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KMID : 0363620140350030093
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Journal of Korean Oriental Medicine
2014 Volume.35 No. 3 p.93 ~ p.102
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Revision and Evaluation of Korean Outpatient Groups-Korean Medicine
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Ryu Ji-Seon
Lim Byung-Mook
Lee Byung-Wook
Kim Chang-Hoon
Han Chang-Ho
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Abstract
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Objectives: This study aimed at revising the Korean Out-patient Groups for Korean Medicine (KOPG-OM, version 1.0) based on clinical similarity and resource use, by using the accumulated claims data, and evaluating the validity of the revised classification system.
Methods: A clinical specialist panel involving 19 specialists from 8 Korean medicine (KM) specialty areas reviewed the classification tree, diagnosis groups and procedure groups in terms of clinical similarity. Several models of outpatient grouping were formulated, with the validity of each tested based on the R2 coefficient of determination for the treatment costs of all visits. To add age splits, the variances of treatment costs by age groups were also analyzed. These statistical analyses were performed using KM claims data of National Health Insurance from 2010 to 2012.
Results: The classification tree designed via panel discussions was used to allocate outpatient cases to 26 diagnosis
groups, with cases involving procedures such as acupuncture, moxibustion and cupping, then allocated to 9 procedure
groups in each diagnosis group. The cases without procedures were categorized into the visit index - medication group. This process resulted in 298 outpatient groups. The R2 values for treatment costs of all visits ranged from 0.38 to 0.69 depending on the providers' types.
Conclusions: The revised model of KOPG-KM has a higher validity for outpatient classification than the current system and can provide better management of the costs of outpatient care in KM.
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KEYWORD
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Korean outpatient groups, patient classification system, Korean medicine
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