ABSTRACT
As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.
ABSTRACT
As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.
ABSTRACT
Objective: Although the Japanese EuroQol instrument was developed in 1998 by a Japanese translation team, the reliability of health state valuations of the fuller questionnaire has not yet been investigated in Japan. We carried out a pilot study to investigate the reliability of health state valuations of the Japanese EuroQol instrument. Methods: The survey was conducted twice with the fuller questionnaire of the Japanese EuroQol instrument in a class of preventive medicine. We analyzed test-retest reliability based on the health state valuations and calculated Cronbach’s coefficient alpha of both tests. Results and Conclusions: The mean valuations of 14 hypothetical health states and ‘death’ between test and retest were not significantly different by paired t-test. The reliability by calculated correlation between test and retest was 0.996 (p<0.0001). In addition, Cronbach’s coefficient alpha of the first test was 0.827, and that of the second test was 0.865. Although good reliability was shown in the present study, our conclusion was limited to applications of population-based surveys because of the small number and limited subjects of the present study. Further investigations are required in the form of a population-based survey.
Subject(s)
Health , Surveys and QuestionnairesABSTRACT
To determine the optimal strategy for prostate cancer screening, the cost-effectiveness of screening was analyzed using a medical decision model. One hundred thousand asymptomatic males between the ages of 40 and 69 were modeled with and without screening. The subjects were divided into three 10−year age groups. We used a 5−year survival rate as an effectiveness point and assumed after 5 year survival free from prostate cancer. We considered three potential programs: 1)screening with digital rectal examination(DRE), 2)screening with prostate specific antigen(PSA), and 3)screening with a combination of DRE and PSA. The study was analyzed from the payer’s perspective, and only direct medical costs were included. For each of the three age groups, PSA screening was more cost−effective than either DRE screening or a combination of DRE and PSA screening. The cost−effectiveness ratio for the combination of DRE and PSA screening was 1.1−2.3 times more expensive than that of PSA screening. If the compliance rate for work−up exams is 80%, the cost−effectiveness of prostate cancer screening is approximate to that of gastric cancer screening. In conclusion, PSA screening is the most cost−effective strategy for prostate cancer screening when compared with both DRE and the combination of DRE and PSA screening. But prostate cancer screening should be carefully conducted, taking the cost−effectiveness of the different strategies and target groups into consideration.
Subject(s)
Public Service AnnouncementABSTRACT
Objective : The economic aspect of pharmaceuticals is becoming a major issue of health care financing in Japan due to the high total volume of drug consumption. To consider the feasibility and usefulness of pharmacoeconomic (PE) studies in health policy making, we aimed to conduct a review of PE studies published in Japan.<BR>Methods : We collected original published PE studies conducted in Japan from 1985 to 1995, by retrieving through computer databases such as MEDLINE and JMEDICINE, as well as other methods. We then reviewed the papers according to a checklist developed by Drummond et al.<BR>Results : Fourteen articles were found to satisfy the inclusion criteria. The overall checklist compliance rate were 45.8%. All of the PE studies were based on randomized clinical trial. Most of the studies lacked some important elements of PE analysis, such as the identification of all important and relevant costs and consequences (14.3%) and the presentation of all issues of concern (7.1%). Furthermore, most models and assumptions used in the studies were considered by us to be unreliable and inappropriate.<BR>Discussion : The quality of PE studies conducted in Japan was not considered by us to be satisfactory and our analysis identified areas for improvement. Further improvement in this field is urgently needed and may be achieved through PE guideline development and the training of specialists.