Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia.
PLoS One. 2021 May 25;16(5):e0252196. doi: 10.1371/journal.pone.0252196. eCollection 2021.
Variations in health care outcomes and services potentially indicate resource allocation inefficiency. Therefore, this study was conducted to examine variations in mortality and hospitalization cases among end-stage renal disease (ESRD) patients receiving hemodialysis (HD) care from medical facilities located in 13 secondary medical care areas (SMAs) of Fukuoka prefecture, Japan. The research was designed as a retrospective, cross-sectional study using insurance claims data. The subjects of the study were older patients (over 65 years old) insured by the Fukuoka prefecture's Latter-Stage Elderly Healthcare Insurance. Using an electronic claims database, we identified patients with chronic kidney disease (CKD) who had received HD care from April 1, 2017 to March 31, 2018. The CKD status was identified using International Classification of Disease, 10th revision code, and HD maintenance status was ascertained using specific insurance procedure codes. A total of 5,243 patients met our inclusion criteria and their records were subsequently reviewed. About 73% (n = 3,809) of patients had admission records during the period studied. Thus, the data regarding hospital length of stay (LOS) and admission costs were analyzed separately. Significant differences in terms of increased risks in hospitalization were evident in a number of SMAs. An increase in mortality risk due to heart failure and malignancy was observed in two separate SMAs. Also, analyzed LOS, total hospitalization cost, and cost per day according to SMAs showed statistically significant variations. The findings highlight the magnitude of the burden of CKD and ESRD in the community. The high prevalence of ESRD, associated mortality, and hospitalized HD patients signal the need for clinicians to assume broader roles in measures against chronic kidney disease through involvement in community awareness programs. To improve patient outcomes, improvement of regional health care provision, the level of medical care, and the development of existing human resources are needed.
医疗服务结果和资源分配的差异可能表明效率低下。因此，本研究旨在检查日本福冈县 13 个二级医疗保健区（SMA）的医疗设施为接受血液透析（HD）治疗的终末期肾脏疾病（ESRD）患者的死亡率和住院病例的差异。该研究设计为回顾性、横断面研究，使用保险索赔数据。研究对象为福冈县晚期老年人医疗保险的老年患者（65 岁以上）。我们使用电子索赔数据库，确定了在 2017 年 4 月 1 日至 2018 年 3 月 31 日期间接受 HD 治疗的慢性肾脏病（CKD）患者。CKD 状态使用国际疾病分类第 10 版代码确定，HD 维持状态使用特定的保险程序代码确定。共有 5243 名患者符合纳入标准，随后对其记录进行了审查。约 73%（n=3809）的患者在研究期间有入院记录。因此，分别分析了住院时间（LOS）和入院费用的数据。在多个 SMA 中，住院风险显著增加。两个独立的 SMA 观察到心力衰竭和恶性肿瘤导致的死亡率风险增加。此外，根据 SMA 分析的 LOS、总住院费用和每天费用显示出统计学上的显著差异。研究结果强调了社区中 CKD 和 ESRD 负担的程度。ESRD 的高患病率、相关死亡率和住院 HD 患者表明，临床医生需要通过参与社区意识项目，在预防慢性肾脏病方面发挥更广泛的作用。为了改善患者预后，需要改善区域医疗服务提供、医疗水平和现有人力资源的开发。
