レセプト情報・特定健診等情報データベースを用いた在宅療養指導管理料・衛生材料等提供加算算定状況の分析

Analysis of the Status of Reimbursement for Home Medical Care Management Guidance and Additional Reimbursement for Provision of Sanitary Materials Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

要旨

　目的：レセプト情報・特定健診等情報データベース（NDB）を活用し，在宅患者の医療処置実施状況と医療・衛生材料供給状況を推察すると共に，在宅医療提供量との関連を解析すること．

　方法：NDBオープンデータ，SCR（Standardized Claim Ratio）データ，政府統計の総合窓口（e-Stat）から在宅療養指導管理料・在宅療養指導管理材料加算・衛生材料等提供加算の算定状況や在宅医療提供量に関するデータを抽出し，在宅医療提供状況との相関関係を分析した．

　結果：自己注射，持続陽圧呼吸療法などを必要とする在宅患者が多く，これらに必要な医療・衛生材料が供給されていると推察された．在宅療養指導管理料などの算定状況は，在宅療養支援病院数，在宅療養支援診療所数，訪問看護ステーション数，訪問診療や訪問看護の提供量など在宅医療提供量によって地域差が生じていた．

　考察・結論：今後は，算定状況が多かった医療処置を必要とする在宅患者への支援ならびに，在宅医療を提供する医療機関，在宅医療の充実が必要であると考える．

　Objective: This study aimed to assess the medical treatment and medical and sanitary materials provided to patients under home care in Japan using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and to analyze the associations with the number and type of medical services that are made available at home for these patients.

　Methods: Data on the reimbursement for home medical care management guidance, additional reimbursement for home medical care management guidance materials and provision of sanitary materials, and use of home medical care services were extracted from the NDB Open Data 2018, Standardized Claim Ratio 2018, and e-Stat (a portal site for Japanese governmental statistics). Correlational analyses were performed.

　Results: Many patients under home care needed self-injection or continuous positive airway pressure. It was estimated that in most cases, medical and sanitary materials were provided to these patients. The amount of reimbursement for home medical care management guidance differed between regions, depending on the number of clinics and hospitals providing home care support, the number of home-visit nursing stations, and the extent of home medical services provided, such as home-visit medical care and home-visit nursing in each prefecture.

　Discussion: In the future, patients who need home care services will require greater support and higher reimbursements. It is important to further increase and improve the quality of home care support and services provided by healthcare institutions and service providers.