Visualization Model for Medical Care Processes by Utilizing Japanese Case-mix Classification and its Application to the Variance Analysis of Clinical Pathway

Abstract

Under the Japanese case-mix system, so called DPC system, patient information is coded using a 14-digit code, which includes principal diagnosis and associated medical care procedures. This system can be a tool for analyzing clinical process. The clinical pathway (CP) is a management plans that provide ideal sequence of staff actions to achieve goals for patients with optimal efficiency. In this study, we collated information on medical care processes in chronological order for each patient using the DPC system, for comparative verification with the CP. The subjects included 54 laparoscopic cholecystectomy cases at Saiseikai Kumamoto Hospital between July and December 2008. We coded relevant information for medical care treatments using 20-digit DPC codes based on the original 14-digit code. The 15th digit refers to fluid administration, 16th digit antibiotic use, 17th digit blood sampling, 18th digit other examinations, 19th digit image, and 20th digit meal. We recorded information on medical care received from the date of admission to the date of discharge in chronological order using these extended DPC codes. We also created extended DPC codes for the CP and analyzed discrepancies with each patient’s extended DPC codes as variance for factor analysis. Our results have indicated that the following factors are associated with occurrence of variance cases with statistical significance: age (over 65 yr old 69.2%, under 65 yr old 43.9%; p=0.024), urgency of the admission (urgent admission 76.9%, scheduled admission 41.5%, p=0.024), inflammation (inflammation 65.0%, non-inflammation 41.2%, p=0.046). Our new method enabled to compare each patient’s individual situation with standard medical care processes specified in the CP, and visualize the actual medical care situation.