Propensity score is defined as the probability of each individual being assigned to the treatment group. Propensity score analysis has recently become the sine qua non of comparative effectiveness studies using retrospective observational data. The present report provides useful information on how to use propensity score analysis as a tool for estimating treatment effects with observational data, including (i) assumptions for propensity score analysis, (ii) how to estimate propensity scores and evaluate propensity score distribution, and (iii) four methods of using propensity scores to control covariates: matching, adjustment, stratification, and inverse probability of treatment weighting.

BACKGROUNDS

The presence of pressure injuries may affect patient discharge destination; however, no related large-scale survey has been conducted in Japan. This study aimed to evaluate the association between pressure injury status and discharge to home from Japanese acute-care hospitals.

METHODS

This retrospective observational cohort study used the Japanese Diagnosis Procedure Combination database from July 1 to 31, 2014. We assessed 340,124 inpatients aged 65 years or older admitted from home. To examine the association between pressure injury status (none, healed, healing, stable, worsened, or developed) and home discharge, we employed multivariable logistic regressions; these were adjusted for patient characteristics and within-hospital clustering using generalized estimating equations.

RESULTS

The prevalence of pressure injuries on admission was 1.9%; the overall proportion of hospital-acquired pressure injuries was 1.1%. The logistic regression analyses showed patients with superficial or deep pressure injuries were less likely to be discharged to home. Furthermore, poor pressure injury status (developed < worsened < stable < healing < healed) was associated with lower likelihood of discharge to home.

CONCLUSIONS

Poor pressure injury status negatively affected hospital discharge destination among elderly patients admitted from home.

BACKGROUND

Caregivers of children with mental health problems have difficulty selecting an appropriate institution for consultation because of a lack of information and poor collaboration between public health centers and child specialists. The Japanese government launched an intervention in 2009 to improve access to child mental health services, including training for healthcare providers, family education using leaflets and homepage services, and promoting cooperation among facilities. The purpose of this study was to assess the effects of the intervention using pre- and post-intervention surveys.

METHODS

We conducted a pre-intervention survey in 16 specialist hospitals in 2008. After the governmental intervention was implemented in eight of the 16 specialist hospitals, we also conducted a post-intervention survey in the same hospitals in 2010. We compared changes in the time between the recognition of a child’s mental health problem and the first visit to a child psychiatrist and the caregivers’ perceived difficulty in selecting an appropriate institution before and after the intervention.

RESULTS

We received 4,323 and 869 answers to the pre- and post-intervention surveys, respectively. The intervention had no significant influence on the time between recognition of symptoms and visiting the specialist hospital. However, there was a significant improvement in caregivers’ perceived difficulty in selecting an appropriate medical institution after the intervention (p < 0.001).

CONCLUSIONS

The governmental intervention was effective in reducing the difficulty of selecting an appropriate institution.

BACKGROUND

Omphalocele is frequently detected prenatally worldwide. Nevertheless, little is known about patient demographics, practice pattern and outcomes.

METHODS

We examined patient demographics, treatment options, and outcomes for patients with omphalocele with and without severe chromosomal abnormalities (trisomy 13 and 18), July 2010–March 2016, using a nationwide database in Japan.

RESULTS

Of 399 patients with omphalocele, 89 had trisomy 13 or 18. The average birthweight was 2,449 g, and the average gestational age was 35 weeks; 65% had other congenital associated anomalies, including circulatory and chromosomal anomalies. About 85% of the patients received abdominoplasty. The median length of mechanical ventilation was 5 (0–30) days. The median length of stay (interquartile range) was 45 (21–94) days. Overall, 52% of the patients were discharged to home without home medical care; this percentage was 65% among those without trisomy 13 or 18. In-hospital mortality was 20% for the total sample of patients, while it was 49% for those with trisomy 13 or 18.

CONCLUSIONS

The present study revealed the patient demographics, treatment practices, and discharge status of infants with omphalocele in Japan. This information is useful in aiding decision making on therapeutic strategies by medical staffs and the families of patients with omphalocele.