Kyushu University Academic Staff Educational and Research Activities Database
List of Papers
Haruhisa Fukuda Last modified date:2021.11.18

Associate Professor / Department of Health Care Administration and Management / Center for Cohort Studies / Faculty of Medical Sciences


Papers
1. Fukuda H, Onizuka H, Murata F, Medical expenditures for community-acquired pneumococcal disease in Japan., Journal of National Institute of Public Health, 72, 1, in press, 2022.01.
2. 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, 24, 4, 497-504, 2021.04.
3. Regenbogen S, Hirose M, Imanaka Y, Oh EH, Fukuda Haruhisa, Gawande A, Takemura T, Yoshihara H, A comparative analysis of incident reporting lag times in academic medical centers in Japan and the United States, Quality & Safety in Health Care, 10.1136/qshc.2008.029215, 19, e10, 2010.12.
4. M. Maeda, Haruhisa 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, 2019.01, Objective: To explore the differences in mean treatment costs between home-based care and hospital-based care in enteral nutrition patients in Japan. Methods: Using claims data from September 2013 to August 2014, we analyzed patients with recorded reimbursements for enteral nutrition at home or in a hospital. Treatment costs were compared using a panel data analysis with an individual fixed effects model that adjusted for the number of comorbidities and fiscal year. Costs were compared for all patients, as well as for specific diseases (pneumonia, sequelae of cerebrovascular disease, and dementia). Results: The study sample comprised 7,783 patients with a cumulative total of 33,751 person-months of data. The mean patient age was 84.4 years for home-based care, 83.7 years for hospital-based care. The panel data analysis found that the cost estimates for hospital-based care were consistently higher than those for home-based care; the difference in adjusted treatment costs were $4,894 for all patients, $5,315 for pneumonia patients, $4,481 for sequelae of cerebrovascular disease patients, and $4,519 for dementia patients (all P < 0.001). Hospital-based care was still more expensive even when long-term care services were included in home-based care treatment cost estimates. Conclusion: Home-based care was consistently and substantially cheaper than hospital-based care in enteral nutrition patients in Japan..
5. Wataru Mimura, Haruhisa Fukuda, Manabu Akazawa, Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan
A multi-centre cross-sectional study, Annals of Clinical Microbiology and Antimicrobials, 10.1186/s12941-020-00348-0, 19, 1, 2020.02, 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..
6. 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, 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 < 0.001). The estimates of SIR were considerably different between models with adjustment of surgery duration and laparoscopic surgery versus models without these adjustments. The two models offered contradictory evidence regarding hospital performance. Multivariate logistic regression analyses that use all available variables from SSI surveillance were found to be superior to NNIS risk index methodology. When calculating SIR, we should consider the exclusion of surgery duration and laparoscopic surgery as risk-adjustment factors..
7. Fukuda Haruhisa, Imanaka Yuichi, 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.
8. Haruhisa Fukuda, Kazuhide Okuma, Yuichi Imanaka, Can experience improve hospital management?, PloS one, 10.1371/journal.pone.0106884, 9, 9, 2014.09, 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 (P< 0.001) at the hospital level and 0.982 (P<0.001) at the surgeon level. The log-linear regression analyses showed that shorter postoperative LOS was significantly associated with high hospital-level case volume (coefficient for an increase of one surgery: 20.006, P= 0.009) and surgeon-level case volume (coefficient for an increase of one surgery: 20.011, P=0.022). Although an increase of one surgery annually at the hospital level was statistically associated with a reduction of preoperative LOS by 1.1% (P =0.006), there was no significant association detected between surgeon-level case volume and preoperative LOS (P=0.504).
Conclusion: Experience at the hospital level may contribute to the improvement of hospital management efficiency.
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..
9. Fukuda Haruhisa, Imanaka Yuichi, Ishizaki Tatsuro, Okuma Kazuhide, Shirai Takako, 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.
10. Haruhisa Fukuda, Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors, Journal of Patient Safety, 10.1097/PTS.0000000000000349, 17, 5, e401-e405, 2021.05, OBJECTIVE: The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. DESIGN: A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. SETTING: Acute care hospitals in Japan. PARTICIPANTS: Hospitals named in articles that included the terms “medical error” and “hospital” were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. EXPOSURE: Medical error case reporting in newspapers. MAIN OUTCOME MEASURES: Changes to hospital inpatient volume after error reports. RESULTS: The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. CONCLUSIONS: Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety..
11. Koki Kato, Haruhisa Fukuda, Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients, Geriatrics and Gerontology International, 10.1111/ggi.12977, 17, 11, 2247-2254, 2017.11, Aim: To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. Methods: We 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. Results: The 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. Conclusions: Despite 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..
12. 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, BACKGROUND: Flow diverters (FDs) have marked the beginning of innovations in the endovascular treatment of large unruptured intracranial aneurysms, but no multi-institutional studies have been conducted on these devices from both the clinical and economic perspectives. OBJECTIVE: To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan. METHODS: We identified patients who had undergone endovascular treatments during the study period (October 2015-March 2018) from a national-level claims database. The outcome measures were retreatment rates and 1-yr total healthcare expenditures, which were compared among patients who had undergone FD, coiling, and stent-Assisted coiling (SAC) treatments. The coiling and SAC groups were further categorized according to the number of coils used. Retreatment rates were analyzed using Cox proportional hazards models, and total expenditures were analyzed using multilevel mixed-effects generalized linear models. RESULTS: The study sample comprised 512 FD patients, 1499 coiling patients, and 711 SAC patients. The coiling groups with ≥10 coils and ≥9 coils had significantly higher retreatment rates than the FD group with hazard ratios of 2.75 (1.30-5.82) and 2.52 (1.24-5.09), respectively. In addition, the coiling group with ≥10 coils and SAC group with ≥10 coils had significantly higher 1-year expenditures than the FD group with cost ratios (95% CI) of 1.30 (1.13-1.49) and 1.31 (1.15-1.50), respectively. CONCLUSION: In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with ≥ 9 coils..
13. Ishizaki Tatsuro, manaka Yuichi, Sekimoto Miho, Fukuda Haruhisa, Mihara Hanako, 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.
14. Haruhisa Fukuda, Hirohisa Imai, Cost effectiveness analysis of liver transplantation, Liver Cancer: Causes, Diagnosis and Treatment, 195-222, 2011.04.
15. Fukuda Haruhisa, Imanaka Yuichi, Hayashida Kenshi, 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.
16. 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, 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..
17. Haruhisa Fukuda, Cost-effectiveness analysis for diabetes care, Nippon rinsho. Japanese journal of clinical medicine, 74, 707-712, 2016.04.
18. 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, Summary: A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO). The treatment indication for GIO in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture. Introduction: The purpose of this study was to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO) from the perspective of the Japanese healthcare system. Methods: A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in postmenopausal Japanese women with osteopenia or osteoporosis using glucocorticoid (GC). An annual discount rate of 2% for both costs and QALYs was applied. The incremental cost-effectiveness ratio (ICER) of 5-year alendronate therapy compared with no therapy was estimated with different combinations of the risk factors such as starting age (45, 55, or 65), femoral neck BMD (% young adult mean (YAM) of 70%, 75%, or 80%), dose of GC (2.5, 5, or 10 mg per day), and the presence of previous fracture (yes or no). Results: For 55-year-old women using GC with a BMD of 75% of YAM, the ICER ranged from $10,958 to $ 29,727 per QALY. Scenario analyses indicated that the lower age, the lower BMD, the higher dose of GC, and the presence of previous fracture associated with lower ICER. The best-case scenario was 45-year-old women with a BMD of 70% of YAM, GC dose of 10 mg per day, and previous fracture, and resulted in healthcare cost-savings. The worst-case scenario was 65-year-old women with a BMD of 80% of YAM, GC dose of 2.5 mg per day, and no previous fracture, and resulted in the ICER of $66,791 per QALY. Sensitivity analyses in the worst-case scenario showed that the annual discount rate for costs and health benefit had the strong influence on the estimated ICER. Although the ICER was influenced by other parameters such as disutility due to vertebral fracture, efficacy of alendronate, and so on, the ICERs remained more than $50,000 per QALY. Conclusions: The cost-effectiveness of preventive alendronate therapy for postmenopausal women with osteopenia or osteoporosis using GC is sensitive to age, BMD, GC dose, and the presence of previous fracture. Our analysis suggested that the treatment indication for postmenopausal women with osteopenia or osteoporosis using GC in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture..
19. Fukuda Haruhisa, Lee Jason, Imanaka Yuichi, 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.
20. 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 and Gerontology International, 10.1111/ggi.12777, 17, 5, 737-743, 2017.05, 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. Geriatr Gerontol Int 2017; 17: 737–743..
21. Fukuda H, Sato D, Moriwaki K, Ishida H., Differences in healthcare expenditure estimates according to statistical approach: A nationwide claims database study on patients with hepatocellular carcinoma., PLoS One, 15, 8, e0237316, 2020.08.
22. Fukuda Haruhisa, Imanaka Yuichi, Hirose Masahiro, Hayashida Kenshi, 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.
23. 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, 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..
24. 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, 2018.01, Objective Few studies have examined the causal relationships between lifestyle habits and obesity. With a focus on eating speed in patients with type 2 diabetes, this study aimed to analyse the effects of changes in lifestyle habits on changes in obesity using panel data. Methods Patient-level panel data from 2008 to 2013 were generated using commercially available insurance claims data and health check-up data. The study subjects comprised Japanese men and women (n=59 717) enrolled in health insurance societies who had been diagnosed with type 2 diabetes during the study period. Body mass index (BMI) was measured, and obesity was defined as a BMI of 25 or more. Information on lifestyle habits were obtained from the subjects' responses to questions asked during health check-ups. The main exposure of interest was eating speed ('fast', 'normal' and 'slow'). Other lifestyle habits included eating dinner within 2 hours of sleeping, after-dinner snacking, skipping breakfast, alcohol consumption frequency, sleep adequacy and tobacco consumption. A generalised estimating equation model was used to examine the effects of these habits on obesity. In addition, fixed-effects models were used to assess these effects on BMI and waist circumference. Results The generalised estimating equation model showed that eating slower inhibited the development of obesity. The ORs for slow (0.58) and normal-speed eaters (0.71) indicated that these groups were less likely to be obese than fast eaters (P<0.001). Similarly, the fixed-effects models showed that eating slower reduced BMI and waist circumference. Relative to fast eaters, the coefficients of the BMI model for slow and normal-speed eaters were -0.11 and -0.07, respectively (P<0.001). Discussion Changes in eating speed can affect changes in obesity, BMI and waist circumference. Interventions aimed at reducing eating speed may be effective in preventing obesity and lowering the associated health risks..
25. 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 Ohmagari, 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 Infectious Diseases, 10.1093/ofid/ofz389, 6, 10, 2019.10, Objective: We implemented a stepwise antimicrobial stewardship program (ASP). This study evaluated the effect of each intervention and the overall economic impact on carbapenem (CAR) use. Method: Carbapenem days of therapy (CAR-DOT) were calculated to assess the effect of each intervention, and antipseudomonal DOT were calculated to assess changes in use of broad-spectrum antibiotics. We carried out segmented regression analysis of studies with interrupted time series for 3 periods: Phase 1 (infectious disease [ID] consultation service only), Phase 2 (adding monitoring and e-mail feedback), and Phase 3 (adding postprescription review and feedback [PPRF] led by ID specialist doctors and pharmacists). We also estimated cost savings over the study period due to decreased CAR use. Results: The median monthly CAR-DOT, per month per 100 patient-days, during Phase 1, Phase 2, and Phase 3 was 5.46, 3.69, and 2.78, respectively. The CAR-DOT decreased significantly immediately after the start of Phase 2, but a major decrease was not observed during this period. Although the immediate change was not apparent after Phase 3 started, CAR-DOT decreased significantly over this period. Furthermore, the monthly DOT of 3 alternative antipseudomonal agents also decreased significantly over the study period, but the incidence of antimicrobial resistance did not decrease. Cost savings over the study period, due to decreased CAR use, was estimated to be US $150 000. Conclusions: Adding PPRF on the conventional ASP may accelerate antimicrobial stewardship. Our CAR stewardship program has had positive results, and implementation is ongoing..
26. 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, 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..
27. 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, 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..
28. Fukuda Haruhisa, Imanaka Yuichi, Hirose Masahiro, Hayashida Kenshi, 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.
29. 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, 2015.07, 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..
30. 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, 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 < 0.05). Conclusions: These healthcare expenditure estimates from a nationally representative sample have potential applications in cost-effectiveness analyses of DAAs..
31. Fukuda H, Sato D, Iwamoto T, Yamada K, Matsushita K., Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections., Scientific Reports, 2020.12.
32. 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 and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2016.05.012, 25, 8, 1829-1837, 2016.08, 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 withcurrent medical practice in Japan..
33. 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 and Social Care in the Community, 10.1111/hsc.12707, 2018.01, 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 < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment..
34. Haruhisa Fukuda, Miki Mizobe, Impact of nonadherence on complication risks and healthcare costs in patients newly-diagnosed with diabetes, Diabetes Research and Clinical Practice, 10.1016/j.diabres.2016.11.007, 123, 55-62, 2017.01, 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..
35. Fukuda Haruhisa, Morikane K, Kuroki M, Kawai S, Hayashi K, Ieiri Y, Matsukawa H, Okada K, Sakamoto F, Shinzato T, Taniguchi S, 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.
36. Fukuda Haruhisa, Imanaka Yuichi, Hirose Masahiro, Hayashida Kenshi, 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.
37. Haruhisa Fukuda, Takahisa Yano, Nobuyuki Shimono, Inpatient Expenditures Attributable to Hospital-Onset Clostridium difficile Infection
A Nationwide Case–Control Study in Japan, PharmacoEconomics, 10.1007/s40273-018-0692-8, 36, 11, 1367-1376, 2018.11, Background: Hospital-onset Clostridium difficile infections (CDIs) have a considerable clinical and economic impact on patients and payers. Quantifying the economic impact of CDIs can guide treatment strategies. However, previous studies have generally focused on acute care hospitals, and few have included cost estimates from non-acute care hospitals such as long-term care facilities. Aim: This study aimed to quantify the hospital-onset CDI-attributable inpatient expenditures and length-of-stay durations in all healthcare institutions that provide inpatient care (including acute and non-acute care) in Japan. Methods: Using national-level insurance claims data, we analyzed patients who had been hospitalized between April 2010 and December 2016. CDI cases were identified and matched with non-CDI controls using hospitalization year, treating hospital, age, sex, surgical procedure, comorbidities, and main diagnoses. Through multivariable regression analyses, we estimated the CDI-attributable inpatient expenditures (2016 US dollars) and length-of-stay durations (days) while adjusting for variations in factors such as patient characteristics, comorbidities, surgery, prescribed antibiotic, geographic region, and hospitalization year. We also analyzed the CDI-attributable inpatient expenditures and length-of-stay durations according to hospital type (acute care and rehabilitation/long-term care). Results: The analysis was conducted using 3768 matched pairs. Overall, CDI-attributable inpatient expenditures and length-of-stay durations were US$3213 and 11.96 days, respectively. Rehabilitation/long-term care hospitals had substantially higher inpatient expenditures and longer hospitalizations than acute care hospitals. Conclusion: This study quantified the hospital-onset CDI-attributable inpatient expenditures and hospitalizations in both acute and non-acute care hospitals. The inclusion of non-acute care hospitals provides a more accurate representation of the economic burden of CDIs..
38. , 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, 2014.10, 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..
39. 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, PloS one, 10.1371/journal.pone.0223835, 14, 10, 2019.10, Background Inappropriate antibiotic prescribing is a cause of antimicrobial resistance. Acute Respiratory Tract Infections (ARTI) are common diseases for those antibiotics are most likely prescribed in outpatient setting. Objectives To clarify factors associated with antibiotic prescribing for non-bacterial acute respiratory tract infections (NB-ARTI) and identify targets for reducing inappropriate prescribing for NBARTI in Japan. Methods We conducted a retrospective, observational study using longitudinal claims data between April 2012 and June 2017. We assessed the rate of and factors associated with inappropriate antibiotic prescribing in outpatient settings for all NB-ARTI consultations included in the database. Results The mean monthly antibiotic prescribing rate per 100 NB-ARTI consultations during the study period was 31.65. The monthly antibiotic prescribing rate per 100 NB-ARTI consultations decreased by 19.2% from April 2012 to June 2017. Adolescents (13-18 years) and adults of working age (19-29 and 30-39 years) were more likely prescribed antibiotics compared with elderly patients . 60 years (aOR: 1.493 [95%CI: 1.482-1.503], 1.585 [95%CI: 1.575-1.595], and 1.507 [95%CI: 1.498-1.516], respectively). Outpatient clinics registered as internal medicine or ear, nose, and throat specialty were more likely to prescribe antibiotics than those of paediatric specialty or other specialties. Among health facility type, clinics without beds (aOR 2.123 [95%CI: 2.113-2.133]) and clinics with beds (aOR: 1.752 [95%CI: 1.7371-1.767]) prescribed significantly more antibiotics for NB-ARTI than outpatient departments inside general hospitals. Conclusions Inappropriate antibiotic prescribing for NB-ARTI is common in Japan. Although the antibiotic prescribing rate has decreased, further interventions are required to promote antimicrobial stewardship (ASP). Education and awareness for adults and promotion of ASP among physicians in clinics without beds are key drivers to reduce inappropriate antibiotic prescribing in Japan..
40. Hayashida Kenshi, Imanaka Yuichi, Fukuda Haruhisa, 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.
41. 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, 2021.12.
42. Haruhisa 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, 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<0.001). Use of steroids was significantly associated with a higher incidence of SSI following cholecystectomy (OR 2.83, P=0.003) and colon surgery (OR 1.27, P=0.040). 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..
43. 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, 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..
44. Haruhisa 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, 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 (< 0.001 for winged steel needles, P = 0.035 for IV catheter stylets and P = 0.044 for suture needles). 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..
45. Edward Evans, Imanaka Yuichi, Sekimoto Miho, Ishizaki Tatsuro, Hayashida Kenshi, Fukuda Haruhisa, Oh Eun-Hwan, Risk adjusted resource utilization for ami patients treated in Japanese hospitals, Health Economics, 10.1002/hec.1177, 16, 4, 347-359, 2007.04.
46. 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, 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..
47. 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, 2015.12, 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..
48. 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, 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 < 0.001) in City A and $91.0 (P = 0.022) in City B. Conclusion: The increase in co-payment rate for high-income individuals in August 2015 negatively affected their utilization of LTC services. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2020; ••: ••–••..
49. Fukuda Haruhisa, Imanaka Yuichi, Kobuse Hiroe, Hayashida Kenshi, Murakami Genki, 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.
50. 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, 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 <.001). At one particular hospital, for which the percentage of open surgery was lowest (33.2%), SIR estimates changed considerably from 0.92 (95% confidence interval: 0.84-1.00) for the model with perioperative variables to 0.79 (0.75-0.85) for the model without perioperative variables. In another hospital with a high percentage of open surgery (88.6%), the estimate of SIR was decreased by 12.1% in the model without perioperative variables. 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..
51. Fukuda Haruhisa, Lee Jason, Imanaka Yuichi, 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.