Personal variation in patient-centered relevance Index based on individual characteristics and medical conditions among patients with diabetes Mellitus in Korea

Abstract

ObjectivesThis study aimed to identify patients at higher risk for regional disengagement from health services using the Patient-centered Relevance Index (P-RI).MethodsThis nationwide retrospective cohort study analyzed the relationship between the P-RI and individual patient characteristics, including medical conditions and healthcare utilization patterns. The National Health Insurance Service claims database was used to characterize healthcare utilization by 3,046,914 patients with DM from 2017 to 2020.ResultsAs compared to the mild condition group, all other groups had a lower P-RI. Significant differences were observed among the groups with P-RI lower by 16.5%, 14%, 13%, 0.4%, and 0.6% in the repeated inpatient treatment (β = -0.165, P < 0.001), complication (β = -0.141, P < 0.001), extended long-term care stay (β = -0.130, P < 0.001), comorbidity (β = -0.041, P < 0.001), and other (β = -0.058, P < 0.001) groups, respectively. Additionally, the P-RI was high among low-income and older patients with high acuity.DiscussionSouth Korea's healthcare delivery system is not regionally self-sufficient. A relatively low P-RI in the high income and younger groups indicates healthcare access inequity. Therefore, a continuous management system that ensures uniform healthcare access needs to be established.