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KMID : 1154920220170010045
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Korean Journal of Insurance Medicine
2022 Volume.17 No. 1 p.45 ~ p.59
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Lee Sea-Won
Choi Kyu-Hye
Lee Jong-Hoon
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Abstract
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Background: The Korean Health Insurance Review and Assessment Service (HIRA) has conducted the nationwide quality assessment of lung cancer management. It was performed on an annual basis in order to reduce variation in clinical practice and infrastructure between institutions. The aim of this study was to evaluate the trends of quality and variation in lung cancer management by analyzing the outcome of quality assessments performed between 2013 and 2016. The results of this study is anticipated to provide the grounds for future directions which may improve the quality of lung cancer management in compliance with the changes regarding epidemiology and management of lung cancer.
Methods: All institutions with the Korean healthcare claims of lung cancer treatment were included for analysis of the database and medical records. A total of 22 indicators were divided into 5 clinical domains. Primary endpoint was the quality of lung cancer management represented by the global score (GS) for each indicator which was calculated by weighting different values per domain. Secondary endpoint was the coefficient of variation (CV) between different types of medical institutions for each indicator. The trends of both endpoints on an annual basis were analyzed.
Results: Most indicators of the personnel and surgical domain showed no significant trend in both the GSs and CVs except for the GS of professional personnel which declined (p=0.042) from 88.9 (2013) to 85.5 (2016). Although there was no statistically significant trend in the GSs and the CVs of the indicators included in the diagnostic and systemic therapy domains, the GSs tended to increase by the years. Within the radiotherapy domain, the GS for assessment during radiotherapy improved (p=0.042) from 92.2 (2013) to 99.4 (2016), while its CV declined (p=0.042) from 0.253 (2013) to 0.037 (2016). The CV for radiotherapy records also tended to decline (p=0.050) from 0.080 (2013) to 0.004 (2017).
Conclusion: The quality of lung cancer management tended to improve in all clinical domains between 2013 and 2017, except for sufficient recruitment of professional personnel. The variation between institutions showed a trend toward reduction in variability with improvement of the quality of lung cancer management, especially in the radiotherapy domain. The results of this study warrants further analysis of the effects of improvement in lung cancer management past the recent years on the actual outcome of lung cancer.
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KEYWORD
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Lung cancer, Quality assurance, Korean, Trend
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