Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
10.3346/jkms.2019.34.e190
- Author:
Sanghyun CHO
1
;
Ji Yeon SHIN
;
Hyun Joo KIM
;
Sang Jun EUN
;
Sungchan KANG
;
Won Mo JANG
;
Hyemin JUNG
;
Yoon KIM
;
Jin Yong LEE
Author Information
1. Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea. jylee2000@gmail.com
- Publication Type:Original Article
- Keywords:
Small Area Variation;
Diabetes Mellitus;
Quality of Health Care
- MeSH:
Blood Pressure;
Continuity of Patient Care;
Diabetes Mellitus;
Humans;
Korea;
Lipoproteins;
Mass Screening;
National Health Programs;
Quality of Health Care;
Small-Area Analysis
- From:Journal of Korean Medical Science
2019;34(31):e190-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Although effective care for type 2 diabetes (T2DM) is well known, considerable inadequate care has been still existed. Variations in achievement of the recommended quality indicators inT2DM care among small areas are not well known in Korea. This study examined the quality of care T2DM care and its geographical variations. METHODS: We used the national health insurance database and national health screening database. Seven quality indicators were used to evaluate continuity of care (medication possession ratio), process of care (hemoglobin A1c test, lipid profile, microalbuminuria test, and eye examination), and intermediate outcome (blood pressure control, and low-density lipoprotein control). Crude and age-standardized proportions were calculated for each 252 districts in Korea. RESULTS: All quality indicators failed to achieve the recommended level. Only about 3% and 15% of the patients underwent eye examination and microalbuminuria test, respectively. Other indicators ranged from 48% to 68%. Wide variation in the quality existed among districts and indicators. Eye examination and microalbuminuria test varied the most showing tenfold (0.9%–9.2%) and fourfold (6.3%–28.9%) variation by districts, respectively. There were 32.4 and 42.7 percentage point gap between the best and the worst districts in hemoglobin A1c test and blood pressure control, respectively. CONCLUSION: Considerable proportion of T2DM patients were not adequately managed and quality of care varied substantially district to district. To improve the quality of diabetes care, it is necessary to identify the poor performance areas and establish a well-coordinated care system tailored to the need of the district.
