Impact of policy alterations on elective percutaneous coronary interventions in Japan
Impact of policy alterations on elective percutaneous coronary interventions in Japan
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DOI：
10.1136/heartjnl-2022-321695
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发表时间：
2023-01
期刊：
影响因子：
5.7
通讯作者：
T. Morishita;D. Takada;J. Shin;S. Kunisawa;K. Fushimi;Y. Imanaka
中科院分区：
文献类型：
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作者：
T. Morishita;D. Takada;J. Shin;S. Kunisawa;K. Fushimi;Y. Imanaka
目的在稳定型心绞痛（SAP）患者中建立合适的经皮冠状动脉介入治疗（PCI）已成为一种独特的性能指标。临床指南要求在择期PCI之前记录SAP患者的缺血。日本厚生劳动省于2018年4月推出了新的报销政策，以促进PCI的适当和明智实施。2018年的报销变更澄清了所需的缺血证明。增加了评价功能性缺血和冠状动脉狭窄的检查，作为报销要求。我们研究了这一报销修订是否对日本SAP的PCI程序产生影响。方法我们使用了2014年4月至2020年3月日本诊断程序组合数据库中的行政索赔数据。我们使用中断时间序列分析与对照，以确定日本报销修订前后对择期PCI手术的影响。主要结局是每月择期PCI手术的变化。急诊PCI手术作为对照组。结果2014年4月至2020年3月期间，共识别出773 240例PCI手术：报销修订前后分别为388 817例和180 462例择期PCI。2018年报销修订后，每月择期PCI手术的趋势发生了显著变化（-106.3，95% CI-155.8至56.8，p<0.01），而急诊PCI的数量在整个研究期间保持稳定。结论在2018年修订择期PCI的报销费率后，每月择期PCI手术显著减少。
Objective Establishing appropriate percutaneous coronary intervention (PCI) in stable angina pectoris (SAP) has become a distinctive performance measure worldwide. Clinical guidelines call for documenting ischaemia in patients with SAP prior to elective PCI. The Japanese Ministry of Health, Labour and Welfare introduced a new reimbursement policy in April 2018 to promote the appropriate and judicious implementation of PCI. The 2018 reimbursement changes clarified the required proof of ischaemia. Tests to evaluate functional ischaemia and coronary stenosis have been added as a requirement for reimbursement. We examined whether this reimbursement revision had an impact on PCI procedures for SAP in Japan. Methods We used administrative claims data in Japan’s Diagnosis Procedure Combination database from April 2014 through March 2020. We used interrupted time series analyses with a control to ascertain the impacts on elective PCI procedures before and after the Japanese reimbursement revision. The primary outcome was the change in elective PCI procedures per month. Emergent PCI procedures served as a control group. Results A total of 773 240 PCI procedures were identified between April 2014 and March 2020: 388 817 and 180 462 elective PCIs before and after the reimbursement revision, respectively. After the 2018 reimbursement revision, significant trend changes were found in elective PCI procedures per month (−106.3, 95% CI −155.8 to −56.8, p<0.01), while the number of emergent PCIs remained stable throughout the study period. Conclusions After revising the reimbursement tariff for elective PCIs in 2018, there was a significant reduction in elective PCI procedures per month.