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Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan
Liu Ning, Babazono Akira, Jamal Aziz, Yoshida Shinichiro, Yamao Reiko, Ishihara Reiko, Matsuda Shinya, Li Yunfei. Public health, 2023-12-21
Topic: Risk, prevention and care in population studies
This study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia. Interrupted time series (ITS). We used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012-2014; post-intervention: 2016-2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction. The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03-0.49; narrow definition: IRR = 0.15, CI = 0.03-0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase. The impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system.
Key findings
- The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03-0.49; narrow definition: IRR = 0.15, CI = 0.03-0.75).
- No significant difference was observed between the treatment and control groups during the post-intervention phase.
Why it matters
This study found that a Japanese policy reducing reimbursement for gastrostomy feeding tubes had remarkably minimal impact on how often the procedure was performed in older adults with dementia. It is about healthcare payment policy and feeding tube use, not about treating, curing, or preventing Alzheimer's disease itself.
Study details
- Effect sizeRR = 0.11; RR = 0.15
- Evidence strengthLow
How this study scored 36/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Public health) |
| Journal's citation record | 1 / 4 | Public Health: journal h-index 142 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 3 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.8 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 1 / 6 | Cited 0.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 3 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Yunfei Li: h-index 20 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Kyushu University: institution h-index 721 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38118244) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 36 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Ning, L., Akira, B., Aziz, J., Shinichiro, Y., Reiko, Y., Reiko, I., et al. (2024). Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan. Public health. https://doi.org/10.1016/j.puhe.2023.11.032
Vancouver
Ning L, Akira B, Aziz J, Shinichiro Y, Reiko Y, Reiko I, et al. Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan. Public health. 2024. doi:10.1016/j.puhe.2023.11.032. PMID: 38118244.
BibTeX
@article{ning2024-38118244,
author = {Ning, Liu and Akira, Babazono and Aziz, Jamal and Shinichiro, Yoshida and Reiko, Yamao and Reiko, Ishihara and Shinya, Matsuda and Yunfei, Li},
title = {{Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan}},
journal = {Public health},
year = {2024},
doi = {10.1016/j.puhe.2023.11.032},
pmid = {38118244},
url = {https://doi.org/10.1016/j.puhe.2023.11.032}
}
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