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Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea

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 c...

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Autores principales: Cho, Sanghyun, Shin, Ji-Yeon, Kim, Hyun Joo, Eun, Sang Jun, Kang, Sungchan, Jang, Won Mo, Jung, Hyemin, Kim, Yoon, Lee, Jin Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689488/
https://www.ncbi.nlm.nih.gov/pubmed/31392852
http://dx.doi.org/10.3346/jkms.2019.34.e190
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author Cho, Sanghyun
Shin, Ji-Yeon
Kim, Hyun Joo
Eun, Sang Jun
Kang, Sungchan
Jang, Won Mo
Jung, Hyemin
Kim, Yoon
Lee, Jin Yong
author_facet Cho, Sanghyun
Shin, Ji-Yeon
Kim, Hyun Joo
Eun, Sang Jun
Kang, Sungchan
Jang, Won Mo
Jung, Hyemin
Kim, Yoon
Lee, Jin Yong
author_sort Cho, Sanghyun
collection PubMed
description 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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spelling pubmed-66894882019-08-12 Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea Cho, Sanghyun Shin, Ji-Yeon Kim, Hyun Joo Eun, Sang Jun Kang, Sungchan Jang, Won Mo Jung, Hyemin Kim, Yoon Lee, Jin Yong J Korean Med Sci Original Article 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. The Korean Academy of Medical Sciences 2019-07-09 /pmc/articles/PMC6689488/ /pubmed/31392852 http://dx.doi.org/10.3346/jkms.2019.34.e190 Text en © 2019 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Cho, Sanghyun
Shin, Ji-Yeon
Kim, Hyun Joo
Eun, Sang Jun
Kang, Sungchan
Jang, Won Mo
Jung, Hyemin
Kim, Yoon
Lee, Jin Yong
Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
title Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
title_full Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
title_fullStr Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
title_full_unstemmed Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
title_short Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
title_sort chasms in achievement of recommended diabetes care among geographic regions in korea
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689488/
https://www.ncbi.nlm.nih.gov/pubmed/31392852
http://dx.doi.org/10.3346/jkms.2019.34.e190
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