The Japanese government has introduced the casemix system for the acute-care hospitals since 2003. The applied casemix system is DPC (Diagnostic Procedures Combination) that was newly developed in Japan. The basic idea of DPC is to classify a patient by the combination of diagnosis and procedures conducted within the hospitalization. The first key of classification is diagnosis, and then types of procedures are considered to decide a particular group. One of the main purposes of DPC project is to implement a standardized dataset of in-patient acute care. The keywords are transparency and accountability. Using this framework, we can evaluate the process of medical services. The DPC project collects the three types of information: Form 1 is a clinical summary that contains information on diagnosis and severity. E file has information of the bundled charge of procedure and F-file indicates the detail of bundled procedures. Form 1, E-file and F-file are matched according to the ID number that is unique for each discharged case. Using these data, we can describe the process of each in-patient treatment. As the DPC scheme covers more than 8 million of acute in-patients cases in Japan, it has become one of the important sources of information for clinical analyses, such as patterns of pharmaceutical use and interventional treatments. Furthermore, DPC database can be used for a large-scale multi-center post-marketing clinical study. It is expected that more epidemiologists would have much interest for use of DPC data for studies of clinical epidemiology and health service researches.
In this article, we have investigated the actual situation of transfer distance of emergency cases by pathology base (neurological, cardiologic, pediatric and injury cases), based on the DPC data of Kumamoto prefecture. We have extracted 36,490 emergency cases of Kumamoto prefecture from the DPC database (1st July 1 2010 to 31st December 2010). Using the master table for the distance between each hospitals and each residential place represented by ZIP code in Japan, we have estimated the transfer distance of each emergency case and calculated the average distances for each of 5 categories (neurological, cardiologic, pediatric and injury cases) for each health care region (HCR). In the case of neurological cases, average, standard deviation (SD) and Coefficient of variance (CV) were 11.9Km, 10.3Km and 25.1% for Kumamoto total. There was a wide variation for average transfer distance from 5.9Km (Kumamoto HCR) to 30.0 km (Kamoto HCR). The situation is similar for cardiac cases, injury cases and pediatric cases. In order to solve this access problem of emergency care, the governance power of Regional Health Care Plan must be strengthened.
We have conducted the situation analysis of emergency division of the DPC based acute care hospitals during 1st and 31st October 2006. The studied hospitals were 180 facilities that contracted with our research team for this study. Each participant hospital was required to register the patients who used the emergency division during 1st to 31st October 2006. We differentiated the cases into three types; primary case, secondary case and tertiary case. Furthermore, we distinguished the hospitals into two types; with and without emergency care centers. Based on this dataset, we have conducted the descriptive analyses concerning the patient type and primary diagnosis of tertiary patients. Contrary to the governmental policy for organization of emergency services, although the facilities with the emergency care center accepted more tertiary cases (88.8 cases per month v.s 32.6; 15.8% vs 4.2%), primary cases represented about 70% as like as facilities without emergency care center. There were little differences in the disease structures of accepted patients between both types. Cerebro-vascular diseases (i.e., cerebral infarction, cerebral hemorrhage, SAH), ischemic heart diseases (AMI and angina pectoris), poisoning, hip and pelvic fractures, pneumonia were common diseases and injuries. In order to realize a balanced emergency care system, the governance power of Regional Health Care Plan must be strengthened.
BACKGROUND: Cancer has been the leading cause of death in Japan since 1981 and the number of cancer deaths in 2010 in Japan was about 354,000. In 2002, The Japanese government has introduced the casemix based evaluation system. This made it possible to use the casemix database for the evaluation of clinical process of cancer treatment. We tried to describe the treatment process of uterus cancer among the Japanese acute care hospitals. MATERIAL AND METHOD: We have extracted 36,490 uterus cancer cases from the DPC database (1st July 1 2010 to 31st October 2010). Using this dataset, we have described the cases according to age category, cancer stage and contents of treatment. RESULTS: Among all cases, cervical cancer cases were 14,498, corpus cancer cases were 15,322 and other types (including unknown) were 6,670. Both corpus and cervical cancer, stage 1 is the most frequent for primary cases. For recurrent cases of corpus cancer, stage 3 was the most frequent (34%) and for cervical cancer, stage 2 was the most frequent (29%). In both case of corpus and cervical cancer, the most frequent regimen was “carboplatin + paclitaxel”. CONCLUSION: By using DPC data, it is possible to describe the treatment process of uterus cancer among the Japanese acute care hospitals. If it become to be possible to combine DPC database with other large scale clinical data, it will be an important information resource to complement such clinical database.