title: The care processes for acute cholecystitis according to clinical practice guidelines based on the Japanese administrative database.
abstract: Acute cholecystitis is one of the most frequently encountered conditions in daily practice in Japan.  However, there is a shortage of detailed data about treatments that have been performed according to the clinical practice guidelines (CPGs) for acute cholecystitis.  We therefore examined the management of acute cholecystitis for adherence to the appropriate CPGs using the Japanese administrative database associated with the Diagnosis Procedure Combination (DPC) system.  We collected data from 6,070 patients with acute cholecystitis, examining for the application of four recommended treatments (administration of antimicrobial drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) and performance of early and laparoscopic cholecystectomy).  The patients were classified according to the procedures documented for each case: no gallbladder drainage (n = 4,333), gallbladder drainage without supportive care (ventilation or hemodiafiltration or the use of vasopressor) (n = 1,591) and gallbladder drainage and supportive care (n = 146).  Multiple logistic regression models revealed that patients with gallbladder drainage without supportive care and those with gallbladder drainage and supportive care significantly higher received administration of antimicrobial drugs and NSAIDs, while these patients underwent less early or laparoscopic cholecystectomy than did patients without gallbladder drainage, after adjusting for potential confounding effects of the clinical variables.  This study demonstrated that there were various differences with regard to the performance of recommended treatments between the levels of procedures required for acute cholecystitis.  In addition, this administrative database was a feasible tool for the evaluation of care processes and will provide useful information contributing to improved quality of medical care.
authors: Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan. amurata@med.uoeh-u.ac.jp
authors: Atsuhiko
authors: A
authors: Murata
authors: Kohji
authors: K
authors: Okamoto
authors: Shinya
authors: S
authors: Matsuda
authors: Kazuaki
authors: K
authors: Kuwabara
authors: Yukako
authors: Y
authors: Ichimiya
authors: Yasufumi
authors: Y
authors: Matsuda
authors: Tatsuhiko
authors: T
authors: Kubo
authors: Yoshihisa
authors: Y
authors: Fujino
authors: Kenji
authors: K
authors: Fujimori
authors: Hiromasa
authors: H
authors: Horiguchi
mesh_terms: D000328:Adult; D041881:Cholecystitis, Acute / Q000628:therapy*; D019992:Databases as Topic / Q000458:organization & administration*; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D007564:Japan; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic