J Korean Med Sci.
2019 Aug;34(31):e190. 10.3346/jkms.2019.34.e190.
Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
- Affiliations
-
- 1Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea. jylee2000@gmail.com
- 2Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
- 3Department of Nursing Science, Shinsung University, Dangjin, Korea.
- 4Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
- 5Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea.
- 6Health Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea.
- 7Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
- 8Department of Public Health and Community Medicine, Seoul Metropolitan Government – Seoul National University Boramae Medical Center, Seoul, Korea.
- KMID: 2455098
- DOI: http://doi.org/10.3346/jkms.2019.34.e190
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.
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