Time trend of medical economic outcomes of endoscopic submucosal dissection for gastric cancer in Japan: a national database analysis

Abstract

This study showed that the complication rate of ESD was stable, whereas the LOS and medical costs of patients were significantly reduced from 2009 to 2011.

Recent Change in Treatment of Disseminated Intravascular Coagulation in Japan

“…[11][12][13] 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.…”

“…Enormous amounts of inpatient data are collected annually, covering approximately 90% of the total acute-care inpatient hospitalizations. [11][12][13][14][15] This system also collects important data during hospitalization in addition to the characteristics of the unique reimbursement system. Each patient's financial data, claim information, and discharge summary (including the principal diagnosis, complications, and comorbidities during hospitalization) are thoroughly recorded in the administrative database of the DPC system.…”

“…These hospitals are dispersed throughout Japan and play leading roles in providing acute-care medicine, advancing medical research, and educating students and medical residents. [11][12][13][14][15] For the present analysis, 3 study periods were established according to the following fiscal years: 2010 (n ¼ 3308), 2011 (n ¼ 5403), and 2012 (n ¼ 5613).…”

“…The DPC-participating hospitals send all the anonymized data to the DPC research group, which in turn sends it to the server in our department. [11][12][13][14][15] The use of DPC data was permitted by all institutions and hospitals that provided detailed data. The research protocol of the study was approved by the ethics committee of medical care and research of the University of Occupational and Environmental Health, Kitakyushu, Japan.…”

“…The severity of chronic comorbid conditions was assessed using the Charlson Comorbidity Index (CCI), which is widely used to record comorbidities and has been validated in various studies. [11][12][13][14][15] The CCI was calculated for each patient as in previous studies that have demonstrated the association between CCI and ICD-10 code. [11][12][13][14][15] The CCI was expressed as the score of all comorbid conditions and was initially evaluated as a continuous variable.…”