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      "title": "若手医師の方が高齢入院患者の死亡率が低い                                          patients treated by older physicians had higher mortality than patients cared for by younger physicians",
      "body": "米国Harvard大学の津川友介氏らは、米国の65歳以上の内科疾患患者を対象に、入院治療の担当医の年齢と30日死亡率などとの関係を調べたところ、60歳以上の医師の治療を受けた患者の死亡リスクが高いことが示唆された。\n\nAbstract\nObjectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.\n\nDesign Observational study.\n\nSetting US acute care hospitals.\n\nParticipants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.\n\nMain outcome measures 30 day mortality and readmissions and costs of care.\n\nResults 736 537 admissions managed by 18 854 hospitalist physicians (median age 41) were included. Patients’ characteristics were similar across physician ages. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), patients’ adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%), 11.1% for physicians aged 40-49 (11.0% to 11.3%), 11.3% for physicians aged 50-59 (11.1% to 11.5%), and 12.1% for physicians aged ≥60 (11.6% to 12.5%). Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians. Similar patterns were observed among general internists and in several sensitivity analyses.\n\nConclusions Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.\n\n\n医師としての経験が長くなるほど、スキルや知識が蓄積されると考えられる。しかし、最新の知識や技術を習得し、新たなエビデンスに注意を払っていなければ、診療内容が時代遅れになる可能性もある。そこで著者らは、医師の年齢が患者のアウトカムに影響を与えているかどうかを検討するための観察研究を計画した。\n\n　メディケアの入院患者データの20％を抽出し、fee-for serviceに加入しており、2011～2014年にDRGの内科疾患で急性期病院に入院した患者を対象とした。待機的手術のための入院は除外した。その上で、入院患者の担当医がホスピタリストまたは一般内科医である場合の、30日死亡率、再入院率、治療費を医師の年齢別に分析した。患者の特性（年齢、性別、人種、一次診断名、併存疾患、居住地の世帯収入の中央値、入院した曜日など）と、医師の特性（性別、出身医学部）でデータを補正し、同じ病院に勤務する医師の年齢による差を比較した。\n\n　対象期間中に73万6537件の入院が発生しており、1万8854人のホスピタリスト（平均年齢42.9歳、中央値は41.0歳）が治療を担当していた。医師を年齢別に分けたところ、40歳未満は1万177人（女性の割合は39.0％）、40～49歳は8016人（34.4％）、50～59歳は3331人（28.7％）、60歳以上は1086人（15.7％）だった。\n\n　30日死亡率は全体では11.1％で、担当医の年齢が40歳未満だった患者では10.8％（95％信頼区間10.7-10.9％）、40～49歳だった患者では11.1％（11.0-11.3％）、50～59歳だった患者では11.3％（11.1-11.5％）、60歳以上だった患者は12.1％（11.6-12.5％）だった。40歳未満だった場合をリファレンスとして調整オッズ比を求めると、40～49歳は1.04（1.02-1.07）、50～59歳は1.07（1.03-1.10）、60歳以上は1.17（1.11-1.23）になった。\n\n　医師の年齢が60歳以上になると、患者の30日死亡率の上昇勾配は急に大きくなっていた。そこで、医師を60歳未満と60歳以上にわけて、年齢が10歳上昇当たりの30日死亡の調整オッズ比を求めたところ、60歳未満は1.03（95％信頼区間1.02-1.05）、60歳以上では1.22（1.08-1.37）だった。\n\n　次に、1年間に担当した入院患者数に基づいて医師を層別化し、少数群（90人未満）、中等度群（91～200人）、多数群（201人以上）に分けて分析した。40歳未満の医師をリファレンスにすると、少数群と中等度群ではホスピタリスト全体と同じく、年齢が上がるにつれてオッズ比が上昇していたが、多数群ではその傾向が消失した。多数群では60歳以上の医師のオッズ比も1.02（0.96-1.09）で有意な上昇はなかった。\n\n　再入院率と医師の年齢の間に有意な関係は見られなかったが、治療費は年齢の高い医師の方がやや高くなっていた。医師が40歳未満だった場合をリファレンスとすると、40～49歳では医療費は1.8％（1.3-2.4％）高く、50～59歳では4.7％（3.8-5.6％）高く、60歳以上では6.3％（4.5-8.0％）高かった。\n\n　以上の結果を一般化できるかどうかを評価するために、ホスピタリストと非ホスピタリストをあわせた一般内科医の治療を受けた患者を対象とする分析も行ったが同様の結果が得られた。さらにいくつかの感度解析も行ったが、やはり同様のパターンが認められた。\n　これらの結果から著者らは、ホスピタリストの治療を受けた入院患者の死亡率は、同じ病院の中でも担当医の年齢が高い方が上昇していた。ただし、1年間に治療する患者数が多い医師の場合には、この関係は見られなかったと結論している。\n\n\n### 医師でも年功序列の仕組みは当てはまらず、最新の知識や技術を習得し、新たなエビデンスに注意を払うことで若手であっても高齢医師より患者さんにとって有益であることが示唆された一方で、裏を返せば高齢医師の質の低下の訴えですね。\n\n# あなたのかかりつけ医はいかがですか？😀\n\n\n\n\n\n\n\n\n原題Physician age and outcomes in elderly patients in hospital in the US: observational study\nBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017)\nCite this as: BMJ 2017;357:j1797\nYusuke Tsugawa, research associate, Joseph P Newhouse, John D MacArthur professor, Alan M Zaslavsky, professor, Daniel M Blumenthal, fellow, Anupam B Jena, Ruth L Newhouse associate professor\nCorrespondence to: Y Tsugawa, Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, 42 Church Street, Cambridge, MA 02138, USA [email protected]              from nikkei medical",
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      "title": "若手医師の方が高齢入院患者の死亡率が低い patients treated by older physicians had higher mortality than patients cared for by younger physicians",
      "body": "米国Harvard大学の津川友介氏らは、米国の65歳以上の内科疾患患者を対象に、入院治療の担当医の年齢と30日死亡率などとの関係を調べたところ、60歳以上の医師の治療を受けた患者の死亡リスクが高いことが示唆された。\n\nAbstract\nObjectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.\n\nDesign Observational study.\n\nSetting US acute care hospitals.\n\nParticipants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.\n\nMain outcome measures 30 day mortality and readmissions and costs of care.\n\nResults 736 537 admissions managed by 18 854 hospitalist physicians (median age 41) were included. Patients’ characteristics were similar across physician ages. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), patients’ adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%), 11.1% for physicians aged 40-49 (11.0% to 11.3%), 11.3% for physicians aged 50-59 (11.1% to 11.5%), and 12.1% for physicians aged ≥60 (11.6% to 12.5%). Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians. Similar patterns were observed among general internists and in several sensitivity analyses.\n\nConclusions Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.\n\n\n医師としての経験が長くなるほど、スキルや知識が蓄積されると考えられる。しかし、最新の知識や技術を習得し、新たなエビデンスに注意を払っていなければ、診療内容が時代遅れになる可能性もある。そこで著者らは、医師の年齢が患者のアウトカムに影響を与えているかどうかを検討するための観察研究を計画した。\n\n　メディケアの入院患者データの20％を抽出し、fee-for serviceに加入しており、2011～2014年にDRGの内科疾患で急性期病院に入院した患者を対象とした。待機的手術のための入院は除外した。その上で、入院患者の担当医がホスピタリストまたは一般内科医である場合の、30日死亡率、再入院率、治療費を医師の年齢別に分析した。患者の特性（年齢、性別、人種、一次診断名、併存疾患、居住地の世帯収入の中央値、入院した曜日など）と、医師の特性（性別、出身医学部）でデータを補正し、同じ病院に勤務する医師の年齢による差を比較した。\n\n　対象期間中に73万6537件の入院が発生しており、1万8854人のホスピタリスト（平均年齢42.9歳、中央値は41.0歳）が治療を担当していた。医師を年齢別に分けたところ、40歳未満は1万177人（女性の割合は39.0％）、40～49歳は8016人（34.4％）、50～59歳は3331人（28.7％）、60歳以上は1086人（15.7％）だった。\n\n　30日死亡率は全体では11.1％で、担当医の年齢が40歳未満だった患者では10.8％（95％信頼区間10.7-10.9％）、40～49歳だった患者では11.1％（11.0-11.3％）、50～59歳だった患者では11.3％（11.1-11.5％）、60歳以上だった患者は12.1％（11.6-12.5％）だった。40歳未満だった場合をリファレンスとして調整オッズ比を求めると、40～49歳は1.04（1.02-1.07）、50～59歳は1.07（1.03-1.10）、60歳以上は1.17（1.11-1.23）になった。\n\n　医師の年齢が60歳以上になると、患者の30日死亡率の上昇勾配は急に大きくなっていた。そこで、医師を60歳未満と60歳以上にわけて、年齢が10歳上昇当たりの30日死亡の調整オッズ比を求めたところ、60歳未満は1.03（95％信頼区間1.02-1.05）、60歳以上では1.22（1.08-1.37）だった。\n\n　次に、1年間に担当した入院患者数に基づいて医師を層別化し、少数群（90人未満）、中等度群（91～200人）、多数群（201人以上）に分けて分析した。40歳未満の医師をリファレンスにすると、少数群と中等度群ではホスピタリスト全体と同じく、年齢が上がるにつれてオッズ比が上昇していたが、多数群ではその傾向が消失した。多数群では60歳以上の医師のオッズ比も1.02（0.96-1.09）で有意な上昇はなかった。\n\n　再入院率と医師の年齢の間に有意な関係は見られなかったが、治療費は年齢の高い医師の方がやや高くなっていた。医師が40歳未満だった場合をリファレンスとすると、40～49歳では医療費は1.8％（1.3-2.4％）高く、50～59歳では4.7％（3.8-5.6％）高く、60歳以上では6.3％（4.5-8.0％）高かった。\n\n　以上の結果を一般化できるかどうかを評価するために、ホスピタリストと非ホスピタリストをあわせた一般内科医の治療を受けた患者を対象とする分析も行ったが同様の結果が得られた。さらにいくつかの感度解析も行ったが、やはり同様のパターンが認められた。\n　これらの結果から著者らは、ホスピタリストの治療を受けた入院患者の死亡率は、同じ病院の中でも担当医の年齢が高い方が上昇していた。ただし、1年間に治療する患者数が多い医師の場合には、この関係は見られなかったと結論している。\n\n\n### 医師でも年功序列の仕組みは当てはまらず、最新の知識や技術を習得し、新たなエビデンスに注意を払うことで若手であっても高齢医師より患者さんにとって有益であることが示唆された一方で、裏を返せば高齢医師の質の低下の訴えですね。\n\n# あなたのかかりつけ医はいかがですか？😀\n\n\n\n\n\n\n\n\n原題Physician age and outcomes in elderly patients in hospital in the US: observational study\nBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017)\nCite this as: BMJ 2017;357:j1797\nYusuke Tsugawa, research associate, Joseph P Newhouse, John D MacArthur professor, Alan M Zaslavsky, professor, Daniel M Blumenthal, fellow, Anupam B Jena, Ruth L Newhouse associate professor\nCorrespondence to: Y Tsugawa, Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, 42 Church Street, Cambridge, MA 02138, USA [email protected]              from nikkei medical",
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      "title": "若手医師の方が高齢入院患者の死亡率が低い",
      "body": "米国Harvard大学の津川友介氏らは、米国の65歳以上の内科疾患患者を対象に、入院治療の担当医の年齢と30日死亡率などとの関係を調べたところ、60歳以上の医師の治療を受けた患者の死亡リスクが高いことが示唆された。\n\nAbstract\nObjectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.\n\nDesign Observational study.\n\nSetting US acute care hospitals.\n\nParticipants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.\n\nMain outcome measures 30 day mortality and readmissions and costs of care.\n\nResults 736 537 admissions managed by 18 854 hospitalist physicians (median age 41) were included. Patients’ characteristics were similar across physician ages. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), patients’ adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%), 11.1% for physicians aged 40-49 (11.0% to 11.3%), 11.3% for physicians aged 50-59 (11.1% to 11.5%), and 12.1% for physicians aged ≥60 (11.6% to 12.5%). Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians. Similar patterns were observed among general internists and in several sensitivity analyses.\n\nConclusions Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.\n\n\n医師としての経験が長くなるほど、スキルや知識が蓄積されると考えられる。しかし、最新の知識や技術を習得し、新たなエビデンスに注意を払っていなければ、診療内容が時代遅れになる可能性もある。そこで著者らは、医師の年齢が患者のアウトカムに影響を与えているかどうかを検討するための観察研究を計画した。\n\n　メディケアの入院患者データの20％を抽出し、fee-for serviceに加入しており、2011～2014年にDRGの内科疾患で急性期病院に入院した患者を対象とした。待機的手術のための入院は除外した。その上で、入院患者の担当医がホスピタリストまたは一般内科医である場合の、30日死亡率、再入院率、治療費を医師の年齢別に分析した。患者の特性（年齢、性別、人種、一次診断名、併存疾患、居住地の世帯収入の中央値、入院した曜日など）と、医師の特性（性別、出身医学部）でデータを補正し、同じ病院に勤務する医師の年齢による差を比較した。\n\n　対象期間中に73万6537件の入院が発生しており、1万8854人のホスピタリスト（平均年齢42.9歳、中央値は41.0歳）が治療を担当していた。医師を年齢別に分けたところ、40歳未満は1万177人（女性の割合は39.0％）、40～49歳は8016人（34.4％）、50～59歳は3331人（28.7％）、60歳以上は1086人（15.7％）だった。\n\n　30日死亡率は全体では11.1％で、担当医の年齢が40歳未満だった患者では10.8％（95％信頼区間10.7-10.9％）、40～49歳だった患者では11.1％（11.0-11.3％）、50～59歳だった患者では11.3％（11.1-11.5％）、60歳以上だった患者は12.1％（11.6-12.5％）だった。40歳未満だった場合をリファレンスとして調整オッズ比を求めると、40～49歳は1.04（1.02-1.07）、50～59歳は1.07（1.03-1.10）、60歳以上は1.17（1.11-1.23）になった。\n\n　医師の年齢が60歳以上になると、患者の30日死亡率の上昇勾配は急に大きくなっていた。そこで、医師を60歳未満と60歳以上にわけて、年齢が10歳上昇当たりの30日死亡の調整オッズ比を求めたところ、60歳未満は1.03（95％信頼区間1.02-1.05）、60歳以上では1.22（1.08-1.37）だった。\n\n　次に、1年間に担当した入院患者数に基づいて医師を層別化し、少数群（90人未満）、中等度群（91～200人）、多数群（201人以上）に分けて分析した。40歳未満の医師をリファレンスにすると、少数群と中等度群ではホスピタリスト全体と同じく、年齢が上がるにつれてオッズ比が上昇していたが、多数群ではその傾向が消失した。多数群では60歳以上の医師のオッズ比も1.02（0.96-1.09）で有意な上昇はなかった。\n\n　再入院率と医師の年齢の間に有意な関係は見られなかったが、治療費は年齢の高い医師の方がやや高くなっていた。医師が40歳未満だった場合をリファレンスとすると、40～49歳では医療費は1.8％（1.3-2.4％）高く、50～59歳では4.7％（3.8-5.6％）高く、60歳以上では6.3％（4.5-8.0％）高かった。\n\n　以上の結果を一般化できるかどうかを評価するために、ホスピタリストと非ホスピタリストをあわせた一般内科医の治療を受けた患者を対象とする分析も行ったが同様の結果が得られた。さらにいくつかの感度解析も行ったが、やはり同様のパターンが認められた。\n　これらの結果から著者らは、ホスピタリストの治療を受けた入院患者の死亡率は、同じ病院の中でも担当医の年齢が高い方が上昇していた。ただし、1年間に治療する患者数が多い医師の場合には、この関係は見られなかったと結論している。\n\n\n### 医師でも年功序列の仕組みは当てはまらず、最新の知識や技術を習得し、新たなエビデンスに注意を払うことで若手であっても高齢医師より患者さんにとって有益であることが示唆された一方で、裏を返せば高齢医師の質の低下の訴えですね。\n\n# あなたのかかりつけ医はいかがですか？😀\n\n\n\n\n\n\n\n\n原題Physician age and outcomes in elderly patients in hospital in the US: observational study\nBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017)\nCite this as: BMJ 2017;357:j1797\nYusuke Tsugawa, research associate, Joseph P Newhouse, John D MacArthur professor, Alan M Zaslavsky, professor, Daniel M Blumenthal, fellow, Anupam B Jena, Ruth L Newhouse associate professor\nCorrespondence to: Y Tsugawa, Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, 42 Church Street, Cambridge, MA 02138, USA [email protected]\nfrom nikkei medical",
      "json_metadata": "{\"tags\":[\"japanese\",\"medical\"],\"links\":[\"https://doi.org/10.1136/bmj.j1797\"],\"app\":\"steemit/0.1\",\"format\":\"markdown\"}"
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  "timestamp": "2017-07-24T00:36:57",
  "op": [
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    {
      "parent_author": "wwjd69",
      "parent_permlink": "re-yoshiko-the-world-s-first-steemit-stained-glass-thank-you-500-followers-500-20170724t003436061z",
      "author": "yoshiko",
      "permlink": "re-wwjd69-re-yoshiko-the-world-s-first-steemit-stained-glass-thank-you-500-followers-500-20170724t003654485z",
      "title": "",
      "body": "そうなんですよ〜steemitのマークって涼しげだなぁ〜と作りながら思いました。",
      "json_metadata": "{\"tags\":[\"japanese\"],\"app\":\"steemit/0.1\"}"
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  "op": [
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    {
      "parent_author": "yoshiko",
      "parent_permlink": "the-world-s-first-steemit-stained-glass-thank-you-500-followers-500",
      "author": "wwjd69",
      "permlink": "re-yoshiko-the-world-s-first-steemit-stained-glass-thank-you-500-followers-500-20170724t003436061z",
      "title": "",
      "body": "おめでとうございます！\n夏にマッチして綺麗ですね☺️\nフォローさせていただきました☺️",
      "json_metadata": "{\"tags\":[\"japanese\"],\"app\":\"steemit/0.1\"}"
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  "timestamp": "2017-07-24T00:34:33",
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    {
      "parent_author": "yoshiko",
      "parent_permlink": "the-world-s-first-steemit-stained-glass-thank-you-500-followers-500",
      "author": "wwjd69",
      "permlink": "re-yoshiko-the-world-s-first-steemit-stained-glass-thank-you-500-followers-500-20170724t003436061z",
      "title": "",
      "body": "おめでとうございます！\n夏にマッチして綺麗ですね☺️",
      "json_metadata": "{\"tags\":[\"japanese\"],\"app\":\"steemit/0.1\"}"
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