The identification of death is critical for epidemiological research. Despite recent developments in health insurance claims databases, the quality of death information in claims is not guaranteed because health insurance claims are collected primarily for reimbursement. We aimed to examine the usefulness and limitations of death information in claims data and to examine methods for improving the quality of death information for aged persons.We used health insurance claims data and enrollment data (as the gold standard) from September 2012 through August 2015 for nondependent persons aged 65–74 years enrolled in Japanese workplace health insurance. Overall, 3,710,538 insured persons were registered in the database during the study period. We analyzed 45,441 eligible persons. Inpatient and outpatient deaths were identified from the discharge/disease status in the claims, with sensitivities of 94.3% and 47.4%, specificities of 98.5% and 99.9%, and PPVs of 96.3% and 95.7%, respectively, using enrollment data as the gold standard. For outpatients, death defined as a combination of disease status and charge data for terminal care still indicated low sensitivity (54.7%).The validity of death information in inpatient claims was high, suggesting its potential usefulness for identifying death. However, given the low sensitivity for outpatient deaths, the use of death information obtained solely from records in outpatient claims is not recommended.

BackgroundDespite the growing number of studies using natural language processing for pharmacovigilance, there are few reports on manipulating free text patient information in Japanese.ObjectiveThis study aimed to establish a method of extracting and standardizing patient complaints from electronic medication histories accumulated in a Japanese community pharmacy for the detection of possible adverse drug event (ADE) signals.MethodsSubjective information included in electronic medication history data provided by a Japanese pharmacy operating in Hiroshima, Japan from September 1, 2015 to August 31, 2016, was used as patients’ complaints. We formulated search rules based on morphological analysis and daily (nonmedical) speech and developed a system that automatically executes the search rules and annotates free text data with International Classification of Diseases, Tenth Revision (ICD-10) codes. The performance of the system was evaluated through comparisons with data manually annotated by health care workers for a data set of 5000 complaints.ResultsOf 5000 complaints, the system annotated 2236 complaints with ICD-10 codes, whereas health care workers annotated 2348 statements. There was a match in the annotation of 1480 complaints between the system and manual work. System performance was .66 regarding precision, .63 in recall, and .65 for the F-measure.ConclusionsOur results suggest that the system may be helpful in extracting and standardizing patients’ speech related to symptoms from massive amounts of free text data, replacing manual work. After improving the extraction accuracy, we expect to utilize this system to detect signals of possible ADEs from patients’ complaints in the future.

This nationwide survey indicates that the annual incidence of severe PPH is increasing. Furthermore, FFP has become more prevalent in small-scale obstetric facilities.

The administration of intensive end-of-life care just before death in older patients has become a major policy concern, as it increases medical costs; however, care intensity does not necessarily indicate quality. This study aimed to describe the temporal trends in the administration of life-sustaining treatments (LSTs) and intensive care unit (ICU) admissions just before death in older inpatients in Japan. We utilized the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Inpatients who were aged ≥65 years and died in October of 2012, 2013, or 2014 were analyzed. The numbers of decedents in 2012, 2013, and 2014 were 3362, 3473, and 3516, respectively. The frequencies of receiving cardiopulmonary resuscitation (CPR) (11.0% to 8.3%), mechanical ventilation (MV) (13.1% to 9.8%), central venous catheter (CVC) insertion (10.6% to 7.8%), and ICU admission (9.1% to 7.8%), declined between 2012 and 2014. After adjusting for age, sex, and type of ward, the declining trends persisted for CPR, MV, and CVC insertion relative to the frequencies in 2012. Our results indicate that the administration of LST just before death in older inpatients in Japan decreased from 2012 to 2014.