Jo HS, Sung JH, Jeong HJ; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4048.
Kangwon National University, Dept. of Preventive Medicine, 192-1 Hyoja- Dong, Chunchon city, 200-701 Tel. 82-33-250-8872 Fax 82-33-250-8875
RESEARCH OBJECTIVE: We attempted to verify and to improve the quality of disease coding on health insurance claim data used in assessing of Korean Burden of Disease. Also, we understood health care organizational characteristics and patients characteristics affecting to coding error. STUDY DESIGN: 1. We organized reviewer group consisting of clinical specialists and researchers of health care management. The target diseases for validation are epilepsy, coronary heart disease, cerebro-vascular disease, rheumatoid arthritis, asthma, lumbar herniated disc disease, frequently utilized disease . 2. Considering the amount of the medical service use, the hospitals to be examined were selected by stratified sampling; consequently, 30 specialized general hospitals, 52 general hospitals, and 49 hospitals were chosen(a total of 131 medical facilities). 3. The validation of data was performed by turning out the agreement rates among the diagnostic code of insurance claim, diagnosis based upon medical records, and judgement by medical recorders. 4. The medical records and electric database of total 5,842 cases within our Korean disease cohort -700 of coronary heart diseases, 892 of stroke, 977 of rheumatoid arthritis, 399 of systemic lupus erythematous disease, 787 of bronchial asthma, 834 of epilepsy, and 1253 of the frequent diseases were checked from May 2003 to December 2003. POPULATION STUDIED: PRINCIPAL FINDINGS: 1. The accuracy rates were 79.7% in epilepsy, 61.4% in coronary heart disease, 75.8% in cerebro-vascular disease, 84.1% in rheumatoid arthritis, 52.6% in asthma, 81.0% in lumbar herniated disc disease, 84.1% in frequently utilized diseases. 2. Age group, utilization type, type of operation, Admission length,and medicare expenditure are related factor.3. We also developed adjustment Model. CONCLUSIONS: Our results show that the validity of data is various among diseases,and also suggest that there are many related factors related validity. As a results, our health insurance cohort through validation and adjustment can be used in broad researches of health care management area such as, assessment of health status and health related quality, choice of priorities in health sector, allocation of resources, and international comparative study. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE:
Publication Types:
Keywords:
- Arthritis, Rheumatoid
- Delivery of Health Care
- Evaluation Studies
- Forms and Records Control
- Health
- Health Policy
- Health Resources
- Health Services
- Health Services Administration
- Health Status
- Humans
- Insurance
- Insurance, Health
- Medical Records
- Medicare
- National Health Programs
- Quality of Health Care
- economics
- organization & administration
- hsrmtgs
UI: 103623511
From Meeting Abstracts