Analysis of administrative data to investigate end-of-life cancer care in a Japanese university hospital: development of methodology
10.2512/jspm.10.177
- VernacularTitle:東北大学病院における5 大がん入院患者の終末期医療の実態：DPC データを用いた方法論の確立
- Author:
Yuko Sato
;
Mitsunori Miyashita
;
Kenji Fujimori
;
Jun Nakaya
;
Yoko Fujimoto
;
Makoto Kurihara
;
Kazuki Sato
;
Chikashi Ishioka
- Publication Type:Journal Article
- Keywords:
palliative care;
DPC data;
end of lIfe care;
quality indicator;
cancer
- From:Palliative Care Research
2015;10(3):177-185
- CountryJapan
- Language:Japanese
-
Abstract:
Purpose：To explore a methodology for evaluating end-of-life （EOL） cancer care using diagnosis procedure combination （DPC） administrative data. Methods： We investigated care provided to inpatients whose deaths were attributed to cancer and occurred between August 2010 and December 2012. We measured the quality of palliative care by dividing the decedents into two groups： those who died in the palliative care unit （PCU） and those who died in the general wards（GW）. Results： A total of 311 inpatient deaths were identified as cancer deaths. Of these, 147 patients were included in the PCU group and 164 in the GW group. We calculated the DPC data as follows： the rates of chemotherapy administered within 30 days before death （PCU 0％, GW 27％） and within 14 days before death （PCU 0％, GW 10％）, admission to the intensive care unit （PCU 0％, GW 2％）, life-sustaining interventions （PCU 0％, GW 3％）, rehabilitation sessions （PCU 10％, GW 26％）, emergency admission （PCU 2％, GW 27％）, and antibiotics （PCU 32％, GW 28％）. In the PCU group, rates of chemotherapy and emergency admission were significantly lower（＜0.0001；＜0.0001, respectively）, and rehabilitation sessions were significantly higher （p＝0.0002） than in the GW group. Conclusion： EOL care in a university hospital can be easily investigated using DPC data. Some limitations are the single-site study design, the health insurance system, and secondary use of administrative data. However, this methodology may be adapted to investigate the entire Japanese claim database and to evaluate EOL cancer care.
