Profiling Hospital Performance of Laparoscopic Cholecystectomy Based on the Administrative Data of Four Teaching Hospitals in Japan

Abstract

Over the last decade in Japan, laparoscopic cholecystectomy (LC) has replaced traditional open cholecystectomy as the standard of elective surgery for cholelithiasis. The laparoscopic approach has a clinical course relatively easier to standardize among the different types of intraabdominal surgery. However, significant practice variation is suspected in Japan, but there has been little demonstration or discussion based on empirical data. Through the analysis of 1589 elective LC cases from four leading teaching hospitals in Japan between 1996 and 2000, this study aims to demonstrate the surgical variations and to investigate their determinants regarding the length of hospital stay and the health care charge. Substantially and significantly large variation existed among the hospitals in terms of the length of hospital stay and the total health care charge, even after the differences in patient factors were adjusted. Particularly, the combined drug and exam charge per day was strikingly different among the four hospitals, which indicated that the daily process also varied widely, as did the total course of inpatient care. In addition, intra-hospital variation was also remained very large even after adjusting for all the potential correlates studied. This study alarmingly points out great room for improvement in the efficiency of health care resource use and potentially in the quality of care through standardization of LC. It has serious implications for the national policy and individual providers under the on-going health care reforms directed toward higher efficiency and quality.

Association between patient age and hospitalization resource use in a teaching hospital in Japan

“…In 1995, one of the authors (YI) developed an administrative database to collect data from more than 10 privately owned tertiary teaching hospitals in Japan. Using the database, we have examined variations in resource use between the participating hospitals [10][11][12][13][14]. In this study, we utilized the administrative database to examine the relationship between patient age and cumulative total charges, diagnostic examination charges, and drugs charges during a 1-year period at one Japanese teaching hospital.…”

Hospital Volume and Quality of Laparoscopic Gastrectomy in Japan

“…This database contained the date of study procedures and we calculated the postoperative LOS and the TC billed during admission, which acted as proxies for in-hospital costs. Japanese charges for hospital care were determined by a standardized fee-for-service payment system and were considered to be good estimates of healthcare costs [17]. TC in this study included physician fees, instrument costs, costs of laboratory and imaging tests, and administration fees, which were listed in the national uniform tariff table.…”

Impact of Hospital Case Volume on the Quality of Laparoscopic Colectomy in Japan

“…Japanese charges for hospital care are determined by a standardized fee-for-service payment system and are considered good measures of overall healthcare costs. 21 TC in this study included physician fees, instrument costs, costs of laboratory or imaging tests, and administration fees, all of which are listed in the national uniform tariff table. OR time was defined as the total time required for anesthetists' procedures, for preparation and positioning of video-images, and active operative time by the surgeons.…”