{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282680272976256.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.11303/jsha.54.139"}},{"identifier":{"@type":"NDL_BIB_ID","@value":"028446585"}},{"identifier":{"@type":"URI","@value":"http://id.ndl.go.jp/bib/028446585"}},{"identifier":{"@type":"URI","@value":"https://ndlsearch.ndl.go.jp/books/R000000004-I028446585"}},{"identifier":{"@type":"NAID","@value":"130006022872"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2017373540"}}],"dc:title":[{"@language":"ja","@value":"大病院を時間外受診する軽症患者の識別と推計"},{"@language":"en","@value":"Identification and estimation of the number of patients with mild disease visiting during after-hours at large hospitals"},{"@language":"ja-Kana","@value":"ダイビョウイン オ ジカン ガイ ジュシン スル ケイショウ カンジャ ノ シキベツ ト スイケイ"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"en","@value":"<p>  Patients with mild disease visiting outpatients services at night, on holidays or in the after-hours （so-called convenient visits） present various problems to the emergency medical system.　In this study, we describe models that we developed to identify patients with mild disease from the data on health insurance claims for outpatient services and a medical record survey to estimate the number of these patients.　A survey of the medical records of outpatients who presented to any one of the 2 medical institutions belonging to the National Hospital Organization at night, on holidays or in the after-hours, excluding those hospitalized on the same day, identified patients with mild disease, and logistic regression analysis using health insurance claim data led to the construction of 3 patient identification models.　Of these, （1） the medical examination category model and （2） medical examination content-medical cost model, which can estimate the number of patients from the data on health insurance claims for outpatient services alone, were used to estimate the number of outpatients with mild disease who presented to any of the 84 hospitals with 200 or more beds belonging to the National Hospital Organization at night, on holidays or in the after-hours, excluding those hospitalized on the same day.　The analyses using models （1） and （2） revealed that the proportion of such patients was 43.8% and 42.8%, respectively, with significant differences, according to estimation by both models, in the proportions of patients with mild disease between institutions with 200-299 beds and those with more than 500 beds （Dunnett’s t　<i>p</i>=0.01, <i>p</i><0.01）.　The results suggest that guidance should be provided to patients attempting to visit hospitals during after-hours to improve the efficiency of the emergency medical system.</p>"},{"@language":"ja","@value":"<p>夜間・休日・時間外に外来受診する軽症患者（いわゆるコンビニ受診）により救急医療提供体制に様々な問題が生じている。本研究では，外来レセプトデータと診療録調査により軽症患者識別モデルを開発し，患者数を推計した。国立病院機構に属する2施設の即日入院を除く夜間・休日・時間外受診した外来患者の診療録調査により軽症患者を判定し，レセプトデータを用いてロジスティック回帰分析を行い，3つの識別モデルを作成した。このうち外来レセプトデータのみで推計できる ① 診療区分モデルと ② 診療内容-医療費モデルを使い，国立病院機構に属する200床以上の84病院の即日入院を除く夜間・休日・時間外受診した外来の軽症患者数を推計した。その結果，モデル ① では43.8%，モデル ② では42.8%であり，いずれも，200-299床の施設と500床以上の施設で軽症患者割合に有意差を認めた（Dunnett’s t　<i>p</i>=0.01, <i>p</i><0.01）。適切な救急医療提供のため必要度に応じた受診支援の検討が必要である。</p>"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1420282801186281216","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"40437570"},{"@type":"NRID","@value":"1000040437570"},{"@type":"NRID","@value":"9000001824058"},{"@type":"NRID","@value":"9000405708851"},{"@type":"NRID","@value":"9000241623383"},{"@type":"NRID","@value":"9000411367709"},{"@type":"NRID","@value":"9000411652678"},{"@type":"NRID","@value":"9000016596937"},{"@type":"NRID","@value":"9000403439285"},{"@type":"NRID","@value":"9000345434313"},{"@type":"NRID","@value":"9000403439251"},{"@type":"NRID","@value":"9000405843706"},{"@type":"NRID","@value":"9000331090286"},{"@type":"NRID","@value":"9000403439247"},{"@type":"NRID","@value":"9000367421898"},{"@type":"NRID","@value":"9000414251781"},{"@type":"NRID","@value":"9000403054394"},{"@type":"NRID","@value":"9000321414060"},{"@type":"NRID","@value":"9000414812799"},{"@type":"NRID","@value":"9000387913164"},{"@type":"NRID","@value":"9000365528742"},{"@type":"NRID","@value":"9000397944657"},{"@type":"NRID","@value":"9000258515628"},{"@type":"NRID","@value":"9000326657395"},{"@type":"NRID","@value":"9000258218148"},{"@type":"NRID","@value":"9000399246730"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/7000026267"}],"foaf:name":[{"@language":"ja","@value":"森脇 睦子"},{"@language":"en","@value":"Moriwaki Mutsuko"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"東京医科歯科大学医学部附属病院クオリティ・マネジメント・センター"},{"@language":"en","@value":"Quality Management Center,  Medical Hospital, Tokyo Medical and Dental University"},{"@language":"en","@value":"Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters"},{"@language":"ja","@value":"国立病院機構本部総合研究センター診療情報分析部"}]},{"@id":"https://cir.nii.ac.jp/crid/1410001205766974467","@type":"Researcher","personIdentifier":[{"@type":"ORCID","@value":"0000-0003-2214-6695"},{"@type":"NRID","@value":"9000345247600"},{"@type":"NRID","@value":"9000330672071"},{"@type":"NRID","@value":"9000367418032"},{"@type":"NRID","@value":"9000411273560"},{"@type":"NRID","@value":"9000367421897"},{"@type":"NRID","@value":"9000378111168"},{"@type":"NRID","@value":"9000356901396"},{"@type":"NRID","@value":"9000410743887"},{"@type":"NRID","@value":"9000365528743"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/yamana"}],"foaf:name":[{"@language":"ja","@value":"山名 隼人"},{"@language":"en","@value":"Yamana Hayato"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo"},{"@language":"ja","@value":"東京大学大学院医学系研究科公共健康医学専攻　臨床疫学・経済学"},{"@language":"en","@value":"Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters"},{"@language":"ja","@value":"国立病院機構本部総合研究センター診療情報分析部"}]},{"@id":"https://cir.nii.ac.jp/crid/1420845751152078720","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"50608750"},{"@type":"NRID","@value":"1000050608750"},{"@type":"NRID","@value":"9000018813288"},{"@type":"NRID","@value":"9000411388207"},{"@type":"NRID","@value":"9000413510602"},{"@type":"NRID","@value":"9000414214177"},{"@type":"NRID","@value":"9000398977215"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/Shinobu_Imai"}],"foaf:name":[{"@language":"en","@value":"Imai Shinobu"},{"@language":"ja","@value":"今井 志乃ぶ"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Clinical Data Management and Research, Clinical Research Center, National Hospital 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正之"},{"@language":"en","@value":"Kakehashi Masayuki"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Graduate School of Biomedical & Health Sciences, Hiroshima University"},{"@language":"ja","@value":"広島大学大学院　医歯薬保健学研究科　健康情報学"}]},{"@id":"https://cir.nii.ac.jp/crid/1420282801198083584","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"50270913"},{"@type":"NRID","@value":"1000050270913"},{"@type":"NRID","@value":"9000024981499"},{"@type":"NRID","@value":"9000261661524"},{"@type":"NRID","@value":"9000279906274"},{"@type":"NRID","@value":"9000258232626"},{"@type":"NRID","@value":"9000241623384"},{"@type":"NRID","@value":"9000010281648"},{"@type":"NRID","@value":"9000009282276"},{"@type":"NRID","@value":"9000298886855"},{"@type":"NRID","@value":"9000343337043"},{"@type":"NRID","@value":"9000395383269"},{"@type":"NRID","@value":"9000000947458"},{"@type":"NRID","@value":"9000379610196"},{"@type":"NRID","@value":"9000345321439"},{"@type":"NRID","@value":"9000405708854"},{"@type":"NRID","@value":"9000018378555"},{"@type":"NRID","@value":"9000010589533"},{"@type":"NRID","@value":"9000309988501"},{"@type":"NRID","@value":"9000380134491"},{"@type":"NRID","@value":"9000283424416"},{"@type":"NRID","@value":"9000018889992"},{"@type":"NRID","@value":"9000242696317"},{"@type":"NRID","@value":"9000399947713"},{"@type":"NRID","@value":"9000254100436"},{"@type":"NRID","@value":"9000251398285"},{"@type":"NRID","@value":"9000399246643"},{"@type":"NRID","@value":"9000018974135"},{"@type":"NRID","@value":"9000018119422"},{"@type":"NRID","@value":"9000000173258"},{"@type":"NRID","@value":"9000399833152"},{"@type":"NRID","@value":"9000391659991"},{"@type":"NRID","@value":"9000308730731"},{"@type":"NRID","@value":"9000010220268"},{"@type":"NRID","@value":"9000241437454"},{"@type":"NRID","@value":"9000018968126"},{"@type":"NRID","@value":"9000266895023"},{"@type":"NRID","@value":"9000391407051"},{"@type":"NRID","@value":"9000270886856"},{"@type":"NRID","@value":"9000006197781"},{"@type":"NRID","@value":"9000345434316"},{"@type":"NRID","@value":"9000018396327"},{"@type":"NRID","@value":"9000016607837"},{"@type":"NRID","@value":"9000264265727"},{"@type":"NRID","@value":"9000399833193"},{"@type":"NRID","@value":"9000010171116"},{"@type":"NRID","@value":"9000356571040"},{"@type":"NRID","@value":"9000240194077"},{"@type":"NRID","@value":"9000258232596"},{"@type":"NRID","@value":"9000242699316"},{"@type":"NRID","@value":"9000265542321"},{"@type":"NRID","@value":"9000331090287"},{"@type":"NRID","@value":"9000308730745"},{"@type":"NRID","@value":"9000254513042"},{"@type":"NRID","@value":"9000403054397"},{"@type":"NRID","@value":"9000366124619"},{"@type":"NRID","@value":"9000399753957"},{"@type":"NRID","@value":"9000254511435"},{"@type":"NRID","@value":"9000009820501"},{"@type":"NRID","@value":"9000241738830"},{"@type":"NRID","@value":"9000006239538"},{"@type":"NRID","@value":"9000333208523"},{"@type":"NRID","@value":"9000288795241"},{"@type":"NRID","@value":"9000321617270"},{"@type":"NRID","@value":"9000241754398"},{"@type":"NRID","@value":"9000025000716"},{"@type":"NRID","@value":"9000361229986"},{"@type":"NRID","@value":"9000321414063"},{"@type":"NRID","@value":"9000414812801"},{"@type":"NRID","@value":"9000341538359"},{"@type":"NRID","@value":"9000241865333"},{"@type":"NRID","@value":"9000242697124"},{"@type":"NRID","@value":"9000242699227"},{"@type":"NRID","@value":"9000272251821"},{"@type":"NRID","@value":"9000381062711"},{"@type":"NRID","@value":"9000387913166"},{"@type":"NRID","@value":"9000382668964"},{"@type":"NRID","@value":"9000365528747"},{"@type":"NRID","@value":"9000323297606"},{"@type":"NRID","@value":"9000308730744"},{"@type":"NRID","@value":"9000254098567"},{"@type":"NRID","@value":"9000397944658"},{"@type":"NRID","@value":"9000404000080"},{"@type":"NRID","@value":"9000009175909"},{"@type":"NRID","@value":"9000368937724"},{"@type":"NRID","@value":"9000326657397"},{"@type":"NRID","@value":"9000402462677"},{"@type":"NRID","@value":"9000399246734"},{"@type":"NRID","@value":"9000018385538"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/read0068448"}],"foaf:name":[{"@language":"ja","@value":"伏見 清秀"},{"@language":"en","@value":"Fushimi Kiyohide"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters"},{"@language":"ja","@value":"国立病院機構本部総合研究センター診療情報分析部"},{"@language":"en","@value":"Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University"},{"@language":"ja","@value":"東京医科歯科大学大学院　医療政策情報学分野"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"1882594X"},{"@type":"LISSN","@value":"1882594X"},{"@type":"EISSN","@value":"2185422X"},{"@type":"NDL_BIB_ID","@value":"000009187281"},{"@type":"ISSN","@value":"1882594X"},{"@type":"NCID","@value":"AA12296781"}],"prism:publicationName":[{"@language":"en","@value":"Journal of the Japan Society for Healthcare Administration"},{"@language":"ja","@value":"日本医療・病院管理学会誌"},{"@language":"en","@value":"Journal of the Japan Society for Healthcare Administration"},{"@language":"ja","@value":"日本医療・病院管理学会誌"}],"dc:publisher":[{"@language":"en","@value":"Japan Society for Healthcare Administration"},{"@language":"ja","@value":"一般社団法人 日本医療・病院管理学会"}],"prism:publicationDate":"2017","prism:volume":"54","prism:number":"3","prism:startingPage":"139","prism:endingPage":"149"},"url":[{"@id":"http://id.ndl.go.jp/bib/028446585"},{"@id":"https://ndlsearch.ndl.go.jp/books/R000000004-I028446585"},{"@id":"https://search.jamas.or.jp/link/ui/2017373540"}],"availableAt":"2017","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=convenient%20visit","dc:title":"convenient visit"},{"@id":"https://cir.nii.ac.jp/all?q=patient%20with%20mild%20disease","dc:title":"patient with mild disease"},{"@id":"https://cir.nii.ac.jp/all?q=large%20hospital","dc:title":"large hospital"},{"@id":"https://cir.nii.ac.jp/all?q=outpatient","dc:title":"outpatient"},{"@id":"https://cir.nii.ac.jp/all?q=estimated%20number%20of%20patients","dc:title":"estimated number of patients"},{"@id":"https://cir.nii.ac.jp/all?q=%E3%82%B3%E3%83%B3%E3%83%93%E3%83%8B%E5%8F%97%E8%A8%BA","dc:title":"コンビニ受診"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%BB%BD%E7%97%87%E6%82%A3%E8%80%85","dc:title":"軽症患者"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A4%A7%E7%97%85%E9%99%A2","dc:title":"大病院"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A4%96%E6%9D%A5%E6%82%A3%E8%80%85","dc:title":"外来患者"},{"@id":"https://cir.nii.ac.jp/all?q=%E6%82%A3%E8%80%85%E6%8E%A8%E8%A8%88","dc:title":"患者推計"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2003153802"},{"@type":"NDL_SEARCH","@value":"oai:ndlsearch.ndl.go.jp:R000000004-I028446585"},{"@type":"CIA","@value":"130006022872"}]}