Hirahara, Norimichi

写真a

Affiliation

School of Medicine, Department of Health Policy and Management (Shinanomachi)

Position

Instructor

Related Websites

Profile 【 Display / hide

  • カリフォルニア大学バークレー校心理学部(認知心理学)卒業。 東京工業大学大学院社会理工学研究科博士課程修了。 英国シェフィールド大学医学部客員研究員、東京大学大学院医学系研究科を経て、慶應義塾大学医学部医療政策・管理学教室にて研究と教育に従事。

Academic Degrees 【 Display / hide

  • 博士(学術), Tokyo Institute of Technology, Coursework

 

Research Areas 【 Display / hide

  • Statistical science

  • Cognitive science

  • Life / Health / Medical informatics

Research Keywords 【 Display / hide

  • JDM

  • MDM

  • 医療ビッグデータ

  • 医療意思決定

  • 意思決定科学

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Books 【 Display / hide

  • 「患者中心」で成功する病院大改造: 医療の質を向上させる15章

    Hirahara Norimichi, 医学書院, 2016.06

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    患者中心の医療のモデルとして知られている米国「プレイントゥリーモデル」の考え方と,導入した医療施設の概要をまとめたもの.患者中心の医療に求められる要素とは何か,医療の質を向上させるためのケアはどういったものか,実践も含めて解説.さらに,病院経営の視点からみた「患者中心の医療」,医療者と患者の関係,医療の質と安全性等にも言及.患者のための病院づくりに応用可能な事例も掲載.(Amazon.co.jpより)

  • 患者と減らそう医療ミス 患者は安全パートナー

    Hirahara Norimichi, エルゼビア・ジャパン, 2005.07

  • みんなの「こんな病院あったらいいな」が実現する本

    Hirahara Norimichi, 日総研出版, 2001.09

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    本書は、「医療サービスという協働作業プロセス」を意味あるものにするために、「関係づくり」という新しいマーケティングの考え方を医療現場で使うことを提案し、その理論の紹介からプロセスの分析、そして現場での応用までを統合的にまとめたものである。(Amazon.co.jpより)

Papers 【 Display / hide

  • First Database Comparison Between the United States and Japan: Coronary Artery Bypass Grafting

    Nawata K., D'Agostino R.S., Habib R.H., Kumamaru H., Hirahara N., Miyata H., Motomura N., Takamoto S., Shahian D.M., Grover F.L.

    Annals of Thoracic Surgery (Annals of Thoracic Surgery)  109 ( 4 ) 1159 - 1164 2020.04

    ISSN  00034975

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    © 2020 The Society of Thoracic Surgeons Background: International collaboration has an interest in health care quality evaluation. We compared characteristics and surgical outcomes between Asian patients in the United States and Japanese patients who undergo adult cardiac surgery. Methods: Using the Japan Adult Cardiovascular Surgery Database (JCVSD) and The Society of Thoracic Surgeons (STS) National Database, we compared Asian patients undergoing isolated coronary artery bypass graft surgery between 2013 and 2016 in Japan and the United States. The STS had 16,903 Asian patients among 573,823 patients of all races undergoing isolated coronary artery bypass graft surgery (2.95%); the JCVSD had 55,570 patients, almost all of whom are Japanese. Descriptive statistics were analyzed independently, then the data were aggregated for comparison. Results: The JCVSD patients were older (69 vs 65 years) with a smaller body surface area (1.65 m2 vs 1.81 m2) and body mass index (24 kg/m2 vs 26 kg/m2). The proportion of males (79% vs 78%), prevalence of chronic lung disease (82% vs 86%), and diabetes mellitus (54% vs 60%) were similar. The JCVSD had higher prevalence of renal disease requiring dialysis (11% vs 6%). The numbers of anastomoses were similar (3.1 vs 3.3); off-pump procedures and the usage of right internal mammary artery were more prevalent (60% vs 15% and 38% vs 7%, respectively) in the JCVSD. The unadjusted operative mortality was 2.7% in the JCVSD and 2.1% in the STS database. Conclusions: Comparisons of coronary artery bypass graft surgery characteristics and outcomes were conducted between the STS National Database and the JCVSD to illustrate the value of international collaboration on adult cardiac surgery databases.

  • Procedure- and Hospital-Level Variation of Deep Sternal Wound Infection From All-Japan Registry

    Hirahara N., Miyata H., Motomura N., Kohsaka S., Nishimura T., Takamoto S.

    Annals of Thoracic Surgery (Annals of Thoracic Surgery)  109 ( 2 ) 547 - 554 2020.02

    ISSN  00034975

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    © 2020 The Society of Thoracic Surgeons Background: The outcome of cardiovascular surgery has been improving over time, but the treatment of postoperative complications such as deep sternal wound infection (DSWI) still needs critical attention. A nationwide surgical registry was analyzed for procedural details and hospital factors related to DSWI. Methods: The study used the Japan Adult Cardiovascular Surgery Database, which captured data from 82% of all the hospitals performing cardiac surgery in Japan. A total of 109,717 surgical cases (34,980 coronary artery bypass grafting, 43,602 valve operations, 31,135 thoracic aortic operations) were included in the study. Results: The overall incidence of DSWI was 1738 (1.6%). The 30-day mortality and operative mortality were 3311 (3.0%) and 5155 (4.7%), respectively. Across the 3 procedures, thoracic aortic operation showed the highest odds ratio (2.61; 95% confidence interval [CI], 2.32 to 2.94) for operative mortality but the lowest (0.91; 95% CI:,0.73 to 1.13) for DSWI incidence. Conversely, coronary artery bypass grafting showed the lowest odds ratio (1.36; 95% CI, 1.24 to 1.49) for operative mortality but the highest (1.52; 95% CI, 1.32 to 1.76) for DSWI. There was also hospital-level variation: Correlation was statistically significant between the observed-to-expected ratio of DSWI incidence and the observed-to-expected mortality ratio of cardiovascular procedures across the hospitals, but the coefficient was small (r = .24, P < .001). Conclusions: Hospitals that have a lower risk-adjusted mortality rate of cardiovascular procedures do not always have a lower risk-adjusted DSWI occurrence rate. In addition, the incidence of DSWI varies across hospitals. We need to consider DSWI independently of surgical mortality, whereas for treatment we should consider both the specific hospital environment and the multidisciplinary care.

  • 5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis

    Mizuno S., Ono K., Mikami Y., Naganuma M., Fukuda T., Minami K., Masaoka T., Terada S., Yoshida T., Saigusa K., Hirahara N., Miyata H., Suda W., Hattori M., Kanai T.

    Intestinal Research (Intestinal Research)  18 ( 1 ) 69 - 78 2020.01

    ISSN  15989100

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    © 2020. Korean Association for the Study of Intestinal Diseases. Background/Aims: 5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. Methods: We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Results: Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P<0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P<0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P<0.05). Conclusions: In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.

  • Laparoscopic Versus Open Appendectomy for Acute Appendicitis in Children: a Nationwide Retrospective Study on Postoperative Outcomes

    Fujishiro J., Watanabe E., Hirahara N., Terui K., Tomita H., Ishimaru T., Miyata H.

    Journal of Gastrointestinal Surgery (Journal of Gastrointestinal Surgery)   2020

    ISSN  1091255X

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    © 2020, The Society for Surgery of the Alimentary Tract. Purpose: Our aim was to compare postoperative outcomes of laparoscopic and open appendectomies for acute appendicitis in children under the circumstance of widespread use of laparoscopic surgery. Method: This study included data on laparoscopic and open appendectomies in children with acute appendicitis from the National Clinical Database, which is a Japanese nationwide surgical database, in 2015. The occurrence rates of complications within 30 days after the surgery and postoperative hospital stay were compared by univariate and multivariate analyses. p < 0.05 was considered statistically significant. Results: This study included 4489 appendectomies, of which 3166 surgeries (70.5%) were performed laparoscopically. Appendectomy was performed for complicated and uncomplicated appendicitis in 1765 (39.3%) and 2724 cases (60.7%), respectively. Postoperative complications within 30 days were observed in 246 operations (5.5%). Organ-space surgical site infection (SSI), deep wound SSIs, and superficial wound SSIs were observed in 2.3%, 1.0%, and 2.4% of operations, respectively. On multivariate analysis, the incidence of postoperative complications (odds ratio 1.21, 95% CI 0.90–1.64, p = 0.207) and the length of hospital stay (median 4 days in both groups, p = 0.835) were not significantly different between patients who underwent laparoscopic or open appendectomy. Subgroup analysis in complicated and uncomplicated appendicitis cases also demonstrated no significant differences in the incidence of postoperative complications between those who underwent laparoscopic or open appendectomy. Conclusion: This study suggested that the occurrence of postoperative complication and the length of hospital stay in pediatric patients who underwent laparoscopic appendectomy are similar with those in pediatric patients who underwent open appendectomy for acute appendicitis.

  • Current status of cardiovascular surgery in Japan, 2015 and 2016: a report based on the Japan Cardiovascular Surgery Database. 1—congenital heart surgery

    Hirata Y., Hirahara N., Murakami A., Motomura N., Miyata H., Takamoto S.

    General Thoracic and Cardiovascular Surgery (General Thoracic and Cardiovascular Surgery)  67 ( 9 ) 731 - 735 2019.09

    ISSN  18636705

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    © 2019, The Japanese Association for Thoracic Surgery. Objectives: We analyzed the mortality and morbidity of congenital heart surgery in Japan by using Japan Cardiovascular Surgery Database (JCVSD). Methods: The data on congenital heart surgery performed between January 2015 and December 2016 were obtained from JCVSD. From the data obtained, the most frequent 20 procedures were selected, and the mortalities and major morbidities were analyzed. In addition, the institutions were classified into three groups according to the number of cardiopulmonary cases for a year, and the distribution of the major operations was calculated. Results: The mortality of ASD repair and VSD repair was under 1% and the mortality of TOF repair, complete AVSD repair, Rastelli operation, CoA complex repair, bidirectional Glenn and TCPC was 2–3%. The mortality of Norwood procedure and TAPVC repair were over 10%. These difficult operations were mainly performed at relatively high-volume institutions. Conclusion: Using the data from JCVSD, the national data of congenital heart surgery, including postoperative complications, were analyzed. Neonatal surgery still has considerable complication rates and further improvement is desired. In addition, it was shown that complicated operations tended to be performed at large volume institutions.

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Reviews, Commentaries, etc. 【 Display / hide

  • Correction to: Current status of cardiovascular surgery in Japan, 2015 and 2016, a report based on the Japan Cardiovascular Surgery Database. 3—Valvular heart surgery (General Thoracic and Cardiovascular Surgery, (2019), 67, 9, (742-749), 10.1007/s11748-019-01161-z)

    Abe T., Nakano K., Hirahara N., Motomura N., Miyata H., Takamoto S.

    General Thoracic and Cardiovascular Surgery (General Thoracic and Cardiovascular Surgery)  67 ( 9 )  2019.09

    ISSN  18636705

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    © 2019, The Japanese Association for Thoracic Surgery. In the original publication of this article, the title was published incorrectly. The correct article title is given in this correction.

  • 診療情報管理士の関与による大規模臨床データベースの診断情報精度向上について

    高橋 新, 福地 絵梨子, 山本 博之, 平原 憲道, 隈丸 拓, 一原 直昭, 宮田 裕章

    日本診療情報管理学会学術大会抄録集 (日本診療情報管理学会)  45回   281 - 281 2019.08

  • 患者の求めるがん情報とは何か 客観的情報と体験的情報

    平原 憲道

    Urology Today (アステラス製薬(株))  26 ( 2 ) 72 - 77 2019.06

    ISSN  1348-0049

  • NCD・学会データを用いた臨床研究ワークショップ 小児外科手術の医療品質評価 リスクモデル作成の進捗報告(続報)

    照井 慶太, 平原 憲道, 立森 久照, 加藤 直広, 藤代 準, 渡辺 栄一郎, 富田 紘史, 岡本 竜弥, 藤雄木 亨真, 岡本 晋弥, 米倉 竹夫, 宮田 裕章, 臼井 規朗, 日本小児外科学会NCD連絡委員会

    日本小児外科学会雑誌 ((NPO)日本小児外科学会)  55 ( 3 ) 484 - 484 2019.05

    ISSN  0288-609X

  • 小児の複雑性虫垂炎に対する虫垂切除術にドレーン留置は有用か?

    藤代 準, 藤雄木 亨真, 平原 憲道, 照井 慶太, 岡本 竜弥, 渡辺 栄一郎, 石丸 哲也, 宮田 裕章, 日本小児外科学会NCD連絡委員会

    日本小児外科学会雑誌 ((NPO)日本小児外科学会)  55 ( 3 ) 564 - 564 2019.05

    ISSN  0288-609X

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Awards 【 Display / hide

  • 日本認知科学会学会賞(特別賞)

    2012.12, 日本認知科学会

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    「乳がん患者の示す治療リスク認知の楽観性 ~闘病ステージによる変化」にて受賞

 

Courses Taught 【 Display / hide

  • MEDICAL PROFESSIONALISM 5

    2020

  • HEALTH POLICY AND MANAGEMENT

    2020

  • MEDICAL PROFESSIONALISM 5

    2019

  • HEALTH POLICY AND MANAGEMENT

    2019