Endocrine Abstracts (2016) 41 EP438 | DOI: 10.1530/endoabs.41.EP438

The change of adherence to a process quality-of-care-indicator after the initiation of clinical audit in Korea

Soo-Kyung Kim1, Se-Hwa Kim2, Kyung Do Han3, Eun-Mi Kim4, Jin-Sook Cho4, Seok O Park5, Tea Sun Park6 & Yong-Wook Cho1

1Bundang Medical Center, CHA University, Seongnam, Republic of Korea; 2Catholic Kwandong University, Incheon, Republic of Korea; 3College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 4Health Insurance Review & Assessment Service, Wonju, Republic of Korea; 5Kwangmyung Sungae Hosiptal, Gwangmyeong, Republic of Korea; 6Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Republic of Korea.

Background: Adherence to recommended guideline for monitoring of glucose control and screening of diabetic complications has been demonstrated to prevent the chronic complications of diabetes. In Korea, the clinical audit for quality of diabetes care has been started in 2011. The aim of this study is to investigate the change of adherence to a process quality-of-care-indicator in diabetes after the initiation of audit in Korea.

Methods: This retrospective study was performed using the national health insurance claims database from the Health Insurance Review & Assessment Service (HIRA) of Korea, from 2009 to 2014. Study patients were aged 30 years or older, had type 2 diabetes, had taking at least one hypoglycemic agent in only one attending clinic at 2009, and had no history of any diabetes-related chronic complications including cardiovascular diseases before December, 2010, cancer, or hospitalization for ≥ 90 days (n=280,698). Process indicators included measurement of HbA1c more than once a year, annual measurement of lipid, annual examination for retinopathy and nephropathy.

Results: The number of patients receiving HbA1c and lipid measurement at least once a year increased to 69.9 and 54.5% in 2014 from 52.7 and 32.5% in 2009. Although the annual screening of nephropathy and retinopathy is also increased gradually, it is still low at 16.5 and 24.5% in 2014. Despite a gradual increase in the proportion of patients who underwent annual measurement of HbA1c and lipid and annual screening for retinopathy and nephropathy, only 6.1% of the patients met all four criteria in 2014 (1.5% in 2009 and 3.9% in 2011).

Conclusion: Although there were improvements in adherence to each process quality-of-care indicator, the percentage of patients undergoing all four examinations annually remained still very low.

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