The recent time trend of outcomes of disseminated intravascular coagulation in Japan: an observational study based on a national administrative database

Abstract

The aim of this study is to investigate the recent trend over time of outcomes of patients with disseminated intravascular coagulation (DIC) based on the Japanese administrative database. A total of 34,711 patients with DIC had been referred to 1,092 hospitals from 2010 to 2012 in Japan. We collected patients' data from the administrative database to compare in-hospital mortality within 14 and 28 days between periods. The study periods were categorized into three groups: 2010 (n = 8,382), 2011 (n = 13,372), and 2012 (n = 12,957). These analyses were performed according to the underlying diseases associated with DIC. The in-hospital mortality within 14 or 28 days of DIC patients with infectious diseases decreased between 2010 and 2012 (within 14 days: 20.4 vs. 18.1 vs. 17.9 %, P = 0.009; within 28 days: 31.1 vs. 28.7 vs. 27.7%, P = 0.003; respectively). Multiple logistic regressions also showed that the period was associated with in-hospital mortality of DIC patients with infectious diseases. The odds ratios of 2011 and 2012 for in-hospital mortality within 14 days were 0.86 [95% confidence intervals (CI) 0.77-0.97] and 0.84 (95% CI 0.75-0.94) whereas those for in-hospital mortality within 28 days were 0.89 (95% CI 0.81-0.98) and 0.83 (95% CI 0.76-0.92), respectively. However, there were no significant differences in mortality of patients with DIC associated with other underlying diseases between 2010 and 2012. This study demonstrated that in-hospital mortality of DIC patients with infectious diseases gradually improved between 2010 and 2012 in Japan.

Effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease based on a national administrative database

“…To control for selection bias with regard to baseline characteristics of patients between groups, we performed generalized propensity score analysis to estimate the dose-response function for each year. The propensity score method has been widely used in observational studies to deal with possible biases [21,22]. We used a multinomial logistic regression model with logit as the link function to obtain generalized propensity scores using the data of patient characteristics, such as type of hemorrhagic peptic ulcer, age, sex, chronic comorbid conditions, use of ambulance transportation and intensive care units, and other treatments of peptic ulcer.…”

Effects of proton pump inhibitor on outcomes of patients with severe acute pancreatitis based on a national administrative database

“…The health care system of Japan has severe financial problems because of the expenses of new medical technology, a rapidly aging society, and extended hospitalization periods for patients [11][12][13][14][15]. To address M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 these issues, the Ministry of Health, Labour and Welfare and its affiliated research institute have begun investigating whether the Japanese case-mix classification system, namely the DPC, can be used to standardize medical profiling and payment [11][12][13][14][15].…”

“…To address M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 these issues, the Ministry of Health, Labour and Welfare and its affiliated research institute have begun investigating whether the Japanese case-mix classification system, namely the DPC, can be used to standardize medical profiling and payment [11][12][13][14][15]. Japanese case-mix projects based on the DPC system were introduced to 82 academic hospitals (the National Cancer Center, the National Cardiovascular Center, and 80 university hospitals) in 2003 [11][12][13][14][15]. Reimbursement from health insurance using the DPC system is common practice in Japan.…”

“…According to the administrative database of the DPC system, the number of acute-care hospitals has increased. An enormous amount of inpatient data are collected annually, covering approximately 90% of the total acute-care inpatient hospitalizations [11][12][13][14][15].…”

“…Additionally, this administrative database contains comprehensive medical information, including all interventional or surgical procedures, and medications that have been indexed in the original Japanese code. The Ministry of Health, Labour and Welfare of Japan assigns these codes [11][12][13][14][15]. The date and the amount of daily care that are delivered are also recorded in the DPC administrative database [11][12][13][14][15].…”