Evaluation of the Validity of Risk-Adjustment Model of Acute Stroke Mortality for Comparing Hospital Performance
병원 성과 비교를 위한 급성기 뇌졸중 사망률 위험보정모형의 타당도 평가

Eun Young Choi, Seon-Ha Kim, Minsu Ock, Hyeon-Jeong Lee, Woo-Seung Son, Min-Woo Jo, Sang-il Lee
2016 Health Policy and Management  
The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity,
more » ... , stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, R 2 values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic = 0.881, Hosmer-Lemeshow test p = 0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic= 0.867, Hosmer-Lemeshow test p= 0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality. 서 론 뇌혈관질환은 우리나라 사망원인 중에서 단일 질환으로는 심장 질환에 이어 2위에 해당하는 주요한 사망원인이며[1], 발병 이후 반 신마비, 감각소실, 언어장애, 치매 등의 후유증으로 이어져 의료비 의 부담을 가중시키고 있다[2]. 무엇보다 뇌혈관질환은 노인 인구 에서의 발생률이 높은 질환이기 때문에[2,3], 고령화 사회에 접어든 우리나라에서 중요한 보건문제로 대두되고 있다. 이에 정부에서는
doi:10.4332/kjhpa.2016.26.4.359 fatcat:xcfebwlowffq5ip7afrockgegm