Journal of Preventive Medicine and Public Health

Original Article

Changes in the Hospital Standardized Mortality Ratio Before and During the COVID-19 Pandemic: A Disaggregated Analysis by Region and Hospital Type in Korea: EunKyo Kang, Won Mo Jang, Min Sun Shin, Hyejin Lee, Jin Yong Lee; J Prev Med Public Health. 2023;56(2):180-189. Published online March 20, 2023; DOI: https://doi.org/10.3961/jpmph.22.479

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Abstract Summary PDF: Objectives
The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic.
Methods
This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients’ in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type.
Results
The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4).
Conclusions
This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.; Summary

Korean summary
코로나19 대유행 지역은 비감염 지역과 달리 2019년에 비해 2020년에 HSMR이 크게 증가했고, 상대적으로 병상 수가 적은 종합병원에서 HSMR이 증가했다. 코로나19 대응에 참여하는 병원은 병원 규모와 관계없이 HSMR이 낮은 경향을 보였다. 감염병 유행 시 병원의 과도한 업무량이 부여되지 않게하고 인력을 적절하게 고용하여 조정하는 것이 필요하다.

COVID-19: Perspective

New Obligations of Health Insurance Review and Assessment Service: Taking Full-fledged Action Against the COVID-19 Pandemic: Seung Mi Yoo, Seol Hee Chung, Won Mo Jang, Kyoung Chang Kim, Jin Yong Lee, Sun Min Kim; J Prev Med Public Health. 2021;54(1):17-21. Published online January 26, 2021; DOI: https://doi.org/10.3961/jpmph.20.594

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In 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to global health systems. The Korea has taken full-fledged actions against this novel infectious disease, swiftly implementing a testing-tracing-treatment strategy. New obligations have therefore been given to the Health Insurance Review and Assessment Service (HIRA) to devote the utmost effort towards tackling this global health crisis. Thanks to the universal national health insurance and state-of-the-art information communications technology (ICT) of the Korea, HIRA has conducted far-reaching countermeasures to detect and treat cases early, prevent the spread of COVID-19, respond quickly to surging demand for the healthcare services, and translate evidence into policy. Three main factors have enabled HIRA to undertake pandemic control preemptively and systematically: nationwide data aggregated from all healthcare providers and patients, pre-existing ICT network systems, and real-time data exchanges. HIRA has maximized the use of data and pre-existing network systems to conduct rapid and responsive measures in a centralized way, both of which have been the most critical tactics and strategies used by the Korean healthcare system. In the face of new obligations, our promise is to strive for a more responsive and resilient health system during this prolonged crisis.

Summary

Korean summary
건강보험심사평가원은 전 국민과 전체 요양기관의 축적된 정보, 전체 요양기관과 연결된 네트워크, 실시간 데이터 공유를 통해 이번 코로나19 위기 대응에 기여했다. 건강보험심사평가원은 1) 진단검사∙약제 등재, 2) 요양기관 내 고위험군 감지, 3) 마스크 중복구매 방지 시스템 구축, 4) 주요 보건의료자원 가동현황 모니터링 시스템 구축, 5) 환자관리 정보시스템 구축 및 익명화된 환자 데이터 공개로 국제협력연구 촉진의 다섯 가지 전략을 성공적으로 수행했다. 건강보험심사평가원은 현재의 보건위기 상황을 극복하고, 코로나19 시대 이후로도 새롭게 주어진 위기대응의 역할과 소명을 다할 것이다.

Citations

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Andre Q Andrade, Jean-Pierre Calabretto, Nicole L Pratt, Lisa M Kalisch-Ellett, Vanessa T Le Blanc, Elizabeth E Roughead
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Original Article

Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data: Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(2):74-81. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.74

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Abstract PDF

Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

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Special Article

Korean National Health Insurance Value Incentive Program: Achievements and Future Directions: Sun Min Kim, Won Mo Jang, Hyun Ah Ahn, Hyang Jeong Park, Hye Sook Ahn; J Prev Med Public Health. 2012;45(3):148-155. Published online May 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.3.148

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Abstract PDF

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

Summary

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Research Support, Non-U.S. Gov't

Effect of Repeated Public Releases on Cesarean Section Rates.: Won Mo Jang, Sang Jun Eun, Chae Eun Lee, Yoon Kim; J Prev Med Public Health. 2011;44(1):2-8.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.2

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Abstract PDF

OBJECTIVES
Public release of and feedback (here after public release) on institutional (clinics and hospitals) cesarean section rates has had the effect of reducing cesarean section rates. However, compared to the isolated intervention, there was scant evidence of the effect of repeated public releases (RPR) on cesarean section rates. The objectives of this study were to evaluate the effect of RPR for reducing cesarean section rates. METHODS: From January 2003 to July 2007, the nationwide monthly institutional cesarean section rates data (1 951 303 deliveries at 1194 institutions) were analyzed. We used autoregressive integrated moving average (ARIMA) time-series intervention models to assess the effect of the RPR on cesarean section rates and ordinal logistic regression model to determine the characteristics of the change in cesarean section rates. RESULTS: Among four RPR, we found that only the first one (August 29, 2005) decreased the cesarean section rate (by 0.81 percent) and continued to have an impact period through the last observation in May 2007. Baseline cesarean section rates (OR, 4.7; 95% CI, 3.1 to 7.1) and annual number of deliveries (OR, 2.8; 95% CI, 1.6 to 4.7) of institutions in the upper third of each category at before first intervention had a significant contribution to the decrease of cesarean section rates. CONCLUSIONS: We could not found the evidence that RPR has had the significant effect of reducing cesarean section rates. Institutions with upper baseline cesarean section rates and annual number of deliveries were more responsive to RPR.

Summary

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English Abstract

The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty.: Won Mo Jang, Sang Jun Eun, Pilyoung Sagong, Chae Eun Lee, Moo Kyung Oh, Juhwan Oh, Yoon Kim; J Prev Med Public Health. 2010;43(6):523-534.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.523

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Abstract PDF

OBJECTIVES
We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. METHODS: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume(over 16 operations in a year) and low volume institutions, after performance reporting (december 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. RESULTS: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p=0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25-0.95) and 10% (beta=-0.102 p<0.01) and cost was not changed (beta=-0.01, p<0.27). The high volume institutions were more decreased than low volume in length of stay. CONCLUSIONS: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginal shifted from low volume institutions to high volume institutions.

Summary

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The factors influencing variation by local areas in antibiotics prescription rate according to the public reporting
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