Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)

Environmental Health and Preventive Medicine, Jun 2017

As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation. Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues—potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care—will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.

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Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)

Nakayama et al. Environmental Health and Preventive Medicine Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Takeo Nakayama 0 1 Yuichi Imanaka 1 Yasushi Okuno 1 Genta Kato 1 Tomohiro Kuroda 1 Rei Goto 1 Shiro Tanaka 1 Hiroshi Tamura 1 Shunichi Fukuhara 1 Shingo Fukuma 1 Manabu Muto 1 Motoko Yanagita 1 Yosuke Yamamoto 1 0 Department of Health Informatics, Kyoto University, School of Public Health , Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501 , Japan 1 Authors' information Members of BiDAME (Big Data Analysis of Medical care for the Elderly in Kyoto): Funakoshi T , Goto Y, Goto E, Hanaki N, Hiragi S, Ikenoue T, Iwao T, Kawakami K, Kondo N, Kunisawa S, Mori Y, Nakatsui M, Neff Y, Ohtera S , Okamoto K, Otsubo T , Saito H, Saito Y, Sakai M, Sato I, Seto K, Shimizu S, Takahashi Y, Yamashita K, Yoshida S , in Kyoto University Hospital / Kyoto University Graduate School of Medicine, School of Public Health , Kyoto, JAPAN As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation. Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues-potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care-will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible. Claims data; Database; Elderly; Evidence-practice gap; Validation - Background As Japan becomes a super-aged society, the question of how medical care for the elderly is provided and the direction of that care are important national issues. Elderly people are physically frail and consequently often have multi-morbidity [1, 2], and thus, treatment patterns are often complex [3–5]. As a result, cases of polypharmacy in elderly people are not uncommon in clinical practice [6]. Treatment guidelines have been created with the aim of avoiding this kind of potentially inappropriate medical care, but those recommendations are not always properly implemented in clinical practice. The problem of when evidence from clinical research and treatment guidelines is not utilized in practice is called an evidence-practice gap [7]. In the USA, there are reports on the state of evidence-based health care [8] and proposals for narrowing the gap in actual clinical practice [9–11]. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. In Japan, the computerization of health and medical information is progressing, and large databases have been established. The utilization of these databases is an important issue. Since the mid-2000s, private companies have created databases of health insurance society claims that are used for research purposes [12, 13]. At the national level, National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) has been constructed together with enforcement of the “Act on Assurance of Medical Care for Elderly People” of 2008. Since 2011, the NDB has been used secondarily for research purposes. These databases are the quantitative information to measure the actual state of medical environment. There are few research papers which reported the actual situation of medical care in elderly based on a large-scale of data in Japan [14, 15], however, none of (...truncated)


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Takeo Nakayama, Yuichi Imanaka, Yasushi Okuno, Genta Kato, Tomohiro Kuroda, Rei Goto, Shiro Tanaka, Hiroshi Tamura, Shunichi Fukuhara, Shingo Fukuma, Manabu Muto, Motoko Yanagita, Yosuke Yamamoto, on behalf of BiDAME: Big Data Analysis of Medical Care for the Elderly in Kyoto. Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), Environmental Health and Preventive Medicine, 2017, pp. 51, Volume 22, Issue 1, DOI: 10.1186/s12199-017-0644-5