• 디지털융복합연구
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• 제16권12호
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• pp.533-540
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• 2018

이 연구는 건강보험 심사평가원 자료를 이용하여 동일 환자의 동일 질환에 대하여 서로 다른 의료기관이 부여하는 질병 코딩의 불일치성을 분석하여 국가 보건 통계 질 향상을 위한 기초 자료로 활용하고자 시행하였다. 건강보험심사평가원 2014년 전체 환자 데이터셋(HIRA-NPS)에서 9,976,826건의 진료비 명세서를 연구 대상으로 하였다. 연구결과 의료기관의 이동 경로에 따라서 질병 코딩 불일치의 차이가 존재 하였고 불일치율은 보건기관 이외의 타 의료기관에서 보건기관으로 이동하였을 때 높아지는 경향이 발견되었고, 상급종합병원 간 이동하였을 때는 불일치율이 현저하게 낮았다. 본 연구의 의료기관 간 질병 코딩 불일치 현황 분석은 국내 의료기관에서 일관성 있는 질병 코딩이 이루어지기 위한 제도적 보완의 필요성을 시사하고 있다.

• 한국보건간호학회지
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• 제28권3호
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• pp.565-573
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• 2014

Purpose: Health Insurance Review & Assessment Service (HIRA) launched an Acute Myocardial Infarction(AMI) assessment for the Payment For Performance(Quality Incentives) Pilot Project from July 2007. Assessment measures of AMI were composed of five process measures and one outcome measure, and each measure was incorporated into one composite quality score to Pay for Performance. Method: For calculation of composite quality score, we considered weighting for the measures using the Delphi method. The questionnaire was composed of three measure groups, 'Reperfusion rate'(Fibrolytic therapy received within 60 minutes of hospital arrival, Primary Percutaneous Coronary Intervention within 120 minutes of hospital arrival), 'Medication prescription rate'(Aspirin at arrival, Aspirin prescribed at discharge, Beta-blocker prescribed at discharge) and 'Survival Index'(30-day mortality rate). Result: A panel composed of 18 and completed a questionnaire by allocation of 10 scores to the three above mentioned measure groups. The Delphi was carried out until three rounds of surveys. In conclusion, each measure group was weighted differently and the 10 scores were allocated as 4.5 to 'Reperfusion rate', 2.5 to 'Medication prescription rate', and 3.0 to 'Survival Index'. Conclusion: The results of this study proposed the calculation method for weighting of Acute Myocardial Infarction quality indicators.

• 척추신경추나의학회지
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• 제17권2호
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• pp.131-139
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• 2022

Objectives This study aimed to analyze the medical utilization of low back pain (LBP) patients after back surgery and estimate the medical costs of Korean and Western medicine collaborative treatment, odds ratio, and hazard ratio between the two groups using the 2019 Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS-2019). Methods Data management and descriptive analysis, logistic regression, and survival analysis were conducted for defining and estimating the LBP patients after back surgery in the NPS 2019 dataset. Results A total of 216,424 patients out of 991,189 were identified as having LBP. Among the patients with LBP, 1,734 were treated with surgery while 214,690 were not. Among those who had surgery, 937 were treated with conventional treatments only and 797 underwent Korean medicine treatments. The odds ratio of the logistic regression analysis was 0.7129, suggesting that Korean medical treatment experience group had a 28.7% lower risk of reoperation than the Western medical treatments only group. The hazard ratio of the survival analysis was 0.9145; thus, the risk probability of reoperation was estimated to be approximately 8.55% lower. The 50% risk of reoperation was 69 days (0.5044) for the conventional group, and 97 days (0.5008) for the Korean medical group in the survival analysis using the Kaplan-Meier graph. Conclusions These results could be utilized in future studies in conducting economic evaluation for estimating cost-effectiveness of Western medicine and Korean medicine treatment compared to Western medicine alone in LBP patients after back surgery in a South Korean perspective. mended and should be applied while taking the necessary precautions.

• Parasites, Hosts and Diseases
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• 제60권5호
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• pp.327-338
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• 2022

This study determined the recent status and trend of Pneumocystis jirovecii pneumonia (PcP) in the non-human immunodeficiency virus (HIV) (non-HIV-PcP) and HIV (HIV-PcP) infected populations using data from the Health Insurance Review & Assessment Service (HIRA) and the Korea Disease Control and Prevention Agency (KDCA). SaTScan and Join-point were used for statistical analyses. Non-HIV-PcP cases showed an upward trend during the study period from 2010 to 2021, with the largest number in 2021 (551 cases). The upward trend was similar until 2020 after adjusting for the population. Seoul had the highest number of cases (1,597) in the non-HIV-PcP group, which was the same after adjusting for the population (162 cases/1,000,000). It was followed by Jeju-do (89 cases/1,000,000). The most likely cluster (MLC) for the non-HIV-PCP group was Seoul (Relative Risk (RR)=4.59, Log Likelihood Ratio (LLR)=825.531), followed by Jeju-do (RR=1.59, LLR=5.431). An upward trend was observed among the non-HIV-PcP group in the Jeju-do/Jeollanam-do/Jeollabuk-do/Gyeongsangnam-do/Busan/Daejeon/Daegu/Ulsan joint cluster (29.02%, LLR=11.638, P<0.001) located in the southern part of Korea. Both women and men in the non-HIV groups showed an overall upward trend of PcP during the study period. Men in the 60-69 age group had the highest annual percentage change (APC 41.8) during 2014-2019. In contrast, the HIV groups showed a falling trend of PcP recently. Men in the 60-69 age group had the most decrease (APC -17.6) during 2018-2021. This study provides an analytic basis for health measures and a nationwide epidemiological surveillance system for the management of PcP.

• 한국임상약학회지
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• 제21권4호
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• pp.347-352
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• 2011

Health insurance review & Assessment service (HIRA) has enforced cutting the drug costs when physicians prescribe split extended release drugs, starting from December, 2010. The objective of this study is to analyze extended release and enteric coated drugs on pharmaceutical reimbursement list in Korea, and to investigate the impact and barriers of the health insurance review on splitting extended-release formulation drugs. By using the ingredient code, extended release and enteric coated formulations make up 7.8% of all drugs in April, 2011. The most frequently used drugs are agent affecting circulatory and digestive system. From the extended release and enteric coated formulations (n=112), 34.8% (n=39) were not available in other dosage forms. According to questionnaire survey for 169 pharmacists (response rate: 73.8%), the rate of splitting and crushing of extended release and enteric coated drugs decreased. When pharmacists correct physician's prescription errors, the biggest problem was lack of other dosage forms. So it is necessary to develop variety of other dosage forms, and computerized checking system for splitting extended-release drugs. It is also important to inform physicians and patients in regard to the problems of split prescription of extended release and enteric coated drugs.

• 한방안이비인후피부과학회지
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• 제34권2호
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• pp.21-37
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• 2021

Objectives : Allergic rhinitis(AR) is a common chronic disease that accounts for 10-40% of the world's population. This study aims to analyze the status of claims, prevalence, and medical utilization of allergic rhinitis patients using representative patients sample data. Methods : This study used the National Patients Sample(HIRA-NPS) of the Health Insurance Review and Assessment Service for 7 years(2010-2016). And we defined AR patients as all statements including J30 or a subcategory of J30 as the main disease, using the Korean Standard Classification of Diseases(KCD-7). The trend of AR patients by year was divided into Western medicine(WM) and Korean medicine(KM), and analyzed by subgroup analysis such as inpatient/outpatient, gender, age, insurance type, and care institution. Results : Patients with AR were mainly claimed for first sub diagnosis in WM and major diagnosis in KM, and the number of claims increased about 1.3 times and 1.4 times compared to 2010 in WM and KM, respectively. In addition, the total annual medical expenses in 2016 increased 1.3 times and 1.7 times compared to 2010, respectively. Conclusions : Both WM and KM are showing a steadily increasing trend in medical use due to allergic rhinitis. Further research is needed by considering genetic and environmental factors and individual characteristics, and linking with additional data.

• 한국임상약학회지
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• 제29권4호
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• pp.231-237
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• 2019

Objective: The aim of this study was to analyze the status of split tablet prescription in South Korea. Methods: We conducted this analysis using 2016 National Patient Sample data from the Health Insurance Review and Assessment Service. We computed split tablet prescription rates by sex and age and determined which medicine and medical specialties had the highest split tablet prescribing rates. Results: The proportion of prescriptions that included split tablets was 15.6% (n=6,687,35). The proportion of prescriptions that included split tablets was higher for females (56.7%) than for males (43.3%), while that of prescriptions including split tablets versus total prescriptions for each sex was higher for males (16.4%) than for females (14.9%) (p<0.001). In the age group under 19 years, the proportion of prescriptions including split tablets (53.7%) was more than half of the total. The highest tablet splitting rate was found to be 89.9% for formoterol fumarate (40 ㎍), and pseudoephedrine hydrochloride (60 mg) had the highest number of prescriptions. Pediatrics (65.6%) was the medical field with the highest rate of split tablet prescription. Conclusion: Split tablets were most prescribed to pediatric patients. To minimize the use of split tablets, it is necessary to develop lower dose tablets and establish a policy that promotes prescription of these lower-dose tablets.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.118-125
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• 2020

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

• 한국임상약학회지
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• 제25권4호
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• pp.273-279
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• 2015

Objective: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. Method: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were subclassified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. Results: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). Conclusion: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.

• 한국병원경영학회지
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• 제25권3호
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• pp.78-86
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• 2020

Purposes: This study purposed to identify factors influencing the composite quality score from the quality assessment program for long-term care hospitals Methodology: The study variables was obtained from HIRA(Health Insurance Review and Assessment Service): the composite quality scores and hospital variables such as number of doctors, nurses, beds, medical technicians, medical equipments, administrative region, ownerships from 3rd (2010) to 7th (2018) quality assessment program. National Statistical Portal(www.kosis.go.kr) provided the number of senior citizens aged over 65 in city·county·district area. SAS 9.4 was used for the data processing and used to analyze the data. Findings: The results showed that composite quality score increased past 9 years. Hospital variables such as number of doctor, nurse, medical technicians, bed and public hospitals had significant positive relationship with the composite quality score. Administrative region(district) showed higher scores compare to that of city. Compare to the score of quality assessment year(2010), as the assessment year move to 2012, 2013, 2015, 2018, results showed higher significant positive coefficients. Practical Implication: Continuously improve the performance of long-term care hospitals, current quality assessment program are needed to update their system such as adopting indicators measuring the service process, or compensating the cost for quality assessment program. It will enable to provide more reasonable and accurate performance assessment scores.