The association between quality of asthma treatment and asthma exacerbation in Korea

Abstract

Background/Objective: Health Insurance Review & Assessment service(HIRA) has evaluated the effect of medical care on asthma and its cost for each medical institution since 2013. However, the validity of evaluation results by HIRA has not been carefully examined. The main goal in my thesis is to test whether the asthma evaluation is significantly associated with asthma care by using the claim data received from HIRA.

Method: The claim data from 1 July 2013 to 30 June 2016 were requested to HIRA. Data generated by HIRA were denoted by M20170512670 and it was remotely accessed for statistical analyses. I considered subjects with J45(asthma) or J46(status asthmaticus) diagnosis code and who aged 15 years or older. T20(general information), T30(healthcare service provided) and T53(outpatient prescription) from M20170512670 were used to determine asthma medication and asthma patients, and then the asthma exacerbation medicines were determined and their rank sums of asthma medicines were calculated. Evaluation results of asthma care for each medical institution were regressed on the asthma exacerbation rate.

Results: I evaluated the association between evaluation results by HIRA and asthma exacerbation rate for each medical institution with regression. If evaluation of medical institution by HIRA was appropriately conducted, medical institution with good evaluation may have smaller asthma exacerbation rate due to low asthma hospitalization and asthma exacerbation drug use than other medical institutions. However, the asthma exacerbation rate and the medical institution with good evaluation were not significantly associated. Furthermore, the asthma exacerbation rate due to the use of asthma exacerbation drugs has been consistently decreasing, and medical institution with good evaluation tends to have higher asthma hospitalization.

Conclusion: Results suggests that evaluation by HIRA may improve the quality of asthma treatment in medical institutions but it does not successfully assess effectiveness of asthma treatment. The results in my thesis may provide useful information to improve the project of HIRA for evaluation on asthma care and further investigation on evaluation criteria for asthma care is necessary to improve the quality of asthma treatment.