건강보험 청구명세서 자료를 이용한 제왕절개 분만율 위험도 보정의 효과
Impact of Risk Adjustment with Insurance Claims Data on Cesarean Delivery Rates of Healthcare Organizations in Korea
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참고문헌
초록
Abstract
Objectives: To propose a risk-adjustment model from insurance claims data, and analyze the changes in cesarean section rates of healthcare organizations after adjusting for risk distribution. Methods: The study sample included delivery claims data from January to September, 2003. A risk-adjustment model was built using the 1st quarter data, and the 2nd and 3rd quarter data were used for a validation test. Patients’ risk factors were adjusted using a logistic regression analysis. The c-statistic and Hosmer-Lemeshow test were used to evaluate the performance of the risk-adjustment model. Crude, predicted and risk-adjusted rates were calculated, and compared to analyze the effects of the adjustment. Results: Nine risk factors (malpresentation, eclampsia, malignancy, multiple pregnancies, problems in the placenta, previous Cesarean section, older mothers, bleeding and diabetes) were included in the final riskadjustment model, and were found to have statistically significant effects on the mode of delivery. The c-statistic (0.78) and Hosmer-Lemeshow test (ဂ2=0.60, p=0.439) indicated a good model performance. After applying the 2nd and 3rd quarter data to the model, there were no differences in the c-statistic and Hosmer-Lemeshow ဂ2. Also, risk factor adjustment led to changes in the ranking of hospital Cesarean section rates, especially in tertiary and general hospitals. Conclusion: This study showed a model performance, using medical record abstracted data, was comparable to the results of previous studies. Insurance claims data can be used for identifying areas where risk factors should be adjusted. The changes in the ranking of hospital Cesarean section rates implied that crude rates can mislead people and therefore, the risk should be adjusted before the rates are released to the public. The proposed risk-adjustment model can be applied for the fair comparisons of the rates between hospitals.
참고문헌 (23)
- Lee SI, "sattitudes toward mode of delivery in SouthKorea-A society with high cesarean sectionrates", 31(2), pp.108~116
- Graham WJ, "s involvement in the decision todelivery by caesarean section", 106, pp.213~220
- Jackson NV, "The influence ofmaternal request on the elective caesareansection rate", 18, pp.115~119 (1998)
- Mould TAJ, "s involvement with the decisionpreceding their caesarean section and theirdegree of satisfaction", 103, pp.1074~1077
- Flamm BL, "Guidelines for appropriateutilization", pp.207~221, Springer-Verlag 1995
- World Health Organization, "Appropriatetechnology for birth", ii, pp.436~437 (1985)
- Curtin S, "Trends in cesarean birthand vaginal birth after previous cesarean", 1991(99) (2001)
- Aron DC, "Impact of risk-adjustingcesarean delivery rates when reporting hospitalperformance", 279, pp.1968~1972 (1998)
- Bailit JL, "Riskadjustment for interhospital comparison ofprimary cesarean rates", 93, pp.1025~1030 (1999)
- Elliott JP, "A moreinformative method than the cesarean sectionrate for assessing a practitioner", 177, pp.139~143
- Keeler EB, "Adjusting cesarean delivery rates forcase mix", 32(4), pp.511~528 (1997), Health Serv Res
- Kritchevsky SB, "Definition and adjustment of cesarean sectionrates and assessments of hospital performance", 11(4), pp.283~291 (1999)
- Lieberman E, "Assessing the role of case mix in cesareandelivery rates", 92(1), pp.1~7 (1998)
- Lee S, "Inter-hospital comparison ofcesarean section rates after risk adjustment", 34(4), pp.337~346
- Koroukian, "Estimating the proportion of unnecessarycesarean sections in Ohio using birth certificatedate", 51(12), pp.1327~1334 (1998)
- Katona M, "Risk factors forcesarean section of primiparous women agedover 35 Years", 81, pp.313~316 (2002)
- Toselli A, "Study of theVariations of the cesarean sections rate in theRhone-Alpes region effect of womenand maternity service characteristics", 78, pp.11~17
- "A joint project of the pennsylvania health carecost contrastment council and thepennsylvania department of health c-sectiondeliveries in pennsylvania"
- Iezzoni LI, "Risk adjustment for measuringhealthcare outcomes", pp.331~363 (1997), Health Administration Press
- Park H, "Assessment of severity adjustmentmeasures for AMI patients in Korea", 10(2), pp.164~175 (2003)
- Iezzoni LI, "Assessing quality usingadministrative data", 127(8), pp.666~674 (1997)
- Iezzoni LI, "Risk adjustment for measuringhealthcare outcomes", 349 (1997), Health Administration Press
- Iezzoni LI, "The Risk of risk adjustment", 278(19), pp.1600~1607