Relationship of oral bacterial number with medical hospitalization costs in analysis of Diagnosis Procedure Combination database from single institution in Japan.

Oral bacteria are known to be associated with perioperative complications during hospitalization. However, no presented reports have clarified the relationship of oral bacterial number with medical costs for inpatients. The Diagnosis Procedure Combination (DPC) database system used in Japan provides clinical information regarding acute hospital patients. The present study was conducted to determine the association of oral bacterial numbers in individual patients treated at a single institution with length of hospital stay and medical costs using DPC data. A total of 2369 patients referred by the medical department to the dental department at Hiroshima University Hospital were divided into the low (n = 2060) and high (n = 309) oral bacterial number groups. Length of hospital stay and medical costs were compared between the groups, as well as the associations of number of oral bacteria with Charlson comorbidity index (CCI)-related diseases in regard to mortality and disease severity. There was no significant difference in hospital stay length between the low (24.3 ± 24.2 days) and high (22.8 ± 20.1 days) oral bacterial number groups. On the other hand, the daily hospital medical cost in the high group was significantly greater (US$1456.2 ± 1505.7 vs. US$1185.7 ± 1128.6, P < 0.001). Additionally, there was no significant difference in CCI score between the groups, whereas the daily hospital medical costs for patients in the high group treated for cardiovascular disease or malignant tumors were greater than in the low number group (P < 0.05). Multivariate regression analysis was also performed, which showed that oral bacterial number, age, gender, BMI, cardiovascular disease, diabetes, malignant tumor, and hospital stay length were independently associated with daily hospitalization costs. Monitoring and oral care treatment to lower the number of oral bacteria in patients affected by cardiovascular disease or cancer may contribute to reduce hospitalization costs.

Estimating the Ratio of Patients with a Certain Disease Between Hospitals for the Allocation of Patients to Clinical Trials Using Health Insurance Claims Data in Japan.

In clinical trials, investigating the ratio of patients with each disease who are treated in a hospital is important for determining the number of patients who are allocated to hospitals. The Japanese health insurance claims data includes standardized disease and medicine data. However, the disease data has some problems in terms of reliability, because the healed diseases are sometimes not deleted or because a disease that a patient does not actually have is registered to claim the cost of the examination. On the other hand, therapeutic medicines are administered to target particular diseases. In this study, we developed a system for estimating the number of patients with each disease using the disease data and the therapeutic medicine data. We converted the ICD-10 code to a 4-grade classification code so that we could predict the diseases in the shallow layer (e.g. gastrointestinal disease) when it was difficult to predict the precise diseases in the deep layer (e.g. gastric ulcers). A table showing the disease code and the corresponding therapeutic medicine code was provided by the Japan Pharmaceutical Information Center (JAPIC). We calculated the disease probability score from the diseases and therapeutic medicines and recorded the predicted disease. For the system evaluation, we used the health insurance claims data from Osaka University Hospital for January 2015. A total of 58,526 diseases were predicted from the health insurance claims data of 18,393 patients. One hundred twenty patients were randomly extracted for use in a chart review that was performed by an expert physician. Two hundred twenty-four of 329 predicted diseases, were correctly predicted; 56 were reasonably predicted, and 49 were incorrectly predicted. The main disease was correctly predicted in 71 patients. In conclusion, we could estimate the number of patients with each disease using the health insurance claims data with a certain degree of accuracy.

Development of a system for transferring images via a network: supporting a regional liaison.

We developed a system that transfers images via network and started using them in our hospital's PACS (Picture Archiving and Communication Systems) in 2006. We are pleased to report that the system has been re-developed and has been running so that there will be a regional liaison in the future. It has become possible to automatically transfer images simply by selecting the destination hospital that is registered in advance at the relay server. The gateway of this system can send images to a multi-center, relay management server, which receives the images and resends them. This system has the potential to be useful for image exchange, and to serve as a regional medical liaison.

Preoperative assessment of thymic veins on multidetector row CT: optimization of contrast material volume.

PURPOSE: Preoperative localization of the thymic veins is considered important to prevent intraoperative severe bleeding prior to video-assisted thoracoscopic thymectomy. The purpose of this study was to determine the optimal dose of contrast material for preoperative CT imaging for the detection of thymic veins on the basis of patient weight. MATERIALS AND METHODS: The records of 31 patients who underwent thymectomy were examined retrospectively. All patients were scanned using an eight-channel multidetector-row computed tomography (CT) scanner at 1.25 mm collimation and a 0.625-mm reconstruction interval. CT scans were obtained after injection of 300 mg I/ml nonionic contrast material at a rate of 2 ml/s. A 90-ml contrast bolus was used for the first 16 consecutive patients (group I), and a 150-ml bolus was used for the following 15 patients (group II). The scan delay was 60 s and 90 s in groups I and II respectively. Two independent radiologists who were blinded to the surgical results evaluated the number of thymic veins observed on preoperative CT, which was later correlated with the actual number of thymic veins clipped during surgery. The responses were analyzed with respect to contrast amount by single bolus and per kilogram of body weight. RESULTS: Thymic veins were correctly detected in 9 of 16 (56%) patients in group I and 14 of 15 (93%) patients in group II. Thymic vein detection was significantly better in patients who received the >or=2.0 ml/kg contrast medium compared to those who received the 1.00-1.99 ml/kg medium (P < 0.05). CONCLUSION: An intravenous contrast material volume of 2 ml/kg (300 mg I/ml) is appropriate for the identification of thymic veins on prethymectomy CT.