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

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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