Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

File： Ishikawa-2019-Relationship-between-accessibility-.pdf

DOI： 10.1016/j.hlpt.2019.10.001

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Hokkaido’s demographic trend of population decrease with aging population is remarkable even in Japan. Although healthcare policy decision-makers need to appropriately allocate resources while grasping regional demands, not much is available on whether medical demand would increase or not for future. In addition, little is known about what impact will current situation have on future demand-supply balance and equality by regions. This study aims to support decision-making in human resource planning for coping with changing population structure by forecasting future demand, and evaluation those regional maldistributions.

Method

We set patients with acute myocardial infarction or cerebral stroke, and all medical care as study subjects and analyzed for 2015, 2025, and 2035 in Hokkaido and each Secondary Medical Care Area. We used a utilization-based approach to estimate the healthcare supply–demand balance in the future. Moreover, we evaluated the regional maldistribution of demand-supply balance by calculating Herfindahl-Hirschman Index, Gini Coefficients, the number of physicians/specialists per patient. Moreover, we conducted sensitivity analysis to evaluation impact on aspects of demand-supply balance by uncertainty of utilization for future.

Results

Our results displayed that concentration of patients will progress, while regional distribution will shrink in all subject. However, from comparison based on all medical care, Gini Coefficients of acute myocardial infarction and cerebral stroke has always been high. This suggest that the resource allocation of them has room for improvement. In addition, our analysis showed the change in this balance will differ in each region in the future. Moreover, demographic change will not consistent with the number of patient change from 2015 to 2035.

Conclusion

These results suggest policy planners should use the number of patient by disease, by region as indicator of demand, instead of provider-to-population ratios being in use today. The result of our sensitivity analysis show two findings. First, the range of each indicator have possible for future. Second, increase of utilization, for instance lowing barrier in the use by development operation of patient transportation in AMI/CS, would improve maldistribution of opportunity for resident to get emergency medical services.

DOI： 10.1186/s12913-019-4470-x

PubMed

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Other Link： http://link.springer.com/article/10.1186/s12913-019-4470-x/fulltext.html

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

File： Forecasting the regional distribution and sufficiency of physicians in Japan with a coupled system dynamics-geographic information system model.pdf

DOI： 10.1186/s12960-017-0238-8

Web of Science

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

File： Forecasting the absolute and relative shortage of physicians in Japan using a system dynamics model approach.pdf

DOI： 10.1186/1478-4491-11-41

Scopus

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Japan Medical Association  

DOI： 10.31662/jmaj.2025-0092

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1186/s12877-025-06303-y

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Other Link： https://link.springer.com/article/10.1186/s12877-025-06303-y/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

ABSTRACT

This study describes the continuity of visiting pharmacist services and investigates factors associated with service discontinuation in a homebound older population in Japan. This retrospective cohort study used medical and long‐term care claims data from older adults aged ≥ 65 years in a city in Tokyo, Japan, who began to receive visiting pharmacist services between April 2014 and March 2019. Participants were followed until service cessation (defined as the absence of service claims for 2 consecutive months) or 12 months from initiation. Reasons for cessation were categorized into death, relocation, hospitalization/institutionalization, or discontinuation based on claims data. Multivariable competing‐risk Cox regression analysis determined factors associated with discontinuation. Death and hospitalization/institutionalization were considered competing risks, and relocation was considered non‐informative censoring. The study included 3952 older adults, with 353 (8.9%) having terminal cancer. The median time to any‐cause cessation was 11 and 2 months for all participants and those with terminal cancer, respectively. Death was the most common reason for cessation, with a 12‐month cumulative incidence of 0.25 (95% confidence interval: 0.24–0.27). Factors associated with a lower likelihood of discontinuation included higher long‐term care need levels, polypharmacy of more than five medications, recent hospitalization, and cancer diagnosis. Conversely, living at home compared to residential facilities, ischemic heart disease, and receiving services from pharmacies providing 24‐h support were linked to a higher discontinuation risk. This study enhances the current understanding of continuity in visiting pharmacist services for older adults. Care should be tailored, considering factors influencing service duration and potential discontinuation.

DOI： 10.1002/prp2.70152

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/ggi.14957

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Aim

To investigate the factors associated with introducing visiting‐pharmacist services for community‐dwelling older adults in Japan.

Methods

We conducted a nested case–control study using claims data in a cohort from a city in Tokyo. Patients aged ≥65 years who received visiting‐pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month–year. Medical and long‐term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long‐term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting‐pharmacist service introduction.

Results

A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98–31.80) for physicians' home visits, 5.83 (5.08–6.70) for hospitalization, and 4.97 (4.16–5.95) for designated‐facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated.

Conclusions

This study provides insights into the introduction of visiting‐pharmacist services for older adults in Japan. Geriatr Gerontol Int 2024; 24: 344–351.

DOI： 10.1111/ggi.14838

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload.

Methods

This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists.

Results

The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities.

Conclusions

The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.

DOI： 10.1186/s12939-023-02036-9

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Other Link： https://link.springer.com/article/10.1186/s12939-023-02036-9/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Abstract

Aim

Kakkonto, a Japanese herbal kampo medicine, is empirically prescribed to improve milk stasis and ameliorate breast inflammation in patients with noninfectious mastitis. We investigated whether early use of kakkonto is associated with a reduction in antibiotic use and surgical drainage in patients with noninfectious mastitis.

Methods

We identified 34 074 patients with an initial diagnosis of noninfectious mastitis within 1 year of childbirth between April 2012 and December 2022 using the nationwide administrative JMDC Claims Database. Patients were divided into the kakkonto (n = 9593) and control (n = 9648) groups if they received and did not receive kakkonto on the day of the initial diagnosis of noninfectious mastitis, respectively. Antibiotic administration and surgical drainage within 30 days after the initial diagnosis of noninfectious mastitis in the two groups were compared using propensity score‐stabilized inverse probability of treatment weighting analysis.

Results

The frequency of antibiotic administration within 30 days after the initial diagnosis of noninfectious mastitis was significantly lower in the kakkonto group than in the control group (10% vs. 12%; odds ratio, 0.88 [95% confidence interval, 0.80–0.96]). The frequency of antibiotic administration during 1–3 and 4–7 days after the initial diagnosis were also significantly lower in the kakkonto group than in the control group. The frequency of surgical drainage did not differ significantly between the two groups.

Conclusions

Kakkonto was associated with reduced administration of antibiotics for noninfectious mastitis, making it a potential treatment option for relieving breast inflammation and promoting antimicrobial stewardship.

DOI： 10.1111/jog.15810

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

There are few reports on regional differences in the supply/utilisation balance and provision of rehabilitation services. This study analysed those regional differences in Japan to help policymakers provide more uniform and efficient rehabilitation services and optimally allocate related resources.

Design

An ecological study.

Setting

47 prefectures and 9 regions in Japan in 2017.

Primary and secondary outcome measures

Primary measures were ‘supply/utilisation (S/U) ratio’, calculated by dividing rehabilitation supply converted to service units, by rehabilitation utilisation and ‘utilisation/expected utilisation (U/EU) ratio’, calculated by dividing utilisation by EU. The EU was defined as utilisation expected from the demography in each area. Data required to calculate these indicators were collected from open sources such as the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan.

Results

The S/U ratios were higher in Shikoku, Kyusyu, Tohoku and Hokuriku regions, and lower in Kanto and Tokai regions. The number of rehabilitation providers per population was higher mostly in the western part of Japan and lower mostly in the eastern part. The U/EU ratios were also higher mostly in the western part, and lower mostly in the eastern part such as Tohoku and Hokuriku regions. The same trend was seen for cerebrovascular disease and musculoskeletal disorder rehabilitation, which accounted for approximately 84% of rehabilitation services. For disuse syndrome rehabilitation, such a trend did not exist, and the U/EU ratio differed by prefectures.

Conclusions

The large surplus in rehabilitation supply in the western part was attributed to the greater number of providers, while the smaller surplus in Kanto and Tokai regions was due to the smaller amount of supply. The number of rehabilitation services used was lesser in the eastern part such as Tohoku and Hokuriku regions, indicating regional differences in the provision of rehabilitation services.

File： Regional disparity in the provision of rehabilitation services using the open data from the Japanese national claimas database an ecological study.pdf

DOI： 10.1136/bmjopen-2023-071670

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Introduction

The association between the physical health of older people and the frequency of going out has been reported, and in recent years, local governments have developed transportation support programs for older people. Although previous studies show an association between the frequency of going out and functional health status, little has been reported on the impact of the choice of means of transport on instrumental activities of daily living (IADL).

Objective

To evaluate the association between choice of transportation means and the risk of decline in IADL among older adults.

Methods

We conducted an observational, population (community-dwelling)-based cohort study using data from the Resident Health Status Survey, and longitudinal panel data at 2-time points in 2016 and 2019. In addition, we combined this panel data and a database on people who were certified as requiring long-term care to identify participants’ IADL. The propensity score matching method was used to classify the respondents into two groups, “active means of transportation” and “passive means of transportation,“ and determine the risk of a decline in means-tested independence after 3 years.

Results

Active means were used by 6,280 (76.2%) and passive means were used by 1,865 (22.6%). 999 (12.1%) individuals declined in IADL in 2019. The results of the comparison by balancing the attributes of “active means of transportation” and “passive means of transportation,“ with propensity score matching, showed that “passive means of transportation” were more likely to be “active” than “passive means of transportation,“ and “active” was more likely to be “passive” The risk of IADL decline was significantly higher than that of “active means of transportation” with an RR of 1.93 (95% CI: 1.62–2.30).

Conclusion

Passive means of transportation in older adults could be a possible risk for decreasing IADL 3 years later. Increasing the number of opportunities and places in the community for older adults to use active means of transportation may be effective in encouraging socially independent living among older adults.

File： s12889-022-14671-y.pdf

DOI： 10.1186/s12889-022-14671-y

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Other Link： https://link.springer.com/article/10.1186/s12889-022-14671-y/fulltext.html

Language：Japanese   Publisher：(一社)日本医療情報学会  

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Publishing type：Research paper (scientific journal)   Publisher：Japanese Society for Hygiene  

DOI： 10.1265/ehpm.22-00084

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

We investigated the prevalence of hypertensive patients and treated hypertensive patients using a Japanese nationwide administrative claims database. We analyzed national database data from 2014, including all claims data, provided by the Ministry of Health, Labour and Welfare of Japan. Hypertensive diseases were identified using Japanese standardized disease codes. Among hypertensive patients, treated hypertensive patients were defined by the prescription of any antihypertensive medication, identified using national health insurance price listing codes. We calculated and compared the number and age-adjusted prevalence of hypertensive patients and treated hypertensive patients by prefecture and the proportion of these patients by the size of medical facilities. In 2014, approximately 27 million Japanese people were identified as hypertensive, among which 89.6% were treated. The age-adjusted prevalence of hypertensive patients (per 100,000 persons) among women and men was 21,414 and 21,084, respectively. The age-adjusted prevalence of treated hypertensive patients (per 100,000 persons) among women and men was 19,118 and 18,974, respectively. While the prevalence of hypertensive and treated hypertensive patients varied geographically, the prevalence remained similar between the sexes. Approximately 59% of hypertensive patients visited clinics (0 to 19 beds) in Japan. In Japan, 27 million people were diagnosed with hypertensive diseases, and approximately 90% of these patients were treated with any antihypertensive medication in 2014. The distribution of hypertensive patients varied geographically throughout Japan.

File： Waki_2022_Prevalence of hypertensive diseases and_ treated hypertensive patients in Japan.pdf

DOI： 10.1038/s41440-022-00924-1

PubMed

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Other Link： https://www.nature.com/articles/s41440-022-00924-1

Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

File： Tsunoda2022_Article_MonthlyTrendsAndSeasonalityOfH.pdf

DOI： 10.1007/s10157-022-02202-3

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Other Link： https://link.springer.com/article/10.1007/s10157-022-02202-3/fulltext.html

Publishing type：Research paper (scientific journal)   Publisher：AME Publishing Company  

DOI： 10.21037/jhmhp-20-93

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Language：English   Publishing type：Research paper (scientific journal)  

File： s12960-020-00524-5.pdf

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Language：Japanese   Publishing type：Research paper (other academic)  

File： レセプト情報等データベースの利活用により作成した国際統計報告に関する検討.pdf

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.hlpt.2020.01.006

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Robot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs. METHODS: A systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs. RESULTS: We identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1-70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases. CONCLUSIONS: The results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.

DOI： 10.1186/s12894-019-0533-x

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Regional disparities in the implementation rates of recombinant tissue-type plasminogen activator and endovascular thrombectomy treatments have been reported in Japan. We simulated the cost-effectiveness of specialist dispatching system in Hokkaido, Japan using Geographic Information System. In the system a qualified specialist is dispatched to another hospital for endovascular thrombectomy. Since the system improved patient accessibility, and the cost- effectiveness was excellent, the system could help enhance the equality and cost-effectiveness of ischemic stroke treatments in Hokkaido.

DOI： 10.3233/SHTI190685

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND PURPOSE: Although endovascular thrombectomy combined with recombinant tissue-type plasminogen activator is effective for treatment of acute ischemic stroke, regional disparities in implementation rates of those treatments have been reported. Drive and retrieve system, where a qualified neurointerventionist travels to another primary stroke center for endovascular thrombectomy, has been practiced in parts of Hokkaido, Japan. This study aims to simulate the cost effectiveness of the drive and retrieve system, which can be a method to enhance equality and cost effectiveness of treatments for acute ischemic stroke. MATERIALS AND METHODS: The number of patients who had acute ischemic stroke in 2015 is estimated. Those patients are generated according to the population distribution, and thereafter patient transport time is analyzed in the 3 scenarios (1) 60-minute drive scenario, (2) 90-minute drive scenario, in which the drive and retrieve system operates within 60-minute or 90-minute driving distance (3) without the system, using geographic information system. Incremental cost-effectiveness rate, quality-adjusted life years, and medical and nursing care costs are estimated from the analyzed transport time. FINDINGS: The incremental cost-effectiveness rate by implementing the system was dominant. Cost reductions of $213,190 in 60-minute drive scenario, and $247,274 in the 90-minute scenario were expected, respectively. Such benefits are the most significant in Soya, Emmon, Rumoi, and Kamikawahokubu medical areas. CONCLUSIONS: The drive and retrieve system could enhance regional equality and cost effectiveness of ischemic stroke treatments in Hokkaido, which can be achieved using existing resources. Further studies are required to clarify its cost effectiveness from hospital perspective.

DOI： 10.1016/j.jstrokecerebrovasdis.2019.05.020

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.hlpt.2019.05.003

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Telemedicine as a technology is expected to resolve issues such as doctor shortages and disparities in medical services. However, high costs of system installation and maintenance inhibit its widespread use. Introduction: This study involved a cost minimization analysis for installation of a teleradiology system in the Hokkaido prefecture of Japan. Conditions under which system utilization is cost-efficient and system utilization is effective for cost reduction were analyzed. Materials and Methods: A cost minimization analysis was conducted using three geospatial points of 50, 100, and 200 km from Sapporo city, the prefectural capital of Hokkaido, assuming a central imaging diagnosis center in Sapporo. The analysis was conducted from the standpoint of both patients and requesting hospitals. Results: From the patient's standpoint, a cost reduction effect was observed at all three distances from system installation. In contrast, from the hospital's standpoint, a cost reduction effect was found only when teleradiology examination was conducted from a distance of at least 100 km from Sapporo. Discussion: Results show that the cost reduction effect for patients increased as the travel distance increased. Although the teleradiology service is beneficial for a wide range of patients, the financial burden on requesting hospitals is significant. Conclusions: The following conditions were found necessary to reduce the requesting hospital's financial burden: the hospital should be far from the imaging diagnosis center, an inexpensive system is to be selected, and the system needs to be utilized continuously.

File： [E042]2019谷川鈴木TEH.pdf

DOI： 10.1089/tmj.2018.0244

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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File： Araseki2013_Article_TheNumberOfJapaneseRadiologicT.pdf

DOI： 10.1007/s12194-013-0220-7

Scopus

PubMed

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J-GLOBAL

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Authorship：Lead author   Language：Japanese   Publishing type：Meeting report  

File： 最終版_2207_JAMIシンポ_ishikawa_詳細抄録.pdf

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Language：Japanese  

File： Monthly IHEP_No.313_11月号_研究部レポート.pdf

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File： 20210330160828.pdf

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Language：Japanese  

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Authorship：Lead author  

File： Monthly IHEP11月号_No.302_研究部レポート.pdf

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Language：Japanese   Publishing type：Internal/External technical report, pre-print, etc.  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Event date： 2024.8

Language：English   Presentation type：Symposium, workshop panel (nominated)  

File： 19th WHO-OECD NHA meeting Agenda_for sharing 19Aug.pdf

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Event date： 2022.11

Language：Japanese   Presentation type：Oral presentation (general)  

File： 3-F-1-04.pdf

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Event date： 2022.3

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Event date： 2020.12

Language：English   Presentation type：Oral presentation (invited, special)  

File： Programa_0017742045_Programacao_Seminario_Internacional_3_e_4_de_dezembro_final_19.11.pdf

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Language：Japanese   Presentation type：Oral presentation (general)  

File： 2-G-1-07.pdf

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File： ishikawa_詳細抄録.pdf

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File： program_20210615.pdf

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File： hrfm29_program.pdf

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Presentation type：Symposium, workshop panel (nominated)  

File： JRC2021_抄録.pdf

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Language：English   Presentation type：Oral presentation (general)  

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File： 2-E-1-06.pdf

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File： JRC2020_MyAbstract_20200525_0927.pdf

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File： JRC2020_MyAbstract_20200525_0927.pdf

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Language：Japanese   Presentation type：Oral presentation (general)  

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Venue：札幌  

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Venue：大阪  

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Venue：大阪  

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Venue：福岡  

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