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

In Japan, about 6000 patients with hemophilia A (PwHA) are separately cared for at ~1000 clinics or hospitals. Interfacility collaboration (IFC) between hemophilia treatment centers and "satellite" medical facilities located closer to patients is necessary to eliminate care disparities. To facilitate IFC, the Japan Hemophilia Network Committee (JHNC) was approved in 2018 by the Japanese Society of Thrombosis and Hemostasis. However, it is unclear whether the JHNC is functioning effectively to provide comprehensive and specialized care to PwHA seen by doctors at non-expert facilities. Therefore, we conducted a retrospective, longitudinal, observational study using the JMDC Claims Database to assess IFC for hemophilia A in Japan. Results are presented in adherence with the "Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)" guidelines.

PwHA were classified into those who were usually treated at non-expert (N = 82) and expert (N = 97) facilities. Using descriptive statistics, we assessed hemophilia-specific care using records of joint examinations and blood coagulation tests in the JMDC database from April 2013 to March 2023. The JMDC claims database has several limitations, including the number of elderly patients and the total number of health insurance associations providing data.

Among patients who usually attended non-expert facilities, the proportion who received hemophilia-specific tests at expert facilities was persistently low during the observation period (6.9%-16.3% for joint examinations and 15.4%-32.6% for blood coagulation tests). The rate of visits to expert facilities among the non-expert facilities group did not increase during the study period. The proportion of invasive procedures with bleeding risks performed at expert facilities was low (< 20%), and some procedures requiring specialist consultation were performed at non-expert facilities.

These results suggest that IFC for the care of PwHA between non-expert and expert hemophilia care medical facilities could be strengthened in Japan.