Long-term effectiveness of the national diabetes quality assessment program in South Korea

Objective: This study examined the long-term effectiveness of the national diabetes quality assessment program (NDQAP) in diabetes.

Research Design and Methods: From the Health Insurance Review and Assessment Service database, 399,984 individuals with diabetes who visited a primary care clinic from July 1, 2012, to June 30, 2013, were included and followed up until May 31, 2021. The NDQAP included five quality assessment indicators: regular outpatient visits, continuity of prescriptions, regular testing of glycated hemoglobin and lipids, and regular fundus examination. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetes complications and all-cause mortality by the achievement of quality assessment indicators.

Results: During the mean follow-up duration of 7.6 ± 1.8 years, 20,054 (5.0%) cases of proliferative diabetic retinopathy (PDR), 6,281 (1.6%) end-stage kidney diseases (ESKD), 1,943 (0.5%) amputations, 9,706 (2.4%) myocardial infarctions (MI), 26,975 (6.7%) strokes, and 35,799 (8.9%) all-cause mortality occurred. Each achievement of quality assessment indicator was associated with a decreased risk of diabetes complications and all-cause mortality. Individuals who were managed in high-quality institutions had a lower risk of PDR (HR, 0.82; 95% CI, 0.80–0.85), ESKD (HR, 0.77; 95% CI, 0.73–0.81), amputation (HR, 0.75; 95% CI, 0.69–0.83), MI (HR, 0.85; 95% CI, 0.82–0.89), stroke (HR, 0.86; 95% CI, 0.84–0.88), and all-cause mortality (HR, 0.96; 95% CI, 0.94–0.98) than those who were not managed in high-quality institutions.

Conclusions: In Korea, the achievement of NDQAP indicators was associated with a decreased risk of diabetes complications and all-cause mortality.