J Korean Med Sci.  2022 Aug;37(30):e234. 10.3346/jkms.2022.37.e234.

Continuing Quality Assessment Program Improves Clinical Outcomes of Hospitalized Community-Acquired Pneumonia: A Nationwide CrossSectional Study in Korea

• An TJ
• Myong JP
• Lee YH
• Kwon SO
• Shim EK
• Shin JH
• Yoon HK
• Jeong SH

• KMID: 2532228
• DOI: http://doi.org/10.3346/jkms.2022.37.e234

Abstract

Background
Pneumonia, which is the third leading cause of death in South Korea, is continuously increasing with the aging society. The Health Insurance Review and Assessment of South Korea conducted a quality assessment (QA) for improving the outcome of community-acquired pneumonia (CAP).
Methods
We conducted a nationwide cross-sectional study of hospitalized CAP in South Korea. First to third QA data were gathered into a single database. The national health insurance database was merged with the QA database for analyzing the medical claims data. Comorbidities, pneumonia severity, and pneumonia care appropriateness were calculated using Charlson comorbidity index (CCI), CURB-65, and core assessment of CAP scores (CAP scores), respectively.
Results
Overall, 54,307 patients were enrolled. The CAP scores significantly improved on QA program implementation (P < 0.001). All the variables demonstrated an association with in-hospital mortality, hospital length of stay (LOS), and 30-day mortality in the univariate analyses. Following the adjustments, higher CCI and CURB-65 scores were associated with higher in-hospital mortality, longer hospital LOS, and higher 30-day mortality. Male sex was associated with higher in-hospital/30-day mortality and shorter hospital LOS. Higher CAP scores were associated with shorter hospital LOS (P < 0.001). Upon QA program implementation, in-hospital mortality (P < 0.001), hospital LOS (P < 0.001), and 30-day mortality (P < 0.001) improved.
Conclusion
Continuing QA program is effective in improving the clinical outcomes of hospitalized CAP.

Keyword

Community-Acquired Infections; Pneumonia; Prognosis; Quality of Health Care

Figure

• 

  Fig. 1 Schematic diagram of the study. Both QA database and medical claims database were manipulated by the HIRA of South Korea. All the data were matched by anonymous join keys. From 1st to 3rd QA rounds, 54,307 hospitalized CAP cases were collected, after excluding the non-CAP cases.QA = quality assessment, HIRA = Health Insurance Review and Assessment Service, CAP = community-acquired pneumonia.

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