹介が推進されることで，外来診療における地域医療の機能分化が期待された。. |
| 115. | 福田 治久, 医療関連感染領域の医療経済評価における費用の評価手法, 日本環境感染学会誌, 29, 6, 387-395, 2014.12. |
| 116. | 福田 治久, 医療関連感染領域の医療経済評価における有効性の評価手法, 日本環境感染学会誌, 29, 6, 396-404, 2014.12. |
| 117. | 福田 治久, 特定保険医療材料を対象にしたレセプトデータ分析の実施可能性, レギュラトリーサイエンス学会誌, 10.14982/rsmp.4.257, 4, 3, 257-264, 2014.10. |
| 118. | Ryu Matsuo, Masahiro Kamouchi, Haruhisa Fukuda, Jun Hata, Yoshinobu Wakisaka, Junya Kuroda, Tetsuro Ago, Takanari Kitazono, Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator for Ischemic Stroke Patients over 80 Years Old: The Fukuoka Stroke Registry, PLOS ONE, 10.1371/journal.pone.0110444, 9, 10, e110444., 2014.10, [URL], Objectives: The benefit of intravenous recombinant tissue plasminogen activator (rt-PA) therapy for very old patients with acute ischemic stroke remains unclear. The aim of this study was to elucidate the efficacy and safety of intravenous rt-PA therapy for patients over 80 years old. Methods: Of 13,521 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 1999 to February 2013, 953 ischemic stroke patients who were over 80 years old, hospitalized within 3 h of onset, and not treated with endovascular therapy were included in this study. Among them, 153 patients were treated with intravenous rt-PA (0.6 mg/kg). For propensity score (PS)-matched case-control analysis, 148 patients treated with rt-PA and 148 PS-matched patients without rt-PA therapy were selected by 1:1 matching with propensity for using rt-PA. Clinical outcomes were neurological improvement, good functional outcome at discharge, in-hospital mortality, and hemorrhagic complications (any intracranial hemorrhage [ICH], symptomatic ICH, and gastrointestinal bleeding). Results: In the full cohort of 953 patients, rt-PA use was associated positively with neurological improvement and good functional outcome, and negatively with in-hospital mortality after adjustment for multiple confounding factors. In PS-matched case-control analysis, patients treated with rt-PA were still at lower risk for unfavorable clinical outcomes than non-treated patients (neurological improvement, odds ratio 2.67, 95% confidence interval 1.61-4.40; good functional outcome, odds ratio 2.23, 95% confidence interval 1.16-4.29; in-hospital mortality, odds ratio 0.30, 95% confidence interval 0.13-0.65). There was no significant association between rt-PA use and risk of hemorrhagic complications in the full and PS-matched cohorts. Conclusions: Intravenous rt-PA therapy was associated with improved clinical outcomes without significant increase in risk of hemorrhagic complications in very old patients (aged. 80 years) with acute ischemic stroke.. |
| 119. | 福田 治久, 医療関連感染領域における医療経済評価の実施手法の概要, 日本環境感染学会誌, 10.4058/jsei.29.324, 29, 5, 324-332, 2014.09, 近年，我が国の医療財政は著しく逼迫しており，診療報酬の総体的な抑制は，医療機関経営の財務をも圧迫している．そのため，限られた医療資源の効率的配分の実現が強く求められており，診療報酬制度は効率性を勘案した評価へとパラダイムシフトが起こりつつある．同時に，医療機関内部においても，どの領域のどの活動にどの程度の資源を投じるか？を科学的に意思決定する動きが加速度的に増しているものと思われる．医療経済評価とは，こうした政策レベル・病院経営レベルにおける意思決定を科学的に判断するためのツールである． 本稿では，医療経済評価の基本的な考え方と，医療経済評価の実施手法について解説する．実施手法は広範囲に及ぶため，医療経済評価の核となる，(1)分析の立場，(2)比較対照，(3)分析手法，(4)分析期間，(5)アウトカム指標，(6)費用の測定，(7)割引，(8)不確実性の取り扱い，の中心事項について紹介する． . |
| 120. | Haruhisa Fukuda, Kazuhide Okuma, Yuichi Imanaka, Can Experience Improve Hospital Management?, PLOS ONE, 10.1371/journal.pone.0106884, 9, 9, e106884, 2014.09, [URL], Background: Experience curve effects were first observed in the industrial arena as demonstrations of the relationship between experience and efficiency. These relationships were largely determined by improvements in management efficiency and quality of care. In the health care industry, volume-outcome relationships have been established with respect to quality of care improvement, but little is known about the effects of experience on management efficiency. Here, we examine the relationship between experience and hospital management in Japanese hospitals. Methods: The study sample comprised individuals who had undergone surgery for unruptured abdominal aortic aneurysms and had been discharged from participant hospitals between April 1, 2006 and December 31, 2008. We analyzed the association between case volume (both at the hospital and surgeon level) and postoperative complications using multilevel logistic regression analysis. Multilevel log-linear regression analyses were performed to investigate the associations between case volume and length of stay (LOS) before and after surgery. Results: We analyzed 909 patients and 849 patients using the hospital-level and surgeon-level analytical models, respectively. The odds ratio of postoperative complication occurrence for an increase of one surgery annually was 0.981 (PConclusion: Experience at the hospital level may contribute to the improvement of hospital management efficiency.. |
| 121. | 福田 治久, 手術部位感染サーベイランスデータの評価と分析, 日本環境感染学会誌, 10.4058/jsei.29.231, 29, 4, 231-239, 2014.07. |
| 122. | 福田 治久, 多変量回帰分析：科学論文を読み解くための基礎知識, 日本環境感染学会誌, 29, 4, 240-255, 2014.07. |
| 123. | 福田敬, 白岩健, 池田俊也, 五十嵐中, 赤沢学, 石田博, 能登真一, 齋藤信也, 坂巻弘之, 下妻晃二郎, 田倉智之, 福田治久, 森脇健介, 冨田奈穂子, 小林慎, 保健医療における費用対効果の評価方法と活用 医療経済評価研究における分析手法に関するガイドライン, 保健医療科学, 62, 6, 325-640, 2013.12, 日本においては、現在のところ実践的に広く使用されている医療経済評価ガイドラインは存在しない。このことは、各研究者によって行われる分析間の比較可能性を困難にし、さらには使用する分析手法がブラックボックスにおちいりやすく、経済評価の透明性が損なわれる結果にもつながっている。そこで、各国で作成されている医療経済評価ガイドラインや公表されている文献を参照しながら、研究班に参加した専門家のコンセンサスによってガイドラインを作成していった。研究班は経済評価の専門家から構成され、まずはガイドラインに必要な13セクションを同定した。各セクション内において、経済評価を行う上で方法論上の論点になる部分を抽出し、それに対する回答を作成するための検討を重ねていった。このプロセスは、2011年度と2012年度の2年度にわたって継続して行われ、参加したメンバーのコンセンサスにより、最終版は2012年度末に完成した。各項目は、簡潔な文章によって記述され、その意味するところを明確にするため3つの星によるレーティングシステムを用いた。ガイドラインでは、原則としては公的医療費支払者の立場を標準とする。ただし、分析の目的によってはそれ以外の立場を用いてもよい。アウトカム指標は、分析者が最も適すると考えるアウトカム指標を用いてよいが、質調整生存年(QALY)を用いた分析を含めることを推奨している。割引率は、費用・効果ともに年率2%で割り引くことを推奨している。本ガイドラインが、日本における経済評価研究の質と比較可能性を高めることが期待される。(著者抄録). |
| 124. | Haruhisa Fukuda, Keita Morikane, Manabu Kuroki, Shinichiro Taniguchi, Takashi Shinzato, Fumie Sakamoto, Kunihiko Okada, Hiroshi Matsukawa, Yuko Ieiri, Kouji Hayashi, Shin Kawai, Toward the rational use of standardized infection ratios to benchmark surgical site infections, AMERICAN JOURNAL OF INFECTION CONTROL, 10.1016/j.ajic.2012.10.004, 41, 9, 810-814, 2013.09, [URL], Background: The National Healthcare Safety Network transitioned from surgical site infection (SSI) rates to the standardized infection ratio (SIR) calculated by statistical models that included perioperative factors (surgical approach and surgery duration). Rationally, however, only patient-related variables should be included in the SIR model. Methods: Logistic regression was performed to predict expected SSI rate in 2 models that included or excluded perioperative factors. Observed and expected SSI rates were used to calculate the SIR for each participating hospital. The difference of SIR in each model was then evaluated. Results: Surveillance data were collected from a total of 1,530 colon surgery patients and 185 SSIs. C-index in the model with perioperative factors was statistically greater than that in the model including patient-related factors only (0.701 vs 0.621, respectively, P Conclusion: Because surgical approach and duration of surgery each serve as a partial proxy of the operative process or the competence of surgical teams, these factors should not be considered predictive variables. Copyright (c) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.. |
| 125. | 福田 治久, 手術部位感染発生率の病院間比較手法の検証：JANISデータを用いた全国多施設研究, 日本環境感染学会誌, 28, 2, 63-73, 2013.03. |
| 126. | Haruhisa Fukuda, Assessment of Methodology to Compare Surgical-Site Infection Rates Across Institutions A Nationwide Multi-Center Study Using JANIS Data, Japanese Journal of Environmental Infections, 10.4058/jsei.28.63, 28, 2, 63-73, 2013.01, [URL], Comparison of surgical site infection (SSI) rates across institutions has been an effective infection control measure, but success relies on the quality of risk adjustments. This study assessed desirable risk-adjustment methodologies for use in the Japan Nosocomial Infections Surveillance (JANIS) network. Patients who underwent 1 of 6 digestive system procedures (APPY, BILI, CHOL, COLN, GAST, or REC) were included. Logistic regression analysis was performed to predict the risk of developing SSI in the following two models: (1) selected variables that consist of an NNIS Risk Index, or (2) all variables that were collected at SSI surveillance. Model performances were assessed using the c-index. Two regression models were also developed that included or excluded factors regarding surgery duration as well as laparoscopic surgery. The difference in the standardized infection ratio (SIR) in each model was then evaluated. Surveillance data were collected from a total of 37,251 procedures from 37 institutions. Odds ratios regarding the development of SSI were generally different between procedures and risk factors. Except for APPY, the c-index was statistically greater in the model with all variables than in the model including risk index factors only (p |
| 127. | H. Fukuda, K. Morikane, M. Kuroki, S. Kawai, K. Hayashi, Y. Ieiri, H. Matsukawa, K. Okada, F. Sakamoto, T. Shinzato, S. Taniguchi, Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption, INFECTION, 10.1007/s15010-012-0317-7, 40, 6, 649-659, 2012.12, Purpose To estimate the impact of surgical site infection (SSI) on postoperative resource consumption for colon and rectal open and laparoscopic surgeries after accounting for infection depth and patient characteristics, and to compare these estimates among institutions. Methods We collected administrative and SSI-related data from eight Japanese hospitals, and used generalized linear models to estimate excess postoperative length of stay (LOS) and charges attributable to SSI. Covariates included wound class, American Society of Anesthesiologists (ASA) score, operation time, emergency, colostomy, trauma, implant, and comorbidities. Results We examined 1,108 colon surgery (CS) and 477 rectal surgery (RS) patients. For open surgery, the postoperative LOS in non-SSI patients was 13.5 (CS) and 15.9 days (RS). Compared with non-SSI patients, the postoperative LOS increased by 4.5 (CS) and 2.8 days (RS) for superficial SSI, 6.8 (CS) and 8.5 days (RS) for deep SSI, and 7.8 and 9.5 days for space/organ SSI. For laparoscopic surgery, the postoperative LOS was 9.8 (CS) and 14.6 days (RS). SSI was significantly associated with increased postoperative LOS for superficial SSI [by 4.8 (CS) and 3.6 days (RS)], deep SSI [by 10.3 (CS) and 23.9 days (RS)], and space/organ SSI [by 8.9 days (RS)]. The postoperative LOS among hospitals was 3.8-10.4 days (CS) and 1.3-12.2 days (RS). Postoperative SSI-attributable charges ranged from $386 to $2,873, depending on organ, procedure, and infection depth. Conclusions This study quantified the impact of SSIs on resource consumption and confirmed significant cost variations among hospitals. These variations could not be explained by patient characteristics or infection type.. |
| 128. | 福田 治久, JANIS/DPC統合データベース構築による胃手術における手術部位感染発生による追加的医療資源の推定, 日本環境感染学会誌, 27, 6, 389-396, 2012.11, 背景： 医療政策に費用対効果の視点を導入する議論は，感染制御領域においても例外ではない．しかしながら，費用対効果の検証に不可欠な，我が国における疾病費用に関する検証は十分に実施されていない．本研究の目的は胃手術の実施症例に対する手術部位感染（SSI）発生による追加的医療資源を推定することである． 方法： 2007年7月から2010年12月の間に6病院において胃手術を実施した症例を解析対象に定めた．使用データは，JANISデータとDPCデータを突合して構築したJANIS/DPC統合データベースである．推定には，従属変数を術後在院日数および術後医療費（出来高換算）に定め，曝露変数をSSIの有無および深さに定めた一般化線形モデルを用いた． 結果： 解析対象症例数は857症例であり，感染者数は42症例であった．SSI発生による術後在院日数の延長および術後医療費の増加は，表層切開創SSIでは6.6日および206千円，深部切開創SSIでは12.8日および398千円，臓器/体腔SSIでは18.3日および1,021千円と推定された． 結論： 本研究は，JANISデータとDPCデータという既存データを突合するJANIS/DPC統合データベースを構築するとともに，6施設を対象に胃手術症例におけるSSI発生による追加的医療資源を推定した．本推定値は，感染制御方策の費用対効果の検証に活用可能である．. |
| 129. | 江上廣一, 廣瀬昌博, 津田佳彦, 大濱京子, 本田順一, 島弘志, 中林愛恵, 福田治久, 今中雄一, 小林祥泰, インシデントレポートからみた臨床研修病院における転倒・転落事例の臨床疫学的側面, 日本医療・病院管理学会誌, 10.11303/jsha.49.205, 49, 4, 205-215, 2012.11, 2007∼09年度に収集された転倒・転落のインシデントレポート1,764件を対象に，転倒率（件/1,000患者・日）を用いて転倒・転落に関する疫学的側面を検討した。患者の平均年齢は男66.6±18.8歳（950件），女69.9±19.2歳（814件）であった。全体の転倒率は1.84件/1,000患者・日，性別では男2.06および女1.87であった。年齢別では，70歳代が2.82件/1,000患者・日（555件）でもっとも高く，高齢者ほど高い傾向にあった。診療科別において，外科系では整形外科が最低で1.14件/1,000患者・日，内科系では循環器内科および呼吸器内科が最低で1.97を示し，外科系より内科系診療科が高い傾向にあった。また，入院から転倒発生までの日数における転倒率（転倒件数）について，入院翌日が0.16件/1,000患者・日（118件）でもっとも高く，ついで入院3日目が0.12（84件），入院当日が0.11（78件）で以降漸減していた。転倒発生の平均値は12.4日であった。 転倒率からみた転倒の疫学的側面から，入院診療科や入院からの日数に応じた防止策を講じることが必要である。. |
| 130. | 江上 廣一, 廣瀬 昌博, 津田 佳彦, 大濱 京子, 本田 順一, 島 弘志, 中林 愛恵, 福田 治久, 今中 雄一, 小林 祥泰, インシデントレポートからみた臨床研修病院における転倒・転落事例の臨床疫学的側面, 日本医療・病院管理学会誌, 49, 4, 15-25, 2012.10. |
| 131. | 江上 廣一, 廣瀬 昌博, 津田 佳彦, 大濱 京子, 本田 順一, 島 弘志, 福田 治久, 今中 雄一, 一般事例における追加的医療費算出の試み, 日本医療・病院管理学会誌, 49, Suppl., 109-109, 2012.09. |
| 132. | 津田 佳彦, 廣瀬 昌博, 江上 廣一, 大濱 京子, 本田 順一, 島 弘志, 福田 治久, 今中 雄一, 本院における患者安全文化醸成度に関する検討, 日本医療・病院管理学会誌, 49, Suppl., 134-134, 2012.09. |
| 133. | 清水沙友里, 福田治久, GISによる急性期医療機関から回復期医療機関への転院によるアクセシビリティの解析：大腿骨頸部骨折地域連携クリティカルパスを例にとって, 日本医療・病院管理学会誌, 10.11303/jsha.49.173, 49, 3, 173-181, 2012.08, 地域連携クリティカルパスをはじめとする地域医療連携の促進によって，患者は技術の高度化・専門化の恩恵を受けながら効率的かつ安全に医療を受けることが可能になる。一方で，医療連携の促進による患者の移動傾向等のアクセシビリティはほとんど明らかになっていない。 そこで本研究は，地域連携の先進的地域の急性期病院において，（1）患者の来院圏の可視化 （2）回復期病院への転院によるアクセシビリティの変化をGISを用いて明らかにすることを目的とした。 本研究における急性期医療機関の実質的な医療圏は，二次医療圏を超えた広範な地域にわたり，32.5%は二次医療圏外の回復期医療機関に転院していた。医療法で定められる二次医療圏と実質的な診療圏の乖離が地理的に明らかとなった。GISを用いてアクセシビリティを把握することによって，医療の実態を反映した医療資源の整備や，医療計画の立案等に活用可能であることが示唆された。. |
| 134. | 清水 沙友里, 福田 治久, GISによる急性期医療機関から回復期医療機関への転院によるアクセシビリティの解析：大腿骨頸部骨折地域連携クリティカルパスを例にとって, 日本医療・病院管理学会誌, 49, 3, 45-53, 2012.07. |
| 135. | 福田 治久, 医療安全対策の有効性評価に係わる課題：インシデント報告システム活性化対策を例にして, 医療の質・安全学会誌, 7, 1, 37-47, 2012.02. |
| 136. | 福田 治久, 計画管理料算定病院における大腿骨頸部骨折および脳卒中を対象にした地域連携クリティカルパスの運用状況に関する全国実態調査, 日本医療・病院管理学会誌, 10.11303/jsha.49.31, 49, 1, 31-39, 2012.01, 厚生労働省は21世紀の医療提供体制の方向性として地域連携を掲げており，これを達成するツールとして地域連携パスがある。本研究は，（1）地域連携を積極的に実施している病院の特徴，および，（2）連携パス運用による機能分化の促進効果，を明らかにすることを目的に実施した。 地域連携診療計画管理料（計画管理料）を算定している全計画管理病院（625病院）を対象に，質問票調査を行った。データ解析には線形回帰モデルを用いた。 232病院（37.1%）から回答を得た。大腿骨頸部骨折症例に対する計画管理料算定割合の高い病院の特徴として，患者数の多さ（p=0.002），短い平均在院日数（p=0.005）などが検出された。診療計画に転院基準を定めた病院は，定めのない病院に比べて，大腿骨頸部骨折の急性期平均在院日数が12.8%短かった（p=0.036）。 本研究は，地域連携を実施する上で，診療計画に転院基準を定めることの重要性を示唆するものである。. |
| 137. | Haruhisa Fukuda, Estimates of Postoperative Resource Utilization Attributable to Surgical Site Infection in Gastrectomy Patients Evidence from the JANIS/DPC Integrated Database, Japanese Journal of Environmental Infections, 10.4058/jsei.27.389, 27, 6, 389-396, 2012.01, [URL], Issues of introducing cost-effectiveness analysis in the field of infection control are inevitably controversial. However, cost of illness studies, which are essential for cost-effectiveness analysis, have not been adequately carried out in Japan. This study estimated postoperative resource consumption attributable to surgical site infection (SSI) in gastrectomy patients who underwent gastrectomy between July 2007 and December 2010 at six participating hospitals. The JANIS/DPC Integrated Database was developed after collecting JANIS-related data and administrative DPC data. The generalized linear model was used to estimate excess postoperative length of stay (LOS) and charges (based on fee-for-service) attributable to SSI. A total of 42 SSI cases were identified among 857 surgeries. The generalized linear model was used to estimate the impact of SSI and revealed that compared with non-SSI patients, postoperative LOS and charges increased by 6.6 days and 206,000 yen for superficial SSI patients, 12.8 days and 398,000 yen for deep SSI patients, and 18.3 days and 1,021,000 yen for organ/space SSI patients, respectively. The JANIS/DPC Integrated Database was developed by combining JANIS-related data and DPC data and used to estimate postoperative extra resource consumption in gastrectomy patients at six hospitals. These data may prove useful in cost-effectiveness analysis for future infection control programs in Japan.. |
| 138. | 江上 廣一, 廣瀬 昌博, 津田 佳彦, 大濱 京子, 本田 順一, 島 弘志, 今中 雄一, 福田 治久, インシデントレポートにおける転倒転落事例の疫学, 日本医療・病院管理学会誌, 48, Suppl., 140-140, 2011.07. |
| 139. | 廣瀬 昌博, 福田 治久, 三原 美津江, 伊藤 孝史, 兼児 敏浩, 今中 雄一, 江上 廣一, 津田 佳彦, 本田 順一, 医療安全対策加算算定病院における医療安全管理体制の整備に関する実態調査, 日本医療・病院管理学会誌, 48, Suppl., 144-144, 2011.07. |
| 140. | 津田 佳彦, 廣瀬 昌博, 江上 廣一, 大濱 京子, 本田 順一, 島 弘志, 今中 雄一, 福田 治久, 患者安全の醸成とキャリア、Lag timeの関連に関する検討, 日本医療・病院管理学会誌, 48, Suppl., 147-147, 2011.07. |
| 141. | H. Fukuda, J. Lee, Y. Imanaka, Costs of hospital-acquired infection and transferability of the estimates: a systematic review, INFECTION, 10.1007/s15010-011-0095-7, 39, 3, 185-199, 2011.06, Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a relatively high frequency of occurrence and considerable damage caused. There has been an increase in the number of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of HAT (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI estimates from existing published literature when evaluating the economic impact of HAI control measures, it has been observed that the results of economic evaluations may not be directly applied to other jurisdictions due to differences in the context and circumstances in which the original results were produced. The aims of this study were to conduct a systematic review of published studies that have produced COHAI estimates from 1980 to 2006 and to evaluate the quality of these estimates from the perspective of transferability. From a total of 89 publications, only eight papers (9.0%) had a high level of transferability in which all components of costs were described, data for costs in each component were reported, and unit costs were estimated with actual costing. We also did not observe a higher citation level for studies with high levels of transferability. We feel that, in order to ensure an appropriate contribution to the infection control program decision-making process, it is essential for researchers who estimate COHAI, analysts who use COHAI estimates for decision-making, as well as relevant journal reviewers and editors to recognize the importance of a transferability paradigm.. |
| 142. | 津田 佳彦, 廣瀬 昌博, 福田 治久, 江上 廣一, 大濱 京子, 本田 順一, 島 弘志, 今中 雄一, 3臨床研修病院における転倒転落および一般事例のLag timeに関する研究, 日本医療マネジメント学会雑誌, 12, Suppl., 177-177, 2011.06. |
| 143. | 中林 愛恵, 廣瀬 昌博, 伊藤 孝史, 三原 美津江, 福田 治久, 竹村 匡正, 岡本 和也, 今中 雄一, 病院管理データによる転倒・転落に起因する追加的医療費算出の試み, 日本医療マネジメント学会雑誌, 12, Suppl., 248-248, 2011.06. |
| 144. | Haruhisa Fukuda, Hirohisa Imai, Cost effectiveness analysis of liver transplantation, Liver Cancer: Causes, Diagnosis and Treatment, 195-222, 2011.04. |
| 145. | H. Fukuda, J. Lee, Y. Imanaka, Variations in analytical methodology for estimating costs of hospital-acquired infections: a systematic review, JOURNAL OF HOSPITAL INFECTION, 10.1016/j.jhin.2010.10.006, 77, 2, 93-105, 2011.02, Quantifying the additional costs of hospital-acquired infections (COHAI) is essential for developing cost-effective infection control measures. The methodological approaches to estimate these costs include case reviews, matched comparisons and regression analyses. The choice of cost estimation methodologies can affect the accuracy of the resulting estimates, however, with regression analyses generally able to avoid the bias pitfalls of the other methods. The objective of this study was to elucidate the distributions and trends in cost estimation methodologies in published studies that have produced COHAI estimates. We conducted systematic searches of peer-reviewed publications that produced cost estimates attributable to hospital-acquired infection in MEDLINE from 1980 to 2006. Shifts in methodologies at 10-year intervals were analysed using Fisher's exact test. The most frequent method of COHAI estimation methodology was multiple matched comparisons (59.6%), followed by regression models (25.8%), and case reviews (7.9%). There were significant increases in studies that used regression models and decreases in matched comparisons through the 1980s, 1990s and post-2000 (P = 0.033). Whereas regression analyses have become more frequently used for COHAI estimations in recent years, matched comparisons are still used in more than half of COHAI estimation studies. Researchers need to be more discerning in the selection of methodologies for their analyses, and comparative analyses are needed to identify more accurate estimation methods. This review provides a resource for analysts to overview the distribution, trends, advantages and pitfalls of the various existing COHAI estimation methodologies. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.. |
| 146. | S. E. Regenbogen, M. Hirose, Y. Imanaka, E-H Oh, H. Fukuda, A. A. Gawande, T. Takemura, H. Yoshihara, A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA, QUALITY & SAFETY IN HEALTH CARE, 10.1136/qshc.2008.029215, 19, 6, e10, 2010.12, Background Delays in reporting of medical errors may signal deficiencies in the performance of hospital-based incident reporting. We sought to understand the characteristics of hospitals, providers and patient injuries that affect such delays. Setting and Methods All incident reports filed between May 2004 and August 2005 at the Kyoto University Hospital (KUH) in Japan and the Brigham and Women's Hospital (BWH) in the USA were evaluated. Lag time between each event and the submission of an incident report were computed. Multivariable Poisson regression with overdispersion, to control for previously described confounding factors and identify independent predictors of delays, was used. Results Unadjusted lag times were significantly longer for physicians than other reporters (3.6 vs 1.8 days, pConclusions Lag time provides a novel and useful metric for evaluating the performance of hospital-based incident reporting systems. Across two very different health systems, physicians reported far fewer events, with significant delays compared with other providers. Even after controlling for important confounding factors, lag times at KUH were nearly triple those at BWH, suggesting significant differences in the performance of their reporting systems, potentially attributable to either the ease of online reporting at BWH or to the greater attention to patient safety reporting in that hospital.. |
| 147. | 福田 治久, 大隈 和英, 猪飼 宏, 今中 雄一, 補助療法の診療プロセスに関する施設間比較 乳房温存術症例を対象にしたDPCデータを用いた検討, 医療情報学連合大会論文集, 30回, 927-928, 2010.11. |
| 148. | H. Fukuda, Y. Imanaka, M. Hirose, K. Hayashida, Impact of system-level activities and reporting design on the number of incident reports for patient safety, QUALITY & SAFETY IN HEALTH CARE, 10.1136/qshc.2008.027532, 19, 2, 122-127, 2010.04, Background Incident reporting is a promising tool to enhance patient safety, but few empirical studies have been conducted to identify factors that increase the number of incident reports. Objective To evaluate how the number of incident reports are related to system-level activities and reporting design. Methods A questionnaire survey was administered to all 1039 teaching hospitals in Japan. Items on the survey included number of reported incidents; reporting design of incidents; and status for system-level activities, including assignment of safety managers, conferences, ward rounds by peers, and staff education. Staff education encompasses many aspects of patient safety and is not limited to incident reporting. Poisson regression models were used to determine whether these activities and design of reporting method increase incident reports filed by physicians and nurses. Results Educational activities were significantly associated with reporting by physicians (53% increase, p Conclusion In accordance with the suggestions by previous studies that examined staff perceptions and attitudes, this study empirically demonstrated that to decrease burden to reporting and to implement staff educations may improve incident reporting.. |
| 149. | Haruhisa Fukuda, Yuichi Imanaka, Tatsuro Ishizaki, Kazuhide Okuma, Takako Shirai, Change in clinical practice after publication of guidelines on breast cancer treatment, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, 10.1093/intqhc/mzp037, 21, 5, 372-378, 2009.10, Objective. Several studies raise questions about whether clinical practice guidelines actually guide practice. We evaluated patterns of use of breast-conserving surgery (BCS) over time to examine the effect of guideline publication. Design. Retrospective analysis of time-series data on breast cancer treatment. Multiple logistic regression analysis was performed, adjusting for covariates including the patient's age, comorbidity status and admission year, to assess whether the use of BCS was higher after publication of treatment guidelines. Setting. Five teaching hospitals participating in the Quality Improvement/Indicator Project (QIP) in Japan. Participants. Female breast cancer patients who received surgical treatment at five teaching hospitals from January 1996 through December 2007 (n = 2199). Main Outcome Measure. Rates of use of BCS. Results. The proportion of BCS use increased from 26.4% before guideline publication to 59.9% after guideline publication in Japan. After controlling for other characteristics, the use of BCS has increased significantly over time, especially since 2001. Women aged 70 years and older (P=0.004) and those with any comorbidity (P Conclusions. This study demonstrated that the adjusted proportion of BCS has increased dramatically since 2001, 2 years after guideline publication in Japan and this is consistent with a relationship between guideline publication and a change in this clinical practice.. |
| 150. | Haruhisa Fukuda, Yuichi Imanaka, Assessment of transparency of cost estimates in economic evaluations of patient safety programmes, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 10.1111/j.1365-2753.2008.01033.x, 15, 3, 451-459, 2009.06, Transparency of costing is essential for decision-makers who require information on the efficiency of a health care programme, because effective decisions depend largely on applicability to their settings. The main objectives of this study were to assess published studies for transparency of cost estimates. We first developed criteria with two axes by reviewing publications dealing with economic evaluations and cost accounting studies: clarification of the scope of costing and accuracy of method evaluating costs. We then performed systematic searches of the literature for studies which estimated prevention costs and assessed the transparency and accuracy of costing based on our criteria. Forty studies met the inclusion criteria. Half of the studies reported data for both the quantity and unit price of programmes in regard to prevention costs. Although 30 studies estimated costs of adverse events, 19 of these described the scope of costing only, and just five studies used a micro-costing method. Among 30 studies that estimated 'gross cost savings' and 'net cost savings', there was a huge discrepancy in labels. Even if a cost study was conducted in accordance with existing techniques of economic evaluation which mostly paid attention to internal validity of cost estimates, without adequate explanation of the process of costing, reproducibility cannot be assured and the study may lose its value as scientific information. This study found that there is tremendous room for improvement.. |
| 151. | Haruhisa Fukuda, Yuichi Imanaka, Hiroe Kobuse, Kenshi Hayashida, Genki Murakami, The subjective incremental cost of informed consent and documentation in hospital care: a multicentre questionnaire survey in Japan, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 10.1111/j.1365-2753.2008.00987.x, 15, 2, 234-241, 2009.04, Objective To reveal the amount of time and financial cost required to obtain informed consent and to preserve documentation. Methods The questionnaire was delivered to all staff in six acute care public hospitals in Japan. We examined health care staff perceptions of the time they spent obtaining informed consent and documenting information. All data were collected in 2006 and estimates in the past week in 2006 were compared to estimates of time spent in a week in 1999. We also calculated the economic costs of incremental amounts of time spent in these procedures. Results In 2006, health care staff took about 3.89 hours [95% Confidence Interval (CI) 3.71-4.07] per week to obtain informed consent and 6.64 hours (95% CI 6.40-6.88) per week to write documentation on average. Between 1999 and 2006, the average amount of time for conducting informed consent was increased to 0.67 (P Conclusions We found a considerable increase in time spent on informed consent and documentation, and associated cost over a 7-year time period. Although greater attention to the informed consent process should be paid to ensure the notions of patient autonomy and self-determination, the increased resources devoted to these practices must be considered in light of current cost containment policies.. |
| 152. | 大隈 和英, 福田 治久, 関本 美穂, 猪飼 宏, 濱田 啓義, 今中 雄一, DPCに基づく包括支払い制度導入後の乳癌治療への影響と変化, 日本外科学会雑誌, 110, 臨増2, 327-327, 2009.02. |
| 153. | Haruhisa Fukuda, Yuichi Imanaka, Masahiro Hirose, Kenshi Hayashida, Factors associated with system-level activities for patient safety and infection control, HEALTH POLICY, 10.1016/j.healthpol.2008.04.009, 89, 1, 26-36, 2009.01, Objective: We examined the relationship between hospital structural characteristics and system-level activities for patient safety and infection control, for use in designing, an incentive structure to promote patient safety. Methods: This study utilized a questionnaire to collect institutional data about hospital infrastructure and volume of patient safety activities from all 1039 teaching hospitals in Japan. The patient safety activities were focused on meetings and conferences, internal audits, staff education and training, incident reporting and infection surveillance. Generalized linear modeling was used. Results: Of the 1039 hospitals surveyed, 418 (40.2%) hospitals participated. The amount of activities significantly increased by over 30% in hospitals with dedicated patient safety and infection control full-time staff (P Conclusions: Hospitals with increased resources had greater spread of patient safety and infection control activities. To promote patient safety programs in hospitals, it is imperative that policy makers require the assignment of dedicated full-time staff to patient safety. Economic Support for hospitals will also be required to assure that safety programs are Sustainable. (C) 2008 Elsevier Ireland Ltd. All rights reserved.. |
| 154. | Haruhisa Fukuda, Yuichi Imanaka, Masahiro Hirose, Kenshi Hayashida, Economic evaluations of maintaining patient safety systems in teaching hospitals, HEALTH POLICY, 10.1016/j.healthpol.2008.04.004, 88, 2-3, 381-391, 2008.12, Objective: The aim of this study was to assess the status and the cost of hospital patient safety systems. Methods: We conducted a national questionnaire survey of all the 1039 teaching hospitals in Japan. The study was constructed to evaluate the costs of the systems for patient safety focused on staff assignment, meetings and conferences, internal audit, staff education and training, incident reporting, infection surveillance, infectious disposal, management of medication use, clinical engineering, and patient counseling. Results: The status to maintain patient safety systems might be at least as decent. The mean estimated total cost of systems for patient safety was US$ 20,449 (95% confidence interval [CI], 19,632-21,266) per 100 bed-months or US$ 8.52 (95% CI, 8.18-8.86) per inpatient-day. The ratio of costs to revenue was 1.68% (95% CI, 1.61-1.75). The annual necessary costs occurring in hospitals where the costs of patient safety were under the average level across all the 1032 teaching hospitals in Japan was US$ 259.7 million. Conclusions: Our results show that hospital-wide activities for patient safety pose significant costs to hospitals and national healthcare systems. Our data may provide financial information for designing and improving patient safety systems. (C) 2008 Elsevier Ireland Ltd. All rights reserved.. |
| 155. | Haruhisa Fukuda, Yuichi Imanaka, Kenshi Hayashida, Cost of hospital-wide activities to improve patient safety and infection control: A multi-centre study in Japan, HEALTH POLICY, 10.1016/j.healthpol.2008.02.006, 87, 1, 100-111, 2008.07, Objective: The aim of this study was to assess the financial costs to hospitals for the implementation of hospital-wide patient safety and infection control programs. Methods: We conducted questionnaire surveys and structured interviews in seven acute-care teaching hospitals with an established reputation for their efforts towards improving patient safety. We defined the scope of patient safety activities by use of an incremental activity measure between 1999 and 2004. Hospital-wide incremental manpower, material, and financial resources to implement patient safety programs were measured. Results: The total incremental activities were 19,414-78,540 person-hours per year. The estimated incremental costs of activities for patient safety and infection control were calculated as US$ 1.100-2.335 million per year, equivalent to the employment of 17-40 full-time healthcare staff. The ratio of estimated costs to total medical revenue ranged from 0.55% to 2.57%. Smaller hospitals tend to shoulder a higher burden compared to larger hospitals. Conclusions: Our study provides a framework for measuring hospital-wide activities for patient safety. Study findings suggest that the total amount of resources is so great that cost-effective and evidence-based health policy is needed to assure the sustainability of hospital safety programs. (c) 2008 Elsevier Ireland Ltd. All rights reserved.. |
| 156. | Tatsuro Ishizaki, Yuichi Imanaka, Miho Sekimoto, Haruhisa Fukuda, Hanako Mihara, Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 10.1111/j.1365-2753.2007.00882.x, 14, 3, 416-421, 2008.06, Objectives To assess predictive value of patient characteristics and severity of aneurysmal subarachnoid haemorrhage (SAH) patients for clinical outcomes, and thereby estimate risk-adjusted clinical outcomes and compare the outcomes across hospitals. Methods We selected 256 aneurysmal SAH patients from eight teaching hospitals in Japan. The clinical outcomes of patients at the time of discharge were assessed by the Glasgow Outcome Scale (GOS). A multiple logistic regression analysis was performed to identify predictors for the GOS status at the time of discharge. The risk-adjusted proportion of patients with a favourable GOS outcome was then estimated for each facility and compared across hospitals. Results The logistic regression analysis revealed that younger age (P Conclusion After comparison of risk-adjusted values across hospitals, the clinical management methods of the hospital that showed the best performance were examined and shared among providers.. |
| 157. | 福田治久, 今中雄一, 廣瀬昌博, 林田賢史, 臨床研修病院における医療安全システムの構築状況に関する研究, 日本医療・病院管理学会誌, 45, 2, 95-104, 2008.04. |
| 158. | 福田 治久, 廣瀬 昌博, 林田 賢史, 今中 雄一, インシデント報告運用システムが報告件数に及ぼす効果, 医療の質・安全学会誌, 2, Suppl., 125-125, 2007.11. |
| 159. | 福田 治久, 廣瀬 昌博, 林田 賢史, 今中 雄一, 臨床研修病院における医療安全活動の展開, 医療の質・安全学会誌, 2, Suppl., 145-145, 2007.11. |
| 160. | Kenshi Hayashida, Yuichi Imanaka, Haruhisa Fukuda, Measuring hospital-wide activity volume for patient safety and infection control: a multi-centre study in Japan, BMC HEALTH SERVICES RESEARCH, 10.1186/1472-6963-7-140, 7, 140, 2007.09, Background: In Japan, as in many other countries, several quality and safety assurance measures have been implemented since the 1990' s. This has occurred in spite of cost containment efforts. Although government and hospital decision-makers demand comprehensive analysis of these activities at the hospital-wide level, there have been few studies that actually quantify them. Therefore, the aims of this study were to measure hospital-wide activities for patient safety and infection control through a systematic framework, and to identify the incremental volume of these activities implemented over the last five years. Methods: Using the conceptual framework of incremental activity corresponding to incremental cost, we defined the scope of patient safety and infection control activities. We then drafted a questionnaire to analyze these realms. After implementing the questionnaire, we conducted several in-person interviews with managers and other staff in charge of patient safety and infection control in seven acute care teaching hospitals in Japan. Results: At most hospitals, nurses and clerical employees acted as the main figures in patient safety practices. The annual amount of activity ranged from 14,557 to 72,996 person-hours ( per 100 beds: 6,240; per 100 staff: 3,323) across participant hospitals. Pharmacists performed more incremental activities than their proportional share. With respect to infection control activities, the annual volume ranged from 3,015 to 12,196 person-hours ( per 100 beds: 1,141; per 100 staff: 613). For infection control, medical doctors and nurses tended to perform somewhat more of the duties relative to their share. Conclusion: We developed a systematic framework to quantify hospital-wide activities for patient safety and infection control. We also assessed the incremental volume of these activities in Japanese hospitals under the reimbursement containment policy. Government and hospital decision makers can benefit from this type of analytic framework and its empirical findings.. |
| 161. | 福田治久, 今中雄一, 感染制御に係るコストとコスト計算の質の評価, 病院管理, 44, 2, 143-151, 2007.04. |
| 162. | Edward Evans, Yuichi Imanaka, Miho Sekimoto, Tatsuro Ishizaki, Kenshi Hayashida, Haruhisa Fukuda, Eun-Hwan Oh, Risk adjusted resource utilization for ami patients treated in Japanese hospitals, HEALTH ECONOMICS, 10.1002/hec.1177, 16, 4, 347-359, 2007.04, Though risk adjustment is necessary in order to make equitable comparisons of resource utilization in the treatment of acute myocardial infarction patients, there is little in the literature that can be practically applied without access to clinical records or specialized registries. The aim of this study is to show that effective models of resource utilization can be developed based on administrative data, and to demonstrate a practical application of the same models by comparing the risk-adjusted performance of the hospitals in our dataset. The study sample included 1748 AMI cases discharged front 10 large, private teaching hospitals in Japan, between 10 April 2001 and 30 June 2004. Explanatory variables included procedures (CABG and PCI), length of stay, outcome, patient demographics, diagnosis and comorbidity status. Multiple linear regression models constructed for the study were able to account for 66.5, 27.7, and 58.4% of observed variation in total charges, length of stay and charges per day, respectively. The performance of models constructed for this study was comparable to or better than performance reported by other studies that made use of explanatory variables extracted from clinical data. The use of administrative data in risk adjustment makes broad scale application of risk adjustment feasible. Copyright (c) 2006 John Wiley & Soils, Ltd.. |
| 163. | K. Hayashida, Y. Imanaka, M. Sekimoto, H. Kobuse, Haruhisa Fukuda, Evaluation of acute myocardial infarction in-hospital mortality using a risk-adjustment model based on Japanese administrative data, Journal of International Medical Research, 10.1177/147323000703500502, 35, 5, 590-596, 2007.01, [URL], This study aimed to develop a new risk-adjustment method to assess acute myocardial infarction (AMI) in-hospital mortality. Risk-adjustment was based on variables obtained from administrative data from Japanese hospitals, and included factors such as age, gender, primary diagnosis and co-morbidity. The infarct location was determined using the criteria of the International Classification of Diseases (10th version). Potential comorbidity risk factors for mortality were selected based on previous studies and their critical influence analysed to identify major co-morbidities. The remaining minor co-morbidities were then divided into two groups based on their medical implications. The major co-morbidities included shock, pneumonia, cancer and chronic renal failure. The two minor co-morbidity groups also demonstrated a substantial impact on mortality. The model was then used to assess clinical performance in the participating hospitals. Our model reliably employed the available data for the risk-adjustment of AMI mortality and provides a new approach to evaluating clinical performance.. |
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