Development of clinical indicators for drug utilization and its application for quality medical care

药物利用临床指标的制定及其在优质医疗中的应用

• 批准号: 18590490
• 负责人: SEKIMOTO Miho
• 金额: $ 2.5万
• 依托单位: Kyoto University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2006
• 资助国家: 日本
• 起止时间: 2006 至 2007
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18590490/
• 关键词: Clinical database; Practice pattern; Blood products; Cerebral infarction; Clinicalpractice guidelines

This study is designed to evaluate the appropriateness of drug utilization by the use of administrative data such as Disease Procedure Combination (DPC, the Japanese equivalent of diagnosis-related group) data or claims data For this research, we chose to focus on : 1) drug therapy in the treatment of cerebral infarctions, and 2) the utilization of blood products.In the first study, we used Japan's administrative (DPC) data, which includes information on tests, medications, procedures, use of intensive, or specialized care, and nursing services itemized by type, quantity, and fees. We analyzed 3,136 patients with acute cerebral infarction from 14 medical institutions. Institutions were divided into three groups according to the distribution of medical costs in the first 2 days, and patient background, treatment process, and outcomes were compared across the groups. As a result of analysis, we observed wide variations in drug utilization patterns across institutions. The differences in … More medical costs for the initial hospitalization period appears to be more influenced by ICU utilization and management policies of institutions than the clinical condition of patients. We observed no significant association between drug utilization and patient outcomes.In the second study, we identified patients who received a blood transfusion, and conducted a survey regarding the use of blood products and evaluated the appropriateness of their use. Our sample population consisted of two hospitals, in which we first conducted a chart review to survey the clinical situations where blood products were used, and subsequently evaluated the appropriateness of the utilization. We developed algorithms to assess the appropriateness of blood transfusion for each blood product In our survey, appropriate use was observed in 70% of red blood cell (RBC) transfusions, 15% of fresh frozen plasma (FFP) transfusions, 56% of platelet transfusions, and 30% of albumin use. The most common clinical situation where blood transfusion occurred included : acute hemorrhage, chronic anemia, and surgery in RBC transfusions ; coagulopathy, and prophylaxis for bleeding in FFP transfusions ; cardiac surgery, cardiac surgery, hematological diseases, and critical illness in platelet transfusions ; and hemorrhagic shock, cardiac surgery, and liver cirrhosis for use of albumin products.Using DPC data, we calculated the observed/expected ratio (O/E ratio) of utilization of each blood product, and attempted to identify hospitals or divisions with over-utilization of blood products. Diagnostic groups were used for estimating the expected volume of blood products utilization. Although we observed a large variation in the O/E ratios, the magnitudes of O/E ratios were not necessarily associated with appropriateness of utilization. Less

本研究旨在利用疾病程序组合(DPC，相当于日本的诊断相关组)数据或索赔数据来评估药物使用的适当性。在本研究中，我们选择关注：1)脑梗塞治疗中的药物治疗，2)血液产品的利用。在第一项研究中，我们使用了日本的行政数据(DPC)，包括测试、药物、程序、使用重症或专科护理的信息，以及按类型、数量和费用分类的护理服务。我们对14家医疗机构的3136例急性脑梗塞患者进行了分析。根据前2天的医疗费用分布将机构分为三组，并比较各组的患者背景、治疗过程和结果。作为分析的结果，我们观察到不同机构的药物使用模式存在很大差异。…中的差异最初住院期的更多医疗费用似乎更多地受到ICU利用和机构管理政策的影响，而不是患者的临床状况。在第二项研究中，我们确定了接受输血的患者，并进行了一项关于血液产品使用的调查，并评估了其使用的适当性。我们的样本人群由两家医院组成，在这两家医院中，我们首先进行了图表回顾，以调查使用血液产品的临床情况，然后评估使用的适当性。我们开发了评估每种血液产品输血适当性的算法在我们的调查中，70%的红细胞(RBC)输注、15%的新鲜冰冻血浆(FFP)输血、56%的血小板输注和30%的白蛋白使用都是适当的。输血最常见的临床情况包括：急性出血、慢性贫血和RBC输注中的手术；FFP输注中的凝血障碍和出血的预防；心脏手术、心脏手术、血液疾病和血小板输注中的危重疾病；失血性休克、心脏手术和使用白蛋白产品的肝硬变。利用DPC数据，我们计算了每种血液产品的观察/预期利用率(O/E比)，并试图确定血液产品过度利用的医院或科室。诊断组用于估计预期的血液产品使用量。虽然我们观察到O/E比率有很大的变化，但O/E比率的大小并不一定与使用的适当性有关。较少

项目成果

Management patterns and healthcare costs for hospitalized patients with cerebral infarction

• DOI: 10.1016/j.healthpol.2008.01.013
• 发表时间: 2008-10-01
• 期刊: HEALTH POLICY
• 影响因子: 3.3
• 作者: Sekimoto, Miho;Kakutani, Chieko;Imanaka, Yuichi
• 通讯作者: Imanaka, Yuichi

Treatment of Subarachnoid Hemorrhage Expert Group.Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan

蛛网膜下腔出血治疗专家组。日本八家教学医院动脉瘤性蛛网膜下腔出血患者的风险调整临床结果比较

• 发表时间: 2008
• 期刊: J Eval Clin Pract 14
• 作者: Ishizaki;T.;Imanaka;Y.;Sekimoto;M.;Fukuda;H.;Mihara;H
• 通讯作者: H

Evaluation of acute myocardial infarction in-hospital mortality by risk ad justment based on Japanese administrativedata.

基于日本行政数据的风险调整评估急性心肌梗死院内死亡率。

• 发表时间: 2008
• 期刊: The Journal of International Medical Research (In press)
• 作者: Hayashida K;Imanaka Y;Sekimoto M;Kobuse H;Fukuda H.
• 通讯作者: Fukuda H.

Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan.

日本八家教学医院动脉瘤性蛛网膜下腔出血患者的风险调整临床结果比较。

• 发表时间: 2008
• 期刊: J Eval Clin Pract 14
• 作者: Ishizaki T;Imanaka Y;Sekimoto M;Fukuda H;Mihara H; Treat-ment of Subarachnoid Hemo-rrhage Expert Group.
• 通讯作者: Mihara H; Treat-ment of Subarachnoid Hemo-rrhage Expert Group.

卵巣癌入院TJ療法における診療プロセスの施設間比較

卵巢癌住院TJ治疗治疗流程的机构间比较

• 发表时间: 2006
• 作者: 白井貴子;関本美穂;石崎達郎;今中雄一
• 通讯作者: 今中雄一