Quality Assessment and Trend for Breast Cancer Treatment Practice Across South Korea Based on Nationwide Analysis of Korean Health Insurance Data During 2013-2017
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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 5-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 consisted of one structural, 17 process-related, and two 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.
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 5-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 consisted of one structural, 17 process-related, and two 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.
참고문헌 (28)
- Sung H, "Global cancer statistics 2020 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 71, pp.209~249 (2021)
- 강미주, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2019", Cancer Research and Treatment, 54(2), pp.330~344 (2022), 대한암학회[DOI]
- 정일용, "Nationwide Analysis of Treatment Patterns for Korean Breast Cancer Survivors Using National Health Insurance Service Data", Journal of Korean Medical Science, 33(44), pp.1~10 (2018), 대한의학회
- "Evaluation report" (2020)[URL]
- "Korean Society for Health Equity in Health" (2022)[URL]
- Kim SH, "Intensity of care at the end of life among older adults in Korea", J Palliat Care, 33, pp.47~52 (2018)
- Goldhirsch A, "Thresholds for therapies : highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009", Ann Oncol, 20, pp.1319~1329 (2009)
- Han D, "Is knowledge translation adequate? A quality assurance study of staging investigations in early stage breast cancer patients", Breast Cancer Res Treat, 132, pp.1~7 (2012)
- Perry N, "European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition : summary document", Oncol Clin Pract, 4, pp.74~86 (2008)
- Raval MV, "Using the NCDB for cancer care improvement : an introduction to available quality assessment tools", J Surg Oncol, 99, pp.488~490 (2009)
- Biganzoli L, "Quality indicators in breast cancer care : an update from the EUSOMA working group", Eur J Cancer, 86, pp.59~81 (2017)
- National Quality Forum, "National voluntary consensus stan-dards for quality of cancer care", National Quality Forum, ~ (2009)
- UCLA appropriateness method user’s manual, "The RAND", pp.2001, Fitch K
- Bedeian AG, "On the use of the coefficient of variation as a measure of diversity", Org Res Methods, 3, pp.285~297 (2000)
- Lunneborg CE, "Encyclopedia of statistics in behavioral science" (2005), John Wiley & Sons
- Burstein HJ, "Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer : American Society of Clinical Oncology Clinical Practice Guideline update on ovarian suppression", J Clin Oncol, 34, pp.1689~1701 (2016)
- Schlam I, "Emerging targeted therapies for early breast cancer", Drugs, 82, pp.1437~1451 (2022)
- Gilligan MA, "Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer", Am J Public Health, 97, pp.539~544 (2007)
- Guller U, "High hospital volume is associated with better outcomes for breast cancer surgery : analysis of 233, 247 patients", World J Surg, 29, pp.994~999 (2005)
- Giorgi Rossi P, "Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative", Br J Cancer, 124, pp.1503~1512 (2021)
- Fan L, "Breast cancer in China", Lancet Oncol, 15, pp.e279~89 (2014)
- Kurebayashi J, "Clinicopathological characteristics of breast cancer and trends in the management of breast cancer patients in Japan : Based on the Breast Cancer Registry of the Japanese Breast Cancer Society between 2004 and 2011", Breast Cancer, 22, pp.235~244 (2015)
- Lin CH, "Molecular subtypes of breast cancer emerging in young women in Taiwan : evidence for more than just westernization as a reason for the disease in Asia", Cancer Epidemiol Biomarkers Prev, 18, pp.1807~1814 (2009)
- Ou-Yang F, "Breast cancer quality of care in Taiwan in relation to hospital volume : a population-based cohort study", Asia Pac J Clin Oncol, 11, pp.308~313 (2015)
- Mukai H, "Quality evaluation of medical care for breast cancer in Japan", Int J Qual Health Care, 28, pp.110~113 (2016)
- 최규혜, "Current Trends in the Quality Assessment of Colorectal Cancer Practice and Treatment in South Korea during 2012-2017", Cancer Research and Treatment, 53(2), pp.487~496 (2021), 대한암학회[DOI]
- Ramsdale EE, "Improving quality and value of cancer care for older adults", Am Soc Clin Oncol Educ Book, 37, pp.383~393 (2017)
- Moth EB, "How do oncologists make decisions about chemotherapy for their older patients with cancer? A survey of Australian oncologists", Support Care Cancer, 26, pp.451~460 (2018)