DRG 64 14
DRG IR-DRGJ-DRG R 2 NHS-Clinical Indicators PCICABG 36 250,418 9,286 11 10 0.4 HCFA-DRGAP-DRGAPR-DRGJ-DRG( ) IR-DRG(International Refined-DRG) J-DRG IR-DRG938 267 J-DRG( ) R J-DRG(0.3070) IR-DRG0.3905 IR-DRG R 2 J-DRG R 2 MDC3 MDC6 MDC7 MDC11 0.5 J-DRG ICD 14 70 IR-DRG
DRG 3 DRG DRG 21 DRG ICD. 36 11 10 9,286 0.4 ICD10 ICD9-CM 1,000 900999 800899 700799 600699 1500599 400499 11300399 200299 200 19 200 69.4 500 5.4 12 57.1. DRG 250,418 DRG HCFA-DRGHealth Care Financing Administration-DRGAP-DRGAll Patient-DRGAPR-DRGAll Patient-DRG APR-DRGAll Patient Refined-DRG 1
183 J-DRG IR-DRG International Refined-DRG267 J-DRG IR-DRG MHIS AP-DRG DRG DRG AP-DRG 1.5 938 DRG IR-DRG DRG J-DRG J-DRG MDC.DRG R IR-DRG J-DRG R DRG (yia) 2 (yiag) 2 R 2 = i i yia 2 i yi=i A= Ag DRG J-DRG IR-DRG R IR-DRG IR-DRG R J-DRG R DRG MHIS 2
0.3150 R 0.4674 MDC:Major Diagnostic Categories R 2 IR-DRG J-DRG J-DRG MDC3 MDC6 MDC7 MDC11 0.5 J-DRG DRG DRG 20 DRG J-DRG 1.0 IR-DRG 51.1 J-DRG 55.9 4.8 20 1.0 IR-DRG 43.5 J-DRG 53.6 10.1 J-DRG IR-DRG DRG AP-DRGJ-DRG IR-DRG.DRGICD DRG ICD 3
DRG DRG DRG IR-DRG1341 941,2 No.30 No.2 No.30 No.30 No.2 R 2 0.043 IR-DRG1341 A DRG No.1 DRG B DRG DRG C DRG ICD NHS NHS-Clinical Indicators Hospital Episode Statistics(HES) Health Authority HES 4
HES NHS 65 30 HES 1995/96 5305.410 1996/97 5040.4 0.93 NHS HES 5.04 No.17 No.17 ICD-10 S72.0 S72.1 S72.2 65 30 ICD-10 S72.0S72.1 S72.2 65 NHS Clinical Indicator 50 30 10 ICD- I21 I22 50 30 ICD-10 I21 I22 50 50 30 1995/96 12277.210 1996/97 12026.01997/98 11320.0 50 56 ICD-10 I60-I64 56 5
ICD-10 167 NHS 56 ICD-10 I60-I64 50 50 1995/96 55.4 1996/97 55.6 1997/98 55.4 65 28 ( ICD-10 S72.0S72.1S72.2) 65 28 ( ICD-10 S72.0S72.1S72.2) 65 65 () 1995/96 62.5 1996/97 61.7 1997/98 62.0 NHS ICD-10 HES ICD ICD ICD ICD ABO R 6
No.19 0.08 100 DPMO Defects per Million Opportunity 4 100 234 6,210 No.8No.11No.14No.16No.22No.33No.35 6 100 3.4 IR-DRG DRG5413 DPMO No.8 No.17 No.8 No.8 100 6,211 66,807 DRG CMICase Mix Index 1.1426 36 No.8 CMI 1.2 No.321.2466No.361.2339No.131.2123 No..DRG 14 18 110 70 7
13 IR-DRG (American Heart Association) (American College of Cardiology) Percutaneous Coronary Intervention(PCI) Coronary Artery Bypass Graft Surgery(CABG) PCI PCI PCI PCI Quality Assurance(QA) QA PCI 200 400 PCI 500 American Board of Internal Medicine(ABIM) 75 PCI 150 PCI PCI 75 Privilege Privilege Case-Mix ABIM PCI 400 8
75 PCI 75 PCI 400 PCI PCI. BRCT 1 RCT a 75 PCI 200-400 PCI C 75 PCI 400 PCI 75 PCI 150 mentor 75 PCI 600 PCI C 75 PCI 200-400 PCI 200 PCI C PCI 0.2-0.4 PCI 10 PCI 75 PCI PCI 36 PCI 9
Intra-aortic balloon pump(iabp) CCU IABP Primary PCI Primary PCI Primary PCI CABG Primariy PCI 36 Coronary Artery Bypass Graft Surgery PCI CABG CABG 100 CABG PCI CABG PCI 400 200 No.2No.15No.32 10
14 10 No.2 PCI 10 No.15 No.32 No.15 25 No.32 32-362 30 0.1 No.32 PCI 15 PCI 75 PCI No. 007 92 UtilizationReview peer review DRG ICD DRG ICD ICD J-DRG ICD DRG CMI DRG 11
Percutaneous Coronary Intervention (PCI) PCI (PTCA) PTCA ( ) (DCA) (TEC) PCI PTCA ( ) glycoprotein IIb/IIIa receptor blocker (Food and Drug Administration; FDA) ( (TEC) (DCA) )angiojet FDA PCI Primary PCI rescue PCI following failed thrombolysis PCI PTCAballoon ICD-9-CM 36.01,36.02,36.04,36.05,36.06 12
.NHS Executive, Performance Assessment Framework : Quality and performance in the NHS: Clinical Indicators. June 1999. http://www.doh.gov.uk/indicat/nhsci.pdf.nhs Executive, Performance Assessment Framework : Quality and performance in the NHS: Clinical Indicators, technical support. June 1999. http://www.doh.gov.uk/indicat/techannx.pdf.smith Jr.SC, et al. ACC/AHA guidelines for percuraneous Coronary Intervention(Revision of the1993 PTCA guideline). A report of the American college of Cardiology/ American Heart Association task Force on Practice Guidelines.JACC 2001;37:.Kimmel SE, et al. The relationship between coronary angioplasty procedure volume and major complications.jama1995; 274:1137-1142..Eagle KA, et al.acc/aha Guidelines for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines. JACC 1999; 34:1262-1347..Smith Jr. SC, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 guidelines). A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2000; 37: 2239i-2239lxvi 13
DRG 1 2 3 0437 571 838 1,361 0438 236 505 643 0439 762 1,067 1,951 0440 349 732 1,260 14
DRG ALOS 1 2 3 0437 16.70 23.58 39.20 0438 6.91 17.02 13.41 0439 28.05 33.87 42.98 0440 10.77 21.39 25.43 15
IR-DRG J-DRG 0.3905 224,888 0.3070 129,284 0.4879 76,892 0.5467 26,581 0.2930 147,996 0.2535 102,703 16
24
26
27
9% 病院別 PCI 死亡率比較 全疾病対象 8% 08 7% 6% 死亡率 5% 4% 3% 2% 06 25 y = 0.0141Ln(x) - 0.04 R 2 = 0.3043 10 04 26 13 15 32 1% 0% 01 03 22 23 33 20 21 02 0 50 100 150 200 250 症例数 症例数 10 以上の病院
20% 主治医別 PCI 死亡率比較 全疾病対象 18% 16% 08-89 32-71 08-48 14% 死亡率 12% 10% 8% 6% 4% 2% 06-73 06-12 04-63 25-76 13-38 13-72 08-40 03-85 32-72 15-09 13-46 15-81 15-73 32-62 10-E1 08-19 13-32 04-74 32-74 10-M9 08-43 y = -0.03Ln(x) + 0.1328 R 2 = 0.1219 13-65 10-O3 01-21 0% 0 10 20 30 40 50 60 70 80 90 100 02-007 症例数 症例数 10 以上の医師