title: Evaluation of compliance with the Tokyo Guidelines for the management of acute cholangitis based on the Japanese administrative database associated with the Diagnosis Procedure Combination system.
abstract: OBJECTIVE
  We aimed to evaluate compliance with the clinical practice guidelines for acute cholangitis (Tokyo Guidelines) using the Japanese administrative database associated with the Diagnosis Procedure Combination (DPC) system.
  
  
  METHODS
  We collected database data from 60,842 acute cholangitis patients, examining 10 recommendations in the Tokyo Guidelines. We counted how many recommendations had been complied with for every patient. The patient compliance score was defined as the rate of compliance with these recommendations (score 0 = 0% to score 10 = 100%). An aggregated patient compliance score was measured according to the severity of acute cholangitis. Severity was categorized as grade I (mild cholangitis; n = 49,630), grade II (moderate cholangitis; n = 10,444), and grade III (severe cholangitis; n = 768).
  
  
  RESULTS
  The mean patient compliance score was significantly higher for patients with grade III than for those with grades II and I (7.6 ± 2.1 vs. 6.5 ± 3.0 vs. 2.9 ± 0.9, p < 0.001, respectively). Multiple linear regression analysis revealed that the severity of acute cholangitis was the parameter most significantly associated with the patient compliance score. The standardized coefficient of grade III was higher than that of grade II (0.657 vs. 0.248, p < 0.001).
  
  
  CONCLUSIONS
  Compliance with the Tokyo Guidelines became higher in accordance with the severity of acute cholangitis.
authors.affiliation: Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan. amurata@med.uoeh-u.ac.jp
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Murata
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujino
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kubo
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002761:Cholangitis / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index