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

本研究旨在通过使用诸如疾病程序组合（DPC，相当于日本的诊断相关组）数据或索赔数据等行政数据来评估药物使用的适当性。在本研究中，我们选择重点关注：1)脑梗死治疗中的药物治疗，以及2)血液制品的利用。在第一项研究中，我们使用了日本的行政（DPC）数据，其中包括有关测试、药物、程序、使用重症或专门护理以及按类型、数量和费用分列的护理服务的信息。我们分析了来自14家医疗机构的3136例急性脑梗死患者。根据就诊前2天的医疗费用分布情况，将各机构分为三组，比较各组患者背景、治疗过程和结局。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。初步住院期医疗费用的差异似乎更多地受到机构ICU使用和管理政策的影响，而不是患者的临床状况。我们观察到药物使用和患者预后之间没有显著的关联。在第二项研究中，我们确定了接受输血的患者，并对血液制品的使用进行了调查，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审查，以调查使用血液制品的临床情况，随后评估了使用血液制品的适当性。在我们的调查中，观察到70%的红细胞（RBC）输注、15%的新鲜冷冻血浆（FFP）输注、56%的血小板输注和30%的白蛋白输注的适当性。输血最常见的临床情况包括：急性出血、慢性贫血、手术输血；凝血功能障碍和FFP输注出血预防；心脏外科、心脏外科、血液学疾病、血小板输注中的危重疾病；失血性休克，心脏手术，肝硬化使用白蛋白产品。利用DPC数据，我们计算了各种血液制品利用的观察/预期比（O/E ratio），并试图识别血液制品过度利用的医院或科室。诊断组用于估计血液制品的预期使用量。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利用的适当性有关。少

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