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Background Real-world big data studies using health insurance claims databases require extraction algorithms to accurately identify target population and outcome. However, no algorithm for Crohn’s disease (CD) has yet been validated. In this study we aim to develop an algorithm for identifying CD using the claims data of the insurance system. Methods A single-center retrospective study to develop a CD extraction algorithm from insurance claims data was conducted. Patients visiting the Kitasato University Kitasato Institute Hospital between January 2015–February 2019 were enrolled, and data were extracted according to inclusion criteria combining the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis codes with or without prescription or surgical codes. Hundred cases that met each inclusion criterion were randomly sampled and positive predictive values (PPVs) were calculated according to the diagnosis in the medical chart. Of all cases, 20% were reviewed in duplicate, and the inter-observer agreement (Kappa) was also calculated. Results From the 82,898 enrolled, 255 cases were extracted by diagnosis code alone, 197 by the combination of diagnosis and prescription codes, and 197 by the combination of diagnosis codes and prescription or surgical codes. The PPV for confirmed CD cases was 83% by diagnosis codes alone, but improved to 97% by combining with prescription codes. The inter-observer agreement was 0.9903. Conclusions Single ICD-code alone was insufficient to define CD; however, the algorithm that combined diagnosis codes with prescription codes indicated a sufficiently high PPV and will enable outcome-based research on CD using the Japanese claims database.

The present study aimed to clarify the usefulness and instructiveness of disaster training for the START (simple triage and rapid treatment) method for MCI (multi-casualty incidents) using the PDCA (plan-do-check-act) cycle. Subjects and Methods: A total of 282 participants, including 136 registered nurses, 124 emergency medical service personnel, and 22 doctors, were recruited from seven disaster training courses. In a training session, the participants were divided into five groups after receiving a review about triage using the START method and participating in a skill check activity in pairs; one group played the role of triage officers and the other groups played the role of affected people. The participants took turns playing each role through five rotations. Training drills consisting of a 1-minute briefing as the 'plan and act' phase, a 2-minute performance as the 'do' phase, and a 2-minute evaluation period as the 'check' phase were carried out after each rotation. Participants' performance was evaluated based on the triage performance and accuracy. In addition, the proportion of immediate victims among un-triaged people was added to these two measurements starting with the third rotation. After the evaluations of each drill, trainers gave the participants feedback in order to improve their performance. Participants playing the role of the next triage officers planned and implemented solutions by themselves. Results: The median performance rates of triage were 40.0% (range, 30.5-50.0) for the first rotation, 65.0% (range, 62.1-78.5) for the second, 83.3% (range, 48.8-96.6) for the third, 84.5% (range, 86.8-96.4) for the fourth, and 89.3% (range, 69.9-100.0) for the fifth. The median accuracy of triage was 25.4% (range 6.9-37.5) in the first rotation, 51.7% (range 43.8-57.1) in the second, 62.7% (range 41.9-89.7) in the third, 75.0% (range 54.7-81.8) in the fourth, and 78.1% (range 46.0-93.8) in the fifth. The performance rate and accuracy of triage both showed significant differences among the first, second, and third rotations. Participants accomplished the following goals for improving the benefit of first triage for MCI: (i) improve the accuracy of triage; (ii) reduce the number of un-triaged people; (iii) give priority to immediate victims; and (iv) gather information about triaged people with respect to their treatment and transport. Conclusion: The present results suggest that a triage training method using the PDCA cycle is effective for developing additional ways to carry out first triage and improving the performance rate and accuracy of first triage for MCI.

Concentrating relatively easy surgical procedures at a regional level may be associated with a reduction in LOS.

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