Decreased Administration of Life-Sustaining Treatment just before Death among Older Inpatients in Japan: A Time-Trend Analysis from 2012 through 2014 Based on a Nationally Representative Sample.
|アブストラクト||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.|
|ジャーナル名||International journal of environmental research and public health|
|投稿者||Sakai, Michi; Ohtera, Shosuke; Iwao, Tomohide; Neff, Yukiko; Uchida, Tomoe; Takahashi, Yoshimitsu; Kato, Genta; Kuroda, Tomohiro; Nishimura, Shuzo; Nakayama, Takeo; On Behalf Of BiDAME Big Data Analysis Of Medical Care For The Elderly In Kyoto|
|組織名||Department of Health Informatics, Kyoto University School of Medicine and Public;Health, Kyoto 606-8501, Japan.;Division of Medical Information Technology and Administration Planning, Kyoto;University Hospital, Kyoto 606-8507, Japan.;Department of Research, Institute for Health Economics and Policy, Tokyo;105-0003, Japan.;Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto;606-8507, Japan.|