Publications

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Sasaki N, Rosenberg M, Shin J, Kunisawa S, Imanaka Y. Hidden populations for healthcare financial protection in the super-aging society: Closing the gap between policy and practice. Clinical Social Work Journal 2023 (accepted) ; DOI: 10.1007/s10615-023-00914-x ; [鍵となる図] ; [Key Figure]

★・関西の社会福祉専門職への質問紙調査から、高齢者の医療における経済的な困難は、本人や家族の社会的・精神的な課題と絡み複雑化することが示唆された。
・無料低額診療事業、成年後見制度など潜在的に役立つ可能性のある制度が必ずしも十分使用されていないことが示された。
・社会福祉専門職の性別(男性)、勤務経験の短さ、自治体機関での勤務が複数の主要な保護制度の使用されにくさと関連した。政策と実践の乖離を縮小するために、専門職自身の経験、価値観などを総合的に検討する反抑圧的老年学的アプローチを含む生涯研修が望まれる。

★・A survey of social work professionals in the Kansai region revealed that the financial difficulties related to health care are often closely intertwined with social and mental health hardships experienced by older people and their families.
・The survey also indicated that ‘free/low-cost medical treatment program’ and the adult guardianship system, which are potentially useful,were infrequently utilized .
・The gender of social workers (male), working at local offices/agencies and less than 10 years’ professional experience were associated with the underutilization of several key protective programs. To reduce the gap between policy and practice, policies should focus on clients’ daily living needs, and new frontline social workers should receive lifelong training including the use of anti-oppressive gerontological approaches.

Yoshigai M, Shin J, Nagano H, Nakabe T, Imanaka Y, KU Task Force to Create Resilient Societies with and after COVID-19. Presenteeism and Social Interaction in the “New Normal” in Japan: a longitudinal questionnaire study. Environmental Health and Preventive Medicine 2024 Volume 29 Pages 3 ; DOI: 10.1265/ehpm.23-00201 ; [鍵となる図] ; [Key Figure]

★＜COVID-19パンデミック下「新しい生活様式」における社会的交流や社会的支援とプレゼンティーズムに関する縦断的アンケート調査を用いた記述と分析＞
・COVID-19感染拡大後「新しい生活様式」の導入に伴う社会的交流・社会的支援とプレゼンティーズムの状況を明らかにし、社会的 交流・社会的支援状況がプレゼンティーズムに影響を及ぼすかについて検討した。
・社会的支 援者の人数が多さや支援の満足度の高さがプレゼンティーズムの低さにつながる可能性が示された。
・家族との会話時間の増加もプレゼンティーズムを軽減する。

★・The aim of this study was to describe the presenteeism of Japanese workers with reference to social interaction and social support following the lifestyle changes due to COVID-19 and to assess whether social interaction and social support affected their presenteeism.
・Our results suggested that social support reduced the presenteeism of the Japanese workers during the “new normal” due to the COVID-19 pandemic.
・Social interaction with family also relieved presenteeism.

Sugawara S, Ishihara T, Kunisawa S, Goto E, Imanaka Y. A panel VAR analysis for the dynamics of medical and long-term care expenditures. Health Economics (First published: 30 December 2023) ; DOI: 10.1002/hec.4794 ; [鍵となる図] ; [Key Figure]

★・高齢者の医療・介護支出の動学的な関係を、パネルベクトル自己回帰モデルで分析した
・高齢者が高価な急性期医療から安価な在宅医療、さらに在宅介護へと段階的に移行していくことが示された
・通所介護が多様な役割を担っていることが示唆された。

★・Dynamics between medical and long-term care expenditures for older adults is analyzed using panel vector autoregressive model.
・There exists intertemporal transition from expensive acute medical care to reasonable at-home medical care, then to at-home long-term care.
・Daycare plays multiple roles in Japanese long-term care.

Egashira S, Shin J, Yoshimura S, Koga M, Ihara M, Kimura N, Toda T, Imanaka Y. Cost-effectiveness of endovascular therapy for acute stroke with a large ischaemic region in Japan: impact of the Alberta Stroke Program Early Computed Tomographic Score on cost-effectiveness. Journal of NeuroInterventional Surgery 2023 (accepted) ; DOI: 10.1136/jnis-2023-021068 ; [鍵となる図] ; [Key Figure]

★・脳卒中患者の転帰と医療費を長期的に推定するモデルを作成し，広範脳梗塞患者に対するカテーテル治療が生活の質を考慮した寿命（質調整生存年）1年を生み出すのにかかる追加費用（増分費用効果比）を算出した。
・本研究で推定した血管内治療の増分費用効果比は483万円と費用対効果に優れたが、この増分費用効果比は虚血領域の程度に大きな影響を受け，極めて大きな脳梗塞（ASPECTSという虚血スコア 3点以下）では費用対効果に優れない可能性も示唆された。
・医療技術が長期的に社会に及ぼす影響を定量化しただけでなく、同一の医療技術の費用対効果が患者特性により大きく異なることを示した点で意義がある。

★・We built a model to estimate long-term costs and outcomes of patients with stroke, and calculated the incremental cost-effectiveness ratio (ICER) of endovascular therapy (EVT) for acute stroke with a large ischemic region.
・EVT was cost-effective with an ICER of 4.83 million JPY/quality-adjusted life year (QALY). However, ICER was so sensitive to the extent of the ischemic region that EVT was cost-ineffective among ASPECTS 3 or lower (extremely large ischemic stroke).
・The present study is notable not only for quantifying the long-term social burden of medical technology, but also for demonstrating the cost-effectiveness varies greatly depending on patient characteristics.

Tajima T, Shin J, Kunisawa S, Sasaki N, Hata K, Fushimi K, Hatano E, Imanaka Y. Cost-Effectiveness Analysis of Adult Living-Donor Liver Transplantation in Japan. Hepatology Research 2023 (in press) ; PMID: 37985222 ; DOI: 10.1111/hepr.13992 ; [鍵となる図] ; [Key Figure]

★・DPC研究グループの日本全国データベースを用いて、成人患者に対する生体肝移植と保存的治療の費用対効果分析を行った。
・Child-Pugh分類Cの患者に対する生体肝移植と保存的治療の比較では、増分費用効果比は208万円/質調整生存年（20,708 米ドル/質調整生存年）と費用対効果的であったが、Child-Pugh分類Bの患者に対する生体肝移植と保存的治療の比較では、増分費用効果比は524万円/QALY（52,153 米ドル/質調整生存年）と費用対効果的ではなかった。
・Child-Pugh分類Cの成人患者において、保存的治療と比較した生体肝移植の費用対効果が示されたことは生体肝移植を支持するエビデンスとなり、日本における生体肝移植の更なる発展に寄与する可能性がある。

★・We performed a cost-effectiveness analysis of living-donor liver transplantation (LDLT) compared to conservative management (CM) for adult patients using the Japanese nationwide database of the DPC research group.
・LDLT compared with CM for patients with Child-Pugh class C was cost-effective, with an incremental cost-effectiveness ratio (ICER) of 2.08 million JPY/QALY (20,708 USD/QALY), whereas LDLT versus CM for patients with Child-Pugh class B was not cost-effectiveness, with an ICER of 5.24 million JPY/QALY (52,153 USD/QALY).
・Demonstration of the cost effectiveness of LDLT compared to CM in adult patients with Child-Pugh class C provides evidence to support LDLT and may help further promote LDLT in Japan.

Kinoshita H, Nishigori T, Kunisawa S, Hida K, Hosogi H, Inamoto S, Hata H, Matsusue R, Imanaka Y, Obama K, Matsumura Y. Identification of complications requiring interventions after gastrointestinal cancer surgery from real-world data: An external validation study. Annals of Gastroenterological Surgery 2023 Jun 11;7(6):1032-1041 ; DOI: 10.1002/ags3.12704

★・複数施設のDPCデータを用い開発されたアルゴリズムは、胃腸癌手術を受けた患者と介入を必要とする合併症の抽出において、高い感度と特異度を示した。
・今後の病院の医療の質の改善や実世界データを使用した全国的な比較研究において有用な結果が得られた。

★・The algorithm developed using DPC data from multiple facilities demonstrated high sensitivity and specificity in extracting patients undergoing gastrointestinal cancer cancer surgery and complications requiring interventions.
・These promising results are valuable for future improvements in hospital quality and nationwide comparative studies using real-world data.

Minato K, Shin J, Kunisawa S, Fushimi K, Imanaka Y. The Total Number of Patients with any of Four Major Fragility Fractures Decreased During the First Wave of the COVID-19 Epidemic in Japan, Commencing Before the State of Emergency Declaration, which was Not as Enforceable as Lockdown. Archives of Osteoporosis 2023 Jun 21;18(1):86 ; PMID: 37344710 ; DOI: 10.1007/s11657-023-01297-9 ; [鍵となる図] ; [Key Figure]

★・自主的イベント中止が要請された2020年2月26日から緊急事態宣言が発令された2020年4月7日までの期間に，2020年4月7日に緊急事態宣言の対象となった7都府県では4つの主な脆弱性骨折の患者数に減少傾向のレベル変化とトレンド変化がみられ，2020年4月16日に緊急事態宣言の対象となった40道府県では4つの主な脆弱性骨折の患者数に減少傾向のレベル変化がみられた．
・4つの主な脆弱性骨折の患者数は，緊急事態宣言が発令された後，前年同時期比で減少していたが，緊急事態宣言の有する人流抑制効果だけによって減少していたのではなく，緊急事態宣言が発令される前から始まっていた人流減少の影響も受けて減少していたことが示唆された．

★・We investigated the impact of public health measures in the first wave of the COVID-19 epidemic on the occurrence of major fragility fractures.
・From the end of February 2020, before the state of emergency (SoE) declaration, decreasing level and slope change were estimated in the seven prefectures, which were subject to the SoE declaration issued on April 7, 2020, while decreasing level change were estimated in the 40 prefectures, which became subject to the SoE declaration on April 16, 2020.
・Our results suggested that the total number of the four major fragility fractures decreased in the year-to-year comparison after the SoE declaration, not only due to the SoE declaration but also due to the decrease in human mobility that occurred before the SoE declaration.

Higuchi T, Shin J, Takada D, Morishita T, Kunisawa S,, Imanaka Y. The Japanese Guide affected the prescription of steroids for COVID 19 inpatients during the COVID 19 epidemic in Japan. Scientific Reports 2023 Jun 3;13(1):9041 ; PMID: 37270639 ; DOI: 10.1038/s41598-023-36199-w ; [鍵となる図] ; [Key Figure]

★・日本におけるCOVID-19入院患者に対するステロイド処方の傾向を示した。
・本研究は，COVID-19のパンデミック時に、診療の手引きが日本人の医師の処方に関する意思決定に影響を与えたことを示唆している。
・一方で、診療の手引きのの推奨事項が必ずしも十分に守られていたわけではない。
・ガイダンスを作成する際に、重症度ごとの推奨薬剤の違いなどを伝えるなど、ガイダンスの遵守を促進するための対策が必要である。

★・We showed the trends of steroid prescriptions for COVID-19 inpatients in Japan.
・The present study suggests that the Japanese Guide influenced Japanese physicians' decisions regarding prescriptions during the COVID-19 pandemic.
・The recommendations in the Japanese Guide were not always followed adequately.
・Measures should be taken to promote compliance with the guidance by communicating the differences in recommendations of drugs for each severity, etc., when preparing the guidance.

Yoshikawa M, Goto E, Shin J, Imanaka Y. Regional disparities in Dementia-free Life Expectancy in Japan: an ecological study, using the Japanese long-term care insurance claims database. PLoS ONE 2023 May 25;18(5):e0280299. ; PMID: 37228050 ; DOI: 10.1371/journal.pone.0280299 ; [鍵となる図] ; [Key Figure]

★・「認知症高齢者の日常生活自立度」を用いて健康余命（Dementia-free Life Expectancy）を算出し、その地域差の関連要因を探索することを目的とした。
・65歳時点の男女の二次医療圏レベルの健康余命を目的変数、地域変数を説明変数として、部分最小二乗法回帰分析を実施した。
・都市性、社会経済条件、医療資源を表す3つの潜在因子が同定された。社会経済的条件は健康余命を最もよく説明した。

★・We aimed to calculate Dementia-free Life Expectancy (De-FLE) based on the “Degree of Independence in Daily Life for the Demented Elderly” and explore the associated factors of its regional difference.
・We conducted a partial least squares (PLS) regression with secondary medical area level De-FLE for both sexes at age 65 as the objective variables and regional factors as explanatory variables.
・Three latent components were identified, which represented urbanicity, socioeconomic conditions, and healthcare resources. Socioeconomic conditions explained De-FLE the best.

Kunisawa S. Postoperative mortality analysis on nationwide data from diagnosis procedure combination database in Japan. PLoS ONE 2023 Jun 8;18(6):e0286264. ; PMID: 37289744 ; DOI: 10.1371/journal.pone.0286264 ; [鍵となる図]

★・全国のDPCデータベースを使用して手術後の死亡率を地域レベルで経時的に解析した。手術コードを用いて2,000以上の手術様式について分析し、研究に取り上げたいくつかの特定の手術において地域間の違いや減少傾向がみられた。この研究は、死亡率を分析する際に医療の質や背景状況を考慮する重要性を示している。

★・The national DPC database was used to analyze mortality rates after surgery over time at the regional level. More than 2,000 surgical modalities were analyzed using surgical codes, and differences and decreasing trends between regions were found for several specific surgeries featured in the study. This study demonstrates the importance of considering quality of care and background conditions when analyzing mortality..

Hirota Y, Shin J, Sasaki N, Kunisawa S, Fushimi K, Imanaka Y. Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia. PLoS ONE 2023 18(2): e0282272 ; PMID: 36827320 ; DOI: 10.1371/journal.pone.0282272 ; [鍵となる図] ; [Key Figure]

★・入院早期に退院調整を開始するためには、誤嚥性肺炎患者の退院先を正確に予測することが重要であるが、それを可能にする予測モデルは開発されていない。
・高齢者施設から入院した症例における自宅もしくは高齢者施設への退院を予測するモデル、自宅から入院した症例における自宅退院を予測するモデルの2種類のマルチレベルロジスティック回帰モデルを開発し検証した。ノモグラムも作成した。
・外部検証において、高齢者施設から入院した症例の自宅／施設退院予測モデル、自宅から入院した症例の自宅退院予測モデルのC統計量は、それぞれ0.67、0.71だった。

★・Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. However, such prediction model has not been developed.
・We developed and validated two multilevel logistic regression models, one model to predict the home or to a nursing home discharge of cases admitted from a nursing home and the other to predict the home discharge of cases admitted from home. Nomograms were also created.
・In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively.

Nagano H, Shin J, Kunisawa S, Fushimi K, Nagao M, Imanaka Y. Impact of the cefazolin shortage on the selection and cost of parenteral antibiotics during the supply disruption period in Japan: A controlled interrupted time series analysis. Journal of Infection and Public Health 2023 Mar;16(3):467-473 ; DOI: 10.1016/j.jiph.2023.01.021 ; [鍵となる図] ; [Key Figure]

★・2019年のセファゾリン(CEZ)供給停止が注射抗菌薬選択とコストに対する影響をコントロールを置いた分割時系列解析を用いて分析した。
・不足病院におけるCEZの使用割合は23.5%から11.1%に減少し、CEZは主にセフトリアキソン、セフメタゾール、アンピシリンスルバクタムに置き換わっていた。分割時系列解析では対照群に比べ、CEZが不足した病院ではより広域のβ-ラクタム薬とクリンダマイシンの使用が増加した。
・対照群に比べ、不足した病院では患者日あたりの注射抗菌薬のコストに有意な変化は認められなかった。

★・We analyze the impact of the 2019 CEZ shortage on the selection and cost of parenteral antibiotics use using controlled interrupted time-series (CITS) analysis.
・The proportion of CEZ use in hospitals with shortage decreased from 23.5% to 11.1%, with CEZ being mainly replaced by ceftriaxone , cefmetazole , and ampicillin/sulbactam . The CITS analysis showed that the use of broader-spectrum beta-lactams and clindamycin increased in hospitals with shortage compared to the control group
・No significant change was observed in the cost of parenteral antibiotics per patient-day in hospitals with shortage compared to the control group

Nakamura N, Kanemura N, Lee S, Fujita K, Morishita T, Takada E, Shibata Y, Kasahara S, Goto H, Fukuno K, Hara T, Yamada T, Sawada M, Tsurumi H, Shimizu M. Prognostic impact of the controlling nutritional status score in patients with peripheral T-cell lymphoma. Leuk Lymphoma 2023 Jun;63(6):1323-1330 ; PMID: 34965828 ; DOI: 10.1080/10428194.2021.2020777

Morishita T, Takada D, Shin J, Kunisawa S, Fushimi K, Imanaka Y. Impact of Policy Alterations on Elective Percutaneous Coronary Interventions in Japan. Heart 2022 Mar 27;109(8):612-618 ; PMID: 36627183 ; DOI: 10.1136/heartjnl-2022-321695 ; [鍵となる図] ; [Key Figure]

★・2018年の待機的PCIの診療報酬改定が本邦における待機的PCI施行症例数に与えた影響についてDPCデータを用いて分割時系列デザインにより分析した。
・2018年の診療報酬改定後は、1か月あたりの待機的PCI施行件数のトレンドの減少が認められた（-106.3、95％信頼区間；-155.8～-56.8 件/月）。

★・Using DPC data, we examined whether the 2018 reimbursement revision for elective PCI had an impact on PCI procedures for SAP in Japan.
・We used controlled ITS analysis to study trends in PCI cases per month in the intervention group relative to the comparison group.
・After the 2018 reimbursement revision, significant trend changes were found in elective PCI procedures per month (-106.3, 95% confidence interval; -155.8 to -56.8, P<0.01), while the number of emergent PCIs remained stable throughout the study period.

Hara K, Nakabe T, Tanaka M Imanaka Y. Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study. BMC Geriatrics 2022 Dec 12;22(1):955 ; PMID: 36510174 ; DOI: 10.1186/s12877-022-03662-8 ; [鍵となる図] ; [Key Figure]

★・日本の介護サービスでは介護の質に関心が寄せられており、質指標としてQOLの導入が検討されている。
・そこで、介護サービス利用者に対して大規模なアンケート調査を実施し、QOL指標（WHO-5およびEQ-5D）を測定した。
・その結果、要介護度とQOL指標との関連が明らかになり、とくに要介護度が高くなると、精神的健康状態は比較的保たれるもののQOL指標が低下する傾向がみられた。

★・In Japan’s super-aging society, one aspect of the quality of care is the user’s quality of life (QOL).
・The results of our large-scale survey revealed that QOL indicators gradually decreased as the level of care required increased.
・It is important to monitor users’ QOL as a quality indicator of care, to improve and manage it.

Tsunemitsu A, Tsutsumi T, Inokuma S, Kobayashi T, Imanaka Y. Effects of hospitalist co-management on rate of initiation of osteoporosis treatment in patients with vertebral compression fractures: Retrospective cohort study. Journal of Orthopaedic Science. 2022 Nov;28(6):1359-1364. ; PMID: 36244847 ; DOI: 10.1016/j.jos.2022.09.013 ; [鍵となる図] ; [Key Figure]

★本邦の1病院において、椎体圧迫骨折患者に対して整形外科とホスピタリストの共同診療を開始したことによる影響を、整形外科単独での診療と比較した。共同診療は入院中の骨粗鬆症治療薬の導入率を向上した(45.2% vs. 3.6%)。共同診療群において治療薬が導入されなかった理由で多かったのは、患者が退院後にかかりつけ医と相談してからの処方を希望した、歯科治療が予定されていた、末期腎不全や予後が限られていたなどの患者要因であった。

★The effects of hospitalist co-management in patients with vertebral compression fractures in a Japanese hospital was compared to orthopedic surgeon-led care. Hospitalist co-management improved the rate of initiation of osteoporosis treatment during hospitalization (45.2% vs. 3.6%). Main Reasons for non-initiation of osteoporosis treatment in the co-management group were patients’ factors such as desire to be treated after consultation with their primary care physicians after discharge, scheduled dental procedure, limited prognosis, and end-stage kidney disease.

Watanabe S, Shin J, Okuno T, Morishita T, Takada D, Kunisawa S, Imanaka Y. Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: A retrospective cohort study in Japan. PLoS One 2022 Sep 26;17(9):e0273952. Published: September 26, 2022 ; PMID: 36156082 ; DOI: 10.1371/journal.pone.0273952 ; [鍵となる図] ; [Key Figure]

★・QIP病院のデータベースによれば、集中治療に関して、新型コロナ患者を多く受け入れた病院ほど、新型コロナ以外の集中治療患者の減少が多い傾向が見られた。
・新型コロナ以外の集中治療患者のリスク調整死亡率について、新型コロナ流行に伴う上昇は認められず、集中治療の医療の質は維持されたことが示唆された。

★・According to the analysis of the QIP database, the decrease in case volumes of non-COVID-19 ICU patients was larger in hospitals continuously accepting COVID-19 ICU patients compared with other hospitals.
・The standardized in-hospital mortality of non-COVID-19 ICU patients did not change in any waves of the epidemic, implying maintained healthcare quality for ICU patients.

Ohki Y, Ikeda Y, Kunisawa S, Imanaka Y. Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan. PLoS One 2022 17(8): e0266211 ; PMID: 36001543 ; DOI: 10.1371/journal.pone.0266211 ; [鍵となる図] ; [Key Figure]

★・大腿骨頸部骨折は高齢者に多くみられる疾患であり、地域医療連携により急性期から回復期、療養期への移行をスムーズに行うことが必要であると考えられている。
・本研究では、6年分（2014年1月1日から2019年12月31日）の国民健康保険・後期高齢者医療制度レセプトデータから日本のある県に居住する大腿骨頸部骨折による入院経験がある患者の入院・外来記録を抽出し、患者の共有を表す医療機関ネットワークを構築することでネットワーク科学を用いて地域医療連携と医療提供の質の関係性を調べた。
・各患者が入院した医療機関のネットワーク上の中心性とその患者の入院日数は負の関係にあり、医療連携が強い医療機関に入院した患者は短い入院日数で退院していることがわかった。
・さらに、ノード埋め込み手法と機械学習を用いた説明能力の高いモデルを用いることで、医療機関ネットワークによって表現される地域医療連携は入院日数に対して20%程度の説明能力を持つことが明らかになった。
・これらの結果は、大腿骨頸部骨折に関する高い質での医療提供のために、地域の医療機関間の連携が重要な役割を果たしていることを示唆している。

★・Femoral neck fractures frequently occur in the elderly. We need to establish regional medical inter-institutional cooperation for the smooth transition from hospitalization in the acute phase to rehabilitation in the recovery phase and long-term care after discharge.
・We analyzed anonymized personal-level patient claims data (for six years, from January 1, 2014, to December 31, 2019) for residents of a prefecture in Japan to build a medical provider network and examined the relationship between medical cooperation and the quality of health care provision using network science.
・The network centrality of the medical provider where each patient was admitted was negatively related to the duration of hospital stays. It shows that patients admitted to medical providers with stronger medical cooperation were discharged after a shorter hospital stay.
・In addition, using node embedding and machine learning, we found the medical cooperation represented by the medical provider network has approximately 20% explanatory ability for the duration of hospital stays.
・ These results indicate that regional medical inter-institutional cooperation plays a significant role in providing high-quality healthcare for femoral neck fractures.

Kohori-Segawa H, Uematsu H, Dorji N, Wangdi U, Dorjee C, Yangchen P, Kunisawa S, Sakamoto R, Imanaka Y. Social and behavioral factors related to blood pressure measurement: A cross-sectional study in Bhutan. PLoS One 2022 Aug 17;17(8):e0271914 ; PMID: 35976922 ; DOI: 10.1371/journal.pone.0271914

★・心血管性疾患はブータン王国の死因第一位を占めています。心血管性疾患を予防するためにも高血圧の早期発見や重症化予防が重要です。
・しかしながら、NCDSTEPS調査中に高血圧の人のうち26％は調査までの人生の中で血圧測定を経験したことがなかったことが分かりました。血圧測定は、男性においては自営業や無職の方、女性においては低所得の方で血圧測定機会が少ないことが分かりました。また、食塩摂取量の多い人や喫煙者など生活習慣にリスクがある人ほど、血圧測定機会が少ないことが分かりました。
・今後、血圧測定の早期発見のためには、無職や自営業の男性や低所得層の女性により注意を払う必要があり、よりリスクの高い生活習慣の悪い人や脆弱な人へのアプローチが重要であると示唆されました。

★・Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection of hypertension is critical for preventing cardiovascular disease. However, approximately 26% of those with hypertension who were detected during the STEPS survey had never had their blood pressure measured.
・Previous blood pressure measurement was significantly associated with age and working status in men (self-employed [odds ratio (OR): 0.219, 95% CI: 0.133–0.361], non-working [OR: 0.114, 95% CI: 0.050–0.263], employee [OR: 1.000]). Previous blood pressure measurement was significantly associated with higher income in women (Quartile-2 [OR: 1.984, 95% CI: 1.209–3.255], Quartile-1 [OR: 2.161, 95% CI: 1.415–3.299], Quartile-4 [OR: 1.000]).
・Multivariate logistic regression showed that people with unhealthy lifestyles (high salt intake [adjusted odds ratio (AOR): 0.247, 95% confidence interval (CI): 0.068–0.893], tobacco use [AOR: 0.538, 95% CI: 0.380–0.761]) had a decreased likelihood of previous blood pressure measurement.
・To promote the early detection of hypertension in Bhutan, we suggest that more attention be paid to low-income women, non-working, self-employed, and low-income men, and a reduction of barriers to blood pressure measurement for people with fragile or unhealthy lifestyles.

Hamada O, Tsutsumi T, Imanaka Y. Efficiency of the Japanese hospitalist system for patients with urinary tract infection: a propensity-matched analysis. Internal Medicine 2023 Apr 15;62(8)1131-1138 ; DOI: 10.2169/internalmedicine.8944-21 ; [鍵となる図] ; [Key Figure]

★・尿路感染症患者を対象としホスピタリスト群の管理がその他診療科と比較しどのようなアウトカムをもたらすか単施設後向き観察研究を行い、傾向スコアマッチングで解析した。
・ホスピタリスト群の管理は死亡率や再入院率を上げず、(在院日数を短縮し医療の質を改善させ、医療費低下との関連が示唆された。
・誤嚥性肺炎(PMID: 31391388)に加え、尿路感染症患者でも日本におけるホスピタリストシステム導入が良い影響を及ぼす可能性が示唆された。

★・We analyzed patients whose most resource-consuming diagnosis at admission was urinary tract infection. Propensity-matched analyses were performed to compare health care economics and the quality of care between the hospitalist system and the conventional system in our hospital.
・Hospitalist care was associated with a decreased length of stay and better quality of care without increased readmission or mortality compared with the conventional system. Hospital costs tended to be decreased.
・We previously reported the favorable impact of the hospitalist system on the quality of care and cost effectiveness within the Japanese medical system in patients with aspiration pneumonia (PMID: 31391388). This study is further evidence of the strong potential for a positive impact of a hospitalist system in Japan.

Kunisawa S, Ishida H, Ikai H, Nagano H, Fujiwara T, Ohdan H, Fujiwara Y, Tajima Y, Ueno T, Fujiwara Y, Shimada M, Suzuki Y, Watanabe Y, Hanazaki K, Kakeji Y, Kumamaru H, Takahashi A, Miyata H, Imanaka Y. Impact of the hospital volume and setting on postoperative complications of surgery for gastroenterological cancers in a regional area of Western Japan. Surgery Today 2022 2023; 53: 214–222 Published: 10 August 2022 ; PMID: 35947194 ; DOI: 10.1007/s00595-022-02569-6 ; [鍵となる図]

★＜NCDデータを用いた中四国地方（西日本）の消化器外科手術後アウトカムの解析＞
・日本消化器外科学会の研究サブグループにて、中四国地方（西日本）の消化器外科手術後のClavien-Dindo分類でグレード3以上の周術期合併症の発生率と、病院の症例数および患者の通院距離の組み合わせで定義される病院の特性の関連について分析した。
・NCDデータベースを用い、胃癌に対する遠位胃切除術（アウトカム発生率5.6％）・胃全摘術（10.2％），結腸癌に対する右半球切除術（5.5％），直腸癌に対する低位前方切除術（10.7％）について解析し、病院の特性とアウトカムの間に関連は認められなかった。
・本研究の結果は、少なくとも中四国地方では，胃がんと大腸がんの主だった手術において病院の症例数のみに基づく集約化を肯定的に支持するものではなかった。

★・A research subgroup from the Japanese Society of Gastroenterological Surgery investigated incidences of perioperative complications of ≥Grade 3 of the Clavien-Dindo classification after gastroenterological surgery and the association of hospital characteristics, which are defined using a combination of hospital case-volume and patients’ hospital travel distance.
・With the Japanese National Clinical Database, we investigated 4 proceduares; distal gastrectomy for gastric cancer (outcome incidence 5.6%),total gastrectomy for gastric cancer (10.2%), right hemicolectomy for colon cancer (5.5%), lower anterior resection for rectal cancer (10.7%) , and after adjusting for backgrounds, no association was determined between the hospital characteristics and the outcome.
・Our study results did not provide positive support for the consolidation and centralization of hospitals based solely on hospital case volume, at least in the Chushikoku region.

Hasumi Y, Hirota Y, Nishimura M. Effect of weekend hospitalization on the duration of fasting in patients with aspiration pneumonia. J Gen Fam Med 2022 June 13;23(5):336-342 ; DOI: 10.1002/jgf2.564

Takahashi H, Terada I, Higuchi T, Takada D, Shin J , Kunisawa S, Imanaka Y. The relationship between new PCR positive cases and going out in public during the COVID-19 epidemic in Japan. PLOS ONE 2022 May 26;17(5):e0266342. Published: May 26, 2022 ; PMID: 35617292 ; DOI: 10.1371/journal.pone.0266342 ; [鍵となる図] ; [Key Figure]

★・本邦のCOVID-19の第一波と第二波の各期間における新規PCR陽性者数と外出行動に関連する4つの指標（人流、外出に関するWeb検索指標、飲食店閲覧回数、ホテル宿泊者数）との関係について、公開データを用いて相互相関解析を行った。
・同指標を第一波と第二波で比較すると、異なるタイムラグ・変化の方向性が見られ、各外出指標間での比較では第二波は第一波より指標間での違いが大きく見られた。
・新たな政策が実施された第二波期間中の方が外出をめぐる人々の行動の複雑さが増しており、PCR陽性者の新規発生数よりも政策こそが、人々の外出行動に影響を与えたことが示唆された。

★・We analyzed the relationship between the number of new PCR positive cases and four indicators of people going out in public during the first and second waves of the COVID-19 in Japan on publicly available data using cross-correlation analysis.
・Comparison of the same indicator between the first and second waves showed different lags and directions of change, and comparisons between each outgoing indicator showed greater differences among indicators in the second wave than in the first wave.
・The complexity of people's behavior regarding going out increased during the second wave when the new policy was implemented, suggesting that the policy may have affected people's mobility more than the number of new PCR positive cases.

Tsutsumi T, Ishibashi M, Takemura M, Isashiki S, Niwa R, Imanaka Y. Quantification of internal medicine resident inpatient care using Diagnosis Procedure Combination database. Internal Medicine 2022 May 21; Epub ahead of print. ; PMID: 35598990 ; DOI: 10.2169/internalmedicine.8726-21

★・内科学会専門医制度の専攻医登録評価システム（J-OSLER）の示す疾患群を、専攻医の経験する疾患がどれだけカバーしているか、DPCデータを活用して量的に評価できることを示した。
・当方法は、内科専門研修プログラムを評価するツールとして汎用性あるものと期待される。

★・DPC-based quantification of patient encounters during internal medicine residency training is effective in evaluating the coverage of the current J-OSLER list.
・Owing to its wide availability and generalization, this method could be used as a universal tool in assessment of internal medicine programs.

Morishita T, Takada D, Shin J, Higuchi T, Kunisawa S, Fushimi K, Imanaka Y. Effects of the COVID-19 pandemic on heart failure hospitalizations in Japan: interrupted Time Series Analysis. ESC Heart Failure 2022 2022 Feb;9(1):31-38. Epub 2021 Dec 16. ; PMID: 34913269 ; DOI: 10.1002/ehf2.13744 ; [鍵となる図] ; [Key Figure]

★・本邦におけるCOVID-19の第1波が心不全入院数に与えた影響について、DPCデータベースを用いて分割時系列分析した。
・緊急事態宣言前後で心不全による入院が減少したことが示されたが、ACEIやARBの処方割合や院内死亡率に悪影響を与えなかった。

★・Using DPC data, we examined the impact of the declaration of a state of emergency on heart failure admission in Japan.
・There was a statistically significant decrease in the number of hospitalizations for heart failure immediately after the declaration of a state of emergency by using interrupted time series analyses.
・The proportion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescriptions did not change before or after the declaration of the emergency.
・In-hospital crude mortality rates also did not worsen before or after the declaration of an emergency.

Lee S, Fujita K, Morishita T, Oiwa K, Tsukasaki H, Negoro E, Hara T, Tsurumi H, Ueda T, Yamauchi T. Association of the Geriatric 8 with treatment intensity and prognosis in older patients with diffuse large B-cell lymphoma. Br J Haematol 2021 Jul;194(2):325-335 ; PMID: 34041751 ; DOI: 10.1111/bjh.17554

Tsunemitsu A, Tsutsumi T, Inokuma S, Imanaka Y. Effects of hospitalist co-management for hip fractures. Journal of Orthopaedic Science 2022 Nov 25:S0949-2658(22)00316-5 ; PMID: 36443140 ; DOI: 10.1016/j.jos.2022.11.004 ; [鍵となる図] ; [Key Figure]

★本邦の1病院において、大腿骨近位部骨折患者に対して整形外科とホスピタリストの共同診療を導入した影響を、整形外科単独での診療と比較した。共同診療は、分割時系列解析では手術待機時間を1.2 日 (95% 信頼区間; -1.9 〜 -0.4) 短縮させた。さらに、入院中の骨粗鬆症治療薬の導入率を向上させ(46.4% vs. 6.3%)、深部静脈血栓症予防のガイドライン遵守率を向上させた(99.3% vs. 88%)。

★The effects of hospitalist co-management in patients with hip fractures in a Japanese hospital was compared to orthopedic surgeon-led care. Hospitalist co-management decreased time to surgery by 1.2 days (95% CI; -1.9 〜 -0.4) in an interrupted time series analysis. It also improved the rate of initiation of osteoporosis treatment during hospitalization (46.4% vs. 6.3%) and adherence rate to guidelines for deep vein thrombosis prophylaxis (99.3% vs. 88%).

Nagano H, Shin J, Morishita T, Takada D, Kunisawa S, Fushimi K, Imanaka Y. Hospitalization for ischemic stroke was affected more in independent cases than in dependent cases during the COVID-19 pandemic: an interrupted time series analysis. PLOS ONE 2021 Dec 17;16(12):e0261587 ; PMID: 34919571 ; DOI: 10.1371/journal.pone.0261587 ; [鍵となる図] ; [Key Figure]

★・本邦におけるCOVID-19の第1波が脳梗塞入院数に与えた影響について、DPCデータベースを用いて分割時系列分析した。
・緊急事態宣言後に脳梗塞入院症例数は減少しており、その割合は自立群が非自立群より大きかったことが示された。
・血栓溶解療法、血管内治療を受けた入院症例が占める割合は有意な減少を認めなかった。

★・We analyzed the impact of the first wave of COVID-19 on the number of hospitalized patients with ischemic stroke on DPC database using interrupted time-series (ITS) analysis.
・The ITS analysis showed a significant decrease in the number of ischemic stroke cases hospitalized. The proportion of decline in the independent group was larger than that in the dependent group.
・The ITS analysis showed that there was no significant change in the proportions of inpatient cases receiving intravenous thrombolysis and endovascular intervention.

Okuno T, Itoshima H, Shin J, Morishita T, Kunisawa S, Imanaka Y. Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan. PLOS ONE 2021 Nov 22;16(11):e0260446 ; PMID: 34807945 ; DOI: 10.1371/journal.pone.0260446 ; [鍵となる図] ; [Key Figure]

★・医療現場に大きな混乱を招いたCOVID-19の第1波において、高齢認知機能障害患者に対する身体拘束実施への影響を、QIPデータベースを用いて解析した。
・ITS解析を行い、コロナ陽性患者を受け入れた病院での身体拘束実施割合増加を認めた。
・コロナ陽性患者受け入れ病院では、ひっ迫する医療現場に加え、医療スタッフの精神的身体的負担が本結果に影響した可能性がある。

★・We evaluated the impact of changes due to the COVID-19 pandemic on physical restraint among elderly patients with cognitive impairment in acute care hospitals using the QIP database.
・The ITS analysis showed an increase in the rate of physical restraint use in hospitals received COVID-19 positive patients.
・Medical staff especially working for hospitals received the Covid 19 positive patients were under pressure owing to the heavy workload, higher risk of infection and prejudice, which may affect our results.

Watanabe S, Shin J, Morishita T, Takada D, Kunisawa S, Imanaka Y. Medium-Term Impact of the Coronavirus Disease 2019 Pandemic on the Practice of Percutaneous Coronary Interventions in Japan. Journal of Atherosclerosis and Thrombosis 2022 2022;29(11):1571-1587. Published: 2022/11/01 Advance Online Publication2021/12/18 ; PMID: 34924456 ; DOI: 10.5551/jat.63194 ; [鍵となる図]

★・日本におけるCOVID-19流行がPCIの実施にどのような中期的な影響を与えたか、QIPデータベースを用いて解析した。
・最初の流行においては、その後の流行に比較し、PCI症例数は大きく減少し、予定PCIは緊急PCIに比較し減少は大きかった。減少は、流行開始後約１年にわたって続いた。
・緊急PCIの院内死亡割合は、流行開始において、有意な変化は見られなかった。

★・DPC data from QIP database were analyzed to clarify the medium term impact of the COVID-19 epidemic on practice of PCIs in Japan.
・The COVID-19's impacts on volumes of PCIs were larger in the first surge than the subsequent, larger in the elective than in the emergency, and continued for approximately one year after the emergence of the epidemic.
・During the epidemic of the COVID-19, in-hospital mortality of cases undertaking emergency PCIs did not change.

Tsutsumi I, Tsutsumi Y, Yoshida C, Komeno T, Imanaka Y. Impact of the Clinical Trials Act on noncommercial clinical research in Japan: An interrupted time-series analysis. Journal of Epidemiology 2022 Jan 5;32(1):27-33 ; PMID: 34690242 ; DOI: 10.2188/jea.JE20210051 ; [鍵となる図] ; [Key Figure]

★＜臨床研究法の施行後、臨床研究の新規件数は大きく減少、特に小規模研究で減少＞
・新薬の臨床試験に係る相次ぐ不正事件を背景に、不正の防止と国民の信頼の確保を目的として、2018年4月から臨床研究法が施行された。その施行が新規臨床研究数に及ぼす影響を、臨床研究レジストリのデータを用いて分割時系列分析で解析した。
・臨床研究法施行直後に、新規臨床試験の月次件数は急落した。月次件数の変化率も大幅に減少した。
・企業が出資する大規模な臨床研究では影響は比較的小さく、サンプルサイズが小さいもの、資金源が非営利のものなど人的・金銭的支援の少ない臨床研究で、新規の月次件数の減少率が特に大きかった。
・臨床研究の裾野を萎ませ、若手の挑戦を妨げることのないよう、我が国の臨床研究を育てる追加施策が必要であろう。

★・We used publicly available data from the University Hospital Medical Information Network (UMIN-CTR), a clinical research registry, to examine the impact of the Clinical Trials Act (CTA) implementation on the number of new clinical studies using an interrupted time-series analysis (ITSA) approach.
・The rate of change in the number of new clinical studies per month decreased significantly in the first year after the CTA enforcement compared to the period before the CTA enforcement. There was also a significant decrease in the number of monthly studies immediately after the CTA was enacted.
・Analyses using the multigroup ITSA showed that the rate of decline in the monthly number of new studies was particularly large for studies with small sample sizes, intervention studies, and studies with nonprofit funding sources. It was suggested that studies with less human and financial support may have been more affected by the Clinical Research Act.

Mukai T, Tsutsumi T, Takaishi E, Hamada O, Sasaki S, Shimokawa T, Imanaka Y. Nurse Practitioner's Geriatric Practice in Japanese Postacute Care Setting. The Journal for Nurse Practitioners 2021 17(10):1250-1255 ; DOI: 10.1016/j.nurpra.2021.08.002

★・診療看護師（Nurse Practitioner：NP）の導入の影響を前向き観察研究で評価した。
・高齢者医療においてNPの導入によるメリットが量的に評価された。日本における今後のタスクシフトのあり方が示唆される。

★・The quality of comprehensive geriatric assessment and medication reconciliation by a nurse practitioner (NP) based in Japan was evaluated by a prospective observational study.
・NPs were suggested to have benefits toward geriatric care that may allow for much-needed task shifting in Japan.

Kishimoto K, Kunisawa S, Fushimi K, Imanaka Y. Individual and nationwide costs for cancer care during the first year after diagnosis among children, adolescents, and young adults in Japan. JCO Oncology Practice 2022 Mar 3;18(3)e351-e359 ; PMID: 34570620 ; DOI: 10.1200/OP.21.00364 ; [鍵となる図] ; [Key Figure]

★＜若年がん患者に関する経済的評価や政策立案を促進するため小児・思春期若年成人（AYA）患者が診断後1年間に要する医療費を推計した＞
・若年層においてがんは主要な死因の一つであり、がん治療は患者や社会に大きな経済的影響を与えることが知られている。
・成人がんの既報（年間医療費 前立腺がん 平均739,147円、子宮頚がん 平均474,756円）と比較し、我が国における小児・AYAがんの診断後1年間患者1人当たり医療費は高額であり、小児（平均 10,029,310円、中央値 8,325,420円、四分位範囲 2,475,160 - 16,690,510円）がAYA（平均 4,089,087円、中央値 1,865,350円、四分位範囲 795,390 - 4,765,085円）より高かった。
・小児・AYAがん患者の診断後1年間国内総医療費は 348.3億円（95％信頼区間 250.8 - 445.7億円）と推計された。

★＜Individual and nationwide costs for cancer care during the first year after diagnosis among children, adolescents, and young adults (AYAs) in Japan were estimated as a foundation for economic evaluation and health policy planning.＞
・Cancer is one of the leading causes of death among younger age groups, and the burden of cancer in young age groups has been reported to be remarkably high.
・The 1-year individual cost was higher in children (mean 10,029,310, median 8,325,420, IQR 2,475,160 to 16,690,510 JPY) than in AYAs (mean 4,089,087, median 1,865,350, IQR 795,390 to 4,765,085 JPY), and these costs were markedly higher than recently reported annual cancer care costs in Japanese adult patients (prostate cancer, mean 739,147 JPY; cervical cancer, mean 474,756 JPY).
・The 1-year nationwide cost after diagnosis was estimated as 34.83×109 (95% CI 25.08×109 to 44.57×109) JPY.

Kohori-Segawa H, Uematsu H, Dorji N, Wangdi U, Dorjee C, Yangchen P, Kunisawa S, Sakamoto R, Imanaka Y. Gender with marital status, cultural differences, and vulnerability to hypertension: Findings from the national survey for noncommunicable disease risk factors and mental health using WHO STEPS in Bhutan. PLOS ONE 2021 Vol.16 Issue 8 Pages e0256811 ; PMID: 34464428 ; DOI: 10.1371/journal.pone.0256811

★<ブータン王国における高血圧の脆弱性に対する社会文化背景格差>
・女性は男性に比べて離別死別別居中の人が婚姻中や未婚よりも高血圧の罹患率が高かった。
・言語別ではシャショップ語やネパール語を話す人がゾンガ語や英語を話す人に比べて高血圧の罹患率が高かった。
・たばこを使用している人の高血圧の罹患率は低かった。過剰な塩分摂取など他の生活習慣のリスクは他国の既知のリスクと同様であった。

★・Women had a higher odds ratio than men when married, and when separated, divorced, or widowed.
・People who speak the Tshanglakha language scored the highest odds, Lhotshampakha was higher than Dzongkha after adjusting for various social and biomedical factors.
・Tobacco use displayed decreased odds for hypertension.
・To promote the early detection and prevention of hypertension, cultural factors also should be considered even within small geographic areas, such as Bhutan.

Umegaki T, Kunisawa S, Nishimoto K, Nakajima Y, Kamibayashi T, Imanaka Y. Paraplegia after open surgical repair vs thoracic endovascular aortic repair for thoracic aortic disease: a retrospective analysis of Japanese administrative data. Journal of Cardiothoracic and Vascular Anesthesia 2022 2022 Apr;36(4):1021-1028. ; PMID: 34446324 ; DOI: 10.1053/j.jvca.2021.07.043

★<胸部大動脈疾患に対する開心術と血管内治療における術後対麻痺についての検討>
・胸部大動脈疾患に対する開心術と血管内治療 (TEVAR) の術後対麻痺についてQuality Indicator/Improvement Project (QIP) における多施設のDPCデータベースを用いて評価した.
・術後対麻痺の発生率は開心術で3.0%, TEVARで2.3%であった (P=0.36). 開心術に対するTEVARのオッズ比は逆数重み付け法で0.81 (95%信頼区間: 0.42-1.59) , 操作変数法で0.88 (0.42-1.86) であった.
・胸部大動脈疾患に対する開心術と血管内治療 (TEVAR) で術後対麻痺の発生率の差はみとめなかった.

★・For this study, data were acquired from a DPC database containing clinical information and administrative data routinely collected from participating hospitals by the Quality Indicator/Improvement Project (QIP).
・We comparatively assessed the postoperative paraplegia risk between open surgical repair and TEVAR in patients with thoracic aortic disease.
・The incidence of postoperative paraplegia was similar between the groups (open surgical repair group: 3.0%; TEVAR group: 2.3%; P = 0.36). The odds ratios of paraplegia for TEVAR (relative to open surgical descending aortic repair) were 0.81 (95% confidence interval: 0.42-1.59) in the inverse probability of treatment weighted-model and 0.88 (0.42-1.86) in the instrumental variable model
・There were no statistical differences in the risk of paraplegia between open surgical repair and TEVAR in thoracic aortic disease patients.

Shin J, Lin H, Imanaka Y. COVID-19 Impact on the Japanese Healthcare System and Comparison of its Countermeasures With South Korea and Taiwan. IJQHC Communications 2021 1(1):lyab008 ; DOI: 10.1093/ijcoms/lyab008

★＜日本の医療システムにおけるCOVID-19の影響と、日本・韓国・台湾のCOVID-19対策の比較＞
・日本・韓国・台湾は他の国々と比べ、COVID-19をよくコントロールしてきた。
・しかし、COVID-19陽性患者数が比較的に少ない日本においても、急性期病院への影響が大きかった。
・日本のCOVID-19対策は、韓国と台湾に比べて緩く、実施開始が遅い傾向があり、国民の協力に大きく依存していた。

★・Asian countries had generally controlled the pandemic better than other countries.
・The number of COVID-19 cases is comparatively low in Japan, our studies show the impact is significant.
・Japanese measures were less strict, less prompt, and less comprehensive compared to those of South Korea and Taiwan, and heavily relied on people's self-restraint.

Bun S, Kishimoto K, Shin J, Maekawa T, Takada D, Morishita T, Kunisawa S, Imanaka Y. Impact of the COVID-19 pandemic on asthma exacerbations in children: a multi-center survey using an administrative database in Japan. Allergology International 2021 Oct;70(4):489-491 ; PMID: 34281768 ; DOI: 10.1016/j.alit.2021.06.001 ; [鍵となる図] ; [Key Figure]

★＜COVID-19流行期におけるぜん息発作の実態調査＞
・入院を必要とするぜん息発作はCOVID-19流行期に劇的に減少した。
・入院患者におけるネブライザーの処方はCOVID-19流行期に減少し、その一方でpMDIの処方は増加傾向がみられた。

★Our data demonstrated 1) a dramatic decrease in pediatric patients with asthma exacerbations who required hospital admission, and 2) a decrease in the prescription of inhaler solutions during hospitalization during the COVID-19 pandemic.

Charani E, McKee M, Ahmad R, Balasegaram M, Bonaconsa C, Merrett GB, Busse R, Carter V, Castro-Sanchez E, Franklin BD, Georgiou P, Hill-Cawthorne K, Hope W, Imanaka Y, Kambugu A, Leather AJ, Mbamalu O, McLeod M, Mendelson M, Mpundu M, Rawson TM, Ricciardi W, Rodriguez-Manzano J, Singh S, Tsioutis C, Uchea C, Zhu N, Holmes AH. Optimising antimicrobial use in humans – review of current evidence and an interdisciplinary consensus on key priorities for research. Lancet Regional Health Europe 2021 Jun 29;7:100161 ; PMID: 34557847 ; DOI: 10.1016/j.lanepe.2021.100161

★＜抗菌薬使用の最適化研究の優先事項：エビデンス・レビューと国際・学際的コンセンサス＞
・薬剤耐性の広がりは2021年G７の焦点である。
・今後、「新薬の開発」とともに、「既存薬の効果の維持・最大化」が必要である。
・政策と戦略計画、薬剤管理と処方システム、処方を最適化する技術、コンテキスト・文化・行動の四領域において、エビデンスのレビューと国際的ステイクホルダーの学際的議論により、薬剤耐性の優先度高い研究課題を同定した。

★・The pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting.
・We need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents.
・We identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours.

Itoshima H, Shin J, Takada D, Morishita T , Kunisawa S, Imanaka Y. The impact of the COVID-19 epidemic on hospital admissions for alcohol-related liver disease and pancreatitis in Japan. Scientific Reports 2021 11(1):14054 ; PMID: 34253741 ; DOI: 10.1038/s41598-021-92612-2 ; [鍵となる図] ; [Key Figure]

★＜COVID-19蔓延がアルコール性肝疾患・膵炎の入院に及ぼす影響＞
・全国多施設（QIPプロジェクト）で精査したところ、COVID-19禍の自粛期間中、アルコール関連肝疾患・膵炎の1,000入院あたりの入院率が1.2倍増加していた。
・アルコール関連肝疾患・膵炎の入院率は女性で特に増加していた。
・自粛期間中の飲酒についてはよく注意する必要があろう。

★・We found that the rate of admissions per 1,000 admissions during the COVID-19 epidemic period (April 2020 to June 2020) was 1.2 times compared to the pre-epidemic period (July 2018 to March 2020) by using QIP project database.
・Analyses stratified by sex revealed that the increases in admission rates of alcohol-related liver disease or pancreatitis for females were higher than for males during the COVID-19 epidemic period.
・During the COVID-19 epidemic, we should pay attention to the problem of harmful alcohol consumption.

Teraoka E, Kunisawa S, Imanaka Y. Trajectories of end-of-life medical and long-term care expenditures for older adults in Japan: retrospective longitudinal study using a large-scale linked database of medical and long-term care claims. BMC Geriatrics 2021 30;21(1):403 ; PMID: 34193081 ; DOI: 10.1186/s12877-021-02215-9

★死亡前５年間の医療費、介護費及びその合計は16,084症例において、６つの異なる軌跡に類型化された。それぞれの特性を見ると、高値持続型では、慢性疾患、臓器不全、神経変性疾患、骨折、経管栄養が関連した。終末期医療の質向上とそれを支える財源の検討に重要な知見である。

★We analyzed trajectories of medical and long-term care expenditures and their sum of 16,084 individual cases during the 60 months before the date of death. We identified six distinct spending trajectories for the total care expenditures. Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. This finding has implications for improving the quality of end-of-life care and its financial foundation.

Nagano H, Takada D, Shin J, Morishita T, Kunisawa S, Imanaka Y. Hospitalization of mild cases of community-acquired pneumonia decreased more than severe cases during the COVID-19 pandemic. International Journal of Infectious Diseases 2021 May; 106: 323–328. ; PMID: 33794382 ; DOI: 10.1016/j.ijid.2021.03.074 ; [鍵となる図] ; [Key Figure]

★日本のおける市中肺炎の入院患者数と重症度に対するCOVID-19流行の影響をDPCデータを用いて分析した。COVID-19流行時（2020年3-7月）に市中肺炎の入院患者は前年度と比較し-45.2%と大きく減少した一方で、緊急入院は一時的な減少にとどまった。A-DROPで重症度別に分析すると、軽症例で入院数の前年度比の減少は大きかった（軽症 -55.2%, 中等症 -45.8%, 重症 -39.4%, 超重症 -33.2% )

★Based on administrative claims data, we evaluated the impact of the COVID-19 epidemic on the number and severity of inpatients for CAP in Japan. During the COVID-19 epidemic (between March and July 2020), the number of inpatient cases for CAP drastically decreased during the epidemic compared with the same period in the past year (-45.2%), despite only a temporary reduction in the number of other urgent admissions. According to the severity score “A-DROP”, milder cases showed a greater decrease in the year-over-year ratio than severe ones (mild -55.2%, moderate -45.8%, severe -39.4%, and extremely severe -33.2%).

Kishimoto K, Bun S, Shin J, Takada D, Morishita T, Kunisawa S, Imanaka Y. Early impact of school closure and social distancing for COVID-19 on the number of inpatients with childhood non-COVID-19 acute infections in Japan. European Journal of Pediatrics 2021 Sep;180(9):2871-2878 ; PMID: 33791861 ; DOI: 10.1007/s00431-021-04043-w ; [鍵となる図] ; [Key Figure]

★COVID-19に対する一斉休校が小児急性感染症の入院患者数に及ぼした影響をDPCデータを用いて分析した。一斉休校後（2020年3月-6月）に小児急性感染症の入院患者数は大幅に減少した。この変化は就学前の年少児において、特に気道感染症と消化管感染症において顕著であった。

★Based on administrative claims data, we confirmed a marked reduction in the number of inpatients for childhood non-COVID-19 acute infections in the post-school-closure period (March – June 2020) in Japan. The main part of the reduction was for pre-school children, particularly in respiratory infection and gastrointestinal infection groups.

Okuno T, Takada D, Shin J, Morishita T, Itoshima H, Kunisawa S, Imanaka Y. Surgical volume reduction and announcement of triage during the 1st wave of the covid-19 pandemic in Japan: a cohort study using interrupted time series analysis. Surgery Today 2021 21:1–8 ; PMID: 33881619 ; DOI: 10.1007/s00595-021-02286-6 ; [鍵となる図] ; [Key Figure]

★新型コロナウイルス感染症（COVID-19）のパンデミックを受けて，日本の各外科学会は手術トリアージを表明した。 本研究では、手術トリアージ声明が、COVID-19第 1 波における予定手術の減少に影響を与えたかどうかを明らかにすることを目的とした。 2018 年 7 月 1 日から 2020 年 6 月 30 日までの間に予定入院で主要な手術を受けた490,719 症例を抽出した。 手術の分類をした後、分時系列解析（ITS）を実施し、トリアージ声明による各手術症例数の減少への影響を検証した。 ITS解析の結果、日本の各外科学会の声明に基づき、トリアージ優先度の低い手術では検定上有意な症例数の減少を認めた。

★Each surgical society stated surgical triage because of the Coronavirus Disease (COVID-19) pandemic. We aimed to identify whether the announcement of surgical priorities by each Japanese surgical society affected the surgical volume decline during the 1st wave of this pandemic. We extracted 490,719 available cases of patients who had elective major surgeries between July 1, 2018, and June 30, 2020. After categorization of surgical specialties, we conducted an interrupted time series analysis (ITS) to validate the decline of each surgical procedure. The ITS analysis showed that non-critical surgeries showed obvious and statistically significant declines in case volume during the 1st wave of the COVID-19 pandemic based on the statement of each surgical society in Japan.

Morishita T, Takada D, Shin J, Higuchi T, Kunisawa S, Imanaka Y. Trends, Treatment Approaches, and In-Hospital mortality for Acute Coronary Syndrome in Japan During the Coronavirus Disease 2019 Pandemic. Journal of Atherosclerosis and Thrombosis 2021 Apr 1. Epub ahead of print ; PMID: 33790127 ; DOI: 10.5551/jat.62746

★日本における新型コロナウイルス感染症パンデミックに対する緊急事態宣言前後での急性冠症候群への診療への影響を分割時系列デザインによる解析で検討した。緊急事態宣言の直後から急性冠症候群（急性心筋梗塞+不安定狭心症）の入院数は統計学的に有意に減少していた。急性冠症候群に対する経皮的冠動脈インターベンション、冠動脈バイパス手術、線溶療法の割合は緊急事態宣言の前後で変化が見られなかった。院内粗死亡率も緊急事態宣言の前後で悪化は見られず、背景因子を調整したロジスティック回帰分析でも同様であった。

★We examined the impact of the declaration of a state of emergency on the treatment of acute coronary syndromes in Japan. There was a statistically significant decrease in the number of hospitalizations for acute coronary syndromes (acute myocardial infarction and unstable angina) immediately after the declaration of a state of emergency by using interrupted time series analyses. The rates of percutaneous coronary intervention, coronary artery bypass graft surgery, and fibrinolysis for acute coronary syndromes did not change before or after the declaration of the emergency. In-hospital crude mortality rates also did not worsen before or after the declaration of an emergency. The risk-adjusted logistic regression analysis also confirmed that the COVID-19 pandemic did not affect the in-hospital mortality.

Shin J, Mizuno S, Okuno T, Itoshima H, Sasaki N, KunisawaS, Kaku M, Yoshida M, Gu Y, Morii D, Shibayama K, Ohmagari N, Imanaka Y. Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals. BMC Infectious Diseases 2021 21:234 ; PMID: 33639873 ; DOI: 10.1186/s12879-021-05921-2

★医療機関における病院感染対策の全体像を把握するため、2015 年時点の基幹型臨床研修病院（ n=1,017 ）を対象とし、調査票調査を行った。調査票調査は、年次変化についても評価するため、約 1 年の間隔で 2 回（ 1 回目： 2016 年 11 月、 2 回目： 2018 年 2 月）実施した。回答病院（1回目： 683 病院、2回目：563 病院）の中、感染制御チーム（ICT ）の活動が行われている病院は 99% を超えていたが、その活動内容には病院により差があり、「抗菌薬が開始された患者に対する介入基準が定められている」病院は約 7 割、抗 MRSA 薬と広域抗菌薬の使用基準がある病院はそれぞれ約 6 割、 5 割に留まっていた。サーベイランスは、手術部位感染や中心静脈カテーテル関連血流感染に対しては約 7 割の病院が行っていたが、カテーテル関連尿路感染のサーベイランスの実施割合は約 5 割、人工呼吸器関連肺炎のサーベイランスの実施は約 4 割に留まっていた。

★We posted questionnaires to all teaching hospitals (n=1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys wereconducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals. The number of valid responses was 678 (response rate, 55.0%) for the 1st survey and 437 (43.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly70% had their own intervention criteria for antibiotics therapies, whereas only about 60% and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50% and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associatedpneumonia, respectively. Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, whichis reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses.

Okuno T, Kunisawa S, Fushimi K, Imanaka Y. Intra-operative autologous blood donation for cardiovascular surgeries in Japan: a retrospective cohort study. PLOS ONE 2021 16(3):e0247282. ; PMID: 33690678 ; DOI: 10.1371/journal.pone.0247282 ; [鍵となる図] ; [Key Figure]

★心臓血管外科手術における希釈式自己血輸血と周術期輸血割合・輸血量の減少との関連をDPCデータを用いて評価した。予定入院後に心臓・大動脈手術を受けた32,433例と4,267例を対象とし、マルチレベル傾向スコアマッチングを行った。日本人患者の場合、欧米で推奨されている大量希釈式自己血輸血でなくても、輸血率や輸血量を減少させる可能性があることが示された。【京都大学HP】"最新の研究成果を知る"

★Large volume intra-operative autologous blood donation (IAD) is difficult to perform for Japanese patients, who are physically small. We evaluated the association between IAD and decrease in perioperative transfusion in cardiovascular surgery using a Japanese administrative database. We enrolled 32,433 and 4,267 patients who underwent cardiac and aortic surgeries. Multilevel propensity score matching showed that IAD could reduce the transfusion rate or amount of red blood cells for Japanese patients, even when the IAD volume was not large.

Shin J, Takada D, Kunisawa S, Imanaka Y. Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure, hospitalization, and worsening of diabetes: an observational study using medical, dental, and pharmacy claims data in Japan. Journal of Clinical Periodontology. 2021 Jun;48(6):774-784 ; PMID: 33544396 ; DOI: 10.1111/jcpe.13441

★某県の国民健康保険・後期高齢者医療制度レセプトデータ（医科・歯科・調剤）から、2015年度に糖尿病薬の処方のある35歳以上の患者の歯周疾患の管理有無および医療費、入院有無を3年間観察した。解析対象患者は、16,583人で、歯周疾患の管理を2年間毎年1回以上行った患者は、管理を受けなかった患者より3年目の医療費が4％減少（adjusted multiplier 0.96, 95% CI: 0.92–1.00）、3年目の入院が10％減少した（aOR 0.90, 95% CI: 0.82–0.98）。観察期間の1～2年目にインスリン投与のなかった13,222人を対象とした解析では、2年間毎年1回以上の歯周疾患管理を受けた患者において3年目にインスリン投与の開始が23％減少した（aOR0.77, 95% CI: 0.64–0.92）。

★We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. The results of the 3-year follow-up showed that the annual healthcare expenditure in the third yearwas 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92–1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82–0.98). The aOR of introducing insulinin the third year for those who had not been prescribed insulin during the previous two years (n=13,222) was 0.77 (95% CI: 0.64–0.92) in the group receiving periodontal management every year.

Okuno T, Takada D, Shin J, Morishita T, Itoshima H, Kunisawa S, Imanaka Y. Impact of the early stage of the coronavirus disease 2019 pandemic on surgical volume in Japan. British Journal of Surgery 2021 znab028,13 February ; PMID: 33793774 ; DOI: /10.1093/bjs/znab028 ; [鍵となる図] ; [Key Figure]

★COVID-19の感染拡大早期における、日本の予定手術件数を前年度比で算出した。8診療科区分のうち、いずれも4月から減少し5月で最低値となり、特に眼科(全年度比52.1％)と耳鼻咽喉科(28.1%) で減少率が大きかった。今後の感染拡大も考慮しつつ、積み残し手術をいかに処理していくかが肝要である。

★The year-over-year trend of scheduled surgeries in Japan during the early stage of the COVID-19 pandemic was calculated. All eight surgical categories, especially ophthalmologic and ear/nose/throat (ENT) surgeries, decreased from April 2020 and reached a minimum in May 2020 (ophthalmologic, 52.1%; ear/nose/throat, 28.1%). It is important to take into account the spread of infection in the future and how to deal with backlog surgeries.

Takada D, Kunisawa S, Imanaka Y. Stages of a transtheoretical model as predictors for the decline of estimated glomerular filtration rate: a retrospective cohort study. Journal of Epidemiology 2022 Jul 5;32(7):323-329. ; PMID: 33487611 ; DOI: 10.2188/jea.JE20200422 Epub 2021 Jul 10.

★・協会けんぽ京都支部の経年的な健診・医療レセプトデータを用いて行動変容ステージモデルにおけるステージが腎機能低下に及ぼす影響を調べた
・ステージが高い集団は翌年の健康行動の改善割合が高く、年齢性別などの他に糖尿病や高血圧や脂質代謝異常症などで調整しても、有意に腎機能低下 (eGFR30%以上の低下)のリスクを軽減した。
・自分がどんな健康行動をすべきか「知っている」だけでは意味がなくて(無関心な人に比べて有意差はなくて)、「これからどんな行動をすべきか具体的に想像できている(と本人が思っている)」と、その後の腎機能低下を遅らせれる可能性を示している

★Compared with the risk associated with the precontemplation stage (stage 1), the preparation, action, and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.It is not enough to "know" what health actions one should take (there is no significant difference compared to those who are indifferent), but if one "can imagine what actions he should take in the future," it is possible to delay the subsequent decline in kidney function.

Becker CB, Taniyama Y, Kondo-Arita M, Sasaki N, Yamada S, Yamamoto K. Unexpected costs of bereavement grief in Japan: Patterns of increased use of medical, pharmaceutical and financial services. OMEGA - Journal of Death and Dying 2021 Feb 2;30222821992193 ; PMID: 33530889 ; DOI: 10.1177/0030222821992193

★遺族の悲嘆は、その精神的・身体的影響により医療、薬剤、金銭面・法的サービスへの依存度が高まるといわれ、日本全国の実態につき調査を実施した。50才台、雇用されていない寡婦、特に高い所得層で依存度が高まり、仕事や生活に深刻な影響を及ぼす’presenteeism’も報告された。同集団は医療費・薬剤費を常用使用群の2.7倍使用し、政府負担は4-10倍となることが示唆され、うち半数は自己負担分を重荷に感じていた。遺族の健康改善策について費用対効果研究が将来必要だろう。

★Our Japan-wide survey (n=1,078) revealed that bereaved who showed increased reliance on medical, pharmaceutical, and financial/legal services was in the ‘50’s age bracket, and for unemployed widows; it corresponded less with low annual income than with high income. Increased users reported their decline in physical health seriously influencing their work and lives, suggesting “presenteeism”. Moreover, they spent 2.7 times more for medical and pharmaceutical services than those reporting continual use, portending 4 to 10 times more Japanese government expense for this group, half of whom considered their own out-of-pocket expenses a financial burden.

Shin J, Takada D, Morishita T, Lin H, Bun S, Teraoka E, Okuno T, Itoshima H, Nagano H, Kishimoto K, Segawa H, Asami Y, Higuchi T, Minato K, Kunisawa S, Imanaka Y. Economic impact of the first wave of the COVID-19 pandemic on acute care hospitals in Japan. Plos One 2020 15(12):e0244852 ; PMID: 33382838 ; DOI: 10.1371/journal.pone.0244852

★QIP参加病院の2年間（2018年7月～2020年6月）のデータの解析結果、前年同月と比べ、医療費収入（入院＋外来）が2020年4, 5, 6月に7%, 14%, 5%減少した。2020年度4～5月の医療費を目的変数とし、2020年3月までの平均医療費、COVID-19確定・疑い患者の在院日数を説明変数とした回帰分析の結果、全病院において平均6.3%の医療費の減少を認めた。さらに、COVID-19確定患者の在院日数1日当たり、2020年4～5月の医療費327,000円の減少を認め、COVID-19患者受け入れ病院の医療費減少がより大きいことが示唆された。

★We analyzed DPC data between July 2018 and June 2020. In percentage terms, claimed hospital charges, which included both inpatients and outpatients, for April, May, and June 2020 decreased by 7%, 14%, and 5%, respectively, compared to the same months in 2019. The result of the regression analysis showed that the claimed charges for hospitals with COVID-19 patients decreased by an additional 327,000 JPY per day of stay for confirmed COVID-19 patients compared to hospitals without COVID-19 patients. It is suggested that hospitals caring for COVID-19 patients were negatively incentivized.

Otokita S*, Uematsu H*, Kunisawa S, Sasaki N, Fushimi K, Imanaka Y. Impact of rehabilitation start time on functional outcomes after stroke. Journal of Rehabilitation Medicine 2020 Epub ahead of print [*:equal contribution] ; PMID: 33284355 ; DOI: 10.2340/16501977-2775

★脳卒中発症後、リハビリテーション開始のタイミングが患者の機能転帰（mRS）に及ぼす影響を、DPCデータを用いて検証した。入院3日目以降のリハビリテーション開始にて、機能転帰が不良になる可能性が示唆された。

★This study analyzed the impact of rehabilitation start time after stroke in acute hospitals using DPC data. Starting post-stroke rehabilitation on the day of admission or second day of hospitalization may be the optimum timing for functional outcomes.

Sasaki N, Yamaguchi N, Okumura A, Yoshida M, Sugawara H, Shin J, Kunisawa S, Imanaka Y. Factors affecting the use of clinical practice guidelines by hospital physicians : the interplay of IT infrastructure and physician attitudes. Implementation Science 2020 15(1):101 ; PMID: 33239076 ; DOI: 10.1186/s13012-020-01056-1

★全国急性期病院の若手研修医向け調査解析により、診療ガイドラインの積極的使用に関連する要因として、医師の診療習慣、診療ガイドライン関連教育、また整備された病院IT環境と医師の電子媒体嗜好の相互作用が同定された。個人と組織レベルの相互作用を考慮してガイドライン実装戦略をたてることが、診療ガイドラインのさらなる活用促進に繋がることが示唆された。

★This study revealed that physicians’ habitual attitudes, CPG-related education and a combination of individual digital preference and superior hospital IT circumstances, is key to bridging the gap between the use and implementation of CPGs.

Naylor NR, Yamashita K, Iwami M, Kunisawa S, Mizuno S, Castro-Sánchez E, Imanaka Y, Ahmad R, Holmes A. Code-sharing in cost-of-illness calculations: an application to antibiotic-resistant bloodstream infections. Frontiers in Public Health 2020 Nov 27;8:562427 ; PMID: 33330310 ; DOI: 10.3389/fpubh.2020.562427

Groenewoud S, Sasaki N, Westert GP, Imanaka Y. Preferences in end of life care substantially differ between the Netherlands and Japan. Medicine. 2020 99 (44)：e22743,October 30 ; PMID: 33126312 ; DOI: 10.1097/MD.0000000000022743

★終末期医療に関する市民の意思について、日本とオランダを比較調査した。日本人は将来の依存状態について考えることを避ける傾向があり、また終末期の自分は周囲の重荷になると考え、死に場所として病院を好む傾向を認めた。一方、オランダ人は主治医が積極的に終末期に関するアプローチを行うことを好む傾向が強かった。Shared decision makingやAdvanced Care Planningを行う際には、このような国際的な価値観・嗜好の違いを考慮に入れる必要がある。

★Preferences in the end-of-life (EoL) care substantially differ between the Netherlands and Japan. These differences should be taken into account a) when interpreting geographical variation in EoL care, and b) if strategies such as shared decision making or advanced care planning – are considered.

Braithwaite J , Vincent C, Garcia-Elorrio E, Imanaka Y, Nicklin W, Sodzi-Tettey S, Bates D. Transformational improvement in quality care and health systems: the next decade. BMC Medicine 2020 Oct 29;18(1):340 ; PMID: 33115453 ; DOI: 10.1186/s12916-020-01739-y

Shin J, Kunisawa S, Imanaka Y. New outcome-specific comorbidity scores excelled in predicting in-hospital mortality and healthcare charges in administrative databases. Journal of Clinical Epidemiology 2020 Oct;126:141-153. ; PMID: 32540387 ; DOI: 10.1016/j.jclinepi.2020.06.011

★DPCデータを使って新しく算出した重みを用いた併存症指数がCharlson comorbidity indexなどの既存の方法より優秀なパフォーマンスを示した。また、死亡の予測のために開発された併存症指数は医療費や在院日数の予測においては併存症の影響を十分に調整できなかった。そこで、併存症指数の開発に用いた集団と異なる集団、アウトカムと異なる研究のためには、併存症指数を構成する重みの再算出または最新の重みの採用を検討する必要がある。

★The comorbidity scores using the new weights derived from a Japanese inpatient database outperformed previous measures, such as the Charlson comorbidity index. The comorbidity scores developed for predicting mortality could not adjust comorbidity burdens thoroughly in models for predicting hospital charges and length of hospital stay. Thus, for different study populations and outcomes, researchers should consider updating them or adopting the newer weights available.

Uematsu H, Yamashita K, Kunisawa S, Imanaka Y. Prediction Model for Prolonged Length of Stay in Patients with Community-Acquired Pneumonia Based on Japanese Administrative Data. Respiratory Investigation 2020 194-203 ; DOI: 10.1016/j.resinv.2020.08.005

★304の急性期病院DPCデータを用いて市中肺炎における在院日数遷延化予測モデルの構築検証を行った。遷延化に関連する有意な要因は年齢・ADL・FiO2・JCS・貧血等であり、C統計量は0.78（95％CI 0.77-0.98）であった。本研究の予測モデルは肺炎の在院日数遷延化のハイリスク患者を同定し適切な入院管理を行う上で有用であると考えられた。

★The development and validation of prediction models of prolonged length of stay in community-acquired pneumonia was performed using administrative data from 304 acute care hospitals in Japan. Significant factors associated with prolongation were age, ADL, FiO2, JCS, anemia, etc. with C-statistic of 0.78 (95% CI 0.77-0.98). Our prediction model was considered useful in identifying patients at high risk of prolonged length of stay and appropriate hospitalization management.

Kohori-Segawa H, Dorji C, Dorji K, Wangdi U, Dema C, Dorji Y, Musumari PM, Techasrivichien T, Sugimoto-Watanabe SP, Sakamoto R, Ono-Kihara M, Kihara M, Imanaka Y. A qualitative study on knowledge, perception, and practice related to non-communicable diseases in relation to happiness among rural and urban residents in Bhutan. PLOS ONE 2020 (2020 June 29) 15(6): e0234257 ; PMID: 32598347 ; DOI: 10.1371/journal.pone.0234257 ; [鍵となる図]

★本研究は、ブータン人の生活習慣病リスクと幸福に関する包括的な質的研究である。2017年にブータンの農村部と都市部にて、18歳以上の男女、79人を対象に実施した。調査データは、インタビュー、参加型観察、身体測定、写真記録によって収集された。これらの観察結果から、より実践的なNCD教育・予防プログラムの開発が必要であり、多世代、宗教権威者、教育現場、医療サービスを巻き込むことが効果的であることが示唆された。

★This is the first comprehensive qualitative study on the NCD-related lifestyle risks among Bhutanese concerning the concept of happiness. Research was conducted in rural and urban communities of Bhutan in 2017 among 79 inhabitants of both genders, aged ≥18. The data was collected by in-depth interviews, participatory observation, photo documentation, and anthropometric measurements. From these observations, it is recommended that more practical NCD education/prevention programs should be urgently introduced in Bhutan that involve multiple generations, religion authorities, educational settings, and medical services.

Takada D, Kunisawa S, Matsubara T, Fushimi K, Yanagita M, Imanaka Y. Developing and validating a multivariable prediction model for in-hospital mortality of pneumonia with advanced chronic kidney disease patients: a retrospective analysis using a nationwide database in Japan. Clinical and Experimental Nephrology 2020 Aug;24(8):715-724 ; PMID: 32297153 ; DOI: 10.1007/s10157-020-01887-8

★腎不全患者の肺炎重症度の判断にA-DROPを使うと脱水(BUNの上昇)という項目の解釈が難しいので、それをやめて一部のADL指標やBMI,CRPなどの基準を使えば１つ１点の単純なスコアでも非常に高い精度で院内死亡が予測できた

★Seven variables were selected, which includes age (male ≥ 70 years, female ≥ 75 years), respiratory failure, orientation disturbance, low blood pressure, the need of assistance in feeding or bowel control, severe or moderate thinness and CRP 200 mg/L or extent of consolidation on chest X-ray ≥2/3 of one lung. The c-statistics of univariate logistic regression for in-hospital mortality of pneumonia with advanced chronic kidney disease patients was 0.8017 using seven variables, while that was 0.7372 using “A-DROP”

Takahashi T, Otsubo T, Kunisawa S, Sasaki N, Imanaka Y. Factors associated with high-dose antipsychotic prescriptions in outpatients with schizophrenia: An analysis of claims data from a Japanese prefecture. Neuropsychopharmacology Reports 2020 Sep;40(3):224-231 ; PMID: 32452649 ; DOI: 10.1002/npr2.12109

★国民健康保険および後期高齢者医療診療報酬データから外来通院中の統合失調症の患者データを抽出し、抗精神病薬の大量処方と、併用薬処方や精神科医による診察の代替変数としての通院・在宅精神療法加算算定との関連について、ロジスティック回帰分析を行った。抗精神病薬大量処方は、抗不安薬/睡眠薬や気分安定薬との併用とも関連するが、特に抗パーキンソン病薬の併用と強く関連する。抗パーキンソン病薬の処方割合が依然として高く、抗精神病薬の大量処方とともに、改善の余地は大きい。また抗精神病薬の減量について、非精神科医へアプローチが重要であることが示唆された。

★This study focused on high-dose antipsychotic prescriptions in outpatients with schizophrenia using claims data, and aimed to identify their correlates. High-dose antipsychotics were associated with anxiolytics/hypnotics, mood stabilizers, prescription by non-psychiatrists, and were strongly associated with anti-Parkinson's agents. It was suggested that the adjustment of anti-Parkinson's agents and the approach to non-psychiatrists are important with regard to reduction of high-dose antipsychotic prescriptions.

Hirota Y, Kunisawa S, Fushimi K, Imanaka Y. Association between clinic physician workforce and avoidable readmission: a retrospective database research. BMC Health Services Research 2020 ;20(1):125. ; PMID: 32070343 ; DOI: 10.1186/s12913-020-4966-4 ; [鍵となる図] ; [Key Figure]

★本研究では、二次医療圏ごとの診療所医師数と回避可能な再入院との関連を検討した。回避可能な入院歴を持つ65歳以上の患者において、診療所医師数が多い二次医療圏では、回避可能な再入院リスクが低いことが示唆された。

★This study aimed to examine the relationship between clinic physician workforce and unplanned readmission for ambulatory care sensitive conditions (ACSCs). We found that in patients who had history of admision for ACSCs, larger clinic physician workforce prevented the occurrence of readmission for ACSCs.

Umegaki T, Kunisawa S, Nishimoto K, Kamibayashi T,　Imanaka Y. Effectiveness of combined antithrombin and thrombomodulin therapy on in-hospital mortality in mechanically ventilated septic patients with disseminated intravascular coagulation. Scientific Reports 2020 Mar 17;10(1):4874 ; PMID: 32184456 ; DOI: 10.1038/s41598-020-61809-2

★本邦ではアンチトロンビン製剤 (AT) やリコンビナントトロンボモデュリン (TM) は敗血症性DIC症例に広く利用されている. DPCデータを用いて大規模多施設コホート研究を行い, AT単独に比べATとTMの併用療法が退院時転帰に影響するかを検討した. AT群は352病院1,017症例、AT+TM群は349病院1,205症例であった. AT+TMはATに対する院内死亡率のオッズ比が0.98 (P=0.84) であり, 統計学的な有意差はみられなかった. アンチトロンビン製剤単独投与と比べ併用療法が死亡率を改善するという結果は示されなかった.

★Antithrombin (AT) and thrombomodulin (TM) combination anticoagulant therapy is frequently used to treat septic patients with DIC in Japan. In this large-scale multicentre retrospective study of adult septic patients with DIC, we compared in-hospital mortality between AT monotherapy and AT+TM combination therapy. The AT group and AT+TM group comprised 1,017 patients from 352 hospitals and 1,205 patients from 349 hospitals, respectively. AT+TM combination therapy was not significantly associated with lower mortality (odds ratio: 0.98; P=0.84). AT+TM combination therapy is not more effective in improving prognoses than the simpler AT monotherapy.

Muguruma K, Kunisawa S, Fushimi K, Imanaka Y. The epidemiology and volume-outcome relationship of extracorporeal membrane oxygenation for respiratory failure in Japan: A retrospective observational study using a national administrative database. Acute Medicine & Surgery 2020 ; 7: e486 ; PMID: 32076555 ; DOI: 10.1002/ams2.486

★本研究は、本邦における呼吸ECMO症例の予後に対して全ECMO症例の施設症例数が与える影響を明らかにする目的で、2010年7月から2018年3月までのDPC調査研究班データベースを用いた後ろ向きコホート研究を行い、全ECMO症例の施設症例数の増加と呼吸ECMO症例の院内死亡率の低下との関連を示した。呼吸ECMOの集約化の有用性が示唆された。

★Using data from the Diagnosis Procedure Combination database between 1 July 2010 and 31 March 2018, the present study aimed to investigate the possible association between outcomes for respiratory ECMO patients and hospital volume of ECMO treatment for any indications in Japan. The result showed that accumulating the experience of ECMO for any indications could positively affect the outcome of ECMO treatment for respiratory failure, which suggests the effectiveness of consolidating ECMO cases in high-volume centers in Japan.

Morii D, Tomono K, Imanaka Y. Economic impact of antimicrobial-resistant bacteria outbreaks on Japanese hospitals. American Journal of Infection Control 2020 Oct;48(10):1195-1199 ; PMID: 31955855 ; DOI: 10.1016/j.ajic.2019.12.006

Sasaki N, Groenewoud S, Kunisawa S, Westert G, Imanaka Y. Public needs for information disclosure on healthcare performance: Different determinants between Japan and the Netherlands. Medicine 2019 ;98:43(e17690) ; PMID: 31651898 ; DOI: 10.1097/MD.0000000000017690

★病院・地域の医療成績に関し、「情報公開を求める」意思と、「地域間の公平性を求める」意思において日本とオランダを比較調査した。日本人において、総じて情報への関心が比較的低く公平性を強く求めず、中でも都会の若い男性において地域間の公平性を求めない傾向があった。また両国において高齢者、女性は公平性を求める傾向が強かった。医療成績の情報開示では社会経済因子に基づくサブグループの関心等の違いを考慮する必要があろう。

★Regarding citizens’ preference and value towards public disclosure and healthcare equity, analyses based on the online survey revealed sharp contrasts between the two countries. Japanese showed relatively lower interest in knowing information and seemed to accept inequality, while the Dutch mostly showed high interest. Female/older respondents tended to show high interest in obtaining information across countries. Health service stakeholders should recognize the varying willingness and competency to use complex information among subgroups, in order to empower the public.

Lin H, Imanaka Y. Effects of copayment in long-term care insurance on long-term care and medical care expenditure. JAMDA 2019 ; PMID: 31623988 ; DOI: 10.1016/j.jamda.2019.08.021

★日本における2015年8月に年間収入が一定金額以上の介護被保険者にサービス利用際の自己負担を1割から2割に上昇した政策に及ぼす介護・医療サービス利用と費用の影響を、差分の差分法で分析した。介護自己負担割合を上昇に、医療と介護のballon effectが見られることにより、介護政策を策定する際に、医療制度と合わせて検討する必要があると考えられる。

★We used the database to include 570,434 person-month records of 23,879 insured individuals. Conducted difference-in-difference estimations to clarify the difference in long-term care and medical care usage and expenditure before and after the change in the copayment limit for qualifying individuals from 10% to 20% in August 2015 in Japan. The increase in insured individuals' copayment would appear to be a "balloon effect" between long-term care and medical service.

Bun S, Kunisawa S, Sasaki N, Fushimi K, Matsumoto K, Yamatani A, Imanaka Y. Analysis of concordance with antiemetic guidelines in pediatric, adolescent, and young adult patients with cancer using a large‐scale administrative database. Cancer Medicine 2019 ;8:6243–6249 ; PMID: 31469518 ; DOI: 10.1002/cam4.2486

★本研究は、小児および思春期・若年成人（AYA）世代がん患者における抗がん剤の投与時の予防的制吐剤のガイドライン適合率を調査した。ガイドラインの一致率は、成人で報告されているガイドライン一致率である70%-90%と比較し低いものであった。（最小度催吐性リスク51.6%、軽度催吐性リスク5.9%、中等度催吐性リスク32.1%、18歳以上の高度催吐性リスク51.1%、18歳未満のHEC 18.2%）。ガイドライン不一致となる因子は、低年齢児、中等度もしくは高度催吐性リスクの抗がん剤の使用、血液疾患および脳腫瘍が抽出された。またステロイドの使用は催吐リスク分類に関わらず避ける傾向が示された。小児およびAYA世代では制吐剤の使用に関して改善する余地がある可能性が示された。

★This study is the rate of concordance with antiemetic guidelines for CINV in the field of pediatric, adolescent, and young adult. The concordance with the antiemetic guidelines in the pediatric population (MinEC 51.6%、LEC 5.9%、MEC 32.1%、HEC ≥ 18yr 51.1%、HEC < 18yr 18.2%) was lower than that in the adults (70-90%). The factors for discordance were younger age, use of moderate and high emetic risk chemotherapeutic drugs, hematological malignancy, and brain tumor. There is substantial scope to improve the antiemetic practice and reduce the risk of discordance with the antiemetic guidelines in pediatric, adolescent, and young adult patients.

Tsutsumi I, Kunisawa S, Yoshida C, Seki M, Komeno T, Fushimi K, Morita S, Imanaka Y. Impact of oral voriconazole during chemotherapy for acute myeloid leukemia and myelodysplastic syndrome: a Japanese nationwide retrospective cohort study. Int J Clin Oncol 2019 24, pages1449–1458 ; PMID: 31300904 ; DOI: 10.1007/s10147-019-01506-x

★本研究は成人急性骨髄性白血病または骨髄異形成症候群の患者における、化学療法開始後7日以内の経口第一世代アゾール薬処方に対する経口ボリコナゾール処方の有用性をDPCデータを用いて調べた研究である。経口第一世代アゾール薬と比較し、経口ボリコナゾール処方は点滴抗真菌薬使用割合を有意に減少させた（−21.0%, 95%信頼区間 − 33.4 to − 8.6）。65歳未満の患者、および化学療法開始3日以内に処方を開始された患者で特に影響が大きかった。経口ボリコナゾール処方は成人急性骨髄性白血病または骨髄異形成症候群の化学療法中の患者に有用である。

★This study aimed to investigate the effectiveness of oral voriconazole (VRCZ) relative to that of first-generation azoles prescribed within 7 days after the onset of chemotherapy among adult patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) under chemotherapy using the Diagnosis Procedure Combination/Per-Diem Payment System. The result shows that an oral VRCZ prescription was significantly associated with a reduction in the proportion of patients switching to intravenous antifungal agents compared to first-generation azole prescription by 21.0% (95% confidence interval [CI] − 33.4 to − 8.6). The impact of oral VRCZ in reducing the proportion of patients switching to intravenous antifungal agents was stronger in patients aged < 65 years and in patients prescribed oral azole within 3 days from the onset of chemotherapy. Oral VRCZ administration may benefit adult patients with AML/MDS undergoing chemotherapy.

Nakabe T, Sasaki N, Uematsu H, Kunisawa S, Wimo A, Imanaka Y. Classification tree model of the personal economic burden of dementia care by related factors of both people with dementia and caregivers in Japan: a cross-sectionalonline survey. BMJ Open 2019 8:e026733 ; PMID: 31289069 ; DOI: 10.1136/bmjopen-2018-026733

★本研究では、認知症の人とその介護者に関連する要因によりサブグループに分類することにより、在宅での認知症介護の経済負担のミクロレベルの決定要因を明らかにした。 認知症介護における資源利用の状況を把握するため、Resource Utilization in Dementia (RUD)を用いたインターネット質問紙調査を実施した。 家族らにより無償提供されるインフォーマルケアのコストは、介護休業者で最も高く、介護者の有職状況や同居状況が、認知症の人の要因よりも関連した。 一方で、介護サービスへの自己負担額は主に認知症の人の要介護度や家族の経済状況が主に関連して分類された。 個人単位での認知症介護の経済負担を分類した本研究結果は、どのような状況下で大きな経済負担を表すか理解するのに役立ち、 日本における認知症ケアシステムの持続可能性を改善するように有用となりうる。

★This study aimed to clarify the micro-level determinants of the economic burden of dementia care at home in Japanese community settings by classifying them into subgroups of factors related to people with dementia and their caregivers. We conducted an online questionnaire survey which use the Resource Utilization in Dementia (RUD) to collect the data about resource use in persons with dementia and their caregivers. Informal care costs were related to caregivers’ employment and cohabitation status rather to the situations of people with dementia. On the other hand, out-of-pocket payments for LTC services were related to care-need levels and family economic status. These classifications will be useful in understanding which situation represents a greater economic burden and helpful in improving the sustainability of the dementia care system in Japan.

Sasaki N, Yamaguchi N, Okumura A, Yoshida M, Sugawara H, Imanaka Y. Does Hospital Information Technology Infrastructure Promote the Implementation of Clinical Practice Guidelines? A Multicenter Observational Study of Japanese Hospitals. BMJ Open 2019 9:e024700 ; PMID: 31203235 ; DOI: 10.1136/bmjopen-2018-024700

★本研究は、質問紙調査（病院管理者向け）と医療管理データを統合して解析し、全国急性期病院のIT環境が広くばらついており、インターネットへのアクセスの良さや有料医療データベース提供などIT環境の充実と、医療の質の高さが関連することを示した。IT環境が充実すると、医療者がエビデンスに基づく最新の医療情報へアクセスしやすくなり、診療ガイドラインの普及と活用の促進に繋がりうる。

★Wide variations were observed in the availability of various IT infrastructure elements across hospitals, especially in local area network availability and access to paid evidence databases. Hospitals with superior IT infrastructure may provide higher-quality care. This allows clinicians to easily access the latest information on evidence-based medicine and facilitate the dissemination of CPGs.

Shin J, Kunisawa S, Fushimi K, Imanaka Y. Effects of preoperative oral management by dentists on postoperative outcomes following esophagectomy: Multilevel propensity score matching and weighting analyses using the Japanese inpatient database. Medicine 2019 Apr;98(17):e15376 ; PMID: 31027127 ; DOI: 10.1097/MD.0000000000015376

★歯科医師による術前口腔管理が食道切除術後のアウトカムに及ぼす影響を調べるため、DPC調査研究班のデータベースより退院日が2016年4月から2017年3月までの開胸および胸腔鏡下食道切除術症例を抽出し、マルチレベル傾向スコア分析を行った（n=2,600、うち開胸：956例、胸腔鏡下手術：1,644例）であった。2つのモデルにより算出した傾向スコアによるIPTW（inverse probability of treatment weighting）解析の結果、術後誤嚥性肺炎の発症割合が開胸食道切除術後は口腔管理群で1.5~1.6%、非管理群で4.0~4.1%（risk difference、RD：–2.5～–2.5%）、胸腔鏡下食道切除術後は口腔管理群で2.4~2.6%、非管理群で4.5~4.6%（RD：–2.1～–2.0%）であり、口腔管理群における発症の有意な減少を認めた。また、口腔管理群の胸腔鏡下食道切除術の医療費が非管理群より有意に削減した（口腔管理群：3,412,071~3,448,760円、非管理群：3,665,198~3,670,003円、差：–253,127~–221,243円）。本結果から、術後合併症のリスクが高いと判断される患者のみではなく、全患者を対象とした通常の周術期管理として術前口腔管理の実施を考慮する必要がある。

★To investigate the effects of preoperative oral management (POM) by dentists on outcomes following both open and thoracoscopic esophagectomy, we extracted data of esophagectomy cases from the Japanese Diagnosis Procedure Combination database, of which discharge dates were between April 2016 and March 2017 (n=2,600; open: 956, thoracoscopic surgery: 1,644 cases). We subsequently conducted propensity score (PS) analyses for multilevel data. IPTW (inverse probability of treatment weighting) analysis using PSs derived by two multilevel models to estimate the average treatment effect, the risk difference of postoperative aspiration pneumonia ranged from –2.49% to –2.02% between the POM and control groups of both open and thoracoscopic esophagectomy cases. IPTW analyses also indicated that the total medical costs of thoracoscopic esophagectomy were reduced by 221,200 to 253,100 Japanese Yen (equivalent to about $2,000 to $2,200). Our results suggested that POM by dentists can be considered as a routine perioperative care for all patients undergoing esophagectomy, regardless of the expected risk for PPC.

Hara K, Nakabe T, Naka T, Tanaka M, Imanaka Y. Visualizing organizational culture in old people’s homes and hospitals in Japan: Human interaction in the IoT era. Human Aspects of IT for the Aged Population. Social Media, Games and Assistive Environments. HCII 2019. Lecture Notes in Computer Science 11593 2019 June ; DOI: 10.1007/978-3-030-22015-0_25

Tanke MAC, Feyman Y, Bernal-Delgado E, Deeny SR, Imanaka Y, Jeurissen P, Lange L, Pimperl A, Sasaki N, Schull M, Wammes J, Wodchis WP, Meyer GS. A challenge to all. A primer on inter-country differences of high-need, high-cost patients. Plos One 2019 Jun 19;14(6):e0217353 ; PMID: 31216286 ; DOI: 10.1371/journal.pone.0217353

★先進 7 カ国（カナダ、英、米、独、日本、オランダ、スペイン）の年間医療費高額患者（上位 5%・1%）集団の特徴、医療費、コスト集中度、医療資源利用の違い等の詳細について、医療管理データ（個票レベル）を用いて示した。総医療費上位5％者の年間総医療費寄与割合は41％（日本）～60％(カナダ)とばらつき、平均入院日数もばらつく等、医療制度の違いも比較検討の際に考慮する必要があると考えられた。

★To better understand the characteristics and healthcare utilization of high-cost populations in different health system, we conducted a cross-sectional descriptive study using patient-level data on high-cost patients in seven high-income OECD member countries. Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada. Differences in the way that health systems are structured likely explains some of this variation.

Hamada O, Tsutsumi T, Miki A, Fukui T, Shimokawa T, Imanaka Y. Impact of the Hospitalist System in Japan on the Quality of Care and Healthcare Economics. Internal Medicine 2019 58(23):3385-3391 ; PMID: 31391388 ; DOI: 10.2169/internalmedicine.2872-19

Takada D, Kunisawa S, Fushimi K, Imanaka Y. Previously-initiated hemodialysis as prognostic factor for in-hospital mortality in pneumonia patients with stage 5 chronic kidney disease: Retrospective database study of Japanese hospitals. Plos One 2019 Feb 28;14(2):e0213105 ; PMID: 30818331 ; DOI: 10.1371/journal.pone.0213105

★日本の透析患者は予後が良いと言われているが、導入患者の感染症や心筋梗塞による死亡が多い事が問題視されている。血液透析を導入していない患者との大規模予後比較研究は少ない。合計903病院CKD5(D)患者の肺炎入院患者の院内死亡を様々な要因でロジスティック回帰・傾向スコア解析・マルチレベル解析・多重代入法を用いた解析を行ったが、いずれにせよ透析患者で有意に予後が良かった。海外のRCTではぎりぎり差が無いとされているが、日本で臨床を行う上では注意が必要である。

★Japanese hemodialysis patients have a good prognosis, but mortality due to myocardial infarction or infective patients are regarded as critical problems, but there are few large-scale papers comparing with patients who had not been introduced hemodialysis. We analyzed in-hospital death of pneumonia hospitalized patients of CKD 5 (D) patient with various variables using multivariate logistic regression, propensity score analysis, multilevel analysis, multiple imputation method. All the analysis revealed previous introduced hemodialysis have a significant good prognosis. Although RCTs abroad indicated no difference, however, we should be careful when we introduce hemodialysis in Japan.

Aoyama T, Kunisawa S, Fushimi K, Sawa T, Imanaka Y. Comparison of surgical and conservative treatment outcomes for type A aortic dissection in elderly patients. Journal of Cardiothoracic Surgery 2018 13(1):129 ; PMID: 30563552 ; DOI: 10.1186/s13019-018-0814-6

★高齢者（80歳以上）のA型急性大動脈解離の術後死亡率や合併症率は高く手術を選択するか保存治療を選択するかには議論がある。そこでDPCデータを用いて、手術と保存治療の転帰を傾向スコアマッチングにより比較した。院内死亡率は有意に手術を選択した患者で低かったが、合併症（脳梗塞、急性腎障害）、入院中の気管切開は手術群で有意に多かった。しかし退院時のADLは両群で差はなく高齢者にとっても手術は有用な治療法であった。

★Whether emergency surgical intervention should be performed in elderly patients with type A acute aortic dissection (AAD) is controversial because of the high postoperative mortality and complication rates Therefore, this study compares the conservative and surgical management of patients with AAD aged > 80 years after adjusting for severity by propensity scores using data from the national inpatient database in Japan. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group after matching, complications were more frequent in the surgical group, but there was no difference in ADL at discharge. Therefore AAD surgery is effective even in the elderly patients.

Iwashita Y, Yamashita K, Ikai H, Sanui M, Imai H, Imanaka Y, JSEPTIC. Epidemiology of mechanically ventilated patients treated in ICU and non-ICU settings in Japan: a retrospective database study. Critical Care 2018 22(1):329 ; PMID: 30514327 ; DOI: 10.1186/s13054-018-2250-3

Umegaki T, Kunisawa S, Kotsuka M, Yamaki S, Kamibayashi T, Imanaka Y. The impact of low body mass index on postoperative outcomes in pancreatectomy patients: a retrospective analysis of Japanese administrative data. Journal of Anesthesia 2018 32(4):624-631 ; PMID: 29936599 ; DOI: 10.1007/s00540-018-2527-3

★膵臓癌手術ではBMI低値症例の予後不良の報告はみられるが, underweight症例の中でWHO分類に沿ったカテゴリーごとの死亡リスクは検討されていない. 膵臓癌手術を受けた6,173症例において, BMIが低値症例(Mild thinness(BMI: 17.00-18.49), Moderate thinness(BMI: 16.00-16.99), Severe thinness(BMI: <16.00))の院内死亡率を標準的なBMI(Normal(BMI: 18.50-24.99))症例を対象に比較検討を行った. 多変量解析の結果, Normal BMIに対してSevere thinnessはオッズ比が2.54(95%信頼区間:1.05-6.08)(p=0.04)であった. 膵臓癌における手術においてSevere thinnessの症例はNormal BMIに対して院内死亡率が統計学的に有意に高くなることが示唆された.

★To comparatively examine in-hospital mortality among different underweight body mass index (BMI) categories in pancreatic cancer patients after pancreatectomy.
We conducted a large-scale multi-center retrospective cohort study of adult patients with pancreatic cancer who underwent pancreatectomy between April 1, 2010 and March 31, 2016. Relative to the normal BMI group, the odds ratios for in-hospital mortality was 2.54 (1.05–6.08; P = 0.04) in the severe thinness group. In conclusion, severe thinness was significantly associated with a higher risk of mortality, and extremely low BMI should be considered a risk factor in pancreatectomy patients.

Hara K, Kunisawa S, Sasaki N,, Imanaka Y. Future Projection of the Physician Workforce and Its Geographic Equity in Japan: A Cohort-Component Model. BMJ Open 2018 8:e023696 ; PMID: 30224401 ; DOI: 10.1136/bmjopen-2018-023696

★医師数地域格差の将来推計を、コホート要因モデルを用いて行った。 都市/地方×医療資源多/寡で二次医療圏を４グループに分けたが、全てで人口対医師数は増加するものの、地域格差自体は拡大し続けることが明らかになった。 また、地方で医師が少ない地域グループでは、医師の高齢化が特に早く進むことが示された。

★We projected the geographic distribution of physicians in Japan in the future by a cohort-component model.we divided 342 areas into 4 area groups based on urban/rural status and lower/higher physician supply, based on earlier studies.As the result, the inequity in the geographical distribution of physicians will expand despite an increase in the number of physicians in rural areas.In addition, the proportion of aged physicians will increase in all areas, especially in rural ones with an initially lower supply, where it will change from 14.4% in 2005 to 31.3% in 2035.

Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K, Kyratsis Y, Meads G, Otter JA, Holmes A, Imanaka Y, Ahmad R. Comparison of national strategies to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections in Japan and England. The Journal of Hospital Infection 2018 100(3):280-298 ; PMID: 30369423 ; DOI: 10.1016/j.jhin.2018.06.026

★本研究では、2つの高所得国間でMRSAに取り組むためのアプローチから何が学べるのかという疑問を扱ったものである。イングランドでは、MRSA血流感染の数が大幅に減少していた。対して、日本では、MRSA数は徐々に減少しているが、依然として主要な感染症であることがわかった。また両国とも、薬剤耐性大腸菌という新たな脅威に直面していることがわかった。またイングランドは、アウトカムベースのインセンティブと懲罰的なメカニズムの組み合わせ、および多分野の院内感染対策チームによる政策が行われており、国レベルの強制的かつ構造的介入が多く行われてきた。日本は、プロセスースのインセンティブによって支持され、自発的なサーベイランスを用いており、勧告や説得的な介入に重点を置いてきた。政策介入は、それぞれの国の疫学的傾向に対応していなければならないが、各国の文化等をも考慮する必要がある。国ごとの政策比較は、将来の感染症や経済的課題に対して持続可能で回復力のあるシステムを創り出すために、介入の適切な組み合わせを知るのに役立つと考えられる。

★National responses to healthcare-associated infections vary between high-income countries but when analysed for contextual comparability, interventions can be assessed for transferability. This study addressed the question: What can be learnt from approaches for addressing MRSA between two high-income countries? In England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multidisciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Policy interventions need to be relevant to local epidemiological trends, while acceptable within health system cultures and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and economic challenges.

Sasaki I, Kondo K, Kondo N, Aida J, Ichikawa H, Kusumi T, Sueishi N, Imanaka Y. Are pension types associated with happiness in Japanese older people?: JAGES Cross-sectional study. Plos One 2018 ; PMID: 29782505 ; DOI: 10.1371/journal.pone.0197423

Hirose M, Nishimura N, Kawamura T, Kumakura S, Telloyan J, Igawa M, Fukuda H, Imanaka Y. Do pharmacists have the most potential for patient safety in Japan? Learning from a 2010 nationwide survey. Journal of Hospital Administration 2018 7(3)40-48 ; DOI: 10.5430/jha.v7n3p40

★医療安全管理体制に関する全国調査において、医師、看護師、薬剤師のうち、一人あたりのインシデントレポート報告件数、研修会参加回数は、安全管理加算と病床数で区分した３つの病院群のいずれにおいても、薬剤師の値は、最も大きく、しかも３群間で有意差が無かった。薬剤師は医療安全活動に貢献する潜在力が大きい職種であることが示唆された。

Uematsu H, Yamashita K, Mizuno S, Kunisawa S, Shibayama K, Imanaka Y. Effect of Methicillin-Resistant Staphylococcus aureus in Japan. American Journal of Infection Control 2018 112:88-96 ; PMID: 29784441 ; DOI: 10.1016/j.ajic.2018.04.214

★本研究では、日本の病院におけるメチシリン耐性黄色ブドウ球菌（MRSA）に起因する臨床的および経済的負担を分析した。DPCデータおよび厚生労働省院感染対策サーベイランス（JANIS）データを突合し、2014年4月から2年の間で入院した57病院・14,905人を調査対象とした。アウトカムとして在院日数・入院費用・院内死亡率とし、MRSA感染患者群とメチシリン感受性黄色ブドウ球菌（MSSA）感染患者群を患者重症度と在院中発症日も調整して比較した。 7,188人と7,717人の患者をそれぞれMRSA群とMSSA群に分類した。調整なしでのMRSA群の疾病負荷に対する効果はそれぞれ1.15倍（95％信頼区間[CI] 1.12-1.19）、1.16倍（95％CI 1.13-1.19）および1.46（オッズ比）（95％CI 1.31-1.61）であった。MRSA群の調整済み効果は1.03倍（95％CI 1.01-1.05）、1.04倍（95％CI 1.01-1.06）および1.14（オッズ比）（95％CI 1.02-1.27）であり、メチシリン耐性の疾病負荷は患者重症度や入院後発症日を調整後も有意に存在することを確認した。また、患者の重症度が重いほど、在院中の黄色ブドウ球菌感染症発症日が遅いほど、MRSAである確率が高く、臨床的・経済的負担は重いことを見出した。

★This study analyzed the clinical and economic burdens attributable to methicillin resistance in Staphylococcus　aureus（MRSA） in Japanese hospitals. We retrospectively investigated data from 14,905 inpatients of 57 hospitals combined with data from nosocomial infection surveillance and administrative claim databases. The outcomes were evaluated according to the length of stay, hospital charges, and in-hospital mortality. We compared the burden of diseases with MRSA to those with methicillin-susceptible Staphylococcus aureus (MSSA) infections based on patients' characteristics and onset periods. We categorized 7,188 and 7,717 patients into MRSA and MSSA groups, respectively. The crude effects of the MRSA group were 1.15 fold (95% confidence interval [CI] 1.12-1.19), 1.16-fold (95% CI 1.13-1.19), and 1.46 (odds ratio) (95% CI 1.31-1.61), respectively. The adjusted effects of the MRSA group were 1.03-fold (95% confidence interval [CI] 1.01-1.05), 1.04-fold (95% CI 1.01-1.06), and 1.14 (odds ratio) (95% CI 1.02-1.27), respectively. The results of the present study found that patient severity and onset delays were positively associated with both MRSA and burden and that the effect of methicillin resistance remained significant after adjustment.

Lertjanyakun V, Chaiyakunapruk N, Kunisawa S, Imanaka Y. Cost-effectiveness of Second-Line Endocrine Therapies in Postmenopausal Women with Hormone Receptor–positive and Human Epidermal Growth Factor Receptor 2–negative Metastatic Breast Cancer in Japan. PharmacoEconomics 2018 36(9), 1113-1124 ; PMID: 29707743 ; DOI: 10.1007/s40273-018-0660-3

★ホルモン受容体（HR）陽性HER2陰性の転移性乳癌に対する2次治療としての各種ホルモン療法について、確率的感度分析を伴う費用対効果分析を行った。exemestane (EXE)、exemestane + everolimus (EXE + EVE)、toremifene (TOR)、fulvestrant (FUL)を対象とした。EXEに比しTOR、FUL(250mg)の増分費用対効果比はそれぞれ約300万円/ QALY、約600万円/ QALYと推計された。他ではかなり高値であった。またこれらの結果は全生存率（overall survival）のハザード比に大きく影響を受けることが明らかとなった。

Nakabe T, Sasaki N, Uematsu H, Kunisawa S, Wimo A, Imanaka Y. The personal cost of dementia care in Japan: a comparative analysis of residence types. International Journal of Geriatric Psychiatry 2018 33(9), 1243-1252; ; PMID: 29892984 ; DOI: 10.1002/gps.4916

★本研究では、日本の認知症介護における個人の経済負担の状況について、居住形態別に把握した。 認知症介護における資源利用の状況を把握には、世界的にも使用されるResource Utilization in Dementia (RUD)を用いて、インターネット質問紙調査を実施した。経済負担を構成する各費用（インフォーマルケアコスト、介護保険サービス自己負担額、介護保険外サービス自己負担額、医療費自己負担額）を、認知症の人の年齢・性別・要介護度で調整したＯＥ比を用いて居住形態別に比較した。 在宅介護ではインフォーマルケアコストは施設入居の場合と比較してはるかに高く、自己負担額は低くても、経済負担が高かった。有料老人ホームやサービス付き高齢者向け住宅の場合は、介護保険外サービスの自己負担額が高かった。本研究の結果は、持続可能な認知症ケアシステムを構築するための政府の財政負担と介護者の経済的負担とのバランスを考慮の一助となりうる。

★This study aimed to quantify the personal economic burden of dementia care in Japan according to residence type. We conducted an online questionnaire survey which use the Resource Utilization in Dementia (RUD) to collect the data about resource use in persons with dementia and their caregivers. To compare dementia care costs among residence types, we calculated the ratio between the observed and expected values (OE ratio) for the costs of dementia care for each residence type by adjusting for the characteristics of people with dementia (care‐needs level, sex, and age categories). In a community setting, informal care costs were much higher than in institutions, and the total costs that included these informal care costs were also higher despite the lower out‐of‐pocket payments. These results support considering the balance between the government's fiscal burden and caregivers' economic burdens to construct a sustainable dementia care system.

Lin H, Tsuji T, Kondo K, Imanaka Y. Development of a Risk Score for the Prediction of Incident Dementia in Older Adults using a Frailty Index and Health Checkup Data: The JAGES Longitudinal Study. Preventive Medicine 2018 112:88-96 ; PMID: 29626553 ; DOI: 10.1016/j.ypmed.2018.04.004

★介護ニーズに関する基本チェックリストと健診データのみを用いて、Cox比例ハザードモデルから、認知症発症のリスクスコアモデル（C統計量は0.733から0.790）を生成した。これにより既存のデータから認知症発症のリスクがスコア化できるようになる。認知症発症のハイリスク者の同定や認知症予防施策の推進に有用なツールに繋がると思われる。JAGES（Japan Gerontological Evaluation Study, 日本老年学的評価研究）との共同研究。

★We performed Cox regression analyses to develop three risk score models for the prediction of incident dementia in older adults using a frailty index (so-called "Kihon chesklist") and health checkup data. We identified 6,656 (9.2%) individuals who developed incident dementia during the observation period. The C-statistics of the risk score models ranged from 0.733 to 0.790. By predicting incident dementia in older adults, these risk score models may help detect persons at high risk for dementia and promote preventive approaches at an early stage. This is a collaborative work with the Japan Gerontological Evaluation Study (JAGES).

Mizuno S, Kunisawa S, Sasaki N, Fushimi K, Imanaka Y. Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan. Plos One 2018 13(1):e0191460 ; PMID: 29351557 ; DOI: 10.1371/journal.pone.0191460

★多施設DPCデータを使用し、急性心筋梗塞入院患者を平日・休日と日中・夜間の4群に分けて、入院中死亡と治療内容を比較・検討した。週末日中に入院した患者は、そのほかの時間帯に入院した患者と比べて、死亡率が高く、多変量解析後もその傾向は変わらなかった。

★Using multicenter DPC data, we compared and examined the in-hospital mortality of acute myocardial infarction patients. We divided patients into the following 4 groups according to the admission time: weekday daytime, weekday night-time, weekend daytime, and weekend night-time. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times, even after adjusting for the covariates (adjusted odds ratio admissions; 1.10; confidence interval: 1.03-1.19)

Hara K, Kunisawa S, Sasaki N, Imanaka Y. Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study. BMJ Open 2018 8(1):e018538 ; PMID: 29317415 ; DOI: 10.1136/bmjopen-2017-018538

★日本の診療科別医師数の地域間格差について、年齢ごとに異なる医療需要を調整したうえで時系列での検証を行った。その結果、内科、外科、整形外科、産婦人科、麻酔科において、都市地方間の格差は拡大傾向にあることが明らかになった。

★We conducted longitudinally examine specialty-specific changes in the geographical distribution of physicians in Japan with adjustments for healthcare demand based on population structure. We found that there was a growing urban睦ural disparity in physician supply in internal medicine, surgery, orthopaedics, OB/GYN, and anaesthesiology.

Yoshihisa Tsuji, Naoki Takahashi, Hiroyoshi Isoda, Koji Koizumi, Sho Koyasu, Miho Sekimoto, Yuichi Imanaka, Shujiro Yazumi, Masanori Asada, Yoshihiro Nishikawa, Hiroshi Yamamoto, Osamu Kikuchi, Tsukasa Yoshida, Tetsuro Inokuma, Shinji Katsushima, Naoki Esaka, Akihiro Okano, Chiharu Kawanami, Nobuyuki Kakiuchi, Masahiro Shiokawa, Yuzo Kodama, Ichiro Moriyama, Takafumi Kajitani, Yoshikazu Kinoshita, Tsutomu Chiba. Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis. Journal of Gastroenterology 2017 52(10):1130-1139. ; PMID: 28374057 ; DOI: 10.1007/s00535-017-1330-5

Umegaki T, Kunisawa S, Nakajima Y, Kamibayashi T, Fushimi K, Imanaka Y. A comparison of in-hospital outcomes between transcatheter and surgical aortic valve replacement in patients with aortic valve stenosis: a retrospective cohort study using administrative data. Journal of Cardiothoracic and Vascular Anesthesia 2017 32(3):1281-1288 ; PMID: 29422279 ; DOI: 10.1053/j.jvca.2017.06.047

★本研究は大動脈弁狭窄における外科的大動脈弁置換術と経カテーテル的大動脈弁置換術の在院時死亡率についてDPCデータ調査研究班のデータを用いて本邦で初めて評価したものである。経カテーテル的大動脈弁置換術は外科的大動脈弁置換術と比較してより良いアウトカムを示し、特に、80歳以上の症例でその傾向が強く示された。

★his study aimed to compare in-hospital outcomes between TAVI and SAVR using a multi-center administrative database in Japan. TAVI produced better clinical outcomes in patients with aortic valve stenosis. The improved outcomes were particularly notable in patients aged 80 years or older.

Hirose M, Kawamura T, Igawa M, Imanaka Y. Patient safety activity under the social insurance medical fee schedule in Japan: An overview of the 2010 nationwide survey. Journal of Patient Safety 2017 ; PMID: 29189440 ; DOI: 10.1097/PTS.0000000000000432

★医療安全対策加算算定病院をA群：加算１＋ベッド数400以上、B群：加算１＋ベッド数399以下およびC群：加算２の３郡に分け、医療安全管理の実態を調査しました。生データから、大規模病院のほうが医療安全対策は進んでいるようにみえるが、100ベッドあたりに換算すると小規模病院のほうが進んでいるという結果が得られたことから、診療報酬によってインセンティブ（加算）を付与することで医療安全対策が一定程度進んでいることが示された。

★Patient safety activities at hospitals in large-scale hospitals were performed more quickly than those in small-scale hospitals. However, when the values were converted to per 100 beds, there were no differences across the three groups. Therefore, Hospitals in group C actually showed the same or greater activity levels than those in groups A and B. PPSCF encouraged hospitals to perform actions for patient safety by providing incentives under the social insurance medical fee schedule in Japan.

Okumura K, Hida K, Kunisawa S, Nishigori T, Hosogi H, Sakai Y, Imanaka Y. Impact of drain insertion after perforated peptic ulcer repair in a Japanese nationwide database analysis. World Journal of Surgery 2017 42(3):758-765 ; PMID: 28920145 ; DOI: 10.1007/s00268-017-4211-4

★DPCデータを使用し、穿孔性消化性潰瘍の閉鎖術における本邦での腹腔内ドレーン留置の現状を分析するとともに、腹腔内ドレーン留置の有効性を検討した。本邦では穿孔部閉鎖術においては90%以上の症例でドレーン留置を行っていた。腹腔内ドレーン留置は術後観血的加療を要する腹腔内合併症の発生を抑制する可能性が示唆された。

★This study aimed to investigate the drain insertion rates in patients who underwent perforated peptic ulcer(PPU) repair in Japan, and to clarify the impact of drain insertion on the postoperative clinical course by using Japanese DPC database. Postoperative drainage was performed in more than ninety per cent of the patients who underwent PPU repair in Japan. Drainage following PPU repair may facilitate patient recovery by reducing the need for postoperative interventions.

Lin H, Otsubo T, Imanaka Y. Survival analysis of increases in care needs associated with dementia and living alone among older long-term care service users in Japan. BMC Geriatrics 2017 17(1):182. ; PMID: 28814271 ; DOI: 10.1186/s12877-017-0555-8

★本研究は京都府の介護保険‎、後期高齢者医療制度、国民健康保険データベースを用いて、2010年10月から2011年9月まで介護サービス利用があった、65歳以上、要介護度5未満の介護サービス利用者を対象とし、2015年3月まで追跡した。Cox Regressionで要介護度悪化予測モデルを構築する。低い要介護度、認知症がある、高齢、女性は要介護度悪化と関連があった。認知症は要介護度悪化にもっとも影響がある要因であり、特に認知症をもつ独居の場合はより影響が大きく見られた。

★We used the Long-term care insurance claims data to identify enrollees who applied for long-term care services between October 2010 and September 2011, and subjects were tracked until March 2015 to examine the influence of dementia and living alone on care needs increases among older long-term care insurance service users in Japan. Dementia, older age, the female sex, and lower care needs levels were associated with a higher risk of care needs increases over the study period, and dementia showed the strongest impact on care needs increases, especially in person who lived alone.

Uematsu H, Yamashita K, Kunisawa S, Otsubo T, Imanaka Y. Prediction of pneumonia hospitalization in adults using health checkup data. Plos One 2017 Jun 29;12(6):e0180159 ; PMID: 28662167 ; DOI: 10.1371/journal.pone.0180159

★京都府特定健康診査データと医療保険レセプトデータを用い、健康診査の結果から将来の肺炎入院を予測するモデルの構築と検証を行った。また、年齢と依存症で肺炎入院を予測したモデルと比較した。今回構築したモデルは年齢・依存症のモデルよりも正確に肺炎の入院を予測することができた。肺炎球菌ワクチン等の適応への示唆等、肺炎の効率的な予防方法に繋がる可能性がある。

★This study aimed to develop a predictive model for pneumonia hospitalization in adults to accurately identify high-risk individuals, using health checkup data and health insurance claims data for residents of Kyoto prefecture. Our prediction model for pneumonia hospitalization performed better than age & comorbidities’ models, and may be useful for supporting the development of pneumonia prevention measures.

Uematsu H, Yamashita K, Kunisawa S, Fushimi K, Imanaka Y. Estimating the disease burden of methicillin-resistant Staphylococcus aureus in Japan: retrospective database study of Japanese hospitals Plos One 2017 Jun 27;12(6):e0179767 ; PMID: 28654675 ; DOI: 10.1371/journal.pone.0179767

★多施設DPCデータを用いて、MRSA感染症を抗菌薬の使用から同定し、非MRSA感染症症例との比較を行った。またDPC全病院におけるMRSA感染症による疾病負荷を推定した。非MRSA感染症症例に比し、MRSA感染症症例の入院費用は約3.4倍、在院日数は約3.0倍、死亡率は3.7倍であった。1584のDPC参加病院におけるMRSA感染症による疾病負荷合計は、2100億円の入院費用増加、434万日の在院日数増加、1万4300人の死亡数増加である可能性が示された。

★This study aimed to estimate the disease burden of methicillin-resistant Staphylococcus aureus infections in Japanese hospitals using Japanese DPC database. The mean hospitalization costs, length of stay, and in-hospital mortality of the anti-MRSA drug group were 3.43, 2.95, and 3.66 times that of the control group, respectively. When extrapolated to the 1584 hospitals, the total incremental burden of MRSA was estimated to be US$2 billion, 4.34 million days, and 14.3 thousand deaths.

Sasaki N, Kunisawa S, Ikai H, Imanaka Y. Differences between determinants of in-hospital mortality and hospitalization costs in patients with acute heart failure: a nationwide observational study from Japan. BMJ Open 2017 Mar 22;7(3):e013753 ; PMID: 28336741 ; DOI: 10.1136/bmjopen-2016-013753

★日本における急性心不全患者の院内死亡率と入院費用の決定要因が異なることを新たに示した研究。本研究結果により同じ診断群分類を入院死亡率と入院費用の予測に用いるべきではないことが示唆された。新たな診断群分類を開発・実装する際に参考になるだろう。

★The study provides a novel understanding that determinants of in-hospital mortality and hospitalization costs differ in acute heart failure in Japan. Our findings indicate that the same case-mix classifications should not be used to predict both inpatient mortality and costs, which would support the development and implementation of future case-mix classifications.

Nori N, Kashima H, Yamashita K, Kunisawa S, Imanaka Y. Learning Implicit Tasks for Patient-Specific Risk Modeling in ICU. Proceedings of the 31st AAAI Conference on Artificial Intelligence (AAAI), 2017 1481-1487

★DPCデータを用い、ICUに入室患者の死亡予測を行った。患者の病態を説明変数としつつ、シングルタスク学習、標準的な学習、近年提案されているいくつかのマルチタスク学習と比べ、本研究で用いたマルチタスクモデルは予測性能が高く、さらに隠れた患者特性を明らかにする手法である。

★Using DPC database, we executed predictions of ICU inpatients mortarity. Predictions are based on patients diseases. Our method achieved higher predictive performance compared with a single-task learning method, the “de facto standard,” and several multi-task learning methods including a recently proposed method for ICU mortality risk prediction. Furthermore, our method uncovers patient-specificity from different viewpoints.

Hara K, Otsubo T, Kunisawa S, Imanaka Y. Examining sufficiency and equity in the geographic distribution of physicians in Japan: a longitudinal study. BMJ Open 2017 Mar 14;7(3):e013922 ; PMID: 28292766 ; DOI: 10.1136/bmjopen-2016-013922

★人口構造の変化を考慮に入れるため、年齢ごとに異なる医療需要を調整して、日本の医師数の地域間格差を時系列で検証した。その結果、人口対医師数は、都市でも地方でも見かけ上増加していたが、需要を調整すると地方は減少傾向、さらに都市の医師密度が高い地域でさえも減少傾向にあることが明らかになった。2000年以降、医師数の地域間格差は一貫して悪化していた。

★This study longitudinally examines the geographic distribution of physicians in Japan by adjusting healthcare demand according to the changing age structure of the population. The number of physicians per 100,000 raw population had seemingly increased in urban and rural areas in Japan. After healthcare demand was adjusted, however, physician supply was observed to decrease even in urban areas with a high initial supply. In addition, physician distribution had consistently become less equitable across the regions since 2000.

Kunisawa S, Fushimi K, Imanaka Y. Reducing length of hospital stay does not increase readmission rates in early-stage gastric, colon, and lung cancer surgical cases in Japanese acute care hospitals. Plos One 2016 Nov 10;11(11):e0166269 ; PMID: 27832182 ; DOI: 10.1371/journal.pone.0166269

★DPCデータを用い、早期胃がん、大腸がん、肺がん手術に対し、術後の在院日数と再入院率を解析した。2010年から4年度にかけていずれの病気でも、在院日数は短縮しており、再入院率の上昇は見られなかった。

★Using DPC data, we analyzed early-stage gastric, colon, and lung cancer surgical patients in Japan. Length of stay reduced but readmission rates did not increased.

Hanaki N, Yamashita K, Kunisawa S, Imanaka Y. The effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan. BMJ Open [Internet] 2016 Dec 9 [cited 2016 Dec 14];6(12):e012194. ; PMID: 27940625 ; DOI: 10.1136/bmjopen-2016-012194

★奈良県の救急搬送データベースを用い、救急搬送時間に対する病院照会の影響を調査した。多変量で調整した結果照会回数が1回増加するごとに搬送時間が6.3分延長していた。3地域に分けての解析結果では、特定の疾患に関して搬送時間が他地域よりも長くなる地域があることが分かった。

★We conducted a cross-sectional study using an ambulance records database from Nara prefecture, Japan. A higher number of request calls was associated with longer time intervals to hospital arrival (addition of 6.3 min per request call). In an analysis dividing areas into three groups, there were differences in transportation time for diseases needing cardiologists, neurologists, neurosurgeons and orthopaedists.

Mizuno S, Kunisawa S, Sasaki N, Fushimi K, Imanaka Y. In-hospital mortality and treatment patterns in acute myocardial infarction patients admitted during national cardiology meeting dates. International Journal of Cardiology 2016 220:929・36 ; PMID: 27420345 ; DOI: 10.1016/j.ijcard.2016.06.168

★多施設DPCデータを使用し、循環器系学術総会開催時期に入院した急性心筋梗塞患者と、それ以外の時期に入院した急性心筋梗塞患者の入院中死亡と治療内容を比較・検討した。入院中死亡に有意差はなく、単変量・多変量ロジスティック回帰分析でも、入院期間と入院中死亡に有意な関連は示されなかった。比較期間を学会の前後3・4週前後と設定すると、学会期間に入院した急性心筋梗塞患者では入院中死亡がむしろ低い傾向にあった。いずれの週を比較期間とした場合でも、学会期間に入院した患者数は8.7～15.1%少なかった。

★Using multicenter DPC data, we compared and examined the in-hospital death and treatment contents of acute myocardial infarction patients admitted at the time of the cardiovascular academic conference meeting and acute myocardial infarction patients hospitalized at other times. There was no significant difference in death during hospitalization, and univariate / multivariate logistic regression analysis showed no significant association between hospital stay and hospital death. Comparison of outcomes using alternate control groups, admission on the meeting days was significantly associated with lower in-hospital mortality of AMI patients after adjustment for the covariates in case of 3 and 4 weeks.

Sugiura S, Ito T, Koyama N, Sasaki N, Ikai H, Imanaka Y. Asymptomatic C-reactive protein elevation in neutropenic children. Pediatrics International 2016 0,1 ; PMID: 27362735 ; DOI: 10.1111/ped.13077

★急性白血病に対する化学療法により、好中球減少をきたしている小児のCRP値（高感度測定法）は感度以下であることが多い。この値がわずかに上昇した場合に関して後方視的に検討を行い、CRP値上昇後48時間以内に発熱性好中球減少症（FN）を発症する可能性が高いこと、この時点で広域抗生剤を投与開始することで効率的にFN発症を抑制できる可能性があることを明らかにした。

★The values of CRP (high sensitivity measurement) are usually undetectable in the patients with acute leukemia who are undergoing chemotherapies. We retrospectively investigated the episodes when the values of CRP were elevated slightly in such patients, and showed that the probability of development of FN is higher in such conditions and prophylactic administration of broad-spectrum antibiotics may prevent it effectively.

Uematsu H, Yamashita K, Kunisawa S, Fushimi K, Imanaka Y. The economic burden of Methicillin-resistant Staphylococcus aureus in community-onset pneumonia inpatients. American Journal of Infection Control 2016 Dec 1;44(12):1628-1633 ; PMID: 27475333 ; DOI: 10.1016/j.ajic.2016.05.008

★多施設DPCデータより、18歳以上の市中肺炎症例において、MRSA感染症を抗菌薬の使用から同定し、傾向スコアを用いて患者背景を統計学的に調整して、非MRSA肺炎との比較を行った。非MRSA肺炎に比し、MRSA肺炎の在院日数は約1.4倍、入院費用は約1.7倍（そのうち抗菌薬は約3.8倍）、死亡率は1.9倍であった。

★This study aimed to estimate the burden of methicillin-resistant Staphylococcus aureus infections in adult inpatients with pneumonia using Japanese DPC database. In propensity score-matching analysis, the median length of stay, antibiotic costs, hospitalization costs and in-hospital mortality of the anti-MRSA drug group were 1.4, 3.8, 1.7 and 1.9 times those of the control group, respectively.

Hayashida K, Umegaki T, Ikai H, Murakami G, Nishimura M, Imanaka Y. The relationship between sedative drug utilization and outcomes in critically ill patients undergoing mechanical ventilation. Journal of Anesthesia 2016 Oct;30(5):763-9 ; PMID: 27312979 ; DOI: 10.1007/s00540-016-2196-z

★ICUで人工呼吸器を装着している重症患者について、鎮静剤の使用パターンとそ のパターンとアウトカムとの関係を、 大規模データを用いて明らかにした日本で最初の研究である。最も一般的に使 用されていた鎮静剤は プロポフォールであり、他の薬剤に比べ良好な患者アウトカムと関連していた。

★This is the first study based on a large-scale analysis in Japan to elucidate sedative drug utilization patterns and their relationship with outcomes in critically ill patients undergoing mechanical ventilation in ICUs. The most commonly used sedative was propofol, which was associated with favorable patient outcomes.

Uematsu H, Kunisawa S, Yamashita K, Fushimi K, Imanaka Y. Impact of weekend admission on in-hospital mortality in severe community-acquired pneumonia patients in Japan. Respirology 2016 905–910, July 2016 ; PMID: 27040008 ; DOI: 10.1111/resp.12788

★国際的臨床ガイドラインが入院を推奨している重症肺炎を対象とし、週末入院が患者のリスク調整死亡率に影響を与えるかを検証し、平日入院時と比較して週末入院時に実施されない傾向のある診療プロセスを同定することを目的とした。重症市中肺炎の週末入院が退院時死亡と正の関連があることが示され、週末入院時の細菌学的検査実施割合が低いこと、及び細菌学的検査実施と退院時死亡に負の関連があることが示された。

★Little is known about the consequences of weekend admission on the quality of care in patients with severe community-acquired pneumonia. We compared the risk-adjusted mortality and guideline-concordant processes of weekend versus weekdays' admission for these patients. Our findings showed that weekend admission was associated with increased mortality in patients with severe community-acquired pneumonia in Japan. This may have been influenced by lower implementation of microbiological testing.

Lin H, Otsubo T, Sasaki N, Imanaka Y. The determinants of long-term care expenditure and their interactions. International Journal of Healthcare Management 2016 ;9(4): 269-279 ; DOI: 10.1080/20479700.2016.1141469

★本研究は2011年6月京都府の介護保険データベースを用いて、65歳以上、要介護度1から5の介護サービス利用者を対象とし、線形重回帰分析を用い、性別、認知症、サービスタイプおよびその他の要因と2011年6月の介護費用との関連を探索した。全体では、認知症あり、高い要介護度、高齢、施設サービスを利用する、女性が地域密着サービスを利用した時、介護費用が高くなった。

★We used descriptive statistics and multiple linear regression analysis, we investigated the associations of gender, dementia, service type, and other factors with Long-term care expenditure. Facility care service use, dementia, older age, higher care needs levels, the female gender, and women who use home care services or community-based/other care services were associated with higher Long-term care expenditure. We also found that individuals with dementia were strongly associated with increased Long-term care expenditure.

Yamada G, Imanaka Y. Input-output analysis on the economic impact of medical care in Japan. Environmental Health and Preventive Medicine 2015 20(5):379-87 (The Most Downloaded Article Award) ; PMID: 26194451 ; DOI: 10.1007/s12199-015-0478-y

★医療に新たに需要が発生すると、それを満たすために各産業で新たな生産が誘発されていく。産業連関分析（投入産出分析）を用い、医療の経済波及効果を算出したところ、国内の各産業への経済波及効果倍率は2.78倍（95%信頼区間2.74-2.90）となり、他産業に比しも非常に高いものとなった。

Uematsu H, Kunisawa S, Kazuto Y, Imanaka Y. The Impact of Patient Profiles and Procedures on Hospitalization Costs through Length of Stay in Community-Acquired Pneumonia Patients Based on a Japanese Administrative Database PLOS ONE 2015 10(4): e0125284 ; PMID: 25923785 ; DOI: 10.1371/journal.pone.0125284

★入院医療費に関連する要因を構造方程式モデリングを用い、入院日数を中間変数とする形で調査した。複数の患者要因が医療費に間接的に（入院日数を介して）強く関連していることが示された。

★Possible factors associated with hospitalization costs were investigated using structural equation modeling with length of stay as an intermediate variable. The result indicated that patient profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects.

Lin H, Otsubo T,Imanaka Y. The effects of dementia and long-term care services on the deterioration of care-needs levels of the elderly in Japan. Medicine 2015 94(7):e525 ; PMID: 25700313 ; DOI: 10.1097/MD.0000000000000525

★京都府介護保険データベースと医療データベースを連結し、要介護度悪化のリスク要因を探索した。2010年から2011年の65歳以上の介護サービス利用者を解析し、「施設サービスの利用」、「男性」、「高齢」および「認知症罹患」が要介護度悪化と関連が見られた。

★We analyzed 50,268 insurance beneficiaries aged 65 years and older who had utilized LTC services between 2010 and 2011 in Kyoto prefecture, Japan to identify predictors of care needs level deterioration and found that dementia, facility care services, the male sex, older age, and lower baseline care needs levels were associated with care needs level deterioration.

Nori N, Kashima H, Yamashita K, Ikai H, Imanaka Y. Simultaneous modeling of multiple diseases for mortality prediction in acute hospital care. Proceedings of the 21st ACM SIGKDD Conference on Knowledge Discovery and Data Mining 2015 855-864 ; DOI: 10.1145/2783258.2783308

★DPCデータを用い、ICUに入室患者の死亡予測を行った。患者の病態を説明変数とするため、患者間の類似点を符号化する方法として、ラプラシアングラフを用い、マルチタスク学習へ組み込みました。既存の医学知識等との高い整合性を示すだけではなく、さらに新たな示唆を生む結果を示すことができた。

★Using DPC database, we executed predictions of ICU inpatients mortarity. Predictions are based on patients diseases. Our multi-taks learning method effectively integrates medical domain knowledge relating to the similarity among diseases and the similarity among Electronic Health Records (EHRs) into a data-driven approach by incorporating graph Laplacians into the regularization term to encode these similarities. Our results are not only consistent with existing medical domain knowledge, but also contain suggestive hypotheses that could be validated by further investigations in the medical domain.

Ukawa N, Tanaka M, Morishima T, Imanaka Y. Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use. International Journal for Quality in Health Care 2015 Feb;27(1):37-45 ; PMID: 25502553 ; DOI: 10.1093/intqhc/mzu091

★周術期の抗菌薬使用法において、組織文化の良好な病院ではそうでない病院に比べて、国内やCDCのガイドラインをより遵守していることが、大規模多施設組織文化調査とDPCデータから示された。

★We demonstrated that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals, using quantitative data from a multicenter culture survey and our administrative database.

Otsubo T, Goto E, Morishima T, Ikai H, Yokota C, Minematsu K, Imanaka Y. Regional variations in in-hospital mortality, care processes, and spending in acute ischemic stroke patients in Japan. Journal of Stroke and Cerebrovascular Diseases 2015 Jan;24(1):239-51 ; PMID: 25444024 ; DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.016

★NDBを用いて急性期脳梗塞治療に関する二次医療圏間の地域差を明らかにした。 院内死亡率で3.2倍、tPA使用率で5.9倍の差がみられ、急性期脳梗塞治療の地域差が顕著に存在することが明らかとなった。 また、脳梗塞治療に従事する医師数が多い地域では、院内死亡率が低く、入院医療費が高かった。 加えて、医療連携が活発である地域ほど、入院医療費が低くなる傾向がみられた。

★Using administrative claims data from National Claims Database (NDB), this study investigates the regional variations and associations among outcomes, care processes, spending, and physician workforce availability in acute ischemic stroke care. The regional variations among SMAs in in-hospital mortality, spending, and tPA utilization were 3.2-, 1.7-, and 5.9-fold, respectively. Higher physician supply was significantly associated with lower in-hospital mortality and higher spending. Additionally, spending had a significantly negative correlation with regional continuity of care planning rate.

Uematsu H, Kunisawa S, Sasaki N, Ikai H, Imanaka Y. Development of a risk-adjusted in-hospital mortality prediction model for community-acquired pneumonia: a retrospective analysis using a Japanese administrative database. BMC Pulmonary Medicine 2014 14:203 ; PMID: 25514976 ; DOI: 10.1186/1471-2466-14-203

★DPCデータのみで、市中肺炎の重症度予測を行った。我々の作成したモデルの識別能はAUC0.89と過去のモデルと比較し、良好であった。これらのモデルを利用すれば、病院間での正確なアウトカム比較を通じて、医療の質の改善につながる可能性がある。

★We developed risk-adjusted mortality prediction models using only DPC administrative data. Our models showed high levels of discrimination for mortality prediction, with a c-statistic of 0.89 (95% confidence interval: 0.89-0.90). These models may support improvements in quality of care through inter-hospital comparisons.

Kobayashi D, Otsubo T, Imanaka Y. The effect of centralization of health care services on travel time and its equality. Health Policy 2014 Mar;119(3):298-306 ; PMID: 25480458 ; DOI: 10.1016/j.healthpol.2014.11.008

★全国健康保険協会京都支部の診療報酬請求データを用いて、虚血性心疾患患者および乳がん患者の、居住地から医療機関までのアクセス時間の地域差を明らかにした。さらに、拠点病院への集中化シミュレーションを行ったところ、平均アクセス時間は短くなり、不平等性も損なわれないことが示された。

★Using medical reimbursement claims data from the Kyoto branch of the Japan Health Insurance Association, we found that there are the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer. Besides, a simulation analysis of centralization to regional core hospitals demonstrated that average patient travel times could be reduced with no detrimental effects on equality of access to care.

Sasaki N, Kunisawa S, Otsubo T, Ikai H, Fushimi K, Yasumura Y, Kimura T, Imanaka Y. The relationship between the number of cardiologists and clinical practice patterns in acute heart failure ― A cross-sectional observational study. BMJ Open 2014 Dec 30;4(12):e005988 ; PMID: 25550294 ; DOI: 10.1136/bmjopen-2014-005988

★全国546 急性期病院における急性心不全38,668 症例を解析対象とした。本研究では、より望ましいとされる各種診療プロセス実施と病院あたり循環器専門医数の多さに関連があることが示された。また、リスク調整院内死亡率と専門医数とが負の関係を認めたことともあわせ、急性心不全の診療の質と人的資源に関連があることが示唆された。

★We found that greater use of recommended therapeutic processes of care in acute heart failure, measured by sex-age-adjusted odds ratios, was associated with a higher number of cardiologists, using a large administrative database. Even after adjusting for disease severity factors, patients admitted to hospitals with fewer cardiologists had a higher likelihood of in-hospital mortality.

Fukuda H, Okuma K, Imanaka Y. Can experience improve hospital management? PLOS ONE 2014 Sep 24;9(9):e106884 ; PMID: 25250813 ; DOI: 10.1371/journal.pone.0106884

Ukawa N, Ikai H, Imanaka Y. Trends in hospital performance in acute myocardial infarction care: a retrospective longitudinal study in Japan. International Journal for Quality in Health Care 2014 Oct;26(5):516-523 ; PMID: 25107593 ; DOI: 10.1093/intqhc/mzu073

Goto E, Lee J, Sasaki N, Imanaka Y. Factors affecting regional variations in hospitalization expenditures of elderly residents in Japan. Journal of Public Health 2014 Volume 22, Issue 4, pp 361-370 ; DOI: 10.1007/s10389-014-0621-z

★高齢者一人あたり入院医療費に関連する要因やその強さは、地域の都市化度によって異なった。病床数以外に、低都市化地域では病院へのアクセスの悪さと高齢者のみ世帯割合の多さが、一方、高都市化地域では医療資源の多さが、入院医療費の高さと関連していると考えられる。全国一律の施策は、一律な効果を実現しないばかりか、地域によっては受療機会を減らすことになりかねない。医療費政策は、地域の特徴を考慮して講じるべきである。

★Our findings emphasize the importance of taking the level of urbanization into account when analyzing regional variations in hospitalization expenditures. Policies designed to contain healthcare expenditures should take into account these regional characteristics in order to better implement regionspecific improvements that ensure affordable healthcare in arapidly aging society.

Kunisawa S, Yamashita K, Ikai H, Otsubo T, Imanaka Y. Survival analyses of postoperative lung cancer patients: an investigation using Japanese administrative data. SpringerPlus 2014 3:217 ; PMID: 24826376 ; DOI: 10.1186/2193-1801-3-217

★Stage情報を有するDPCデータを用いて、肺癌術後５年間の生存解析を行った。臨床登録データと類似の結果を呈し、また、症例の多い病院群で高い生存率がみられた。今後、広域地域のがんの治療成績のモニタリングなどに利用しうる、Administrative Databaseの潜在力を示した。我が国のAdministrative Databaseを用いれば、限界はあるものの、低コストで、迅速に、しかもデータ整備が不十分な病院群データも対象として生存率を推計できる等の利点がある。

★Using an administrative database with staging information, we analyzed5-year-survival curves after the initial hospitalization due to primarynon-small cell lung cancer. The curves approximated those of the cancerregistry database. Hospitals with higher case volume showed higher 5-yearsurvival. We showed a potential of the Japanese administrative database totimely describe and monitor cancer survival rates, low in cost, of all thehospitals including those weak in data management.

Kobuse H, Morishima T, Tanaka M, Murakami G, Hirose M, Imanaka Y. Visualizing variations in organizational safety culture across an inter-hospital multifaceted workforce. Journal of Evaluation in Clinical Practice 2014 2014;20(3):273-80. ; PMID: 24661540 ; DOI: 10.1111/jep.12123

Kunisawa S, Kobayashi D, Lee J, Otsubo T, Ikai H, Yokota C, Minematsu K, Imanaka Y. Factors associated with the administration of tissue plasminogen activator for acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases 2014 23(4):724-731. ; PMID: 23910512 ; DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.033

★急性期脳梗塞患者の約5％にtPA投与が見られた。tPA投与には年齢や重症度が関連するが、患者宅と病院との距離には関連が見られなかった。リスク調整を行ったうえで、救急搬送が行われている場合にはtPA投与に至る割合が約４倍となり(オッズ比 4.3)、救急搬送の重要性が再認識された。

★Intravenous tPA was found to be administered to approximately 5% of acute ischemic stroke patients. The administration of tPA was associated with age and stroke severities, but not with distance from patient home to hospital. After risk adjustment, ambulance use was significantly associated with tPA use (OR: 4.3), which emphasizes the need for emergency calls for an ambulance in suspected stroke patients.

Morishima T, Lee J, Otsubo T, Imanaka Y. Association of health care expenditures with aggressive versus palliative care for cancer patients at the end of life: A cross-sectional study using claims data in Japan. International Journal for Quality in Health Care 2014 26(1):79-86. ; PMID: 24225269 ; DOI: 10.1093/intqhc/mzt081

★終末期がん患者への過剰医療や緩和ケアを示す指標のうちのいくつかが終末期医療費の増加と関連していることがレセプトデータから明らかになった。終末期がん患者への過剰治療を適正化すれば終末期医療費を削減できるかもしれないことが示唆された。

★We revealed that indicators of both aggressive and palliative end-of-life care for terminally-ill cancer patients were associated with higher healthcare spending at the end of life, using health insurance claims data. These results may support the coherent development of measures to optimize aggressive care and reduce the financial burdens of terminal cancer care.

Sasaki H, Otsubo T, Imanaka Y. Widening disparity in the geographic distribution of pediatricians in Japan. Human Resources for Health 2013 Nov 22;11:59 ; PMID: 24267031 ; DOI: 10.1186/1478-4491-11-59

★小児科医師数の推移は、地域の都会化度因子と医療資源因子で、４タイプに分類された。都会化が進むも医療資源が少ない地域で最も増加が激しかった。一方、田舎で医療資源が少ない地域では、数は維持されているが、若い医師や女性医師など新たな医師の流入は無く、すでに高齢な医師のさらなる高齢化が進んでいる。これらの地域では、近い将来に医師不足が急速に問題化する恐れが強い。

★The trends of the pediatrician workforce were classified into four types according to the two factors: urbanization and healthcare resources. In highly urbanized and low-resource areas, the workforce increased most sharply. On the other hand, in lowly urbanized and low-resource areas, the already-old workforce were maintained in size without entry of younger or women doctors, and they were getting older. This situation alarms a dangerous state of future critical shortage in doctors in these areas.

Kunisawa S, Morishima T, Ukawa N, Ikai H, Otsubo T, Ishikawa KB, Yokota C, Minematsu K, Fushimi K, Imanaka Y. The association of geographical factors with administration of tissue plasminogen activator for acute ischemic stroke. Journal of American Heart Association 2013 Sep 17;2(5):e000336 ; PMID: 24045119 ; DOI: 10.1161/JAHA.113.000336

★全国に分布する603病院の急性期脳梗塞114,194例を分析した。tPA投与率は、全体の約５％で、高齢者および重症例でより低い傾向がみられ、運転アクセス時間とは関係なかった。関連因子を調整しても、救急搬送の有無に強く関連していた（オッズ比　４）。これらの結果は、都会か地方かに係らず同様であり、脳卒中が疑われるときに迅速に救急車を呼ぶことの重要性を示唆するものであった。

★We analyzed administrative claims data from 114,194 acute ischemic stroke cases admitted to 603 hospitals in Japan. Approximately 5.1% of patients received tPA. The administration of tPA was associated with patient age and severity of stroke symptoms, but driving time showed no association. Ambulance use was significantly associated with tPA administration (OR: 4.0) even after adjustment for covariates. These results are consistent across differentially urbanized regions, and suggest the importance of calling an ambulance for suspected stroke.

Park S, Sasaki N, Morishima T, Ikai H, Imanaka Y. The number of cardiologists, case volume and in-hospital mortality in acute myocardial infarction patients. International Journal of Cardiology 2013 Oct;168(4):4470-1 ; PMID: 23871346 ; DOI: 10.1016/j.ijcard.2013.06.139

★多くの先行研究では急性心筋梗塞の症例数とアウトカムでの負の関係が報告されてきたが、本研究では症例数より、循環器専門医数が院内死亡率と負の関係であることがわかった。循環器専門医を集中させることがより医療の質を高める効果的な方案になりえると理解する必要がある。

★Several studies have demonstrated an inverse volume-outcome relationship in AMI, but our study showed that in-hospital mortality was inversely associated with the number of cardiologists per hospital, but not with case volume. This founding suggests understanding the possible advantages of concentrating cardiologists to specific institutions in order to improve the quality of care for AMI patients.

Park S, Lee J, Ikai H, Otsubo T, Imanaka Y. Decentralization and centralization of healthcare resources: investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in Japan. Health Policy 2013 Nov;113(1-2):100-9. ; PMID: 23830562 ; DOI: 10.1016/j.healthpol.2013.06.005

★循環器専門医数の多い病院(集中化)とDPC病院数の多い二次医療圏(分散化)では、急性心筋梗塞患者における死亡率が低いことがわかった。医療の質を高めるのための集中化と分散化のメカニズムを理解して、実際に政策を立てる際にそれらのバランスを取る必要がある。

★Centralization of cardiologist at the hospital level and decentralization of acute hospitals at the regional level may be contributing factors for improving the quality of care in Japan. Policymakers need to strike a balance between these two approaches to improve healthcare provision and quality.

Sasaki N, Lee J, Park S, Umegaki T, Kunisawa S, Otsubo T, Ikai H, Imanaka Y. Development and Validation of an Acute Heart Failure-Specific Mortality Predictive Model Based on Administrative Data. Canadian Journal of Cardiology 2013 Sep;29(9):1055-61 ; PMID: 23395282 ; DOI: 10.1016/j.cjca.2012.11.021

★85急性期病院における8620名の急性心不全患者について、DPCデータ内の年齢、性別の他、入院時の併存症、NYHA分類などを用いて、高い院内死亡予測力をもつモデルを開発した(C-statistic = 0.80)。当該モデルを用いて多くの病院で同様の定義でリスク調整予測死亡率を算出することができるようになり、評価や改善に使いうる。

★We developed a new acute heart failure (AHF) mortality prediction model using an administrative database in Japan. The use of only 11 variables including older age, New York Heart Association (NYHA) functional class and severe comorbid conditions were able to accurately predict in-hospital mortality (C-statistic = 0.80). This model may facilitate risk adjustments for AHF and can contribute to further hospital evaluations.

Park S, Lee J, Ikai H, Otsubo T, Ukawa N, Imanaka Y. Quality of care and in-hospital resource use in acute myocardial infarction: Evidence from Japan. Health Policy 2013 Aug;111(3):264-72 ; PMID: 23800607 ; DOI: 10.1016/j.healthpol.2013.05.015

★医療政策を立てる際、より低い医療費はより高い効率性を示しているという仮定で、単純に医療費のみに着目する考え方がある。しかし、本研究では急性心筋梗塞における医療費の高い病院グループに比べ、低い病院グループでは死亡率が高いことがわかった。 政策立案者はこの関係を理解した上で、医療政策を立てる必要がある。

★At first glance, hospitals with lower resource use may appear to possess a higher level of efficiency, and policymakers may be inclined to set standards of low healthcare spending to contain costs. However, our study showed that poor quality of care in outcome measures was associated with lower resource use among AMI patients. Policymakers need to understand this inverse association before health policymaking.

Kunisawa S, Otsubo T, Lee J, Imanaka Y. Improving the assessment of prescribing: Use of a 'substitution index'. Journal of Health Services Research & Policy 2013 Jul;18(3):138-43 ; PMID: 23595576 ; DOI: 10.1177/1355819612473593

★日本での後発薬の使用状況を、部門別、薬効別で解析した。後発薬の利用可能の最大値は部門や取扱い薬により大きく異なり、最大値を考慮した公正な指標を提案する。

★We analyzed the use of generic drugs categorized by sectors and drug types. We found not only differences in generic drug use rates, but also significant differences in maximum substitutability among sectors and clinical disciplines. We propose a fairer measure to assess the use of generic drugs in a policy context.

Yamashita K, Ikai H, Nishimura M, Fushimi K, Imanaka Y. Effect of certified training facilities for intensive care specialists on mortality in Japan. Critical Care and Resuscitation 2013 15(1):28-32. ; PMID: 23432498 ; DOI: WOS:000343200000006

★ICU専門医研修施設に認定されたICUで治療を受けた患者の予後とそうでない患者との予後とを、リスク要因を統計的に調整して比較し、前者が優れていたことを示した。

★Patients who were treated in ICUs certified as training facilities for intensive care specialists had better outcome than patients treated in ICU without this certification.

Umegaki T, Nishimura M, Tajimi K, Fushimi K, Ikai H, Imanaka Y. An in-hospital mortality equation for mechanically ventilated patients in intensive care units. Journal of Anesthesia 2013 Aug;27(4):541-9 ; PMID: 23475475 ; DOI: 10.1007/s00540-013-1557-0

Lee J, Morishima T, Kunisawa S, Sasaki N, Otsubo T, Ikai H, Imanaka Y. Derivation and validation of in-hospital mortality prediction models in ischaemic stroke patients using administrative data. Cerebrovascular Diseases 2013 35(1):73-80. ; PMID: 23429000 ; DOI: 10.1159/000346090

★DPCの調査項目データとして追加された脳梗塞患者の重症度情報を用い、精度の高い死亡予測モデルを開発した。

★Recent additions of disease severity information to Japanese administrative data (DPC data) were shown to achieve high accuracy of mortality prediction in stroke patients, thereby supporting further outcomes research.

Motohashi T, Hamada H, Lee J, Sekimoto M, Imanaka Y. Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture. Health Policy 2013 111(1):60-7. ; PMID: 23628484 ; DOI: 10.1016/j.healthpol.2013.03.014

★日本の急性期病院における高齢患者の在院日数の長期化や転院に関連する、地域の医療･介護資源を調べた。その結果、二次医療圏内の医療･介護資源の充実（療養病床数等）は、患者の転院をより可能にし、在院日数を短縮させることが示唆された。

Tanaka M, Lee J, Ikai H, Imanaka Y. Development of efficiency indicators of operating room management for multi-institutional comparisons. Journal of Evaluation in Clinical Practice 2013 19(2):335-41. ; PMID: 22332870 ; DOI: 10.1111/j.1365-2753.2012.01829.x

★手術室あたりの手術件数、手術室利用時間、手術手技報酬は病院規模や人員数等の違いが大きな影響を及ぼす（R2＝0.34～0.5）。２２４病院の医療管理データを用い、これらの違いを統計学的に調整し多施設比較可能な手術室運用の効率性評価指標を開発した。

Lee J, Morishima T, Park S, Otsubo T, Ikai H, Imanaka Y. The association between health care spending and quality of care for stroke patients in Japan. Journal of Health Services Research & Policy 2013 18(2): 77-82. ; DOI: 10.1177/1355819612473454

★脳梗塞に対する医療費が低い地域では、プロセスの質指標が低いことが示された。一方、医療費と院内死亡率に関連は見られなかった。

★Testing the associations between spending and quality of care revealed that lower spending regions were associated with reduced performance in processes, but not with in-hospital mortality in ischemic stroke care.

Morishima T, Ikai H, Imanaka Y. Cost-effectiveness analysis of omalizumab for the treatment of severe asthma in Japan and the value of responder prediction methods based on a multinational trial. Value in Health Regional Issues 2013 2(1): 29–36. ; DOI: 10.1016/j.vhri.2013.01.007

★気管支喘息の高額薬剤であるオマリズマブの費用対効果を調べるとともに、レスポンダー（よく効く患者）を予測する検査方法の発見の経済的価値を見積もった。

★We conducted an economic evaluation of omalizumab in patients with severe asthma and estimated the expected value of perfect information of responder prediction methods.

Morishima T, Lee J, Otsubo T, Ikai H, Imanaka Y. Impact of hospital case volume on quality of end-of-life care in terminal cancer patients. Journal of Palliative Medicine 2013 16(2):173-8. ; PMID: 23140184 ; DOI: 10.1089/jpm.2012.0361

★がん患者の終末期医療の質と、病院の症例数とが相関していることを発見した。

★We demonstrated an association between quality of end-of-life care and case volume, using a large-scale insurance claims database.

Morishima T, Imanaka Y, Otsubo T, Hayashida K, Watanabe T, Tsuji I. Burden of household environmental tobacco smoke on medical expenditure for Japanese women: a population-based cohort study. Journal of Epidemiology 2013 23(1):55-62. ; PMID: 23183111 ; DOI: 10.2188/jea.JE20120072

★コホート研究において家庭内で受動喫煙に暴露された女性とそうでない女性の医療費とを比較し、受動喫煙に起因する超過医療費を評価した。

★This is a long-term cohort study that assessed the excess in healthcare spending caused by environmental tobacco smoke in homes.

Morishima T, Otsubo T, Gotou E, Kobayashi D, Lee J, Imanaka Y. Physician adherence to asthma treatment guidelines in Japan: focus on inhaled corticosteroids. Journal of Evaluation in Clinical Practice 2013 19(2):223-9. ; PMID: 21689218 ; DOI: 10.1111/j.1365-2753.2011.01708.x

★気管支喘息治療のガイドラインで重症度に関係なく推奨されている吸入ステロイド剤の処方の有無に関係する医療者側の要因と患者側の要因を明らかにした。

★We explored the determinants of prescription of inhaled corticosteroids for patients with asthma, using an insurance claims database.

Hamada H, Sekimoto M, Imanaka Y. Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan. Health Policy 2012 107(2-3):194-201. ; PMID: 22277879 ; DOI: 10.1016/j.healthpol.2012.01.002

Kunisawa S, Ikai H, Imanaka Y. Incidence and prevention of postoperative venous thromboembolism: are they meaningful quality indicators in Japanese health care settings? World Journal of Surgery 2012 36(2):280-6. ; PMID: 21879424 ; DOI: 10.1007/s00268-011-1229-x

Ikai H, Morimoto T, Shimbo T, Imanaka Y, Koike K. Impact of postgraduate education on physician practice for community-acquired pneumonia. Journal of Evaluation in Clinical Practice 2012 18(2):389-95. ; PMID: 21208347 ; DOI: 10.1111/j.1365-2753.2010.01594.x

Umegaki T, Ikai H, Imanaka Y. The impact of acute organ dysfunction on patients' mortality with severe sepsis. Journal of Anaesthesiology, Clinical Pharmacology 2011 27(2):180-4. ; PMID: 21772676 ; DOI: 10.4103/0970-9185.81816

Fukuda H, Lee J, Imanaka Y. Costs of hospital-acquired infection and transferability of the estimates: a systematic review. Infection 2011 39(3):185-99. ; PMID: 21424853 ; DOI: 10.1007/s15010-011-0095-7

★院内感染によるコストの研究のシステマティックレビューを行い、原価計算の方法とその記述レベルを評価した。その結果、原価の要素と単価の明示を含む、計算過程の透明性や再現性を確保した研究は少なく、1割に満たなかった。

★A systematic review showed that only <10% of studies that produced cost estimates of HAIs had a high level of transferability, with reported cost components and unit costs.

Umegaki T, Sekimoto M, Imanaka Y. Impact of intensive care unit physician on care processes of patients with severe sepsis in teaching hospitals. Journal of Anesthesia & Clinical Research. 2011 2(2):120-125. ; DOI: 10.4172/2155-6148.1000120

Lee J, Imanaka Y, Sekimoto M, Nishikawa H, Ikai H, Motohashi T; Quality Indicator/Improvement Project (QIP) Expert Group for Clinical Evaluation. Validation of a novel method to identify healthcare-associated infections. Journal of Hospital Infection 2011 77(4):316-20. ; PMID: 21277647 ; DOI: 10.1016/j.jhin.2010.11.013

★DPCデータから院内感染の発生を同定する方法を開発した。チャートレビュー結果と照合し、その方法の妥当性を実証した。

★Chart review analysis was used to demonstrate the high validity of an HAI identification method based on antibiotic utilization patterns in administrative data.

Otsubo T, Imanaka Y, Lee J, Hayashida K. Evaluation of resource allocation and supply-demand balance in clinical practice with high-cost technologies. Journal of Evaluation in Clinical Practice 2011 17(6):1114-21. ; PMID: 20630009 ; DOI: 10.1111/j.1365-2753.2010.01484.x

★我が国では、高額医療機器設置の導入規制がないが、世界的に見て設置数は非常に多い。そこで地域の需給バランスを評価する指標を開発し、MRIとESWLに適用し、過剰供給地域群とその特性を見出した。

Fukuda H, Lee J, Imanaka Y. Variations in analytical methodology for estimating costs of hospital-acquired infections: a systematic review. Journal of Hospital Infection 2011 77(2):93-105. ; PMID: 21145131 ; DOI: 10.1016/j.jhin.2010.10.006

★院内感染に関わるコストの推定方法について系統的レビューを行い、その動向を示した。

★A systematic review tracked the distribution and trends in HAI cost estimation methodologies, which focused on matched comparisons, regression models, and case reviews.

Lee J, Imanaka Y, Sekimoto M, Ikai H, Otsubo T. Healthcare-associated infections in acute ischemic stroke patients from 36 Japanese hospitals: risk-adjusted economic and clinical outcomes. International Journal of Stroke. 2011 6(1): 16-24. ; PMID: 21205236 ; DOI: 10.1111/j.1747-4949.2010.00536.x

★脳梗塞患者において、多変量でリスク調整を行い、医療費、在院日数、院内死亡率の、院内感染による増分を定量的に示した。

★We identified HAI incidence in stroke patients based on antibiotic utilization patterns. We quantified the increases in hospital charges, length of stay, and mortality due to HAI by statistically controlling effects of the other risk factors.

Nishikawa H, Imanaka Y, Sekimoto M, Ikai H. Verification bias in assessment of the utility of MRI in the diagnosis of cruciate ligament tears. American Journal of Roentgenology 2010 195(5):W357-64. ; PMID: 20966301 ; DOI: 10.2214/AJR.10.4189

Umegaki T, Sekimoto M, Ikai H, Imanaka Y. Current anticoagulation therapy for sepsis-induced disseminated intravascular coagulation in Japan: results of multicenter study using administrative data. Journal of the Japanese Society of Intensive Care Medicine 2010 17(4):555-559. ; DOI: 10.3918/jsicm.17.555

Umegaki T, Sekimoto M, Hayashida K, Imanaka Y. An outcome prediction model for adult intensive care. Critical Care and Resuscitation : journal of the Australasian Academy of Critical Care Medicine 2010 12(2):96-103. ; PMID: 20513217

Regenbogen SE, Hirose M, Imanaka Y, Oh EH, Fukuda H, Gawande AA, Takemura T, Yoshihara H. A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA. Quality and Safety in Health Care 2010 19(6):e10-e13. ; PMID: 20194219 ; DOI: 10.1136/qshc.2008.029215

Sasaki H, Imanaka Y, Sekimoto M, Lee J, Otsubo T. Antimicrobial prescription patterns for children hospitalized with pneumonia and compliance to guidelines in Japan: a multicenter study. Journal of Evaluation in Clinical Practice 2010 16(5):987-9. ; PMID: 20626540 ; DOI: 10.1111/j.1365-2753.2009.01237.x

Sekimoto M, Imanaka Y, Shirai T, Sasaki H, Komeno T, Lee J, Yoshihara K, Ashihara E, Maekawa T. Risk-adjusted assessment of incidence and quantity of blood use in acute-care hospitals in Japan: an analysis using administrative data. Vox Sanguinis 2010 98(4):538-46. ; PMID: 20002605 ; DOI: 10.1111/j.1423-0410.2009.01290.x

Murakami G, Imanaka Y, Kobuse H, Lee J, Goto E. Patient perceived priorities between technical skills and interpersonal skills: their influence on correlates of patient satisfaction. Journal of Evaluation in Clinical Practice 2010 16(3):560-8. ; PMID: 20438604 ; DOI: 10.1111/j.1365-2753.2009.01160.x

Hayashida K, Imanaka Y, Murakami G, Takahashi Y, Nagai M, Kuriyama S, Tsuji I. Difference in lifetime medical expenditures between male smokers and non-smokers. Health Policy 2010 94(1):84-9. ; PMID: 19775772 ; DOI: 10.1016/j.healthpol.2009.08.007

Fukuda H, Imanaka Y, Hirose M, Hayashida K Impact of system-level activities and reporting design on the number of incident reports for patient safety. Quality and Safety in Health Care 2010 19(2):122-7. ; PMID: 20351160 ; DOI: 10.1136/qshc.2008.027532

Lee J, Imanaka Y, Sekimoto M, Ishizaki T, Hayashida K, Ikai H, Otubo T. Risk-adjusted increases in medical resource utilization associated with health care-associated infections in gastrectomy patients. Journal of Evaluation in Clinical Practice 2010 16(1):100-6. ; PMID: 20367820 ; DOI: 10.1111/j.1365-2753.2009.01121.x

★胃切除患者の院内感染を、DPCデータにて抗菌薬使用のパターンから同定する手法を開発し、医療費、抗菌薬薬剤費、在院日数における、院内感染による増加分を定量的に示した。

★In gastrectomy patients, we developed an HAI identification method based on antibiotic utilization patterns in administrative data, and analyzed HAI-associated increases in hospital costs, antibiotic costs, and length of stay.

Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Contribution of bile duct drainage on resource use and clinical outcome of open or laparoscopic cholecystectomy in Japan. Journal of evaluation in clinical practice. 2010 16(1):31-8. ; PMID: 20367813 ; DOI: 10.1111/J.1365-2753.2008.01109.X

Kuwabara K, Matsuda S, Imanaka Y, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K, Ikeda S, Yasunaga H. Injury severity score, resource use, and outcome for trauma patients within a Japanese administrative database. Journal of Trauma - Injury, Infection and Critical Care 2010 68(2):463-70. ; PMID: 19935111 ; DOI: 10.1097/TA.0b013e3181a60275

Kuwabara K, Matsuda S, Anan M, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Difference in resource utilization between patients with acute and chronic heart failure from Japanese administrative database. International journal of cardiology. 2010 141(3):254-9. ; PMID: 19157584 ; DOI: 10.1016/J.IJCARD.2008.11.197

Bech M, et al [incl. Imanaka Y]. The influence of economic incentives and regulatory factors on the adoption of treatment technologies: A case study of technologies used to treat heart attacks. Health Economics 2009 18(10):1114-1132. ; PMID: 18972326 ; DOI: 10.1002/hec.1417

Fukuda H, Imanaka Y, Ishizaki T, Okuma K,Shirai T. Change in clinical practice after publication of guidelines on breast cancer treatment. International Journal for Quality in Health Care 2009 21(5):372-8. ; PMID: 19700780 ; DOI: 10.1093/intqhc/mzp037

Nishikawa H, Imanaka Y, Sekimoto M, Hayashida K, Ikai H. Influence of verification bias on the assessment of MRI in the diagnosis of meniscal tear. American Journal of Roentgenology 2009 193(6):1596-602. ; PMID: 19933653 ; DOI: 10.2214/AJR.08.2223

Nojo T, Imanaka Y, Ishizaki T, Sekimoto M, Yoshino M, Kurosawa T, Takao H, Ohtomo K. Lung cancer incidence in middle-aged men estimated by low-dose computed tomography screening. Lung Cancer 2009 65(1):56-61. ; PMID: 19019487 ; DOI: 10.1016/j.lungcan.2008.10.004

Shirai T, Imanaka Y, Sekimoto M, Ishizaki T; QIP Ovarian Cancer Expert Group. Primary chemotherapy patterns for ovarian cancer treatment in Japan. The Journal of Obstetrics and Gynaecology Research 2009 35(5):926-34. ; PMID: 20149043 ; DOI: 10.1111/j.1447-0756.2009.01033.x

Kawasaki K, Sekimoto M, Ishizaki T, Imanaka Y. Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan. Journal of Anesthesia 2009 23(2):235-41. ; PMID: 19444563 ; DOI: 10.1007/s00540-008-0736-x

Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H, Mihara H, Tsuji N, Yamaguchi A; Japan Council for Quality Health Care, Expert Group on Healthcare-Associated Infection Control and Prevention. Factors affecting performance of hospital infection control in Japan. American Journal of Infection Control 2009 37(2):136-42. ; PMID: 19249641 ; DOI: 10.1016/j.ajic.2008.03.005

Hayashida K, Imanaka Y, Otsubo T, Kuwabara K, Ishikawa KB, Fushimi K, Hashimoto H, Yasunaga H, Horiguchi H, Anan M, Fujimori K, Ikeda S, Matsuda S. Development and analysis of a nationwide cost database of acute-care hospitals in Japan. Journal of Evaluation in Clinical Practice 2009 15(4):626-33. ; PMID: 19522724 ; DOI: 10.1111/j.1365-2753.2008.01063.x

Fukuda H, Imanaka Y, Hirose M, Hayashida K. Factors associated with system-level activities for patient safety and infection control. Health Policy 2009 89(1):26-36. ; PMID: 18538442 ; DOI: 10.1016/j.healthpol.2008.04.009

Fukuda H, Imanaka Y. Assessment of transparency of cost estimates in economic evaluations of patient safety programmes. Journal of Evaluation in Clinical Practice 2009 15(3):451-9. ; PMID: 19366392 ; DOI: 10.1111/j.1365-2753.2008.01033.x

Fukuda H, Imanaka Y, Kobuse H, Hayashida K, Murakami G. The subjective incremental cost of informed consent and documentation in hospital care: a multicentre questionnaire survey in Japan. Journal of Evaluation in Clinical Practice 2009 15(2):234-41. ; PMID: 19335478 ; DOI: 10.1111/j.1365-2753.2008.00987.x

Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K, Hayashida K. Impact of timing of cholecystectomy and bile duct interventions on quality of cholecystitis care. International Journal of Surgery 2009 7(3):243-9 ; PMID: 19376278 ; DOI: 10.1016/J.IJSU.2009.04.003

Kuwabara K, Matsuda S, Fushimi K, Anan M, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Differences in practice patterns and costs between small cell and non-small cell lung cancer patients in Japan. The Tohoku Journal of Experimental Medicine. 2009 217(1):29-35. ; PMID: 19155605 ; DOI: 10.1620/TJEM.217.29

Fukuda H Imanaka Y, Hirose M, Hayashida K. Economic evaluations of maintaining patient safety systems in teaching hospitals. Health Policy 2008 88(2-3):381-91. ; PMID: 18514966 ; DOI: 10.1016/j.healthpol.2008.04.004

Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Cost of open versus laparoscopic appendectomy. La Clinica Terapeutica 2008 159(3):155-63. ; PMID: 18594744

Sekimoto M, Kakutani C, Inoue I, Ishizaki T, Hayashida K, Imanaka Y. Management patterns and healthcare costs for hospitalized patients with cerebral infarction. Health Policy 2008 88(1):100-9. ; PMID: 18378349 ; DOI: 10.1016/j.healthpol.2008.01.013

Fukuda H, Imanaka Y, Hayashida K. Cost of hospital-wide activities to improve patient safety and infection control: a multi-centre study in Japan. Health Policy 2008 87(1):100-11. ; PMID: 18394745 ; DOI: 10.1016/j.healthpol.2008.02.006

Ishizaki T, Imanaka Y, Oh EH, Sekimoto M, Hayashida K, Kobuse H. Association between patient age and hospitalization resource use in a teaching hospital in Japan. Health Policy 2008 87(1):20-30. ; PMID: 18067988 ; DOI: 10.1016/j.healthpol.2007.10.007

Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H, Mihara H, Tsuji N, Yamaguchi A; Japan Council for Quality Health Care, Expert Group on Healthcare-Associated Infection Control and Prevention. Impact of hospital accreditation on infection control programs in teaching hospitals in Japan. American Journal of Infection Control 2008 36(3):212-9. ; PMID: 18371518 ; DOI: 10.1016/j.ajic.2007.04.276

Kuwabara K, Matsuda S, Imanaka Y, Fushimi K, Hashimoto H, Ishikawa K. The effect of age and procedure on resource use for patients with cerebrovascular disease. Journal of Health Services Research and Policy 2008 13(1):26-32. ; PMID: 18325153 ; DOI: 10.1258/jhsrp.2007.007009

Ishizaki T, Imanaka Y, Sekimoto M, Fukuda H, Mihara Hwith the Treatment of Subarachnoid Hemorrhage Expert Group. Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan. Journal of Evaluation in Clinical Practice 2008 14(3):416-21. ; PMID: 18373576 ; DOI: 10.1111/j.1365-2753.2007.00882.x

Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data. Environmental Health and Preventive Medicine 2008 13(3):130-7. ; PMID: 19568897 ; DOI: 10.1007/s12199-007-0022-9

Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Impact of age and procedure on resource use for patients with ischemic heart disease. Health Policy 2008 85(2):196-206. ; PMID: 17825454 ; DOI: 10.1016/j.healthpol.2007.07.015

Oh EH, Imanaka Y, Hayashida K, Kobuse H. Meta-analysis comparing clinical effectiveness of drug-eluting stents, bare metal stents and coronary artery bypass surgery. International Journal of Evidence-Based Healthcare 2007 5(3):296-304. ; PMID: 21631793 ; DOI: 10.1111/j.1479-6988.2007.00071.x

Fushimi K, Hashimoto H, Imanaka Y, Kuwabara K, Horiguchi H, Ishikawa KB, Matsuda S. Functional mapping of hospitals by diagnosis-dominant case-mix analysis. BMC Health Services Research 2007 7(4):50-57. ; PMID: 17425788 ; DOI: 10.1186/1472-6963-7-50

Hayashida K, Imanaka Y, Sekimoto M, Kobuse H, Fukuda H. Evaluation of acute myocardial infarction in-hospital mortality using a risk-adjustment model based on Japanese administrative data. Journal of International Medical Research 2007 35(5):590-596. ; PMID: 17900397 ; DOI: 10.1177/147323000703500502

Hayashida K, Imanaka Y, Fukuda H. Measuring hospital-wide activity volume for patient safety and infection control: a multi-centre study in Japan. BMC Health Services Research 2007 7(9):140-146. ; PMID: 17764578 ; DOI: 10.1186/1472-6963-7-140

Hirose M, Regenbogen SE, Lipsitz S, Imanaka Y, Ishizaki T, Sekimoto M, Oh EH, Gawande AA. Lagtime in incident reporting system at a university hospital in Japan. Quality and Safety in Health Care 2007 16(2):101-4. ; PMID: 17403754 ; DOI: 10.1136/qshc.2006.019851

Evans E, Imanaka Y, Sekimoto M, Ishizaki T, Hayashida K, Fukuda H, Oh EH. Risk adjusted resource utilization for AMI patients treated in Japanese hospitals. Health Economics 2007 16(4):347-359. ; PMID: 17031780 ; DOI: 10.1002/hec.1177

Murakami G, Inoue T, Saito M. On cognitive reliability of hospital organisational environment and work performance. International Journal of Healthcare Technology and Management 2007 8(4):388-398. ; DOI: 10.1504/IJHTM.2007.013170

International Hospital Federation and World Health Organization. (Imanaka Y as the principal investigator for the Western Pacific Region) A Global Study on Experiences in Hospital Sector Reform: The performance of hospitals under changing socio-economic conditions. WHO 2007

Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H. Profiling of resource use variation among six diseases treated at 82 Japanese special functioning hospitals, based on administrative data. Health Policy 2006 78(2-3):306-18 ; PMID: 16343686 ; DOI: 10.1016/j.healthpol.2005.11.006

Sekimoto M, Imanaka Y, Kitano N, Ishizaki T, Takahashi O. Why are physicians not persuaded by scientific evidence? A grounded theory interview study. BMC Health Services Research 2006 6(7):92-100. ; PMID: 16872522 ; DOI: 10.1186/1472-6963-6-92

Sekimoto M, Imanaka Y, Hirose M, Ishizaki T, Murakami G, Fukata Y; QIP Cholecystectomy Expert Group. Impact of treatment policies on patient outcomes and resource utilization in acute cholecystitis in Japanese hospitals. BMC Health Services Research 2006 6(3):40-46. ; PMID: 16569249 ; DOI: 10.1186/1472-6963-6-40

Ishizaki T, Yoshida H, Suzuki T, Watanabe S, Niino N, Ihara K, Kim H, Fujiwara Y, Shinkai S, Imanaka Y. Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese. Archives of Gerontology and Geriatrics 2006 42(1):47-58. ; PMID: 16081171 ; DOI: 10.1016/j.archger.2005.06.001

Kuwabara K, Imanaka Y, Ishizaki T. Quality and productive efficiency in simple laceration treatment. Journal of Evaluation in Clinical Practice 2006 12(2):164-173. ; PMID: 16579825 ; DOI: 10.1111/j.1365-2753.2006.00597.x

Ishizaki T, Kai I, Imanaka Y. Self-rated health and social role as predictors for 6-year total mortality among a non-disabled older Japanese population. Archives of Gerontology and Geriatrics 2006 42(1):91-99. ; PMID: 16046010 ; DOI: 10.1016/j.archger.2005.05.002

Sekimoto M, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. Journal of hepato-biliary-pancreatic surgery 2006 2006;13(1):10-24. ; PMID: 16463207 ; DOI: 10.1007/S00534-005-1047-3

Hayashida K, Imanaka Y. Inequity in the price of physician activity across surgical procedures. Health Policy 2005 74(1):24-38. ; PMID: 16098409 ; DOI: 10.1016/j.healthpol.2004.12.005

Hirose M, Imanaka Y, Ishizaki T, Sekimoto M, Harada Y, Kuwabara K, Hayashida K, Oh EH, Evans SE. Profiling hospital performance of laparoscopic cholecystectomy based on the administrative data of four teaching hospitals in Japan. World Journal of Surgery 2005 29(4):429-435. ; PMID: 15770381 ; DOI: 10.1007/s00268-004-7535-9

Oh EH Imanaka Y, Evans E. Determinants of the diffusion of computed tomography and magnetic resonance imaging. International Journal of Technology Assessment in Health Care 2005 21(1):73-80. ; PMID: 15736517 ; DOI: 10.1017/s0266462305050099

Sekimoto M, Imanaka Y, Evans E, Ishizaki T, Hirose M, Hayashida K, Fukui T. Practice variation in perioperative antibiotic use in Japan. International Journal for Quality in Health Care 2004 16(5):367-373. ; PMID: 15375097 ; DOI: 10.1093/intqhc/mzh066

Ishizaki T, Imanaka Y, Oh E, Kuwabara K, Hirose M, Hayashida K, Harada Y. Association of hospital resource use with comorbidity status and patient age among hip fracture patients in Japan. Health Policy 2004 69(2):179-187. ; PMID: 15212865 ; DOI: 10.1016/j.healthpol.2003.12.018

Ishizaki T, Imanaka Y, Hirose M, Hayashida K, Kizu M, Inoue A, Sugie S. Estimation of the impact of providing outpatients with information about SARS infection control on their intention of outpatient visit. Health Policy 2004 69(3):293-303. ; PMID: 15276309 ; DOI: 10.1016/j.healthpol.2004.04.008

Sekimoto M, Asai A, Ohnishi M, Nishigaki E, Fukui T, Shimbo T, Imanaka Y. Patients' preferences for involvement in treatment decision making in Japan. BMC Family Practice 2004 5(1):1-10. ; PMID: 15053839 ; DOI: 10.1186/1471-2296-5-1

Ishizaki T, Kai I, Kobayashi Y, Matsuyama Y, Imanaka Y. The effect of aging on functional decline among older Japanese living in a community: a 5-year longitudinal data analysis. Aging Clinical and Experimental Research 2004 16(3):233-239. ; PMID: 15462467 ; DOI: 10.1007/BF03327389

Hirose M, Imanaka Y, Ishizaki T, Evans E. How can we improve the quality of health care in Japan? Learning from JCQHC hospital accreditation. Health Policy 2003 66(1):29-49 ; PMID: 14499164 ; DOI: 10.1016/S0168-8510(03)00043-5

Imanaka Y. Macro and micro costing of atherosclerosis-related diseases in the Japanese health care system. Atherosclerosis. 2003 4(2):189-190. ; DOI: 10.1016/S1567-5688(03)90813-0

Ishizaki T, Yoshida H, Kumagai S, Watanabe S, Shinkai S, Suzuki T, Shibata H, Imanaka Y. Active life expectancy based on activities of daily living for older people living in a rural community in Japan. Geriatrics and Gerontology International 2003 3:S78-S82. ; DOI: 10.1111/j.1444-0594.2003.00099.x

Imanaka Y, Hayashida K, Nakatani I, Kuwabara K. Validation of a theory-based costing methodology through simulation in a virtual hospital: Towards a standardized model of patient-level costing with two-dimensional components. The Proceedings of 4th World Congress of International. Health Economics Association. 2003 4:54-55.

Sekimoto M, Imanaka Y. Practice variation in perioperative antibiotic prophylaxis in Japan. The Proceedings of 20th ISQua International Conference on Quality in Health Care, Dallas. 2003 20:54-55.

Hirose M, Imanaka Y, Ishizaki T, Sekimoto M, Harada Y, Kuwabara K, Hayashida K, Oh EH, Evans E. Profiling hospital performance of laparoscopic cholecystectomy based on administrative data. World journal of surgery 2003 29(4):429-35 ; PMID: 15770381 ; DOI: 10.1007/s00268-004-7535-9

Pierre Moise, Stéphane Jacobzone and the ARD-IHD Experts Group [incl. Imanaka Y, Ishizaki T, Ogawa T] OECD Study of Cross-National Differences in the Treatment, Costs and Outcomes of Ischaemic Heart Disease (OECD Health Working Papers NO.3) OECD 2003 ; DOI: 10.1787/18152015

Pierre Moise, Stéphane Jacobzone and the ARD-IHD Experts Group [incl. Imanaka Y]. OECD Study of Cross-national Differences in the Treatment, Costs and Outcomes of Ischaemic Heart Disease (OECD Health Working Papers NO.3) - Annex 1: Tables & Charts. OECD 2003 ; DOI: 10.1787/18152015

Pierre Moise, Stéphane Jacobzone and the ARD-IHD Experts Group [incl. Imanaka Y]. OECD Study of Cross-national Differences in the Treatment, Costs and Outcomes of Ischaemic Heart Disease (OECD Health Working Papers NO.3) - Annex 2: Charts. OECD 2003 ; DOI: 10.1787/18152015

Lynelle Moon, Pierre Moise, Stéphane Jacobzone and the ARD-Stroke Experts Group [incl. Imanaka Y, Ishizaki T, Ogawa T] Stroke Care in OECD Countries: A Comparison of Treatment, Costs and Outcomes in 17 Countries (OECD Health Working Papers NO.5) OECD 2003 ; DOI: 10.1787/18152015

Lynelle Moon, Pierre Moise, Stéphane Jacobzone and the ARD-Stroke Experts Group. Stroke Care in OECD Countries: A Comparison of Treatment, Costs and Outcomes in 17 Countries (OECD Health Working Papers NO.5) – Annex OECD 2003 ; DOI: 10.1787/18152015

Tokunaga J, Imanaka Y. Influences of length of stay on patient satisfaction with hospital care in Japan. International Journal for Quality in Health Care 2002 14(6):493-502. ; PMID: 12515335 ; DOI: 10.1093/INTQHC/14.6.493

Ishizaki T, Imanaka Y, Hirose M, Kuwabara K, Ogawa T, Harada Y. A first look at variations in use of breast-conserving surgery at five teaching hospitals in Japan. International Journal for Quality in Health Care 2002 14(5):411-8. ; PMID: 12389807 ; DOI: 10.1093/INTQHC/14.5.411

Rahman M, Sekimoto M, Hira K, Koyama H, Imanaka Y, Fukui T. Is Bacillus Calmette-Guerin revaccination necessary for Japanese children? Preventive Medicine 2002 35(1):70-7 ; PMID: 12079443 ; DOI: 10.1006/PMED.2002.1043

Akamizu T, Nakao K, Imanaka Y. Economic evaluation of female hormone replacement therapy for osteoporosis and fractures in elderly women. Japanese Journal of Health Economics and Policy 2002 11:23-42.

Ishizaki T, Kai I, Kobayashi Y, Imanaka Y. Functional transitions and active life expectancy for older Japanese living in a community. Archives of Gerontology and Geriatrics 2002 35(2):107-20. ; PMID: 14764349 ; DOI: 10.1016/S0167-4943(02)00002-X

Hayashida K, Nagasue I, Fukuda T, Gunji A. The natural history model of hepatitis C virus infection and the economic evaluation of alpha interferon treatment. Journal of Epidemiology 2002 12(1):22-32. ; PMID: 11848181 ; DOI: 10.2188/JEA.12.22

Ishizaki T. Maintaining and improving health status in an aged society. Aging and Health: An International Symposium

Jee-Hughes M, Jacobzone S with the OECD study collaborative expert group [incl. Imanaka Y]. OECD study of cross-national differences in the treatment, costs and outcomes of breast cancer. OECD 2001 (web site)

WHO Study WPRO Expert Group (Imanaka Y as the principal investigator for the Western Pacific Region). Hospitals within healthcare systems: Their capacity to meet the needs of populations - Western Pacific Region. WHO 2001

The Technological Change in Health Care Research Network [incl. Imanaka Y]. Differences in technological change around the world: Evidence from heart attack care. Health Affairs 2001 20(3):25-42.

Ishizaki T, Watanabe S, Suzuki T, Shibata H, Haga H. Predictors for functional decline among nondisabled older Japanese living in a community during a 3-year follow-up. Journal of the American Geriatrics Society 2000 48(11):1424-9. ; PMID: 11083318 ; DOI: 10.1111/J.1532-5415.2000.TB02632.X

Tokunaga J, Imanaka Y, Nobutomo K. Effects of patient demands on satisfaction with Japanese hospital care. International Journal for Quality in Health Care 2000 12(5):395-401. ; PMID: 11079219 ; DOI: 10.1093/INTQHC/12.5.395

Imanaka.Y. Casemix refinement by extracting and integrating multi-dimensional severity information from routine data. Casemix Quarterly 2000 2:21-24. (PDF)

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