Implementation of the Chronic Disease Care System and its association with health care costs and continuity of care in Korean adults with type 2 diabetes mellitus

Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study

OBJECTIVES

Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.

METHODS

Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression.

RESULTS

The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.

CONCLUSIONS

The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

The effect of continuity of care of dyslipidaemia patients on preventable hospitalisation and healthcare expenditures

Although continuous treatment leads to better patient outcomes, evidence regarding the effect of the continuity of care (COC) on preventable hospitalisation and medical expenses in Korea for patients with dyslipidaemia is insufficient. We evaluated the effect of COC on preventable hospitalisation and medical expenses for patients with dyslipidaemia. This study used National Health Insurance Sampling cohort data (2008-2015). We measured COC with the Bice-Boxerman index based on the outpatient visits of patients diagnosed with dyslipidaemia for the first time. Preventable hospitalisation included admission for cardiovascular disease (CVD) and all costs for outpatient visits. We evaluated the association of COC with preventable hospitalisation and medical expenses using a generalised estimating equation model. Patients (N = 53,372) with newly diagnosed dyslipidaemia participated. Compared to non-hospitalised patients, hospitalised patients had higher fragmentation scores for CVD, met more healthcare providers, had higher total outpatient visits and had a lower proportion of primary healthcare providers served. A higher fragmentation score was associated with an increased risk of hospitalisation (rate ratio [RR]: 1.873, 95% confidence interval [CI]: 1.520-2.309) and healthcare expenditure (RR: 1.381, 95% CI: 1.322-1.442). The magnitude of the effect of COC on hospitalisation differed according to patients' drug intake and residence location. Fragmentation of care was associated with preventable hospitalisation and increased healthcare costs, especially for patients taking medications/living in rural areas. It is necessary to promote a more effective COC.

The Effect of Chronic Disease Management Program on the Risk of Complications in Patients With Hypertension in Korea

BACKGROUND

A chronic disease management program was implemented in April 2012 to lower out-of-pocket costs for repeat visits to the same clinic. The aim of this study was to investigate the association between participating in this program and the onset of complications among patients with hypertension using whole-nation claims data.

METHODS

We used National Health Insurance Service data (2011-2018) and patients with newly detected hypertension from 2012 to 2014 were selected. Chronic disease management program reduces the out-of-pocket expenses of consultation fee from 30% to 20% when patients enroll in this program by agreeing to visit the same clinic for the treatment of hypertension or diabetes. As the dependent variable, acute myocardial infarction (MI), stroke, chronic kidney disease (CKD), and heart failure (HF) were selected. For analysis, cox proportional hazards model was used.

RESULTS

Total participants were 827,577, among which 102,831(12.6%) subjects participated in the chronic disease management. Participants of the chronic disease management program were more likely to show lower hazard ratios (HRs) than those of non-participants in terms of all complications (MI: HR, 0.75; 95% confidence interval [CI], 0.68-0.82; stroke: HR, 0.75; 95% CI, 0.72-0.78; CKD: HR, 0.90; 95% CI, 0.85-0.96; HF: HR, 0.56; 95% CI, 0.52-0.61).

CONCLUSION

The results showed that participants of the chronic disease management program were less likely to have hypertension complications compared to non-participants. Enhancing the participation rate may be related to better outcomes and reducing medical expenses among patients with chronic diseases.

Impact of continuity of care on risk for major osteoporotic fracture in patients with new onset rheumatoid arthritis

There is a clear relationship between rheumatoid arthritis (RA) and major osteoporotic fracture (MOF), although there is limited evidence on the effect of continuity of care (COC) on MOF in these patients. We investigated the association between COC and risk of MOF, including fractures of the lumbar spine and pelvis, forearm, and hip, among newly diagnosed RA patients aged ≥ 60 years. A total of 8715 incident RA patients from 2004 to 2010 were included from the Korean National Health Insurance Service-Senior cohort database. Participants were categorized into a good and bad COC group according to the COC index. The cumulative incidence of MOF was higher in RA patients with bad than in those with good COC (p < 0.001). The incidence rates of MOF were 4439 and 3275 cases per 100,000 person-years in patients with bad and good COC, respectively. RA patients with bad COC had an increased incidence of overall MOF (adjusted hazard ratio, 1.32; 95% confidence interval, 1.14–1.53), with the highest increase in risk being that of forearm fracture. An increased MOF risk in patients with bad COC was predominantly observed in females. This study suggested that interventions that can improve COC in patients with RA should be considered.

Chronic Disease Management for People With Hypertension

Objectives: To assess the effectiveness of continuity of care policies by identifying the impact of a chronic disease management program on the continuity of care in patients with hypertension in South Korea. Methods: The propensity score matching method was used to control selection bias, and the difference-in-differences method was used to compare the impact on the treatment and control groups according to the policy intervention. Results: The continuity of care index of hypertensive patients using the difference-in-differences analysis outcome of the chronic disease management program was higher than that of the non-participating hypertensive patients. Conclusion: Continuous treatment is vital for chronic diseases such as hypertension. However, the proportion of those participating in the intervention was low. Encouraging more hypertensive patients to participate in policy intervention through continuous research and expanding the policy to appropriately reflect the increasing number of chronic diseases is necessary.

A cost-effectiveness analysis of the Chronic Disease Management Program in patients with hypertension in Korea

BACKGROUND

The Chronic Disease Management Program (CDMP) of Korea has been introduced to improve care continuity in patients with hypertension and diabetes.

OBJECTIVE

This study evaluated the cost effectiveness of the CDMP in patients with hypertension from the perspective of the healthcare payer.

METHODS

A cost-effectiveness analysis was performed based on a Markov simulation model. The cost and effect of the CDMP versus usual care was compared in individuals aged 40 years or above. The two strategies were presumed to result in a difference in the incidence of myocardial infarction, stroke, and chronic kidney disease. The model was analyzed over the lifetime of the cohort. Incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference in lifetime costs by the difference in lifetime effects (quality adjusted life years, QALYs) between the two strategies. Costs were expressed in Korean Won (KRW).

RESULTS

The ICER value of the CDMP participation strategy was -5 761 088 KRW/QALY compared to usual care. Similar tendencies were found when limiting the population to only clinic users (-3 843 355 KRW/QALY) and national health examination participants (-5 595 185 KRW/QALY).

CONCLUSION

The CDMP was highly cost-effective in patients with hypertension aged 40 years or above. Implementing efficient policies that enhance care coordination and improve outcomes in patients with hypertension is important.

Status and Influential Factors of Intelligent Healthcare in Nursing Homes in China

With the support of the Chinese government, nursing homes have increasingly adopted Internet and intelligent information technology to provide daily healthcare services to residents. However, no research has reported the status of intelligent healthcare in nursing homes. From September 2017 to May 2018, we conducted a survey of 197 nursing homes and collected information on their general characteristics, the intelligent healthcare services provided, the effectiveness of the application products used, and the attitudes of the staff and residents toward intelligent healthcare. Overall, 79.69% of the surveyed nursing homes have provided intelligent healthcare services, including medical care services (eg, chronic disease management and intelligent nursing) and daily life services (eg, fall monitoring and wireless positioning). Portable health monitoring devices and data management and service platforms are the most used healthcare products. The attitudes of staff probably affected the development of intelligent healthcare. Financial investment and the attitudes of staff and residents are factors that influence the effectiveness of the application of intelligent healthcare products in nursing homes. With the support of national policies, nursing homes have implemented primary intelligent healthcare. Stakeholders play pivotal roles in the provision of intelligent healthcare services.

Knowledge levels among elderly people with Diabetes Mellitus concerning COVID-19: an educational intervention via a teleservice

AIM

To investigate knowledge levels concerning COVID-19 in elderly patients with T2DM.

METHODS

This cross-sectional, quantitative, observational, and descriptive study was undertaken among elderly individuals with T2DM involved in a body balance rehabilitation program that had been suspended due to social isolation. The study participants comprised elderly individuals with T2DM, contactable using fixed or mobile telephones. Data concerning participants' socioeconomic variables and knowledge of COVID-19 were collated, using a Brazil Ministry of Health guidelines checklist. Mann-Whitney and Spearman's correlation tests were used to analyze their responses.

RESULTS

Of 30 elderly participants, 76.7% were women and 63.3% were married. The average age was 69.96 ± 4.46 years. The most cited information medium was television (96.6%). Of a possible 24 correct responses on the checklist, the median correct response score was 7.5. No significant relationship was observed between the total checklist score and the variables studied.

CONCLUSION

Elderly participants did not have in-depth knowledge concerning COVID-19, which suggests that their knowledge sources may be deficient or that their capacity to retain information was inadequate.