Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan.
Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
Diabetes Res Clin Pract. 2019 Sep;155:107750. doi: 10.1016/j.diabres.2019.05.029. Epub 2019 Jun 20.
To calculate process quality measures of diabetes care in Japan using nationwide exclusive claims database.
Using the National Database of health insurance claims during 2015-2016, the proportions of outpatients who received recommended examinations at least annually among those with regular antidiabetic medication were calculated as quality indicators, reported altogether and by prefecture and institutional certification (from the Japan Diabetes Society). Distributions of institutional-level quality indicators were also reported.
Among 4,154,452 outpatients, 96.7% underwent HbA1c or glycated albumin examination. Retinopathy examination was conducted among 46.5% of patients [prefecture (range): 37.5%-51.0%, institutional certification: 44.8% (without) vs. 59.8% (with)]. Urinary qualitative examination was conducted among 67.3% of patients at institutions with <200 beds (prefecture: 54.1%-81.9%, institutional certification: 66.8% vs. 92.8%), whereas urinary quantitative albumin or protein examination was conducted among 19.4% of patients (prefecture: 10.8%-31.6%, institutional certification: 18.7% vs. 54.8%). Distributions of institutional-level quality indicators showed that most institutions without institutional certification seldomly order urinary quantitative examination.
Although the quality indicator for glycaemic control examination was favourable, some aspects of diabetes care were suboptimal and varied greatly by prefecture and institution; individual and organisational efforts to improve quality of diabetes care would be needed in Japan.
利用全国专有的医疗保险索赔数据库，计算日本糖尿病护理的过程质量指标。
使用 2015-2016 年国家医疗保险索赔数据库，计算定期使用抗糖尿病药物的患者中每年至少接受一次推荐检查的门诊患者比例，作为质量指标，按县和机构认证（来自日本糖尿病协会）进行汇总报告。还报告了机构级质量指标的分布情况。
在 4154452 名门诊患者中，96.7%接受了 HbA1c 或糖化白蛋白检查。对 46.5%的患者进行了视网膜病变检查[县（范围）：37.5%-51.0%，机构认证：44.8%（无）与 59.8%（有）]。在床位数<200 的机构中，67.3%的患者进行了尿定性检查（县：54.1%-81.9%，机构认证：66.8%与 92.8%），而 19.4%的患者进行了尿定量白蛋白或蛋白检查（县：10.8%-31.6%，机构认证：18.7%与 54.8%）。机构级质量指标的分布情况表明，大多数没有机构认证的机构很少进行尿定量检查。
尽管血糖控制检查的质量指标良好，但糖尿病护理的某些方面仍不理想，且因县和机构而异；日本需要个人和组织努力改善糖尿病护理质量。
