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The evaluation indexes of antimicrobial use (AMU) in sub-prefectural regions have not been established because these regional units are susceptible to the effects of population inflows and outflows. We defined the difference in AMU calculated each year as a new evaluation index and compared the AMU of secondary medical areas with those already reported for Japan and each prefecture. Patients/1000 inhabitants/day (PID) for oral antibiotics in 2013 and 2016 were calculated using the National Database of Health Insurance Claims and Specific Health Checkups. ΔPID was defined as the difference between the PIDs in 2013 and 2016. Differences in AMUs for Japan and prefectures that have already been published were also calculated, and the concordance rate with ΔPID in each secondary medical area was evaluated. Antibiotics and age groups with less than 50% concordance between secondary medical area and previously reported AMU changes were observed. This revealed that even at the secondary medical area level, which is more detailed than the prefectural level, the AMU changes were not consistent. Therefore, in order to appropriately promote measures against antimicrobial resistance, we suggest the necessity of not only surveying AMU at the national or prefectural levels but also examining sub-prefectural trends in AMU.

The accuracy and correspondence between the measured concentrations from the survey and predicted concentrations on the basis of the three types of statistical antimicrobial use in Japan was evaluated. A monitoring survey of ten representative antimicrobials: ampicillin (APL), cefdinir (CDN), cefpodoxime proxetil (CPXP), ciprofloxacin (CFX), clarithromycin (CTM), doxycycline (DCL), levofloxacin (LFX), minocycline (MCL), tetracycline (TCL), and vancomycin (VMC), in the influent of sewage treatment plant (STP) located in urban areas of Japan, was conducted. Then, the measured values were verified in comparison with the predicted values estimated from the shipping volumes, sales volumes, and prescription volumes based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). The results indicate that the correspondence ratios between the predicted concentrations calculated on the basis of shipping and NDB volumes and the measured concentrations (predicted concentration/measured concentration) generally agreed for the detected concentration of antimicrobials in the STP influent. The correspondence ratio on the basis of shipping volume was, for CFX, 0.1; CTM, 2.9; LFX, 0.5; MCL, 1.9; and VMC, 1.7, and on the basis of NDB volume the measured concentration was CFX, 0.1; CTM, 3.7; DCL, 0.4; LFX, 0.7; MCL, 1.9; TCL, 0.6; and VMC, 1.6. To our knowledge, this is the first report to evaluate the accuracy of predicted concentrations based on sales, shipping, NDB statistics and measured concentrations for antimicrobials in the STP influent.

Aim Mental health issues are a significant global concern, with psychiatric occupational therapy (OT) playing a crucial role in non‐pharmacological treatment. In Japan, psychiatric OT is reimbursed under the national medical fee system. This study aimed to elucidate changes in psychiatric OT claims in Japan and analyze these changes by gender and age group. Methods The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data from fiscal years 2014–2022 was used. The number of psychiatric OT claims was analyzed by fiscal year, age group, sex, and region. Simple regression analysis, Mann–Whitney U test, and Spearman's rank correlation were used for statistical analysis. Results Inpatient psychiatric OT claims significantly increased from 2014 to 2022, particularly among the elderly (≥70 years) and those aged < 20 years. Outpatient claims significantly decreased after the onset of the COVID‐19 pandemic. Females had significantly higher inpatient claims than males, but no significant difference was observed for outpatients. Substantial regional disparities were found in the implementation of psychiatric OT. Conclusion The increase in inpatient psychiatric OT claims, especially among the elderly and younger populations, highlights the growing importance of age‐specific interventions. The decline in outpatient claims raises concerns about the impact of the pandemic on community‐based rehabilitation. Policymakers should consider revising reimbursement schemes to support sustained outpatient OT provision and ensure its integration as a core component of inclusive mental health care systems.

CPT¬ 2025 Professional Edition is the definitive American Medical Association (AMA)-authored resource to help health care professionals correctly report and bill medical procedures and services. Health care professionals want accurate reporting of services rendered and reimbursement. Payers want efficient claims processing. Correct reporting and billing of medical procedures and services begins with CPT¬ 2025 Professional Edition. Only the AMA, with the help of physicians and other experts in the health care community, creates and maintains the Current Procedural Terminology (CPT¬) code set. No other codebook has the accurate, complete official guidelines for the latest and current procedural terminology for procedures and services to help you code and report medical services and procedures properly. The AMA also takes the copyright protection of its content very seriously and is committed to providing the most effective anti-piracy efforts for its authors and readers, such as inclusion of the Amazon Anti Privacy Sticker and nonintrusive light-yellow dots on almost every page to reduce print reproduction in accordance with current copyright rules and laws. Recognizing that racism is a threat to the advancement of health equity and a barrier to appropriate medical care, as well as the power of images in contributing and limiting what bodies physicians, medical professionals, and students learn to see and define as normal and standard, the CPT 2025 Professional Edition will feature 29 diversity-related illustrations to counter a deep-seated, culturally, and systemically biased norm. These diversity-related images continue advancing inclusive and equitable representation of a diverse range of skin tones in our medical educational resources for everyone who uses our codebook in their daily work, practice, and education. Features and Benefits The CPT¬ 2025 Professional Edition codebook covers hundreds of code, guideline and text changes and features: CPT¬ Changes, CPT¬ Assistant, and Clinical Examples in Radiology citations — provides cross-referenced information to popular AMA resources that can enhance your understanding of the CPT code set. A comprehensive index — locate codes related to a specific procedure, service, anatomic site, condition, synonym, eponym or abbreviation quickly. Anatomical and procedural illustrations — help improve coding accuracy and understanding of the anatomy and services/procedures discussed. Overall codebook table of contents —enable a quick search of the entire codebook's content for quick access. Section table of contents — provide a useful tool to navigate effectively and quickly through each section's codes. Complete list of the additions, deletions and revisionsfor codes and code descriptors — provide a summary and quick reference of the 2025 changes in the codes without having to compare editions. Multiple appendices — offer additional information for modifiers; add-on codes; images of vascular families; re-sequenced codes, MAAAs and PLA services, digital medicine-services taxonomy; guidance for classifying various AI applications of AI for medical services and procedures; and all audio-only telemedicine CPT codes. Comprehensive E/M code selection tables — aid physicians and coders in assigning the most appropriate evaluation and management codes. Notes pages at the end of every code set section and subsection.

An insightful overview of health insurers and a guide to sustainability for provider organizations.Physicians experience ongoing frustrations in their relationships with health plans. Even as they struggle to keep up with accelerating clinical advances, they face daunting challenges from payers that are transitioning from traditional fee-for-service contracts to complex alternative payment models. In Health Plans Unmasked, Martin Lustick, MD, offers insights and guidance for those who face the herculean task of transforming their business practices to achieve financial stability while improving outcomes for their patients.By explaining both how and why insurance companies behave the way they do, Dr. Lustick helps providers avoid mistakes and take advantage of opportunities for success. He provides information on:• The evolution of health care financing in the United States• The nuts and bolts of health plan capabilities and the real motives of health plan administrators• Tips for successful contracting strategies • Alternative payment models and the promises of value-based careWith a career spanning five decades as a practicing pediatrician, chief operating officer of a medical group, chief medical officer of a hospital, and chief medical officer of a health plan, Dr. Lustick provides a straightforward guide to sustainability for provider organizations. Physicians, office managers, and anyone in a health-related field will benefit from his breaking down the role of health plans in our health care ecosystem.

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed because of virus mutations, vaccine dissemination, treatment development and policies, among other factors. These factors have a dynamic and complex effect on the characteristics and outcomes of patients. Therefore, there is an urgent need to understand those changes and update the evidence. We used a large-scale real-world data set of 937,758 patients with COVID-19 from a nationwide claims database that included outpatients and inpatients in Japan to investigate the changes in their characteristics, outcomes and risk factors for severity/mortality from the early pandemic to the delta variant-predominant waves. The severity of COVID-19 was defined according to the modified World Health Organization clinical-progression ordinal scale. With changing waves, mean patient age decreased, and proportion of patients with comorbidities decreased. The incidences of \"severe COVID-19 or death (i.e. ≥severe COVID-19)\" and \"death\" markedly declined (5.0% and 2.9%, wild-type-predominant; 4.6% and 2.2%, alpha variant-predominant and 1.4% and 0.4%, delta variant-predominant waves, respectively). Across the wave shift, risk factors for ≥ severe COVID-19 and death, including older age, male, malignancy, congestive heart failure and chronic obstructive pulmonary disease, were largely consistent. The significance of some factors, such as liver disease, varied as per the wave. This study, one of the largest population-based studies on COVID-19, showed that patient characteristics and outcomes changed during the waves. Risk factors for severity/mortality were similar across all waves, but some factors were inconsistent. These data suggest that the clinical status of COVID-19 will change further with the coming epidemic wave.

Background Coronavirus disease 2019 (COVID-19) has resulted in substantial morbidity and mortality globally. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) covers 99.9% of health insurance claim receipts by general practitioners. The purpose of this study is to investigate the nationwide number of inpatient orthopedic surgeries in Japan during the effect of state of emergency (SoE) due to COVID-19. Method The NDB has been publicly available since 2014. We retrospectively reviewed the NDB from April 2019 to March 2022. We gathered the monthly number of all inpatient orthopedic surgeries. We also classified orthopedic surgeries into the following 11 categories by using K-codes, Japanese original surgery classification: fracture, arthroplasty, spine, arthroscopy, hardware removal, hand, infection/amputation, ligament/tendon, tumor, joint, and others. By using the average number from April to December 2019 as the reference period, we investigated the increase or decrease orthopedic surgeries during the pandemic period. Results The NDB showed that the average number of total inpatient orthopedic surgeries during the reference period was 115,343 per month. In May 2020, monthly inpatient orthopedic surgeries decreased by 29.6% to 81,169 surgeries, accounting for 70.3% of the reference period. The second SoE in 2021 saw no change, while the third and fourth SoEs showed slight decreases compared to the reference period. Hardware removal and tumor surgeries in May 2020 decreased to 45.3% and 45.5%, respectively, while fracture surgeries had relatively small decreases. Conclusion According to NDB, approximately 1.3 million orthopedic inpatient surgeries were performed or claimed in a year in Japan. In May 2020, the first SoE period of the COVID-19 pandemic, the number of inpatient orthopedic surgeries in Japan decreased by 30%. Meanwhile, the decrease was relatively small during the SoE periods in 2021.

Background COVID-19 patients with preexisting interstitial lung disease (ILD) were reported to have a high mortality rate; however, this was based on data from the early stages of the pandemic. It is uncertain how their mortality rates have changed with the emergence of new variants of concern as well as the development of COVID-19 vaccines and treatments. It is also unclear whether having ILD still poses a risk factor for mortality. As COVID-19 continues to be a major concern, further research on COVID-19 patients with preexisting ILD is necessary. Methods We extracted data on COVID-19 patients between January 2020–August 2021 from a Japanese nationwide insurance claims database and divided them into those with and without preexisting ILD. We investigated all-cause mortality of COVID-19 patients with preexisting ILD in wild-type-, alpha-, and delta-predominant waves, to determine whether preexisting ILD was associated with increased mortality. Results Of the 937,758 adult COVID-19 patients, 7,333 (0.8%) had preexisting ILD. The proportion of all COVID-19 patients who had preexisting ILD in the wild-type-, alpha-, and delta-predominant waves was 1.2%, 0.8%, and 0.3%, respectively, and their 60-day mortality was 16.0%, 14.6%, and 7.5%, respectively. The 60-day mortality significantly decreased from the alpha-predominant to delta-predominant waves (difference − 7.1%, 95% confidence intervals (CI) − 9.3% to − 4.9%). In multivariable analysis, preexisting ILD was independently associated with increased mortality in all waves with the wild-type-predominant, odds ratio (OR) 2.10, 95% CI 1.91–2.30, the alpha-predominant wave, OR 2.14, 95% CI 1.84–2.50, and the delta-predominant wave, OR 2.10, 95%CI 1.66–2.66. Conclusions All-cause mortality rates for COVID-19 patients with preexisting ILD decreased from the wild-type- to the more recent delta-predominant waves. However, these patients were consistently at higher mortality risk than those without preexisting ILD. We emphasize that careful attention should be given to patients with preexisting ILD despite the change in the COVID-19 environment.