Hospitalizations for Ambulatory Care Sensitive Conditions in a Large City of Japan: a Descriptive Analysis Using Claims Data
Hospitalizations for Ambulatory Care Sensitive Conditions in a Large City of Japan: a Descriptive Analysis Using Claims Data
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DOI：
10.1007/s11606-022-07713-z
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发表时间：
2022-07-12
影响因子：
5.7
通讯作者：
Kobayashi, Yasuki
中科院分区：
文献类型：
--
作者：
Iba, Arisa;Tomio, Jun;Kobayashi, Yasuki
背景：门诊护理敏感性疾病（ACSC）的住院是不同卫生系统初级保健质量的一个指标。在日本，患者可以选择任何具有全民健康保险（UHC）的医疗机构，这些入院的数据是未知的。目的描述日本某城市ACSC的入院现状。设计回顾性观察性研究，使用索赔数据。参加对象大东京地区某大城市0-74岁的国民健康保险（NHI）受益人。我们从2013年4月至2017年3月期间的所有住院索赔中提取了ACSC入院。我们计算了三个类别的年龄和性别特异性ACSC年入院率：急性，慢性和疫苗可预防。我们根据行政区域和比率，使用泊松回归模型估计了ACSC类别的年龄调整后的入学率。我们还估计了ACSC入院的医疗费用和住院时间。在91，350例住院事件中，我们确定了7666例（8.4%）为ACSC入院。男性的ACSC年入院率高于女性（p < 0.001），尤其是慢性ACSC。15-39岁年龄组的入院率最低，最年轻（0-4岁）和最年长（70-74岁）年龄组的入院率较高。与城市中心相比，新开发地区的慢性ACSC住院率较低（率比[RR]：0.79，95%置信区间[CI]：0.71-0.87），居民区的慢性ACSC住院率较高（RR：1.14，95% CI：1.04-1.24）。总的医疗费用为所有ACSC入院占总住院费用的5.8%，在城市的全民健康保险。结论：日本ACSC的入院率男性高于女性，在年龄方面呈U形趋势，与其他UHC国家一样，并因地区而推迟。这项研究提供了可能的因素，以减少ACSC的招生。
Background Hospitalization for ambulatory care sensitive conditions (ACSCs) is an indicator of the quality of primary care in different health systems. In Japan, where patients can choose any healthcare facility with universal health coverage (UHC), data on these admissions are unknown. Objective To describe the current situation of ACSC admissions in a city of Japan. Design Retrospective observational study using claims data. Participants Beneficiaries aged 0-74 years of the National Health Insurance (NHI) program in a large city in the Greater Tokyo Area. We extracted ACSC admissions from all inpatient claims between April 2013 and March 2017. Main Measures We calculated age- and sex-specific annual ACSC admission rates for three categories: acute, chronic, and vaccine-preventable. We estimated the age-adjusted admission rates by ACSC category according to administrative districts and rate ratios using Poisson regression models. We also estimated medical expenditures and lengths of stay for ACSC admissions. Key Results Of 91,350 hospitalization episodes, we identified 7666 (8.4%) that were ACSC admissions. Males had higher annual ACSC admission rates than females (p < 0.001), especially for chronic ACSCs. Admission rates were lowest in those aged 15-39 years and higher in the youngest (0-4 years) and oldest (70-74 years) age groups. Age-adjusted chronic ACSC admission rates were lower in a newly developed area (rate ratio [RR]: 0.79, 95% confidence interval [CI]: 0.71-0.87) and higher in a residential area (RR: 1.14, 95% CI: 1.04-1.24) than in the center of the city. Total medical expenditures for all ACSC admissions accounted for 5.8% of the total inpatient expenditures of NHI in the city. Conclusions ACSC admission rates in Japan were higher for males than for females and showed a U-shaped trend in terms of age, as in other countries with UHC, and deferred by region. This study provided possible factors to reduce ACSC admissions.