Asami Sadaharu, Urayama Kevin Y, Kobayashi Daiki, Onozaki Kohei, Takahashi Osamu
Department of Cardiology, Musashino Tokushukai Hospital, Tokyo, Japan.
Division of Epidemiology, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
JMA J. 2023 Jul 14;6(3):300-306. doi: 10.31662/jmaj.2022-0207. Epub 2023 Jun 12.
In 2018, the fee schedule for nutrition support teams (NSTs) in Japanese hospitals was changed. The change was intended to encourage more hospitals to establish NSTs, and this study aims to investigate whether this change had the desired effect. Specifically, we will look at the proportion of hospitals with NSTs before and after the 2018 revision to see if there was a significant increase in the number of hospitals with NSTs.
The study analyzed administrative data from 10 Japanese prefectures dating from June 2015 to September 2021 using an interrupted time-series design. The analysis focused on all acute care hospitals within these prefectures and measured the percentage of hospitals with NSTs. Subgroup analyses were conducted based on hospital size and functions. In April 2018, the intervention, a fee schedule revision, was implemented.
We analyzed 1,471 acute care hospitals. Immediately after the intervention, the percentage of hospitals with NSTs increased by 4.59% (95% CI = 3.92%, 5.26%) and by 0.66% (95% CI = 0.57%, 0.75%) quarterly thereafter. We observed a marked increase in NST formation among large-sized (20.9%), medium-sized (28.0%), and highly acute care hospitals (hospitals with emergency medical care centers and intensive care units, 22.3% and 23.6%, respectively). We also noted a moderate increase among hospitals with convalescent rehabilitation units (10.1%) and a modest increase among small-sized hospitals (6.9%).
Relaxation of the NST fee requirement increased the proportion of hospitals with NSTs in Japan, especially among larger and highly acute care hospitals.
2018年，日本医院营养支持团队（NST）的收费标准发生了变化。这一变化旨在鼓励更多医院组建NST，本研究旨在调查这一变化是否产生了预期效果。具体而言，我们将观察2018年修订前后设有NST的医院比例，以了解设有NST的医院数量是否有显著增加。
本研究采用间断时间序列设计，分析了2015年6月至2021年9月来自日本10个县的行政数据。分析聚焦于这些县内的所有急症医院，并测量设有NST的医院的百分比。根据医院规模和功能进行了亚组分析。2018年4月实施了干预措施，即收费标准修订。
我们分析了1471家急症医院。干预措施实施后，设有NST的医院百分比立即增加了4.59%（95%置信区间=3.92%，5.26%），此后每季度增加0.66%（95%置信区间=0.57%，0.75%）。我们观察到大型医院（20.9%）、中型医院（28.0%）以及高度急症医院（设有急诊医疗中心和重症监护病房的医院，分别为22.3%和23.6%）中NST组建数量显著增加。我们还注意到设有康复疗养单元的医院中有适度增加（10.1%），小型医院中有适度增加（6.9%）。
放宽NST收费要求提高了日本设有NST的医院比例，尤其是在大型和高度急症医院中。
