• 한국노년학
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• v.30 no.1
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• pp.81-91
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• 2010

The purpose of this study was to test a validity and reliability of Cognitive Performance Scale(CPS), a cognitive measure generated from 5 items(comatose status, decision making, short-term memory, making self understood, and eating). Method: 393 patients in 2 hospitals for the elderly with dementia were measured with CPS by two nurses independently. The inter-rater agreement was tested by comparing two scores. The CPS score was compared with GDS, which was measured by doctors and nurses, and MMSE score which was drawn from the claim data of Health Insurance Review & Assessment Service. Result: The correlation coefficient between CPS and GDS was 0.742(p<0.0001), CPS and MMSE was -0.794(p<0.0001). The Cronbach's coefficient alpha of CPS was 0.742, Kappa value was 0.772~1.000. The CPS showed high validity and reliability in long term care hospitals of Korea.

• Korean Journal of Clinical Pharmacy
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• v.21 no.3
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• pp.249-255
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• 2011

Objective: To examine the drug use (prescribing) pattern of serious drug-drug interactions (DDIs, contraindicated drug interactions) using real world data. Prescription patterns were examined in terms of dispensing types. Method: Retrospective drug utilization review (DUR) study was performed. One hundred and six datasets of serious DDIs (DDI pairs) were determined among DDI datasets that Ministry of Health & Welfare announced for the DUR system from 2004 to 2005. Electronically transacted ambulatory patients' prescription database to Health Insurance Assessment and Review Services (HIRA) from July, 2005 to June, 2006 was collected with personal information deidentified and analyzed in terms of types of dispensing as a contributing factor. Results: After prescription data analysis per each patient, total number of DDI cases using 95 DDI pairs was 5,511, which accounted for 2.6 cases per patients. DDI cases between two drugs from each of community pharmacy dispensing- type prescription were considerable (63% vs. 24% in those from each of in-institutional dispensing-type prescription and vs. 13% in those from a community pharmacy dispensing-type prescription and an in-institutional dispensingtype prescription). Conclusions: DDI cases from different prescribers were found to be significant. Thus, the concurrent DUR process between prescriptions from different physicians and institutions should be implemented for the safe drug use.

• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.156-160
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• 2011

서론: 본 연구는 불필요한 소화기관용 약제의 처방이 한국에서의 처방전 당 약물 개수를 증가시키는 것과의 연관성을 검토하고자 수행되었다. 연구방법: 연구를 위한 자료로 건강보험심사평가원의 처방전 데이터와 환자의 기타 모든 의료보험 청구데이터를 이용하였고, 두 데이터셋을 연결하여 처방전들을 소화기관용 약제의 필요성에 따라 소화기관질환 그룹, 관절염질환 그룹,소화기관용 약제 처방이 불필요할 것으로 그 외 질환 그룹으로 구분, 분리하였다. 결과: 처방전 당 약물의 평균 개수의 분포는 세 그룹에서 비슷한 양상을 보였는데, 관절염질환 그룹과 그 외 질환 그룹의 거의 절반 이상은 한 개의 소화기관용 약제를 포함하였다. 세 그룹 모두 처방전 당 약물 개수와 처방전 당소화기관용 약제의 개수가 1차 선형관계를 보였다. 그 외 질환 그룹에서는 처방전 당 전체 약물이 평균 6개를 넘는 경우, 적어도 한 개의 소화기관용 약제가 포함되었다. 본 연구는 불필요한 소화기관용 약제를 처방하는 것은 다제처방의 매우 유의한 예측인자임을 보였다. 결론: 향후, 약제 처방전의 질을 향상시키기 위해서는 각각의 약물을, 특히 소화기관용 약제를, 처방 시 약제의 불가피한 필요성에 대해 판단할 수 있어야 할 것이다.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.2
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• pp.51-56
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• 2015

Objective : We analyzed present condition of cooperative medical care using claims data of HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE form patients treated by Korean-Western cooperative medicine. The study aimed to offer guidelines in selecting disease-related research in developing Korean-Western convergence technology. Method : Based on the patients using Korean medical service, we analyzed claims data of patients using Korean medical service and western medical service from January 2012 to December 2013. We were assigned to the server remotely. With the concept of 'episode of care', we rebuilt claims data and analyzed present condition of cooperative medical usage. Results : We analyzed present condition of cooperative medical care per episode of care. Among outpatients, Low back pain, lumbar region(M5456) was the highest number. Among inpatients, Sciatica due to intervertebral disc disorder(M511) was the highest number. Conclusion : Based on the claims data provided by HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, we have derived a list of multy frequently disease frequently treated by cooperative medical care by analyzing present condition.

• Korean Journal of Clinical Pharmacy
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• v.20 no.3
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• pp.262-267
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• 2010

Therapeutic duplication of prescriptions is the most frequently reported inappropriate drug use in Korea. To prevent significant problems during drug prescribing and dispensing, prospectively, development of standard including drug lists considered as therapeutic duplications for the prioritized drug classes first would be necessary. This study was aimed to analyze frequent drug classes of therapeutic duplications by healthcare providers in clinical practice settings. National health claims data for drug review and reimbursement (1,426,065 prescriptions dated March 19, 2008) were analyzed. Therapeutic duplication was defined as the prescription including more than 2 ingredients belonging to the same KFDA drug classification numbers that considered to have therapeutic similarities. The following 3 drug classes were mostly frequent therapeutic duplication classes: 114 anti-pyretics, analgesics and anti-inflammatory drugs; 117 drugs for psycho-nervous system; 141 Antihistamines. About 3.5% of overall prescriptions analyzed showed therapeutic duplications. This result might be starting step to develop DUR therapeutic duplication standard.

• Journal of Convergence for Information Technology
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• v.8 no.4
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• pp.9-14
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• 2018

The purpose of this study was to analyse the relationship between the characteristics of the patients who received oral antihyperglycemic drugs and their medical adherence in Korea. The study method was a cross-sectional study using the patient sample data of the Health Insurance Review and Assessment Service for 2016, and it was analyzed with 109 major components of diabetes drug. The medical adherence was slightly higher in male than female. The patriots & veterans(free) type had the highest medication adherence because they have low self burden to access medical institutions compared to other insurance types. It is expect that this study result will be used as a basic data to understand the burden of outpatients with health insurance and establish a policy to reduce of the self outpatients' burden with chronic diseases such as type 2 diabetes.

• Journal of Korea Entertainment Industry Association
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• v.14 no.6
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• pp.201-208
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• 2020

The purpose of this study was to analyze the claim data of Health Insurance Review & Assessment Service to determine what factors affected the length of stay in patients aged 65 and older and undergoing total knee arthroplasty due to the principal diagnosis of gonarthrosis by the type of medical institutions. As a result of making an analysis, gender, age, medical security type, severity, residential area and the number of sickbeds were identified as the factors that influenced the length of stay in each type of medical institutions. At this point in time when an increase in the elderly population triggered by population aging and another subsequent increase in medical expenses put a heavy strain on household and national economy, it's necessary to consider how to shorten the length of stay and how to ensure the efficient management of sickbeds based on the findings of this study. In addition, this study is of significance in that it could be used as basic data on quality life-care for elderly patients by the introduction of a systematic management system geared toward lessening patient burden for medical expenses.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.8
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• pp.407-414
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• 2016

This study was conducted to provide basic data to evaluate the appropriateness of convalescent hospitalization treatment by investigating the number of hospitalization days and the total treatment expenses of a total of 44,037 monthly billing statements requested from the Health Insurance Review and Assessment Service. Evaluated data consisted of medical care expenses of patients of the diem payment system hospitalized at convalescent hospitals in Daejeon, Chungnam, Chungbuk and Sejong from January through December of 2014. According to the analysis result of the general characteristics of the study objects and the canonical correlation analysis of the top 15 main diagnosis names, 7 canonical functions have been deducted. Among them, six canonical functions were shown to be statistically significant (p<0.001), and canonical function 1 had a chi-squared value of 5955.49 and 98 degrees of freedom at p<0.001 level. Overall, the results indicated that if health and welfare service in the regional society is magnified, social hospitalization can be reduced.

• Health Policy and Management
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• v.16 no.2
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• pp.49-76
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• 2006

The aim of this study was to explore the effects of a computerized review program which was introduced in August 1, 2003, using claims data for acute respiratory infection related diseases. National Health Insurance (NHI) claims data on respiratory infection related diseases before and after the introduction, with six month intervals respectively, were used for the analysis. Clinic was the unit of observation, and clinics with only one physician whose specialty was internal medicine, pediatrics, otorhinolaryngology and family medicine and clinics with a general practitioner were selected. The final sample had 7,637 clinics in total. Indices used to measure practice pattern was prescription rates of antibiotics, prescription rates of injection drug per visit, treatment costs per claim, and total costs per claim. Changes in the number of claims for major disease categories and upcoding index for disease categories were used to measure claiming behavior. Data were analysed using descriptive analysis, t-test for indices changes before and after the introduction, analysis of variance (ANOVA) for practice pattern change for major disease categories, and multiple regression analysis to identify whether new system influenced on provider' practice patterns or not. Prescription of antibiotics, prescription rates of injection drug, treatment costs per claim, and total costs per claim decreased significantly. Results from multiple regression analysis showed that a computerized review system had effects on all the indices measuring behavior. Introduction of the new system had the spillover effects on the provider's behavior in the related disease categories in addition to the effects in the target diseases, but the magnitude of the effects were bigger among the target diseases. Rates of claims for computerized review over total claims for respiratory diseases significantly decreased after the introduction of a computerized review system and rates of claims for non target diseases increased, which was also statistically significant. Distribution of the number of claims by disease categories after the introduction of a computerized review system changed so as to increase the costs per claims. Analysis of upcoding index showed index for 'other acute lower respiratory infection (J20-22)', which was included in the review target, decreased and 'otitis media (H65, H66)', which was not included in the review target, increase. Factors affecting provider's practice patterns should be taken into consideration when policies on claims review method and behavior changes. It is critical to include strategies to decrease the variations among providers.

• The Journal of the Korea Contents Association
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• v.11 no.5
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• pp.270-279
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• 2011

This study to analyze differences of cancer patient's health utilizations in medical aid program and national health insurance by analysing health insurance claims data, and identify effects of health care systems. The majors results of the research were as follows. First, cancer patients in medical aid program more used total medical expenditures than in national health insurance mostly by many outpatient visits and long term hospitalization. Second, results of multiple regression, cancer patients in medical aid program more used total expenditures and inpatient expenditures. But, outpatient expenditures weren't different, cancer patients in medical aid program more visited medical institutions and hospitalized long term periods than in national health insurance. Therefore, it is too early to conclude that moral hazard is in health utilizations of medical aid program, because cancer patients in medical aid program many use in benefits for many nonbenefit burdens.