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

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Version 2 2023-07-20, 20:26
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posted on 2023-07-20, 20:26 authored by Ji Hye Huh, Serim Kwon, Gui Ok Kim, Bo Yeon Kim, Kyoung Hwa Ha, Dae Jung Kim

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.  

Funding

This study was supported by the Joint Project on Quality Assessment Research of the Health Insurance Review and Assessment Service, Republic of Korea. This study used the Health Insurance Review and Assessment Service data (No.M20220127796) made by the Health Insurance Review and Assessment Service.

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