The nationwide retrospective cohort study by Health Insurance Review and Assessment Service proves that asthma management decreases the exacerbation risk of asthma

Nam-Eun Kim,Hyeon-Jong Yang,Sanghun Lee,Ae Gi Hwang,Sungho Won,Bo Yeon Kim,Ji Hyeon Shin

doi:10.1038/s41598-021-81022-z

Abstract

Medical costs have recently increased in South Korea due to the rising rate of asthma. Primary clinics serve an important role in asthma management, as they are the first stop for patients presenting with symptoms. The Health Insurance Review and Assessment Service (HIRA) in South Korea has assessed asthma-management quality since 2013, but studies are lacking on whether these assessments have been performed properly and contribute toward reducing asthma exacerbations. Therefore, we investigated whether the HIRA’s quality assessments have decreased asthma exacerbations using national health insurance claims data from 2013 to 2017 of 83,375 primary-clinic and 15,931 tertiary-hospital patients with asthma. These patients were classified into four groups based on disease severity according to the monthly prescribed amount of asthma medication using K-means clustering. The associations between HIRA assessments and asthma exacerbation were analyzed using a generalized estimating equation. Our results showed that exacerbation odds gradually decreased as the HIRA assessments progressed, especially in the mild-severity group, and that exacerbation risk among patients with asthma decreased in the order of assessment grades: “Unsatisfactory,” “Satisfactory,” and “Tertiary.” Therefore, we may conclude that asthma exacerbations may decrease with high quality asthma management; appropriate quality assessment could be helpful in reducing asthma exacerbations.

Highlights

Quality assessments of asthma management have been performed in South Korea since 2013 to improve the quality of asthma management provided by medical institutions
Intervention implementation in quality assessment could be tested while collecting evidence of clinical effectiveness that improved asthma management; such a study would be considered a type 3 hybrid design, i.e. a national-scale implementation study without effectiveness studies performed in advance[19]
Our large cohort study showed that institution assessment grade, severity, sex, age, Medication possession ratio (MPR), comorbidities, and assessment itself may be important factors related to asthma exacerbations

Summary

Introduction

Quality assessments of asthma management have been performed in South Korea since 2013 to improve the quality of asthma management provided by medical institutions. Asthma management in tertiary hospitals was assumed to be the best among medical institutions, as they had sufficient personnel, facilities, and equipment as prescribed by the ordinance of the Ministry of Health and Welfare. Intervention implementation in quality assessment could be tested while collecting evidence of clinical effectiveness that improved asthma management; such a study would be considered a type 3 hybrid design, i.e. a national-scale implementation study without effectiveness studies performed in advance[19]. The quality assessment considered the performance rate of each asthma care indicator rather than exacerbation rate in the classification of satisfactory clinics and it was evaluated whether satisfactory asthma management decreases asthma exacerbation regardless of severity. As part of the Joint Project on Quality Assessment Research by HIRA, we aimed to investigate whether asthma management quality assessments by the HIRA effectively classify the institutions and help encourage proper management to decrease asthma exacerbations

Objectives

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Conclusion