Interfacility Collaboration for Hemophilia Care in Japan: A Retrospective Database Study Using a Japanese Healthcare...

Area of Science:

• Hematology
• Public Health
• Health Services Research

Background:

• Approximately 6000 patients with hemophilia A (PwHA) in Japan receive care across numerous facilities.
• Interfacility collaboration (IFC) between hemophilia treatment centers and satellite facilities is vital to reduce care disparities.
• The Japan Hemophilia Network Committee (JHNC) was established to facilitate IFC, but its effectiveness is unproven.

Purpose of the Study:

• To assess the effectiveness of IFC for hemophilia A care in Japan.
• To evaluate the provision of specialized hemophilia care at non-expert facilities.
• To identify areas for improvement in the care delivery network for PwHA.

Main Methods:

• A retrospective, longitudinal, observational study using the JMDC Claims Database (April 2013-March 2023).
• Patients with hemophilia A were categorized into those usually treated at non-expert (N=82) versus expert (N=97) facilities.
• Hemophilia-specific care was assessed via joint examinations and blood coagulation tests, adhering to STROBE guidelines.

Main Results:

• Patients at non-expert facilities showed persistently low rates of hemophilia-specific tests at expert facilities (6.9%-16.3% for joint exams, 15.4%-32.6% for coagulation tests).
• Visits to expert facilities did not increase for the non-expert group during the study period.
• A low proportion (<20%) of invasive procedures with bleeding risks were performed at expert facilities, with some specialist procedures occurring at non-expert sites.

Conclusions:

• Current IFC for hemophilia A care in Japan is insufficient.
• There is a significant need to enhance collaboration between non-expert and expert hemophilia care facilities.
• Improved IFC is essential to ensure comprehensive and specialized care for all PwHA.