Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

The National Clinical Database as an Initiative for Quality Improvement in Japan

  • Murakami, Arata (Department of Cardiovascular Surgery, Gunma Children's Medical Center) ;
  • Hirata, Yasutaka (Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo) ;
  • Motomura, Noboru (Department of Cardiac Surgery, Sakura Hospital, Toho University) ;
  • Miyata, Hiroaki (Department of Health Quality Assessment, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo) ;
  • Iwanaka, Tadashi (Department of Pediatric Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo) ;
  • Takamoto, Shinichi (The Mitsui Memorial Hospital)
  • Received : 2014.07.22
  • Accepted : 2014.08.22
  • Published : 2014.10.05
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Grover FL, Shroyer AL, Hammermeister K, et al. A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases. Ann Surg 2001;234:464-72. https://doi.org/10.1097/00000658-200110000-00006
  2. Ferris TG, Torchiana DF. Public release of clinical outcomes data: online CABG report cards. N Engl J Med 2010;363: 1593-5. https://doi.org/10.1056/NEJMp1009423
  3. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002;123:110-8. https://doi.org/10.1067/mtc.2002.119064
  4. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part 1--history, rationale, consequences. Ann Thorac Surg 2011;92(3 Suppl):S2-11. https://doi.org/10.1016/j.athoracsur.2011.06.100
  5. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part 2--implementation. Ann Thorac Surg 2011;92(3 Suppl):S12-23. https://doi.org/10.1016/j.athoracsur.2011.06.101
  6. Mavroudis C, Jacobs JP. Congenital Heart Surgery Nomenclature and Database Project: overview and minimum dataset. Ann Thorac Surg 2000 Apr;69(4 Suppl):S2-17.
  7. Jacobs JP, Jacobs ML, Lacour-Gayet FG, et al. Stratification of complexity improves the utility and accuracy of outcomes analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Pediatr Cardiol 2009;30:1117-30. https://doi.org/10.1007/s00246-009-9496-0
  8. Motomura N, Miyata H, Tsukihara H, Okada M, Takamoto S; Japan Cardiovascular Surgery Database Organization. First report on 30-day and operative mortality in risk model of isolated coronary artery bypass grafting in Japan. Ann Thorac Surg 2008;86:1866-72. https://doi.org/10.1016/j.athoracsur.2008.08.001
  9. Motomura N, Miyata H, Tsukihara H, Takamoto S; Japan Cardiovascular Surgery Database Organization. Risk model of valve surgery in Japan using the Japan Adult Cardiovascular Surgery Database. J Heart Valve Dis 2010;19:684-91.
  10. Motomura N, Miyata H, Tsukihara H, Takamoto S; Japan Cardiovascular Surgery Database Organization. Risk model of thoracic aortic surgery in 4707 cases from a nationwide single- race population through a web-based data entry system: the first report of 30-day and 30-day operative outcome risk models for thoracic aortic surgery. Circulation 2008;118(14 Suppl):S153-9. https://doi.org/10.1161/CIRCULATIONAHA.107.756684
  11. Miyata H, Murakami A. The first report on risk models based on the Japan Congenital Cardiovascular Surgery Database. J Thorac Cardiovasc Surg 2014 Jan 15 [In press].
  12. Roques F, Nashef SA, Michel P; EuroSCORE study group. Risk factors for early mortality after valve surgery in Europe in the 1990s: lessons from the EuroSCORE pilot program. J Heart Valve Dis 2001;10:572-7.
  13. Miyata H, Motomura N, Kondo MJ, Fushimi K, Ishikawa KB, Takamoto S. Toward quality improvement of cardiovascular surgery in Japan: an estimation of regionalization effects from a nationwide survey. Health Policy 2009;91:246-51. https://doi.org/10.1016/j.healthpol.2008.11.003
  14. Miyata H, Motomura N, Ueda Y, Tsukihara H, Tabayashi K, Takamoto S. Toward quality improvement of thoracic aortic surgery: estimating volume-outcome effect from nationwide survey. Eur J Cardiothorac Surg 2009;36:517-21. https://doi.org/10.1016/j.ejcts.2009.03.020
  15. Tomotaki A, Miyata H, Hashimoto H, Murakami A, Ono M. Results of data verification of the Japan congenital cardiovascular database, 2008 to 2009. World J Pediatr Congenit Heart Surg 2014;5:47-53. https://doi.org/10.1177/2150135113508794
  16. Miyata H, Gotoh M, Hashimoto H, et al. Challenges and prospects of a clinical database linked to the board certification system. Surg Today 2014 May 23 [Epub].
  17. Kenjo A, Miyata H, Gotoh M, et al. Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 2014;218:412-22. https://doi.org/10.1016/j.jamcollsurg.2013.11.007
  18. Kobayashi H, Miyata H, Gotoh M, et al. Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database. J Gastroenterol 2014;49: 1047-55. https://doi.org/10.1007/s00535-013-0860-8
  19. Roland M. Linking physician's pay to the quality of care - a major experiment in the United Kingdom. N Engl J Med 2004;351:1448-54. https://doi.org/10.1056/NEJMhpr041294
  20. Reinertsen JL. Zen and the art of physician autonomy maintenance. Ann Intern Med 2003;138:992-5. https://doi.org/10.7326/0003-4819-138-12-200306170-00011
  21. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44:Suppl:166-206. https://doi.org/10.2307/3348969

Cited by

  1. Pharmacoepidemiology in Japan: medical databases and research achievements vol.1, pp.None, 2015, https://doi.org/10.1186/s40780-015-0016-5
  2. Quality of Big Data in health care vol.28, pp.6, 2014, https://doi.org/10.1108/ijhcqa-07-2014-0080
  3. Validation of the board certification system for expert surgeons (hepato‐biliary‐pancreatic field) using the data of the National Clinical Database of Japan: part 1 ‐ Hepatectomy of vol.23, pp.6, 2014, https://doi.org/10.1002/jhbp.344
  4. Validation of the board certification system for expert surgeons (hepato‐biliary‐pancreatic field) using the data of the National Clinical Database of Japan: part 2 – Pancreatoduoden vol.23, pp.6, 2014, https://doi.org/10.1002/jhbp.348
  5. The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients vol.32, pp.2, 2014, https://doi.org/10.21470/1678-9741-2017-0053
  6. Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study vol.21, pp.1, 2014, https://doi.org/10.1007/s10120-017-0764-z
  7. Frequency and risk factors for venous thromboembolism after gastroenterological surgery based on the Japanese National Clinical Database (516 217 cases) vol.3, pp.5, 2014, https://doi.org/10.1002/ags3.12275
  8. Contemporary Outcomes of Surgical Aortic Valve Replacement in Japan vol.84, pp.2, 2014, https://doi.org/10.1253/circj.cj-19-0674
  9. Contemporary use and trends in percutaneous coronary intervention in Japan: an outline of the J-PCI registry vol.35, pp.3, 2014, https://doi.org/10.1007/s12928-020-00669-z
  10. Improving cardiac surgical quality: lessons from the Japanese experience vol.29, pp.7, 2020, https://doi.org/10.1136/bmjqs-2019-010125
  11. One-Year Outcome After Percutaneous Coronary Intervention for Acute Coronary Syndrome ― An Analysis of 20,042 Patients From a Japanese Nationwide Registry ― vol.85, pp.10, 2014, https://doi.org/10.1253/circj.cj-21-0098