6/Aug/2008 in Queen’s town6/Aug/2008 in Queen’s town

Outcomes of Japanese Disease Outcomes of Japanese Disease Management for Metabolic Management for Metabolic

Syndrome Syndrome

Medical WG in APAN Queen’s town Medical WG in APAN Queen’s town

Naoki Nakashima, M.D., Ph.D.Naoki Nakashima, M.D., Ph.D.Department of Medical InformaticsDepartment of Medical InformaticsKyushu University HospitalKyushu University Hospital

Background of the projectBackground of the project

Pre-Diabetes

Not

Cared

Specialist Doctors

Cared

130 million citizen

in Japan

10 million4 million

1million

Family doctors

DropoutAcute and

Chronic Diabetic

Complications

Increase of Increase of Medical CostMedical Cost

3million

Diabetes Mellitus

Problems１． Continuously increasing patients and complications２． Low hospitalization rate of patients (51%)　　　３． Shortage of specialist Drs. (=3,300） for diabetes

Patients QOL

Medical cost

Japanese Government startedJapanese Government started “ Particular Health Check-up System “ Particular Health Check-up System (PHCS = Tokutei Kenshin)”(PHCS = Tokutei Kenshin)” from April 2008from April 2008

All of 40All of 40 ～～ 74yo Japanese citizen (56 million) 74yo Japanese citizen (56 million) will have to take standard health examinationwill have to take standard health examination

List of basic examinationList of basic examination Questionnaire (weight change, smoking, exercise)Questionnaire (weight change, smoking, exercise) A physical examination A physical examination

Height, Weight (BMI), Waist, Blood PressureHeight, Weight (BMI), Waist, Blood Pressure Blood/Urine chemistryBlood/Urine chemistry

TG, HDL-C, LDL-C, GOT, GPT, γ-GTP, TG, HDL-C, LDL-C, GOT, GPT, γ-GTP, Fasting Blood glucose HbA1c, Hemoglobin, glucosuriaFasting Blood glucose HbA1c, Hemoglobin, glucosuria

Moderate and high risk groups are required to rModerate and high risk groups are required to receive standard healthcare counseling eceive standard healthcare counseling

Flow from health check-up Flow from health check-up to healthcare counseling to healthcare counseling

Low risk group Moderate risk group High risk

group

Information provide

Face to face counseling (once)

Follow up(e-mail, phone)

75.1％ 13.4％ 11.5％

Intervention 2

Intervention 1

Data Data AccumulationAccumulation

And And StratificationStratification

Arrangement Arrangement of Health of Health Check-upCheck-up

Annual Health Annual Health Check-upCheck-up

Arrangement Arrangement of Health of Health

counselingcounseling

Navigation Navigation system of system of

counselingcounseling

Health Health counselingcounseling

Dunning of Health Dunning of Health Check-upCheck-up

Planning Planning next yearnext year

Data Data analysisanalysis

Daily Health Daily Health counseling and counseling and

SupportSupport

Encourage to attend Encourage to attend a clinica clinic

Dunning of Health Dunning of Health counselingcounseling

Information Provided for all

Motivation Support for moderate and high risk groups

strong Support for high risk group

For patients of Life Style Diseases

Yearly Work Flow of PHCS as a Disease Management

Start !

Stratification

Intervention 2

AnalysisPlan

Assessment

Intervention 1

Stratification Logic in PHCSStratification Logic in PHCS

Big Waist　　　　　　　　　　　（ M 85cm, ≧F 90cm)≧

Normal Waist　　　　　　 Obese　　　　　　　（ M<85cm, F<90cm)　　　　　　　　 （ BMI 25≧ ）　　　　

Normal Waist Normal Weight 　　　　　　　（ M<85cm, F<90cm)　　　　　　　 　　 （ BMI<25 ）

　　　　

Waist and Obesity

Grouping for

Healthcare

counseling

Strong SupportGroup

Motivation SupportGroup

Information provided

Group

≧2

1

≧3

1, 2

0

Number of Risk Factors*

65-74y.o.

0

*Risk Factors① 　 Blood Glucose ：

Fasting ≧ 100 mg/dlHbA1c ≧ 5.2 %Under medication

② 　 Lipidemia ：Triglyceride ≧ 150 mg/dlHDL-cholesterol<40 mg/dlUnder madication

③ 　 BP ： Systoric ≧ 130 mmHgDiastoric ≧ 85 mmHgUnder medication

④ 　 Smoking history ：　 +

*④ is counted if there is one point at least in ① ～③ .

Expected Privacy Problem of PHCSExpected Privacy Problem of PHCS

・ Insurers will have economical penalties from 5year later, if they can not achieve outcomes the government sets.

・ Insurer has close relationship to each company in Japan.

・ Companies may start discrimination of obese employees with PHCS data (employment, salary, career, duty, etc).

・We should make a strict law which prohibits illegal use of privacy data by insurers ASAP.

Carna ConsortiumCarna Consortium

Kyushu University

Diabetes Specialist Doctors

Saiseikai Kumamoto Hospital

Kyushu Electronic Power Co. and group （ QIC ，　 QBS ）

Tokio Marine & Nichido Fire Insurance Co.

Fukuoka Prefecture Medical Association

Fukuoka City Medical Association

The Authorization document from Fukuoka Prefecture Medical Association

Members

Assented by

2003-2005 Japan Science and Technology Agency(Ministry of Education, Culture, Sports, Science and Technology )

2005　　 Ministry of Economy, Trade and Industry2006　　 Ministry of Economy, Trade and Industry2008 Ministry of Economy, Trade and Industry2008 Japan Science and Technology Agency2008 Ministry of Health, Labour and Welfare2008 Ministry of Education, Culture, Sports, Science and Technology

Funded by

IT system developed by Carna for PHCS IT system developed by Carna for PHCS

Data management system

Booking system

Navi systemfor indigivual

meeting

Management System forfollow up

counseling

Evaluation and

reporting system

Navi system for group meeting

Navi system for follow up counseling

develped

Under developed

ICT system (1) for data management system ICT system (1) for data management system for health check-up and healthcare counselingfor health check-up and healthcare counseling

Down loadable

Data upload by HL7, Csv or input by hand

Automatic stratification

Appropriate information according to each result of health check-up

HL7 CDA data

Down loadable

Secure Internet browsing

ICT system (2) for navigation of health counselingICT system (2) for navigation of health counseling

1. Quality management of counseling

2. Automatic providing of information

3. Management of Personalized plan

4. Education tool of instructor

5. Using many animation for education

*All data are accumulated as HL7CDA

Verification study of PHCS in 2007 by the Carna (results of stratification)

Effects of Intervention on Loss of Weight

in verification study in 2007

Effects of Intervention on Loss of Waist in verification study in 2007

Effects of Intervention on blood examination

in verification study in 2007 （ indicator of diabetes mellitus ）Blood sugar n Change by intervention p value

(mg/dl)

　 All 175 +0.24 ± 1.0 0.812　 Lowrisk 94 - 1.3 ± 0.65 0.054　 Moderate risk 16 - 0.5 ± 2.22 0.825　 High risk 46 - 1.2 ± 1.31 0.350　 Having medication 19 +12.0 ± 7.53 0.130

ＨｂＡ１ｃ (%) n Change by intervention p value ( ％ ) 　 All 144 -0.03 ± 0.28 0.231　 Low risk 74 -0.03 ± 0.35 0.437　 Moderate risk 15 +0.04 ± 0.10 0.679　 High risk 38 -0.14 ± 0.05 0.004　 Having medication 17 +0.11 ± 0.13 0.419

Effects of Intervention on blood examination in verification study in 2007 （ indicator of dyslipidemia ）

Triglyceride n Change by intervention (mg/dl) p value　 All 144 -15.2 ± 7.16 0.036　 Low risk 74 -3.91 ± 6.16 0.528　 Moderate risk 15 -24.4 ± 23.2 0.311　 High risk 38 -32.8 ± 20.8 0.124　 Having medication 17 -16.5 ± 19.7 0.413

ＨＤＬ cholesterol n Change by intervention (mg/dl) p value All 175 +2.71 ± 0.72 <0.001　 Low risk 94 +3.70 ± 0.82 <0.001　 Moderate risk 16 +4.25 ± 1.95 0.046　 High risk 46 +0.90 ± 1.73 0.606　 Having medication 19 +0.90 ± 2.70 0.744

ＬＤＬ cholesterol n Change by intervention (mg/dl) p value All 155 +2.27 ± 1.80 0.209　 Low risk 83 +0.90 ± 1.96 0.648　 Moderate risk 15 +5.75 ± 6.84 0.415　 High risk 40 +2.15 ± 4.39 0.627　 Having medication 17 +6.13 ± 6.16 0.335

Effects of Intervention on blood examinationin verification study in 2007 （ indicator of liver function ）

ＧＯＴ n Change by intervention (IU) p value　 All 144 -1.41 ± 1.04 0.176　 Low risk 74 +0.07 ± 0.65 0.918　 Moderate risk 15 -0.93 ± 0.86 0.296　 High risk 38 -3.95 ± 3.61 0.281　 Having medication 17 -2.59 ± 1.85 0.181

ＧＰＴ n Change by intervention (IU) p value　 All 144 -3.12 ± 1.17 0.009　 Low risk 74 +0.41 ± 0.95 0.672　 Moderate risk 15 -1.20 ± 2.35 0.617　 High risk 38 -9.90 ± 3.22 0.004　 Having medication 17 -5.50 ± 4.21 0.253

ｒＧＴＰ n Change by intervention (IU) p value　 All 175 -13.0 ± 4.32 0.003　 Low risk 94 - 1.9 ± 1.38 0.160　 Moderate risk 16 - 1.0 ± 4.81 0.838　 High risk 46 -25.6 ± 11.6 0.032　 Having medication 19 +47.7 ± 25.6 0.079

Conclusion In Japan, the new health check-up system followed by heaIn Japan, the new health check-up system followed by hea

lthcare counseling, which has been enforced in April 2008, althcare counseling, which has been enforced in April 2008, a

nd the online reimbursement of medical fee, which will be acnd the online reimbursement of medical fee, which will be ac

hieved in 2011, will change the circulation and accumulation hieved in 2011, will change the circulation and accumulation

of health and medical information. We need to establish secuof health and medical information. We need to establish secu

re and patient-centeredre and patient-centered social system for the alterations. As a social system for the alterations. As a

model of the social system, we presented a newly developed model of the social system, we presented a newly developed

Japanese disease management for diabetes mellitus “Carna”.Japanese disease management for diabetes mellitus “Carna”.

If you have any questions, call to Carna office, +81-92-263-4385Or carna@med.kyushu-u.ac.jp

Please send all presentation files to

nnaoki@med.kyushu-u.ac.jpnnaoki@med.kyushu-u.ac.jp

If you have any questions, call to Carna office, +81-92-263-4385Or carna@med.kyushu-u.ac.jp