Takahiro Higashi - Academia.edu (original) (raw)

Papers by Takahiro Higashi

This product is part of the RAND Corporation research brief series. RAND research briefs present ... more This product is part of the RAND Corporation research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

Esophagus, 2020

Background It will be important for the Japan Esophageal Society (JES) to show an evident advanta... more Background It will be important for the Japan Esophageal Society (JES) to show an evident advantage of its institution certification system. To achieve this essential task, we used nationally acquired big data to re-analyze 5-year survival information. Methods In 2008–2009, there were 4897 thoracic esophageal cancer patients who underwent esophagectomy and were registered in the National Database of Hospital-based Cancer Registries. We divided these patients into two groups, those who underwent surgery at an Authorized Institute for Board Certified Esophageal Surgeons (AIBCES) or a Non-AIBCES. We then compared the patient backgrounds and 5-year survival rates between these two groups, with and without propensity score matching. Results There were 3080 (63%) patients who underwent esophagectomy at an AIBCES and 1817 (37%) who underwent surgery at a Non-AIBCES. Comparison of the Kaplan–Meier survival curves using log-rank tests indicated a significant difference between the AIBCES and...

Diabetes Research and Clinical Practice, 2019

To calculate process quality measures of diabetes care in Japan using nationwide exclusive claims... more To calculate process quality measures of diabetes care in Japan using nationwide exclusive claims database. Methods: Using the National Database of health insurance claims during 2015-2016, the proportions of outpatients who received recommended examinations at least annually

BMC health services research, Oct 21, 2016

Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government... more Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were...

Health and quality of life outcomes, Jan 23, 2005

While falls and urinary incontinence are prevalent among older patients, who sometimes rely on pr... more While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown. Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored. Patients had ...

New England Journal of Medicine, 2007

Background There is emerging concern that the methods used to measure the quality of care unfairl... more Background There is emerging concern that the methods used to measure the quality of care unfairly penalize providers caring for patients with multiple chronic conditions. We therefore sought to study the relationship between the quality of care and the number of medical conditions a patient has. Methods We assessed measurements of the quality of medical care received in three cohorts of community-dwelling adult patients in the Community Quality Index study, the Assessing Care of Vulnerable Elders study, and the Veterans Health Administration project (7680 patients in total). We analyzed the relationship between the quality of care that patients received, defined as the percentage of quality indicators satisfied among those for which patients were eligible, and the number of chronic medical conditions each patient had. We further explored the roles of characteristics of patients, use of health care (number of office visits and hospitalizations), and care provided by specialists as explanations for the observed relationship. Results The quality of care increased as the number of medical conditions increased. Each additional condition was associated with an increase in the quality score of 2.2% (95% confidence interval [CI], 1.7 to 2.7) in the Community Quality Index cohort, of 1.7% (95% CI, 1.1 to 2.4) in the Assessing Care of Vulnerable Elders cohort, and of 1.7% (95% CI, 0.7 to 2.8) in the Veterans Health Administration cohort. The relationship between the quality of care and the number of conditions was little affected by adjustment for the difficulty of delivering the care recommended in a quality indicator and for the fact that, because of multiple conditions requiring the same care, a patient could be eligible to receive the same care process more than once. Adjustment for characteristics of patients, use of health care, and care provided by specialists diminished the relationship, but it remained positive. Conclusions The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases.

Japanese Journal of Clinical Oncology, 2012

The importance of quality assurance in cancer screening has recently gained increasing attention ... more The importance of quality assurance in cancer screening has recently gained increasing attention in Japan. To evaluate and improve quality, checklists and process indicators have been developed. To explore effective methods of enhancing quality in cancer screening, we started a randomized control study of the methods of evaluation and feedback for cancer control from 2009 to 2014. Methods: We randomly assigned 1270 municipal governments, equivalent to 71% of all Japanese municipal governments that performed screening programs, into three groups. The high-intensity intervention groups (n ¼ 425) were individually evaluated using both checklist performance and process indicator values, while the low-intensity intervention groups (n ¼ 421) were individually evaluated on the basis of only checklist performance. The control group (n ¼ 424) received only a basic report that included the national average of checklist performance scores. We repeated the survey for each municipality's quality assurance activity performance using checklists and process indicators. Results: In this paper, we report our study design and the result of the baseline survey. The checklist adherence rates were especially low in the checklist elements related to invitation of individuals, detailed monitoring of process indicators such as cancer detection rates according to screening histories and appropriate selection of screening facilities. Screening rate and percentage of examinees who underwent detailed examination tended to be lower for large cities when compared with smaller cities for all cancer sites. Conclusions: The performance of the Japanese cancer screening program in 2009 was identified for the first time.

Japanese Journal of Clinical Oncology, 2010

Objective: To evaluate the appropriateness of current checklists created by a governmental commit... more Objective: To evaluate the appropriateness of current checklists created by a governmental committee to assess screening programs run by municipal governments and service provider facilities for gastric and colorectal cancer, and to accumulate expert opinions to provide insights aimed at the next revision. Methods: We convened an expert panel that consisted of physicians nominated by regional offices of the Japanese Society for Gastrointestinal Cancer Screening and radiology technicians nominated by the technician chapter of the society. The panel rated the appropriateness of each checklist item on a scale of 1-9 (1, extremely inappropriate; 9, extremely appropriate) twice, between which they had a face-to-face discussion meeting. During the process they were allowed to propose modifications and additions to the items. Results: In the first round of rating, the panelists rated all 57 and 56 checklists items for gastric and colorectal cancer, respectively, as appropriate based on an acceptance rule determined a priori. During the process of the face-to-face discussion, however, the panel proposed modifications to 23 (40%) and 22 (39%) items, respectively, and the addition of 27 new items each. After integrating overlapping items and rating again for appropriateness, 66 and 64 items, respectively, were accepted as the revised checklist set. Conclusions: The expert panel considered current checklists for colorectal and gastric cancer-screening programs and facilities to be suitable. Their proposals for a new set of checklist items will help further improve the checklists.

Annals of Internal Medicine, 2004

Background: Although pharmacotherapy is critical to the medical care of older patients, medicatio... more Background: Although pharmacotherapy is critical to the medical care of older patients, medications can have considerable toxicity in this age group. To date, research has focused on inappropriate prescribing and policy efforts have aimed at access, but no comprehensive measurement of the quality of pharmacologic management using explicit criteria has been performed. Objective: To evaluate the broad range of pharmacologic care processes for vulnerable older patients.

International Journal for Quality in Health Care, 2013

Objective. To develop a set of process-of-care quality indicators (QIs) that would cover a wide r... more Objective. To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. Design. A retrospective medical record review. Settings. Eighteen designated cancer care hospitals throughout Japan. Participants. A total of 1685 patients diagnosed with gastric cancer in 2007. Main Outcome Measures. Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. Results. Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). Conclusions. Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

International Journal for Quality in Health Care, 2015

Objective: The purpose of this study is to measure adherence rate to the quality indicators (QI) ... more Objective: The purpose of this study is to measure adherence rate to the quality indicators (QI) in clinical practice to evaluate the quality of care for breast cancer patients in Japan. Design: A retrospective record review. Setting: Two hundred twenty-four designated breast cancer care hospitals throughout Japan. Participants: A total of 15 227 patients diagnosed with breast cancer in 2005. Main Outcome Measures: The adherence rate of seven items that correspond to QIs of medical care, which were developed using an adaptation of RAND/UCLA (University of California, Los Angeles) appropriateness method. Results: The lowest quality score was the drug therapy adherence to the St. Gallen consensus recommendations, for which the overall quality score 52.8%. The highest quality score was the adherence rate of hormone receptor testing, for which overall quality score was 97.8%. The greatest variations across facilities were for HER-2 testing and for radiation therapy after breast-conserving surgery. The least variation was for hormone receptor testing. Conclusions: There was a range of measurements for the adherence rate to each QI, suggesting that the desired standards of care had not necessarily pervaded all facilities. It is necessary to strive for widespread implementation of QIs and realization of the significance of measuring the medical care quality among physicians treating breast cancer.

Annals of Internal Medicine, 2005

Background: Although assessment of the quality of medical care often relies on measures of proces... more Background: Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent patient outcomes is unclear. Objective: To examine the link between the quality of care that patients received and their survival.

JACC: Cardiovascular Interventions, 2014

The aim of this study was to evaluate the appropriateness of percutaneous coronary intervention (... more The aim of this study was to evaluate the appropriateness of percutaneous coronary intervention (PCI) in Japan and clarify the association between trends of pre-procedural noninvasive testing and changes in appropriateness ratings. BACKGROUND Although PCI appropriateness criteria are widely used for quality-of-care improvement, they have not been validated internationally. Furthermore, the correlation of appropriateness ratings with implementation of newly developed noninvasive testing is unclear. METHODS We assigned an appropriateness rating to 11,258 consecutive PCIs registered in the Japanese Cardiovascular Database according to appropriateness use criteria developed in 2009 (AUC/2009) and the 2012 revised version (AUC/2012). Trends of pre-procedural noninvasive testing and appropriateness ratings were plotted; logistic regression was performed to identify inappropriate PCI predictors. RESULTS In nonacute settings, 15% of PCIs were rated inappropriate under AUC/2009, and this percent increased to 30.7% under AUC/2012 criteria. This was mostly because of the focused update of AUC, in which the patients were newly classified as inappropriate if they lacked proximal left anterior descending lesions and did not undergo pre-procedural noninvasive testing. However, these cases were simply not rated under AUC/2009. The amount of inappropriate PCIs increased over 5 years, proportional to the increase in coronary computed tomography angiography use. Use of coronary computed tomography angiography was independently associated with inappropriate PCIs (odds ratio: 1.33; p ¼ 0.027). CONCLUSIONS In a multicenter, Japanese PCI registry, approximately one-sixth of nonacute PCIs were rated as inappropriate under AUC/2009, increasing to approximately one-third under the revised AUC/2012. This significant gap may reflect a needed shift in appropriateness recognition of methods for noninvasive pre-procedural evaluation of coronary artery disease.

Skip main navigation and go to section navigation Skip main navigation and go to page content Opt... more Skip main navigation and go to section navigation Skip main navigation and go to page content Optimum graphic presentation of this site requires a modern standards-friendly browser. The browser or PDA you are using may not display exactly as intended, but you will still be ...

New England Journal of Medicine, 2007

This product is part of the RAND Corporation research brief series. RAND research briefs present ... more This product is part of the RAND Corporation research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

Esophagus, 2020

Background It will be important for the Japan Esophageal Society (JES) to show an evident advanta... more Background It will be important for the Japan Esophageal Society (JES) to show an evident advantage of its institution certification system. To achieve this essential task, we used nationally acquired big data to re-analyze 5-year survival information. Methods In 2008–2009, there were 4897 thoracic esophageal cancer patients who underwent esophagectomy and were registered in the National Database of Hospital-based Cancer Registries. We divided these patients into two groups, those who underwent surgery at an Authorized Institute for Board Certified Esophageal Surgeons (AIBCES) or a Non-AIBCES. We then compared the patient backgrounds and 5-year survival rates between these two groups, with and without propensity score matching. Results There were 3080 (63%) patients who underwent esophagectomy at an AIBCES and 1817 (37%) who underwent surgery at a Non-AIBCES. Comparison of the Kaplan–Meier survival curves using log-rank tests indicated a significant difference between the AIBCES and...

Diabetes Research and Clinical Practice, 2019

To calculate process quality measures of diabetes care in Japan using nationwide exclusive claims... more To calculate process quality measures of diabetes care in Japan using nationwide exclusive claims database. Methods: Using the National Database of health insurance claims during 2015-2016, the proportions of outpatients who received recommended examinations at least annually

BMC health services research, Oct 21, 2016

Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government... more Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were...

Health and quality of life outcomes, Jan 23, 2005

While falls and urinary incontinence are prevalent among older patients, who sometimes rely on pr... more While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown. Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored. Patients had ...

New England Journal of Medicine, 2007

Background There is emerging concern that the methods used to measure the quality of care unfairl... more Background There is emerging concern that the methods used to measure the quality of care unfairly penalize providers caring for patients with multiple chronic conditions. We therefore sought to study the relationship between the quality of care and the number of medical conditions a patient has. Methods We assessed measurements of the quality of medical care received in three cohorts of community-dwelling adult patients in the Community Quality Index study, the Assessing Care of Vulnerable Elders study, and the Veterans Health Administration project (7680 patients in total). We analyzed the relationship between the quality of care that patients received, defined as the percentage of quality indicators satisfied among those for which patients were eligible, and the number of chronic medical conditions each patient had. We further explored the roles of characteristics of patients, use of health care (number of office visits and hospitalizations), and care provided by specialists as explanations for the observed relationship. Results The quality of care increased as the number of medical conditions increased. Each additional condition was associated with an increase in the quality score of 2.2% (95% confidence interval [CI], 1.7 to 2.7) in the Community Quality Index cohort, of 1.7% (95% CI, 1.1 to 2.4) in the Assessing Care of Vulnerable Elders cohort, and of 1.7% (95% CI, 0.7 to 2.8) in the Veterans Health Administration cohort. The relationship between the quality of care and the number of conditions was little affected by adjustment for the difficulty of delivering the care recommended in a quality indicator and for the fact that, because of multiple conditions requiring the same care, a patient could be eligible to receive the same care process more than once. Adjustment for characteristics of patients, use of health care, and care provided by specialists diminished the relationship, but it remained positive. Conclusions The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases.

Japanese Journal of Clinical Oncology, 2012

The importance of quality assurance in cancer screening has recently gained increasing attention ... more The importance of quality assurance in cancer screening has recently gained increasing attention in Japan. To evaluate and improve quality, checklists and process indicators have been developed. To explore effective methods of enhancing quality in cancer screening, we started a randomized control study of the methods of evaluation and feedback for cancer control from 2009 to 2014. Methods: We randomly assigned 1270 municipal governments, equivalent to 71% of all Japanese municipal governments that performed screening programs, into three groups. The high-intensity intervention groups (n ¼ 425) were individually evaluated using both checklist performance and process indicator values, while the low-intensity intervention groups (n ¼ 421) were individually evaluated on the basis of only checklist performance. The control group (n ¼ 424) received only a basic report that included the national average of checklist performance scores. We repeated the survey for each municipality's quality assurance activity performance using checklists and process indicators. Results: In this paper, we report our study design and the result of the baseline survey. The checklist adherence rates were especially low in the checklist elements related to invitation of individuals, detailed monitoring of process indicators such as cancer detection rates according to screening histories and appropriate selection of screening facilities. Screening rate and percentage of examinees who underwent detailed examination tended to be lower for large cities when compared with smaller cities for all cancer sites. Conclusions: The performance of the Japanese cancer screening program in 2009 was identified for the first time.

Japanese Journal of Clinical Oncology, 2010

Objective: To evaluate the appropriateness of current checklists created by a governmental commit... more Objective: To evaluate the appropriateness of current checklists created by a governmental committee to assess screening programs run by municipal governments and service provider facilities for gastric and colorectal cancer, and to accumulate expert opinions to provide insights aimed at the next revision. Methods: We convened an expert panel that consisted of physicians nominated by regional offices of the Japanese Society for Gastrointestinal Cancer Screening and radiology technicians nominated by the technician chapter of the society. The panel rated the appropriateness of each checklist item on a scale of 1-9 (1, extremely inappropriate; 9, extremely appropriate) twice, between which they had a face-to-face discussion meeting. During the process they were allowed to propose modifications and additions to the items. Results: In the first round of rating, the panelists rated all 57 and 56 checklists items for gastric and colorectal cancer, respectively, as appropriate based on an acceptance rule determined a priori. During the process of the face-to-face discussion, however, the panel proposed modifications to 23 (40%) and 22 (39%) items, respectively, and the addition of 27 new items each. After integrating overlapping items and rating again for appropriateness, 66 and 64 items, respectively, were accepted as the revised checklist set. Conclusions: The expert panel considered current checklists for colorectal and gastric cancer-screening programs and facilities to be suitable. Their proposals for a new set of checklist items will help further improve the checklists.

Annals of Internal Medicine, 2004

Background: Although pharmacotherapy is critical to the medical care of older patients, medicatio... more Background: Although pharmacotherapy is critical to the medical care of older patients, medications can have considerable toxicity in this age group. To date, research has focused on inappropriate prescribing and policy efforts have aimed at access, but no comprehensive measurement of the quality of pharmacologic management using explicit criteria has been performed. Objective: To evaluate the broad range of pharmacologic care processes for vulnerable older patients.

International Journal for Quality in Health Care, 2013

Objective. To develop a set of process-of-care quality indicators (QIs) that would cover a wide r... more Objective. To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. Design. A retrospective medical record review. Settings. Eighteen designated cancer care hospitals throughout Japan. Participants. A total of 1685 patients diagnosed with gastric cancer in 2007. Main Outcome Measures. Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. Results. Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). Conclusions. Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

International Journal for Quality in Health Care, 2015

Objective: The purpose of this study is to measure adherence rate to the quality indicators (QI) ... more Objective: The purpose of this study is to measure adherence rate to the quality indicators (QI) in clinical practice to evaluate the quality of care for breast cancer patients in Japan. Design: A retrospective record review. Setting: Two hundred twenty-four designated breast cancer care hospitals throughout Japan. Participants: A total of 15 227 patients diagnosed with breast cancer in 2005. Main Outcome Measures: The adherence rate of seven items that correspond to QIs of medical care, which were developed using an adaptation of RAND/UCLA (University of California, Los Angeles) appropriateness method. Results: The lowest quality score was the drug therapy adherence to the St. Gallen consensus recommendations, for which the overall quality score 52.8%. The highest quality score was the adherence rate of hormone receptor testing, for which overall quality score was 97.8%. The greatest variations across facilities were for HER-2 testing and for radiation therapy after breast-conserving surgery. The least variation was for hormone receptor testing. Conclusions: There was a range of measurements for the adherence rate to each QI, suggesting that the desired standards of care had not necessarily pervaded all facilities. It is necessary to strive for widespread implementation of QIs and realization of the significance of measuring the medical care quality among physicians treating breast cancer.

Annals of Internal Medicine, 2005

Background: Although assessment of the quality of medical care often relies on measures of proces... more Background: Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent patient outcomes is unclear. Objective: To examine the link between the quality of care that patients received and their survival.

JACC: Cardiovascular Interventions, 2014

The aim of this study was to evaluate the appropriateness of percutaneous coronary intervention (... more The aim of this study was to evaluate the appropriateness of percutaneous coronary intervention (PCI) in Japan and clarify the association between trends of pre-procedural noninvasive testing and changes in appropriateness ratings. BACKGROUND Although PCI appropriateness criteria are widely used for quality-of-care improvement, they have not been validated internationally. Furthermore, the correlation of appropriateness ratings with implementation of newly developed noninvasive testing is unclear. METHODS We assigned an appropriateness rating to 11,258 consecutive PCIs registered in the Japanese Cardiovascular Database according to appropriateness use criteria developed in 2009 (AUC/2009) and the 2012 revised version (AUC/2012). Trends of pre-procedural noninvasive testing and appropriateness ratings were plotted; logistic regression was performed to identify inappropriate PCI predictors. RESULTS In nonacute settings, 15% of PCIs were rated inappropriate under AUC/2009, and this percent increased to 30.7% under AUC/2012 criteria. This was mostly because of the focused update of AUC, in which the patients were newly classified as inappropriate if they lacked proximal left anterior descending lesions and did not undergo pre-procedural noninvasive testing. However, these cases were simply not rated under AUC/2009. The amount of inappropriate PCIs increased over 5 years, proportional to the increase in coronary computed tomography angiography use. Use of coronary computed tomography angiography was independently associated with inappropriate PCIs (odds ratio: 1.33; p ¼ 0.027). CONCLUSIONS In a multicenter, Japanese PCI registry, approximately one-sixth of nonacute PCIs were rated as inappropriate under AUC/2009, increasing to approximately one-third under the revised AUC/2012. This significant gap may reflect a needed shift in appropriateness recognition of methods for noninvasive pre-procedural evaluation of coronary artery disease.

Skip main navigation and go to section navigation Skip main navigation and go to page content Opt... more Skip main navigation and go to section navigation Skip main navigation and go to page content Optimum graphic presentation of this site requires a modern standards-friendly browser. The browser or PDA you are using may not display exactly as intended, but you will still be ...

New England Journal of Medicine, 2007