The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan
The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan
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DOI：
10.3389/fped.2020.00114
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发表时间：
2020-03-24
影响因子：
2.6
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Okubo, Yusuke;Miura, Masaru;Yasunaga, Hideo
目的：既往研究表明糖皮质激素对预防川崎病 (KD) 患者冠状动脉病变 (CAL) 有效，2012 年日本 KD 临床指南对糖皮质激素的使用进行了更改。然而，指南更改对医疗保健利用和临床结果有何影响却知之甚少。 方法：我们利用日本国家住院患者数据库对川崎病 (KD) 患者中 18 岁以下的患者进行了一项回顾性观察研究。 2010-2015。分析了实践模式的最新趋势，我们根据糖皮质激素的使用将医院分为四组：（1）持续使用医院，（2）开始使用医院，（3）停止使用医院，（4）从未使用医院。然后，我们比较了指南变更前后的医疗保健利用率和冠状动脉病变风险。结果：我们确定了 24,517 名川崎病住院患者。 2010年至2014年，KD住院患者中糖皮质激素的使用比例从8.9%增加至17.4%。所有类型的医院冠状动脉病变均有所减少，但减少幅度在2012年临床指南变更后开始使用糖皮质激素治疗的医院中最为显着（调整后OR，0.22；95%CI，0.07-0.68）。此外，持续使用糖皮质激素、开始使用医院和从不使用医院的医院显示住院费用降低，而在临床指南改变后停止使用糖皮质激素的医院医疗费用增加，这与其他组中观察到的自然趋势相反。遵守指南的医院的医疗费用降低幅度最大。结论：早期使用糖皮质激素可能是 KD 患者治疗的一种节省成本的策略，且不会增加 CAL 的风险。
Objective: Previous studies showed the efficacy of glucocorticoids on prevention of coronary artery lesions (CAL) among Kawasaki disease (KD) patients, and clinical guideline for KD in Japan was changed regarding glucocorticoid use in 2012. However, little is known regarding how the guideline change had impacts on healthcare utilizations and clinical outcomes.Methods: We conducted a retrospective observational study using national inpatient database in Japan among KD patients aged under 18 years during 2010-2015. Recent trends in practice patterns were analyzed, and we divided the hospitals into four groups based on glucocorticoid use: (1) consistently using hospital, (2) started using hospital, (3) stopped using hospital, and (4) never using hospital. Then, we compared healthcare utilizations and risks of coronary artery lesions before and after the guideline change.Results: We identified 24,517 inpatients with KD. From 2010 to 2014, use of glucocorticoid increased from 8.9 to 17.4% of KD inpatients. All types of hospitals showed reduction in coronary artery lesions, but the reduction was the most prominent in hospitals that started using glucocorticoid therapy after clinical guideline change in 2012 (adjusted OR, 0.22; 95%CI, 0.07-0.68). Also, Glucocorticoid consistently using hospitals, started using hospitals, and never using hospitals showed reductions in hospitalization costs, whereas hospitals that stopped using glucocorticoids after clinical guideline change had elevated healthcare costs as opposed to natural trends observed in other groups. Guideline complying hospitals had the greatest reductions in healthcare costs.Conclusions: The early stage glucocorticoid use could be a cost-saving strategy for treatment for KD patients without increasing risks of CAL.