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JKM > Volume 35(3); 2014 > Article
Ryu, Lim, Lee, Kim, and Han: Revision and Evaluation of Korean Outpatient Groups-Korean Medicine

Abstract

Objectives:

This study aimed at revising the Korean Out-patient Groups for Korean Medicine (KOPG-OM, version 1.0) based on clinical similarity and resource use, by using the accumulated claims data, and evaluating the validity of the revised classification system.

Methods:

A clinical specialist panel involving 19 specialists from 8 Korean medicine (KM) specialty areas reviewed the classification tree, diagnosis groups and procedure groups in terms of clinical similarity. Several models of outpatient grouping were formulated, with the validity of each tested based on the R2 coefficient of determination for the treatment costs of all visits. To add age splits, the variances of treatment costs by age groups were also analyzed. These statistical analyses were performed using KM claims data of National Health Insurance from 2010 to 2012.

Results:

The classification tree designed via panel discussions was used to allocate outpatient cases to 26 diagnosis groups, with cases involving procedures such as acupuncture, moxibustion and cupping, then allocated to 9 procedure groups in each diagnosis group. The cases without procedures were categorized into the visit index - medication group. This process resulted in 298 outpatient groups. The R2 values for treatment costs of all visits ranged from 0.38 to 0.69 depending on the providers' types.

Conclusions:

The revised model of KOPG-KM has a higher validity for outpatient classification than the current system and can provide better management of the costs of outpatient care in KM.

Fig. 1.
Classification Flow for KOPG-KM
jkm-35-3-93f1.tif
Table 1.
26 Disease Groups in KOPG-KM
Oder KCD-6 code Name
1 A00-B99 Infectious and parasitic diseases
2 C00-D48 Neoplasms
3 D50-D89 Diseases of the blood and immune mechanism
4 E00-E90 Endocrine, nutritional and metabolic diseases
5 F00-F99 Mental and behavioral disorders
6 G00-G99 Diseases of the nervous system
7 H00-H95 Diseases of the eye and adnexa
8 I00-I99 Diseases of the circulatory system
9 J00-J22 Acute respiratory diseases
10 J30-J99 Chronic respiratory diseases
11 K00-K99 Diseases of the digestive system
12 L00-L99 Diseases of the skin and subcutaneous tissue
13 M00-M36 Diseases of the joints and connective tissue
14 M60-M99 Diseases of the back and spine
15 M40-M54 Diseases of the musculoskeletal system
16 N00-N99 Diseases of the genitourinary system
17 O00-O99 Pregnancy, childbirth and the puerperium
18 P00-Q99 Certain conditions originating in the perinatal period
19 R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
20 S00-S99 Musculoskeletal injury
21 T00-T99 Injury, poisoning and certain other consequences of external causes
22 Z00-Z99/U00-U19 Factors influencing health status, contact with health services, and codes for special purposes
23 U20-U39 KM diseases
24 U50-U59 KM disease patterns of external contraction
25 U60-U79 KM Qi, blood, organs diseases patterns
26 U95-U98 KM Sasang constitutional medicine diseases patterns
Table 2.
9 Medication- Procedure Groups in KOPG-KM
Oder Name
1 non-acupuncture
2 single acupuncture
3 multiple acupuncture
4 single acupuncture+moxibustion
5 multiple acupuncture+moxabustion
6 single acupuncture+cupping
7 multiple acupuncture+cupping
8 acupuncture+moxibustion+cupping
9 medication+procedures
Table 3.
Divided Age Groups in KOPG-KM
Disease groups Medication-procedure groups Age (years)
G00-G99 Diseases of the nervous system single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication+procedures 0–64 / >64

K00-K99 Diseases of the digestive system single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication+procedures 0–17/ 18–64/ >64

M00-M36 Diseases of the joints and connective tissue single acupuncture+moxibustion 0–64 / >64
single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication+procedures 0–64 / >64

40-M54 Diseases of the musculoskeletal system single acupuncture+moxibustion 0–64 / >64
single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication+procedures 0–64 / >64

M60-M99 Diseases of the back and spine single acupuncture+moxibustion 0–64 / >64
single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication+procedures 0–64 / >64

R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication 0–17/ >17
medication+procedures 0–17/ 18–64/ >64

U20-39 KM diseases single acupuncture+cupping 0–64 / >64
multiple acupuncture+moxabustion 0–64 / >64
multiple acupuncture 0–64 / >64
medication 0–17/ >17
medication+procedures 0–17/ 18–64/ >64
Table 4.
R2 of KOPG-OM vs. Revised Model (KOPG-KM)
KM clinic data KM hospital data
N(visit) R2 (%) N(visit) R2 (%)
KOPG-OM 2010 data 94,025,463 9.50 - -
2011 data 94,971,038 9.87 - -
2012 data 23,388,209 9.75 731,670 22.80
Revised model (KOPG-KM) 2010 data 94,385,071 39.09 3,044,347 69.41
2011 data 95,056,203 44.12 3,132,393 38.26
2012 data 23,397,537 46.57 709,780 46.64

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