title: The national clinical database as an initiative for quality improvement in Japan.
abstract: The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.
authors.affiliation: Department of Cardiovascular Surgery, Gunma Children's Medical Center.
authors.forename: Arata
authors.initials: A
authors.lastname: Murakami
authors.affiliation: Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Hirata
authors.affiliation: Department of Cardiac Surgery, Sakura Hospital, Toho University.
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.affiliation: Department of Health Quality Assessment, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
authors.affiliation: The Mitsui Memorial Hospital.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
keywords: Clinical database; Medical board; Medical expenditure; Patient safety; Quality improvement