Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study

  • Yeong Geun Gwon (Review and Assessment Research Division, Health Insurance Review & Assessment Service) ;
  • Seung Jin Han (Primary Care Improvement Division, Health Insurance Review & Assessment Service) ;
  • Kyoung Hoon Kim (International Policy Research Division, Health Insurance Review & Assessment Service)
  • Received : 2023.01.09
  • Accepted : 2023.03.24
  • Published : 2023.05.31
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Abstract

Objectives: Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. Methods: Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. Results: The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. Conclusions: The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

Keywords

References

  1. Organisation for Economic Cooperation and Development (OECD). OECD reviews of health care quality: Korea 2012 [cited 2022 Jul 22]. Available from: https://www.oecd.org/publications/oecd-reviews-of-health-care-quality-korea-9789264173446-en.htm.
  2. Freund T, Campbell SM, Geissler S, Kunz CU, Mahler C, Peters-Klimm F, et al. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. Ann Fam Med 2013;11(4):363-370. https://doi.org/10.1370/afm.1498
  3. Organisation for Economic Cooperation and Development (OECD). Health at a glance 2021: OECD indicators. Paris: OECD Publishing; 2021, p. 164-167.
  4. Rocha JV, Santana R, Tello JE. Hospitalization for ambulatory care sensitive conditions: what conditions make inter-country comparisons possible? Health Policy Open 2021;2:100030.
  5. Van Loenen T, Faber MJ, Westert GP, Van den Berg MJ. The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries. Scand J Prim Health Care 2016;34(1):5-12. https://doi.org/10.3109/02813432.2015.1132883
  6. NHS Digital. NHS outcomes framework (NHS of): national statistics, open data, experimental statistics, official statistics; 2022 [cited 2022 Jul 22]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-outcomes-framework.
  7. Centers for Medicare and Medicaid Services. 2021 National impact assessment of the Centers for Medicare & Medicaid Services (CMS) quality measures report [cited 2022 Jul 22]. Available from: https://www.cms.gov/files/document/2021-national-impact-assessment-report.pdf.
  8. Agency for Healthcare Research and Quality (AHRQ). AHRQ quality indicators-guide to prevention quality indicators: hospital admission for ambulatory care sensitive conditions; 2001 [cited 2022 Jul 22]. Available from: https://www.ahrq.gov/downloads/pub/ahrqqi/pqiguide.pdf.
  9. Kim JA, Yoon S, Kim LY, Kim DS. Towards actualizing the value potential of Korea Health Insurance Review and Assessment (HIRA) data as a resource for health research: strengths, limitations, applications, and strategies for optimal use of HIRA data. J Korean Med Sci 2017;32(5):718-728. https://doi.org/10.3346/jkms.2017.32.5.718
  10. van Loenen T, van den Berg MJ, Westert GP, Faber MJ. Organizational aspects of primary care related to avoidable hospitalization: a systematic review. Fam Pract 2014;31(5):502-516. https://doi.org/10.1093/fampra/cmu053
  11. Organisation for Economic Cooperation and Development. Health care quality and outcome (HCQO) 2020-21 indicator definitions [cited 2022 Jul 22]. Available from: https://oecd.org/els/health-systems/Definitions-of-Health-Care-Quality-Outcomes.pdf.
  12. Cho KH, Nam CM, Lee SG, Kim TH, Lee SH, Park EC. Measuring of quality of care in patients with stroke and acute myocardial infarction: an application of algebra effectiveness model. Medicine (Baltimore) 2019;98(20):e15353.
  13. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19(3):335-351. https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.3.CO;2-Q
  14. Kunst AE, Amiri M, Janssen F. The decline in stroke mortality: exploration of future trends in 7 Western European countries. Stroke 2011;42(8):2126-2130. https://doi.org/10.1161/STROKEAHA.110.599712
  15. Degano IR, Salomaa V, Veronesi G, Ferrieres J, Kirchberger I, Laks T, et al. Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations. Heart 2015;101(17):1413-1421. https://doi.org/10.1136/heartjnl-2014-307310
  16. Salah HM, Minhas AM, Khan MS, Khan SU, Ambrosy AP, Blumer V, et al. Trends in hospitalizations for heart failure, acute myocardial infarction, and stroke in the United States from 2004 to 2018. Am Heart J 2022;243:103-109. https://doi.org/10.1016/j.ahj.2021.09.009
  17. Lecoffre C, de Peretti C, Gabet A, Grimaud O, Woimant F, Giroud M, et al. National trends in patients hospitalized for stroke and stroke mortality in France, 2008 to 2014. Stroke 2017;48(11):2939-2945. https://doi.org/10.1161/STROKEAHA.117.017640
  18. Kim Y, Ahn Y, Cho MC, Kim CJ, Kim YJ, Jeong MH. Current status of acute myocardial infarction in Korea. Korean J Intern Med 2019;34(1):1-10. https://doi.org/10.3904/kjim.2018.381
  19. Han MK, Heo JH, Rha JH, Bae HJ, Yoon BW. Recommendations for the establishment of stroke unit in Korea. Korean J Stroke 2008;10:72-75 (Korean).
  20. Health Insurance Review and Assessment Service (HIRA). 2019 Report on quality assessment: results from national quality assessment program. Wonju: HIRA; 2020, p. 109-119 (Korean).
  21. Lee SW. National evaluation program for emergency medical center. J Korean Med Assoc 2020;63(4):184-186 (Korean). https://doi.org/10.5124/jkma.2020.63.4.184
  22. Wang JM, Kim BO, Bae JW, Oh DJ. Implementation of national health policy for the prevention and control of cardiovascular disease in South Korea: regional-local cardio-cerebrovascular center and nationwide registry. Korean Circ J 2021;51(5):383-398. https://doi.org/10.4070/kcj.2021.0001
  23. Organisation for Economic Cooperation and Development (OECD). Health: health care quality indicators [cited 2022 Jul 22]. Available from: http://stats.oecd.org/.
  24. Park KS. Factors affecting awareness of myocardial infarction symptoms among the general public in Korea. Epidemiol Health 2020;42:e2020032.
  25. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean Stroke Society and Clinical Research Center for Stroke. J Stroke 2013;15(1):2-20. https://doi.org/10.5853/jos.2013.15.1.2
  26. Agency for Healthcare Research and Quality (AHRQ). National healthcare quality and disparities report chartbook; 2017 [cited 2022 Jul 22]. Available from: https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/index.html.
  27. Kim W, Choy YS, Lee SA, Park EC. Implementation of the Chronic Disease Care System and its association with health care costs and continuity of care in Korean adults with type 2 diabetes mellitus. BMC Health Serv Res 2018;18(1):991.
  28. Lim SM, Seo SH, Park KS, Hwangbo Y, Suh Y, Ji S, et al. Performance of a community-based noncommunicable disease control program in Korea: patients 65 years of age or older. J Korean Med Sci 2020;35(31):e268.
  29. Lee JJ, Bae SG. Implementation of a care coordination system for chronic diseases. Yeungnam Univ J Med 2019;36(1):1-7. https://doi.org/10.12701/yujm.2019.00073
  30. Kim S, Choi S, Kim J, Park S, Kim YT, Park O, et al. Trends in health behaviors over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey. Epidemiol Health 2021;43:e2021026.
  31. Kim AM, Park JH, Yoon TH, Kim Y. Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply. BMC Health Serv Res 2019;19(1):259.
  32. Bae JH, Han KD, Ko SH, Yang YS, Choi JH, Choi KM, et al. Diabetes fact sheet in Korea 2021. Diabetes Metab J 2022;46(3):417-426. https://doi.org/10.4093/dmj.2022.0106
  33. Kim HC, Lee H, Lee HH, Seo E, Kim E, Han J, et al. Korea hypertension fact sheet 2021: analysis of nationwide population-based data with special focus on hypertension in women. Clin Hypertens 2022;28(1):1.
  34. Rotar AM, van den Berg MJ, Kringos DS, Klazinga NS. Reporting and use of the OECD Health Care Quality Indicators at national and regional level in 15 countries. Int J Qual Health Care 2016;28(3):398-404. https://doi.org/10.1093/intqhc/mzw027
  35. Park BJ, Sung JH, Park KD, Seo SW, Kim SH. Report of the evaluation for validity of discharged diagnosis in Korean Health Insurance Database. Seoul: Seoul National University; 2003, p. 24-25 (Korean).