Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data

Hirokazu Tanaka; Takehiro Sugiyama; Noriko Ihana-Sugiyama; Kohjiro Ueki; Yasuki Kobayashi; Mitsuru Ohsugi

doi:10.1016/j.diabres.2019.02.001

Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data

Diabetes Res Clin Pract. 2019 Mar:149:188-199. doi: 10.1016/j.diabres.2019.02.001. Epub 2019 Feb 8.

Authors

Hirokazu Tanaka¹, Takehiro Sugiyama², Noriko Ihana-Sugiyama³, Kohjiro Ueki⁴, Yasuki Kobayashi⁵, Mitsuru Ohsugi³

Affiliations

¹ Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan.
² Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan. Electronic address: tsugiyama-tky@umin.ac.jp.
³ Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Japan; Department of Diabetes, Endocrinology and Metabolism, Center Hospital, National Center for Global Health and Medicine, Japan.
⁴ Department of Diabetes, Endocrinology and Metabolism, Center Hospital, National Center for Global Health and Medicine, Japan; Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Japan.
⁵ Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan.

PMID: 30742858
DOI: 10.1016/j.diabres.2019.02.001

Abstract

Aim: To assess the temporal changes in the quality indicators pertaining to the process measures of diabetes care during a recent decade in Japan.

Methods: A five-fold repeated cross-sectional study was conducted using health insurance claims data provided by the Japan Medical Data Center between April 2006 and March 2016. We identified 46,631 outpatients with antidiabetic medication who regularly visited hospitals or clinics at least every three months. We evaluated the quality indicators pertaining to glycemic control monitoring, lipid profile monitoring, retinopathy screening, nephropathy screening, and appropriate medication choice. The proportions of patients who received appropriate examinations/prescriptions, by observation period and either the type of antidiabetic medication or facility type were estimated using generalized estimating equation (GEE) models with multiple covariate adjustments.

Results: The quality indicator values for appropriate medication choice and nephropathy screening improved between 2007 and 2015, whereas those for glycemic control monitoring and retinopathy screening remained suboptimal. Patients prescribed medications in larger hospitals were likelier to undergo the recommended examinations (e.g. retinopathy screening: 36.1% (95% CI: 35.4-36.7%) for clinic, 40.6% (95% CI: 39.1-42.2%) for smaller hospital, and 46.0% (95% CI: 44.8-47.2%) for larger hospital in 2015).

Conclusions: Several process measures of diabetes care remained suboptimal in Japan.

Keywords: Guideline adherence; Japan; Preventive medicine; Quality assessment; Quality indicators; Trends.

Publication types

Historical Article

MeSH terms

Adult
Aged
Cross-Sectional Studies
Diabetes Mellitus / therapy*
Female
Guideline Adherence
History, 21st Century
Humans
Japan
Male
Middle Aged
Young Adult