Validation of recorded data is a prerequisite for studies that utilize administrative databases. The present study evaluated the validity of diagnoses and procedure records in the Japanese Diagnosis ...Procedure Combination (DPC) data, along with laboratory test results in the newly-introduced Standardized Structured Medical Record Information Exchange (SS-MIX) data.
Between November 2015 and February 2016, we conducted chart reviews of 315 patients hospitalized between April 2014 and March 2015 in four middle-sized acute-care hospitals in Shizuoka, Kochi, Fukuoka, and Saga Prefectures and used them as reference standards. The sensitivity and specificity of DPC data in identifying 16 diseases and 10 common procedures were identified. The accuracy of SS-MIX data for 13 laboratory test results was also examined.
The specificity of diagnoses in the DPC data exceeded 96%, while the sensitivity was below 50% for seven diseases and variable across diseases. When limited to primary diagnoses, the sensitivity and specificity were 78.9% and 93.2%, respectively. The sensitivity of procedure records exceeded 90% for six procedures, and the specificity exceeded 90% for nine procedures. Agreement between the SS-MIX data and the chart reviews was above 95% for all 13 items.
The validity of diagnoses and procedure records in the DPC data and laboratory results in the SS-MIX data was high in general, supporting their use in future studies.
•Validity of DPC and SS-MIX data was tested using chart review results as references.•Specificity of DPC diagnoses was high; sensitivity was low and varied by conditions.•Procedure records in DPC data were highly sensitive and specific.•Accuracy of SS-MIX laboratory data exceeded 95% in all 13 items examined.
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FFLJ, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, ODKLJ, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Updated Information on NDB Yasunaga, Hideo
Annals of Clinical Epidemiology,
01/2024, Volume:
6, Issue:
3
Journal Article
Peer reviewed
Open access
The Ministry of Health, Labour, and Welfare, Japan launched a national administrative claims database in 2009, which is called the National Database of Health Insurance Claims and Specific Health ...Checkups of Japan (NDB). Detailed information on the NDB was reported in Annals of Clinical Epidemiology in 2019. The present report provides updated information on the NDB. In 2020, the provision of data to private companies, as well as public sectors and academic entities, was legislated. As of 2024, the Ministry of Health, Labour, and Welfare is planning linkage of NDB data with several other national databases. Our previous literature review identified a total of 126 original articles using the NDB and NDB Open Data published from 2013 to 2022. Our updated review identified 94 original articles using the NDB and NDB Open Data in the recent two years. Studies using the NDB are gradually increasing, but there is still room for enhancing NDB studies on various subject areas.
Goreisan is a herbal Kampo medicine used for treating chronic subdural hematoma (CSDH) in Japan. Experimental studies have suggested that Goreisan exerts a hydrogogue effect, but clinical evidence ...for the effectiveness of Goreisan in CSDH is currently lacking. Using a national Japanese inpatient database, we examined the association between Goreisan use and reoperation rates after burr-hole surgery for CSDH. We identified 36,020 patients, including 3,889 Goreisan users and 32,131 nonusers. Propensity scores of receiving Goreisan were calculated based on hospital characteristics and patient backgrounds (age, sex, body mass index, activities of daily living, consciousness level, comorbidities, antithrombotic agent use, mannitol infusion, and corticosteroid infusion). One-to-one propensity-score matching created 3,879 pairs of Goreisan users and nonusers. Propensity-matched analysis revealed that Goreisan use was significantly associated with a lower reoperation rate (4.8%) compared with nonuse (6.2%) (risk difference, −1.4%; 95% confidence interval (CI), −2.4% to −0.38%). The number needed to prevent one reoperation was 72 (95% CI, 41–265). Instrumental-variable analysis showed similar results to the propensity-matched analysis. These results suggest that Goreisan use reduced the need for reoperation after burr-hole surgery for CSDH.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Background: Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care ...utilization planning.Methods: We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies.Results: Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively.Conclusion: Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
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FFLJ, NUK, ODKLJ, UL, UM, UPUK
The mortality rate of severely ill patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unknown because of differences in patient background, clinical settings, ...and sample sizes between studies. We determined the in-hospital mortality of VA-ECMO patients and the proportion weaned from VA-ECMO using a national inpatient database in Japan.
Patients aged ≥ 19 years who received VA-ECMO during hospitalization for cardiogenic shock, pulmonary embolism, hypothermia, poisoning, or trauma between 1 July 2010 and 31 March 2013 were identified, using The Japanese Diagnosis Procedure Combination national inpatient database.
The primary outcome was in-hospital mortality and the secondary outcome was the proportion weaned from VA-ECMO. A total of 5263 patients received VA-ECMO during the study period. The majority of patients had cardiogenic shock (n = 4,658). The number of patients weaned from VA-ECMO was 3389 (64.4%) and in-hospital mortality after weaning from VA-ECMO was 1994 (37.9%). In-hospital mortality without cardiac arrest in the cardiogenic shock group was significantly lower than that in patients with cardiac arrest (70.5% vs. 77.1%, p <0.001). In the multivariable logistic regression including multiple imputation, higher age and greater or smaller body mass index were significantly associated with in-hospital mortality, whereas hospital volume was not associated with such mortality.
The present nationwide study showed high mortality rates in patients who received VA-ECMO, and in particular in patients with cardiogenic shock and in patients with cardiac arrest. Weaning from VA-ECMO did not necessarily result in survival. Further studies are warranted to clarify risk-adjusted mortality of VA-ECMO using more detailed data on patient background.
OBJECTIVES:The role of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients remains unknown. This study investigated the effect of ...intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation on reducing mortality of cardiogenic shock patients.
DESIGN:Retrospective cohort study.
SETTING:The Japanese Diagnosis Procedure Combination national inpatient database.
PATIENTS:Cardiogenic shock adult patients receiving peripheral venoarterial extracorporeal membrane oxygenation at admission were identified in the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2013.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:The primary outcomes were all-cause 28-day mortality and in-hospital mortality, and the secondary outcome was the proportion of patients weaned from venoarterial extracorporeal membrane oxygenation, using propensity score matching. Eligible patients (n = 1,650) were divided into the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group (n = 604) and the venoarterial extracorporeal membrane oxygenation–alone group (n = 1,064). Propensity score matching created matched cohort of 533 pairs. In the propensity score–matched analysis, all-cause 28-day mortality and in-hospital mortality were significantly lower in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than the venoarterial extracorporeal membrane oxygenation–alone group (48.4% vs 58.2%; p = 0.001 and 55.9% vs 64.5%; p = 0.004, respectively). In Cox regression, there was a significant difference in survival between the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group and the venoarterial extracorporeal membrane oxygenation–alone group (hazard ratio, 0.74; 95% CI, 0.63–0.86; p < 0.001). The proportion of patients weaned from venoarterial extracorporeal membrane oxygenation was significantly higher in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than in the venoarterial extracorporeal membrane oxygenation–alone group (82.6% vs 73.4%; p < 0.001).
CONCLUSIONS:In a national inpatient database, intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation was associated with improved mortality and successful weaning from venoarterial extracorporeal membrane oxygenation. Randomized controlled studies are required to confirm the mortality-reducing effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation.
To investigate the temporal trend in the national incidence of bronchiolitis hospitalizations, their characteristics, inpatient resource use, and hospital cost from 2000 through 2016.
We performed a ...serial, cross-sectional analysis of nationally representative samples (the 2000, 2003, 2006, 2009, 2012, and 2016 Kids' Inpatient Databases) of children (age <2 years) hospitalized for bronchiolitis. We identified all children hospitalized with bronchiolitis by using
466.1 and
J21. Complex chronic conditions were defined by the pediatric complex chronic conditions classification by using inpatient data. The primary outcomes were the incidence of bronchiolitis hospitalizations, mechanical ventilation use, and hospital direct cost. We examined the trends accounting for sampling weights.
From 2000 to 2016, the incidence of bronchiolitis hospitalization decreased from 17.9 to 13.5 per 1000 person-years in US children (25% decrease;
< .001). In contrast, the proportion of bronchiolitis hospitalizations among overall hospitalizations increased from 16% to 18% (
< .001). There was an increase in the proportion of children with a complex chronic condition (6%-13%; 117% increase), hospitalization to children's hospital (15%-29%; 93% increase), and mechanical ventilation use (2%-5%; 184% increase; all
< .001). Likewise, the hospital cost increased from $449 million to $734 million (63% increase) nationally (with an increase in geometric mean of cost per hospitalization from $3267 to $4086; 25% increase;
< .001 adjusted for inflation) from 2003 to 2016.
From 2000 through 2016, the incidence of bronchiolitis hospitalizations among US children declined. In contrast, mechanical ventilation use and nationwide hospital direct cost substantially increased.
Because generalized pustular psoriasis (GPP) is rare, there are few studies reporting treatments and outcomes for large numbers of patients.
To report treatments and outcomes in a large cohort of ...patients hospitalized with GPP.
Using a Japanese national inpatient database, we identified 1516 patients with GPP who required hospitalization between July 2010 and March 2019. We categorized patients into 3 medication groups: biologics (294 patients), oral agents without biologics (948 patients), and systemic corticosteroids only (274 patients). We investigated their characteristics, treatments, and outcomes.
Mean age was 66 years (interquartile range: 52-77 years). Fifty patients (3.3%) were admitted to the intensive care unit, 125 (8.2%) required blood pressure support, and 63 (4.2%) died. Patients who received biologics were younger and had fewer comorbidities. In-hospital mortality was lower in the biologics group (1.0% biologics group vs 3.7% oral-agents group vs 9.1% corticosteroids-only group; P < .001) as was morbidity (5.4% vs 8.2% vs 12%, respectively; P = .02). Among those who received biologics, IL-17 inhibitor use increased over time, with in-hospital mortality and morbidity comparable to those of tumor necrosis factor inhibitors.
Retrospective study design. Some patients received multiple medications.
Biologic treatments showed favorable outcomes compared with other treatments.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose
To clarify recent trends in glaucoma surgery in Japan, including minimally invasive glaucoma surgery.
Study design
Retrospective cohort study.
Methods
We used the Diagnostic Procedure ...Combination database, a nationwide administrative database in Japan. Patients who underwent glaucoma-related procedures were included. We calculated the number of surgeries stratified by procedures and age categories. We also investigated the number of glaucoma-related procedures in combination with cataract surgery.
Results
From fiscal years 2011 to 2019, we identified 134,331 glaucoma-related procedures at 720 hospitals. The total number of glaucoma-related procedures increased by 215% from 6516 in 2011 to 20,569 in 2019. The numbers of filtering surgeries, trabeculotomies, and glaucoma drainage devices with plates GDD(p +) procedures significantly increased (
P
= 0.002, 0.002, and 0.006, respectively), whereas the number of cyclocryotherapy procedures significantly decreased (
P
= 0.002). The number of iStent procedures increased by 49% from 371 in 2018 to 551 in 2019. The ≥ 65 year age group accounted for > 80% of the iStent procedures. In the 0 to 14 year age group, trabeculotomy accounted for about 70% of the procedures, and the GDD(p +) procedure became the second most common procedure after trabeculotomy because of the decrease in filtering surgeries. Among combination surgeries, trabeculotomy was most frequently performed. The proportion of combination surgery increased, especially in trabeculotomy.
Conclusions
The total number of glaucoma-related procedures increased throughout the observation period. Before 2017 filtering surgery was the most common procedure, whereas trabeculotomy was most common after 2018. The proportion of trabeculotomies performed in combination with cataract surgery continuously increased.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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