Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Respir Res. 2021 Mar 21;22(1):87. doi: 10.1186/s12931-021-01684-1.
The Korean Health Insurance Review and Assessment Service (HIRA) has launched the Chronic Obstructive Pulmonary Disease (COPD) Quality Assessment Program (CQAP) since 2014. We aimed to reveal the influence of this national program on clinical outcomes and the burden of COPD in Korea.
The CQAP is conducted annually. We used healthcare claims data linked with the results of the program provided by HIRA between May 2014 and April 2017. Patients were considered to have COPD if they visited a hospital for COPD management during the assessment term. Those who visited a medical institution for COPD and were prescribed COPD medications at least twice were assessed by the CQAP (assessed subjects, AS; not-assessed subjects, NAS). CQAP evaluated the pulmonary function test conduction rate, regular visitation rate, and prescription rates of COPD medications.
Among the 560,000 patients with COPD, about 140,000 were assessed by the CQAP annually. In both groups, the pulmonary function test conduction rate and inhaled bronchodilator prescription rate improved since 2014. Compared to the NAS group, the risk of admission and all-cause mortality rate in the AS group were significantly reduced by 21.2% and 40.7%, respectively. In patients who were assessed for 3 consecutive years, all of the above variables were high at baseline and were not improved much from implementation of CQAP. In matching analysis, we observed this improvement to be limited in the COPD quality assessment year.
The CQAP by the health insurance bureau has improved the management protocol and prognosis of COPD.
韩国健康保险审查评估服务机构（HIRA）自 2014 年以来启动了慢性阻塞性肺疾病（COPD）质量评估计划（CQAP）。我们旨在揭示该国家计划对韩国 COPD 的临床结果和负担的影响。
CQAP 每年进行一次。我们使用 HIRA 提供的医疗保健索赔数据与该计划的结果进行了链接，时间范围是 2014 年 5 月至 2017 年 4 月。如果患者在评估期间因 COPD 管理而到医院就诊，则认为患有 COPD。那些到医疗机构就诊并至少两次开 COPD 药物的患者接受 CQAP 评估（评估对象，AS；未评估对象，NAS）。CQAP 评估了肺功能测试的实施率、定期就诊率和 COPD 药物的处方率。
在 56 万名 COPD 患者中，每年约有 14 万人接受 CQAP 评估。在两组中，自 2014 年以来，肺功能测试的实施率和吸入支气管扩张剂的处方率都有所提高。与 NAS 组相比，AS 组的住院风险和全因死亡率分别降低了 21.2%和 40.7%。在连续 3 年接受评估的患者中，所有上述变量在基线时均较高，且自 CQAP 实施以来并未得到太大改善。在匹配分析中，我们观察到这种改善仅限于 COPD 质量评估年度。
医疗保险局的 CQAP 改善了 COPD 的管理方案和预后。
