• Radiation Oncology Journal
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• v.37 no.4
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• pp.249-253
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• 2019

Purpose: We aimed to analyze the trend in intensity-modulated radiation therapy (IMRT) use in Korea from 2011 to 2018. Materials and Methods: We collected data from the Health and Insurance Review and Assessment Service (HIRA) big data based on the National Health Insurance Service claims and reimbursements records using primary treatment planning codes (HD 041) for IMRT from 2011 to 2018. We analyzed the changing patterns in clinical application to specific tumor sites and regional differences in IMRT utilization. Results: The use of IMRT has exhibited an 18-fold steep rise from 1,921 patients in 2011 to 34,759 in 2018. With regard to IMRT in 2018, 70% of patients (24,248/34,759) were treated in metropolitan areas (Seoul, Incheon, and Gyeonggi Province). IMRT was most commonly used to treat breast, lung, and prostate cancers in 2018. Among these, the use of IMRT for breast cancer shows the most remarkable increase from 2016 when the National Health Insurance began to cover IMRT for all solid tumors. Conclusion: The use of IMRT is steadily increasing to treat cancer and is concentrated in metropolitan areas.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.11 no.1
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• pp.53-64
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• 2016

Objectives : The aim of this study is to assess the usage of diagnosis codes for somatic dysfunctions and the general characteristics of patients diagnosed with the code, by analyzing health insurance data provided by the Health Insurance Review & Assessment Service(HIRA) of Korea. This investigation is intended to outline future and willing to contribute to further use of diagnosis code and the approach of Oriental Medicine to somatic dysfunction. Materials and Methods : By analyzing HIRA data, those diagnosed with M99 codes, a code attributed to somatic dysfunction, were selected for analysis. Patients included were assessed for the relevant general characteristics, and the specific diagnostic criteria. The current usage rates and noteworthy characteristics of diagnostic codes of somatic dysfunctions were assessed. A comparative analysis between clinical departments and subcategories, and a comparative analysis to data of 2014 was conducted. Results : Patients given M99 codes constituted a small minority of all patients diagnosed in 2011 as shown by HIRA data. The codes were more frequently to older patients, females, outpatients, and those who filed for Health Insurance compensation. Medical institutions participating in the diagnosis were mostly primary care facilities, usually specializing in orthopedic(Western medicine sector) and internal medicine (Oriental Medicine sector). The most registered code in 2011 and 2014 was M995. The same trend can be observed in Oriental/Western medicine institutions and Public health center, on the other hand, between them, have some different patterns both 2nd and 3rd. Conclusions : This investigation is that of current usage of diagnostic codes of somatic dysfunction. HIRA insurance claim data was analyzed. Based on the current results, more precise diagnostic standards of somatic dysfunction are warranted. This study will provide a foundation for future Oriental Medicine approach to somatic dysfunctions.

• Health Policy and Management
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• v.20 no.4
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• pp.45-57
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• 2010

Background : If different cost efficiency indexes were informed to the same clinic depending on the inclusion or exclusion of pharmacy cost, it may impair the reliability of provider-profiling system. This study aimed to investigate whether the omission of pharmacy cost affects cost-efficiency rankings in medical clinics. Methods : Data for ambulatory care cost at 23,112 medical clinics were collected from the claims database, which was constructed after review by the Health Insurance Review and Assessment Service (HIRA) of Korea in April 2007. We calculated two types of cost efficiency indexes by inclusion or exclusion of pharmacy cost for a medical clinic. The agreement between the decile rankings of the two indexes was also assessed using the weighted kappa statistic of Landis and Koch. Results : When the cost efficiency index for total cost including pharmacy cost was compared with the index for total cost excluding it, the agreement between the two indexes was only 55%. The agreements between the two indexes were relatively low within specialties which have larger pharmacy volume of total cost and lower correlation between total cost with or without pharmacy cost included than the average level of all the specialties. Conclusion : These results suggest that the omission of pharmacy cost may result in contradictory outcomes that may be confusing to a medical institution and may impair the reliability of provider-profiling systems. It is very important to standardize profiling criteria for the reliability of provider profiling system.

• Archives of Plastic Surgery
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• v.45 no.5
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• pp.441-448
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• 2018

Background Previously, surveys have been used to investigate breast reconstruction statistics. Since 2015, breast reconstruction surgery after mastectomy has been covered by the National Health Insurance Service in Korea, and data from breast reconstruction patients are now available from the Health Insurance Review and Assessment Service (HIRA). We investigated statistics in breast reconstruction in Korea through statistics provided by the HIRA Big Data Hub. Methods We investigated the number of cases in mastectomy and breast reconstruction methods from April 1, 2015 to December 31, 2016. Data were furnished by the HIRA Big Data Hub and accessed remotely online. Results were tabulated using SAS Enterprise version 6.1. Results The 31,155 mastectomy cases included 7,088 breast reconstruction cases. Implant-based methods were used in 4,702 cases, and autologous methods in 2,386. The implant-based reconstructions included 1,896 direct-to-implant and 2,806 tissue-expander (2-stage) breast reconstructions. The 2-stage tissue-expander reconstructions included 1,624 expander insertions (first stage) and 1,182 expander-to-permanent-implant exchanges (second stage). Of the autologous breast reconstructions, 705 involved latissimus dorsi muscle flaps, 498 involved pedicled transverse rectus abdominis myocutaneous (TRAM) flaps, and 1,183 involved free-tissue transfer TRAM flaps, including deep inferior epigastric perforator free-tissue transfer flaps. There were 1,707 nipple-areolar complex reconstructions, including 1,565 nipple reconstructions and 142 areola reconstructions. The 1-year mean number of breast reconstructions was 4,050. Conclusions This was the first attempt to evaluate the total number of breast reconstruction procedures using accurate, comprehensive data, and our findings may prove valuable as a foundation for future statistical studies of breast reconstruction procedures in Korea.

• Quality Improvement in Health Care
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• v.27 no.2
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• pp.73-82
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• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

• Health Policy and Management
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• v.21 no.2
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• pp.195-212
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• 2011

Objectives: This study investigates the relationship between nurse staffing levels and differences in patient outcomes in terms of average length of stay, in-hospital mortality rate and 30-day death rate in order to evaluate the effectiveness of a policy that differentiates fees for inpatients on the basis of nurse-to-bed ratios. Methods: We obtained information on inpatients from health insurance claims data published by the Health Insurance Review and Assessment Service(HIRA) in 2008, organizational factors(type of hospital, ownership) from the records of the hospital report system in 2008, and nurse staffing levels, which were graded on a scale of 1 to 7, from data compiled between December 15, 2007, and September 20, 2008. The data were segregated according to type of hospital and quarter and finally 3,517 records of 1,182 hospitals were analyzed using multi-level analysis. Results: The average length of stay in grade 1~6 hospitals was lower than that in grade 7 ones, but the difference was much below one day. No significant difference was found among different grades in tertiary hospitals. Further, variations in staffing levels did not result in any significant difference in the in-hospital mortality rate and 30-day death rate. Conclusions: High nurse staffing levels did not result in better patient outcomes compared with low staffing levels. We therefore recommend modifying the above nurse staffing policy so as to make it more effective in improving patient outcomes.

• Journal of the korean academy of Pediatric Dentistry
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• v.51 no.2
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• pp.185-196
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• 2024

Temporomandibular joint disorders (TMDs) can occur at any age, including childhood and adolescence, and pain-related TMDs can affect growth and quality of life. In the present study, recent trends in the diagnosis and treatment of TMDs in children and adolescents were analyzed over a 10-year period. Using 10 years of data from the Health Insurance Review and Assessment Service (HIRA) and Jeonbuk National University (JBNU) Dental Hospital, patients between 0 and 19 years of age diagnosed with K07.6 (temporomandibular joint disorders) were analyzed by 5-year bins. Both datasets indicated a higher prevalence in females (1.2-fold in HIRA, 1.5-fold in JBNU) and in ages 15 to 19 years (72.1% in HIRA, 74.7% in JBNU). HIRA reported a 42.3% increase in prevalence per 100,000 people, from 651.4 in 2011 to 927.0 in 2020. JBNU reported K07.66 (masticatory muscle disorders) as the most common diagnosis in subjects under 10 years of age and K07.60 (internal derangement of temporomandibular joint) in those over 10 years of age. In addition, both were treated mainly by a combination of physical therapy and medication, and the treatment rate increased in accordance with age. Because TMDs can affect various structures in the orofacial region and cause pain that tends to differ with age, an early and specific diagnosis appropriate for age is important for treatment. Therefore, pediatric dentists need to promptly recognize TMDs in children and adolescents and consult with specialists as the prevalence increases.

• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.90-99
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• 2011

Health Insurance Review & Assessment Service (HIRA) claims database has a high potential to detect signals of new drug interactions. The aim of this study was to evaluate the usefulness of information component (IC) and relative risk (RR) as a tool for signal detection, and to analyze the possible drug interactions caused by clopidogrel using HIRA claims database. This study was performed in elderly patients over 65 years of age who administered clopidogrel from January 2005 to June 2006 in South Korea. Serious Adverse Events (SAEs) as drug interactions of clopidogrel were defined as any ambulatory hospitalization for ischemic diseases within comcomitant medication period of clopidogrel. Information Component (IC) and Relative Risk (RR) were calculated to compare the proportion of drug-SAE pairs in order to select drug specific SAEs. IC and RR signals of clopidogrel drug interaction were screened when IC's 95% confidence interval was greater than 0 and RR's 95% confidence interval was greater than 1 respectively. All detected signals were compared to references such as $Micromedex^{(R)}$ and 2010 Drug Interaction $Facts^{TM}$. Sensitivity, specificity, positive predicted value and negative predicted value were used to evaluate usefulness of this method. Among 13,252,930 cases of elderly patients who co-administered clopidogrel and other drugs, 47,485 cases were detected as SAE. Of these, one-hundred nine cases were detected by the IC-based data-mining approach and ninety one cases were detected by the RR-based data-mining approach. Total One-hundred sixty three unrecognized signals were detected by IC or RR. Twelve signals from IC-based data-mining (57.1%) were corresponded with drug interactions from references and eight signals from RR-based data-mining (38.1%) were corresponded with drug interactions from references. These signals include proton pump inhibitors, calcium channel blockers and HMG CoA reductase Inhibitors, which were known to affect CYP450 metabolism. Further studies using HIRA claims database are necessary to develop appropriate data-mining measure.

• Journal of Korean Academy of Nursing
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• v.39 no.3
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• pp.409-421
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• 2009

Purpose: In this research multi-level analysis was done to identify factors related to quality of services. Patient characteristics and organizational factors were considered. Methods: The data were collected from the Health Insurance Review and Assessment Service(HIRA) data base. The sample was selected from 17,234 patients who had been admitted between January 2007 and May 2008 to one of 253 long-term care hospitals located in Seoul, six other metropolitan cities or nine provinces The data were analyzed with SAS 9.1 using multi-level analysis. Results: The results indicated that individual level variables related to quality of service were age, cognitive ability, patient classification, and initial quality scores. The organizational level variables related to quality of service were ownership, number of beds, and turnover rate. The explanatory power of variables related to organizational level variances in quality of service was 23.72%. Conclusion: The results of this study indicate that differences in the quality of services were related to organizational factors. It is necessary to consider not only individual factors but also higher-level organizational factors such as nurse' welfare and facility standards if quality of service in long term care hospitals is to be improved.

• Journal of Preventive Medicine and Public Health
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• v.41 no.2
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• pp.80-83
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• 2008

An economic evaluation is required in order to apply to the Health Insurance Review and Assessment Service (HIRA) for a listing in the national drug formulary. To assist companies in preparing the necessary documents, HIRA published guidelines for the economic evaluation of pharmaceuticals in 2006. The guidelines are composed of two parts: guidance and explanatory notes. Each guideline reflects the best practice which meets both the theoretical consensus within the academic community and local situations, like data availability. To enhance the transparency of evaluation, guidelines emphasize the reproducibility of data and analysis result. That is, all evaluation processes are required to be described in enough detail to be replicated by reviewers. With growing experience and theoretical development in this area, HIRA guidelines will be revised periodically.