Cancer Res Treat.  2023 Apr;55(2):570-579. 10.4143/crt.2022.882.

Quality Assessment and Trend for Breast Cancer Treatment Practice across South Korea Based on Nationwide Analysis of Korean Health Insurance Data during 2013-2017

• Choi KH
• Sung SY
• Lee SW
• Jeon YW
• Kim SH
• Lee JH

• KMID: 2541244
• DOI: http://doi.org/10.4143/crt.2022.882

Abstract

Purpose
Quality assessment of breast cancer treatment in South Korea showed the upward standardization of the grade since 2013, but treatment disparities still have existed. This study analyzed the five year trend between 2013 and 2017 in the assessment of breast cancer treatment practice using the Korean health insurance data.
Materials and Methods
All the medical records including surgery, chemotherapy, and radiotherapy for 7,354 patients a year on average were evaluated. Twenty indices were consisted of one structural, 17 process-related, and 2 result-related factors. We calculated the coefficient of variation (CV) annually to determine the variation in adherence rate of evaluation indices according to the type of institution (advanced vs. general hospital vs. clinic).
Results
Based on the initial assessment in 2013, 10 out of 20 indicators showed significant variation among the types of institutions with a CV of less than 0.1%. Six of them had a CV decline of less than 0.1%. The CV was still 0.1% or higher in the four indicators, including the composition of professional staff, the implementation of target therapy, the average length of hospital stay, and the hospitalization cost. Regarding the first-grade of assessment, there was a statistically significant relationship between the institution type (p=0.029) and region (metropolitan vs. province, p<0.001).
Conclusion
There were disparities in the structural and systemic treatment factors depending on the institutional type. The quality improvement of the regional institutions and multidisciplinary experts for breast cancer is necessary.

Keyword

South Korea; Breast neoplasms; Quality assessment; Health insurance

Figure

• 

  Fig. 1 Definition of 20 evaluation indices. AI, aromatase inhibitors; DRG, diagnosis-related group; FISH, fluorescence in situ hybridization; HER2, human epidermal growth factore receptor 2; NCCN, National Comprehensive Cancer Network; SISH, silver-enhanced in situ hybridization.

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  Fig. 2 Coefficient of variation by institution type from 2013 to 2017. (A) Structural indicator and report fidelity. (B) Surgery-related indicators. (C) Systemic therapy–related indicators. (D) Radiotherapy-related indicators. (E) Result indicators. AI, aromatase inhibitors.

• 

  Fig. 3 Distribution of grades according to evaluation year in 2013 vs. 2017 (A), metropolitan area vs. provinces (B), and advanced general hospital vs. general hospital (C).

Reference

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