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Fukuda H.,Kyushu University | Shimizu S.,Institute for Health Economics and Policy | Ishizaki T.,Tokyo Metropolitan University

Objectives To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Design Retrospective cohort study. Setting Two groups of hospitals were categorized according to healthcare delivery approach: The first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Participants Patients aged 65 years and above who had undergone hip fracture surgery. Measurements Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. Results The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Conclusion Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare. © 2015 Fukuda et al. Source

Okumura Y.,Institute for Health Economics and Policy | Tachimori H.,National Institute of Mental Health | Matsumoto T.,National Health Research Institute | Nishi D.,National Institute of Mental Health

Rationale: Little is known about psychotropic medication prescriptions prior to drug overdose. Objectives: We aimed to examine the possible associations between the risk of overdose and exposures to various psychotropic medications. Methods: We conducted a matched case-control study of 3 groups of patients aged 12-74 years, using a large-scale health insurance claims database in Japan (population 1.2 million). A total of 351 cases with drug poisoning were compared with two control groups without overdose: 1755 patients with any treatment (general controls) and those with depression (high-risk controls). Current, past, and nonusers were patients most recently exposed to psychotropic medications ≤90 days, 91-180 days, and ≥180 days before the index date. Results: Current sedative-hypnotic use was associated with an increased odds of overdose relative to general control nonusers (odds ratio [OR], 21.5; 95 % confidence interval [CI], 9.7-47.8) and high-risk control nonusers (OR, 2.6; 95 % CI, 1.9-3.5). In the comparison of cases and high-risk controls, the ORs for overdose were higher among excessive dosage users than among usual dosage users (OR, 4.3; 95 % CI, 3.0-6.1), among barbiturate users than among benzodiazepine/Z-drug only users (OR, 4.5; 95 % CI, 2.3-8.7), and among multiple provider episodes than among single provider episodes (OR, 4.4; 95 % CI, 1.7-11.0). Psychiatrists prescribed more than 77 % of potentially questionable prescriptions. Conclusions: These results highlight the need for psychiatrists to monitor prescribed medications and balance the benefits and risks of pharmacological treatments. © 2015 Springer-Verlag Berlin Heidelberg. Source

Fukuda H.,Institute for Health Economics and Policy | Lee J.,Kyoto University | Imanaka Y.,Kyoto University
Journal of Hospital Infection

Quantifying the additional costs of hospital-acquired infections (COHAI) is essential for developing cost-effective infection control measures. The methodological approaches to estimate these costs include case reviews, matched comparisons and regression analyses. The choice of cost estimation methodologies can affect the accuracy of the resulting estimates, however, with regression analyses generally able to avoid the bias pitfalls of the other methods. The objective of this study was to elucidate the distributions and trends in cost estimation methodologies in published studies that have produced COHAI estimates. We conducted systematic searches of peer-reviewed publications that produced cost estimates attributable to hospital-acquired infection in MEDLINE from 1980 to 2006. Shifts in methodologies at 10-year intervals were analysed using Fisher's exact test. The most frequent method of COHAI estimation methodology was multiple matched comparisons (59.6%), followed by regression models (25.8%), and case reviews (7.9%). There were significant increases in studies that used regression models and decreases in matched comparisons through the 1980s, 1990s and post-2000 (P = 0.033). Whereas regression analyses have become more frequently used for COHAI estimations in recent years, matched comparisons are still used in more than half of COHAI estimation studies. Researchers need to be more discerning in the selection of methodologies for their analyses, and comparative analyses are needed to identify more accurate estimation methods. This review provides a resource for analysts to overview the distribution, trends, advantages and pitfalls of the various existing COHAI estimation methodologies. © 2010 The Hospital Infection Society. Source

Niino Y.,Institute for Health Economics and Policy
BioScience Trends

Cesarean sections sometimes save the lives of mothers and babies; however, they are excessively used compared to medical necessity, which is influenced by various factors that are explored in this article. Since, in most cases the risks of cesarean sections are greater than the benefits, particularly in cesareans that are not medically indicated, it is astonishing that cesarean surgery is the most common surgical procedure, taking away resources from medically necessary care. While economic incentive is counted among the reasons for the increasing cesarean trend, the situation is not so simple since many factors interact to cause the trend. Since reversal of the vaginal birth after cesarean (VBAC) trend downward is correlated with revised policy statements by e.g. American College of Obstetricians and Gynecologists (ACOG), which have since been partially moderated, it became much more difficult for medical institutions to provide VBACs due to concerns about liability. Although whether to give birth by cesarean delivery is a matter for informed consent, yet childbearing women are influenced significantly by their health service providers' opinions. Even though the World Health Organization (WHO) recommends the most peripheral level of maternity care for normal pregnancy and childbirth that is safe using midwives, yet the percentage of midwife deliveries is low. Among other things, it has been suggested that more childbirth by midwife delivery and in out-of-hospital settings can reduce medically unnecessary cesareans and the undue risks associated with them, and free up medical resources for those in need. Source

Asami Y.,Pfizer | Goren A.,Health Outcomes Practice | Okumura Y.,Institute for Health Economics and Policy
Journal of Occupational and Environmental Medicine

OBJECTIVE:: The aim of this study was to investigate whether depression severity was associated with work impairments, regardless of the diagnosis. METHODS:: We conducted a cross-sectional study among 17,820 Japanese workers using an Internet-based survey. Work impairments were assessed using the Work Productivity and Activity Impairment questionnaire. Participants were grouped according to whether they had a past-year diagnosis of depression by physicians and current depression severity assessed with the Patient Health Questionnaire-9. RESULTS:: Among the undiagnosed, high severity respondents had greater overall work impairment than low severity respondents (33.3% vs 14.8%). Significant interactions between diagnosis and severity indicated greater impairments among undiagnosed than among diagnosed respondents (except on absenteeism). CONCLUSIONS:: Depression severity was associated with work productivity loss, even among the undiagnosed, suggesting a need for early detection, referral, and treatment of depression in the workplace. Copyright © 2015 by American College of Occupational and Environmental. Source

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