Quality of care for diabetes patients using National Health Insurance claims data in Japan

Tomio, Jun; Toyokawa, Satoshi; Tanihara, Shinichi; Inoue, Kazuo; Kobayashi, Yasuki

doi:10.1111/j.1365-2753.2009.01287.x

Cited by 24 publications

(36 citation statements)

References 21 publications

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“…We found similar adherence rates to those of corresponding QIs in hospital ambulatory primary care settings in Japan, 2004‐2007: taking smoking status information (23.5% vs 24%) and prescribing inhaled steroids to asthmatic patients with daily short‐acting beta 2 agonist inhalers (85.5% vs 82%). Adherence to the QI of annual eye examinations in diabetes patients was higher than that shown in primary care settings in Japan (21.3% vs 12.4%‐13.9%), but was similar to the 20.8% adherence shown for National Health Insurance claims data …”

Section: Discussionsupporting

confidence: 65%

Quality of primary care provided in community clinics in Japan

Ozaki¹,

Matsumura

Iwamoto³

et al. 2018

J of Gen and Family Med

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Background Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan. Methods Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process‐oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC‐J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic. Results A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%. Conclusions The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.

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Section: Discussionsupporting

confidence: 65%

Quality of primary care provided in community clinics in Japan

Ozaki¹,

Matsumura

Iwamoto³

et al. 2018

J of Gen and Family Med

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“…Because all the format and data fields recorded on HICs are identical regardless of the insurance provider [14], they can be used to evaluate the effects of health policy changes on patients' behaviours [15] and to measure the effectiveness of clinical procedures [16]. Because all the format and data fields recorded on HICs are identical regardless of the insurance provider [14], they can be used to evaluate the effects of health policy changes on patients' behaviours [15] and to measure the effectiveness of clinical procedures [16].…”

Section: Introductionmentioning

confidence: 99%

Evaluating measles surveillance: comparison of sentinel surveillance, mandatory notification, and data from health insurance claims

et al. 2010

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Inadequate notification is a recognized problem of measles surveillance systems in many countries, and it should be monitored using multiple data sources. We compared data from three different surveillance sources in 2007: (1) the sentinel surveillance system mandated by the Act on Prevention of Infectious Diseases and Medical Care for Patients Suffering Infectious Diseases, (2) the mandatory notification system run by the Aichi prefectural government, and (3) health insurance claims (HICs) submitted to corporate health insurance societies. For each dataset, we examined the number of measles cases by month, within multiple age groups, and in two categories of diagnostic test groups. We found that the sentinel surveillance system underestimated the number of adult measles cases. We also found that HIC data, rather than mandatory notification data, were more likely to come from individuals who had undergone laboratory tests to confirm their measles diagnosis. Thus, HIC data may provide a supplementary and readily available measles surveillance data source.

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“…; Tomio et al. ). Health policy experts often attribute the suboptimal quality to fee‐for‐service compensation, which incentivizes visit quantity rather than quality (Harris and Zwar ; Collier ; Stremikis, Davis, and Guterman ).…”

mentioning

confidence: 97%

“…Key Words. Pay-for-performance, quality of care, quality improvement, chronic disease careResearch has documented deficiencies in health care quality in many industrialized countries (Seddon et al 2001;McGlynn et al 2003; The Study Group of Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology et al 2003;Hussey et al 2004;Tomio et al 2010). Health policy experts often attribute the suboptimal quality to fee-for-service compensation, which incentivizes visit quantity rather than quality (Harris and Zwar 2007;Collier 2009;Stremikis, Davis, and Guterman 2010).…”

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confidence: 99%

An Examination of Pay‐for‐Performance in General Practice in Australia

Greene

2013

Health Services Research

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Objective. This study examines the impact of Australia's pay-for-performance (P4P) program for general practitioners (GPs). The voluntary program pays GPs A$40 and A$100 in addition to fee-for-service payment for providing patients recommended diabetes and asthma treatment over a year, and A$35 for screening women for cervical cancer who have not been screened in 4 years. Design. Three approaches were used to triangulate the program's impact: (1) analysis of trends in national claims for incentivized services pre-and postprogram implementation; (2) fixed effects panel regression models examining the impact of GPs' P4P program participation on provision of incentivized services; and (3) in-depth interviews to explore GPs' perceptions of their own response to the program.Results. There was a short-term increase in diabetes testing and cervical cancer screens after program implementation. The increase, however, was for all GPs. Neither signing onto the program nor claiming incentive payments was associated with increased diabetes testing or cervical cancer screening. GPs reported that the incentive did not influence their behavior, largely due to the modest payment and the complexity of tracking patients and claiming payment. Implications. Monitoring and evaluating P4P programs is essential, as programs may not spark the envisioned impact on quality improvement. Key Words. Pay-for-performance, quality of care, quality improvement, chronic disease careResearch has documented deficiencies in health care quality in many industrialized countries (Seddon et al. 2001;McGlynn et al. 2003; The Study Group of Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology et al. 2003;Hussey et al. 2004;Tomio et al. 2010). Health policy experts often attribute the suboptimal quality to fee-for-service compensation, which incentivizes visit quantity rather than quality (Harris and Zwar 2007;Collier 2009;Stremikis, Davis, and Guterman 2010). Pay-for-performance (P4P) programs, which pay clinicians based upon achieving or improving specific quality metrics, are increasingly being used to improve quality of care. P4P programs range from offering small bonuses (approximately $400)

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Quality of care for diabetes patients using National Health Insurance claims data in Japan

Abstract: We found high performance rates for HbA1c testing, while the annual rates for eye examinations and nephropathy screenings were suboptimal. Using administrative data would facilitate more comprehensive assessment of the quality of care in Japan.

Cited by 24 publications

References 21 publications

Quality of primary care provided in community clinics in Japan

Quality of primary care provided in community clinics in Japan

Evaluating measles surveillance: comparison of sentinel surveillance, mandatory notification, and data from health insurance claims

An Examination of Pay‐for‐Performance in General Practice in Australia

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