백내장 수술의 적정성 및 질 관리방안
- Type
- Research report
- Issued Date
- 2022-11
- Publisher
- 건강보험심사평가원
- Table Of Contents
- 1. 연구 개요 ······························································································································· 1
가. 연구 제목 ························································································································· 1
나. 연구 수행 조직 및 역할 분담 ······················································································ 1
2. 연구 목적 및 필요성 ············································································································ 2
가. 연구 배경 ························································································································· 2
1) 백내장 수술의 발전 ····································································································· 2
2) 백내장 수술의 증가 추세 ···························································································· 3
3) 비급여 인공수정체 사용의 증가 ················································································ 3
4) 백내장 수술의 적정성 평가 ························································································ 4
나. 연구 목적 ························································································································· 7
다. 연구 방법 ························································································································· 8
1) 백내장 수술의 적응증, 적정성 평가의 개념적 틀과 이론 정립 ·························· 8
2) 건강보험심사평가원 청구 자료 분석 ········································································ 9
3) 국내·외 현황 조사 및 문헌 고찰 ············································································· 10
4) 표적집단면접조사(FGI) ······························································································ 11
5) 백내장 수술 적응증 관련 검사 평가 ······································································ 12
6) 백내장 질 관리 방안 제시 ······················································································· 13
3. 연구추진 일정 ····················································································································· 14
가. 회의 개최 ······················································································································· 14
나. 표적집단면접조사(FGI) 시행 ······················································································· 14
4. 현황 파악 및 청구 자료 분석 ·························································································· 15
가. 국내·외 백내장 수술 현황 ························································································· 15
나. 국내 백내장 수술 건수 청구 자료 분석 ··································································· 17
1) 분석 방법 ····················································································································· 17
2) 연령별 연간 백내장 수술 발생률(10만명당) ························································· 19
3) 출생 코호트별 연간 백내장 수술 발생률(10만명당) ············································ 20
4) 종별 백내장 수술 건수 추이(의원) ········································································· 22
5) 종별 백내장 수술 건수 추이(안과전문병원) ·························································· 24
6) 종별 백내장 수술 건수 추이(종합병원) ·································································· 26
7) 종별 백내장 수술 건수 추이(상급종합병원) ·························································· 27
다. 국내 백내장 검사 관련 청구 자료 분석 ··································································· 29
1) 분석 방법 ····················································································································· 29
2) 분석 결과 ····················································································································· 31
5. 백내장 수술의 적응증 및 적정성 제고 방안 ································································ 32
가. 국외 적응증 사례 ·········································································································· 32
1) Centers for Medicare and Medicaid Services(미국) ··································· 32
2) 미국안과학회(American Academy of Ophthalmology; AAO) 백내장 수술 가이드라인 ··· 33
3) Medical Management Plus, Inc. 백내장 수술 가이드라인 ····························· 34
4) Southern Cross Health Insurance(뉴질랜드) ················································· 34
5) The Shrewsbury and Telford Hospital (영국) ················································ 34
나. 국내 적응증 사례 ·········································································································· 36
1) 국내 백내장 수술 표준진료지침 ············································································ 36
2) 백내장 교과서 ··········································································································· 37
다. 표적집단면접조사 결과 Ⅰ (수술 적응증 등) ·························································· 38
1) 표적집단면접조사 정의 ····························································································· 38
2) 표적집단면접조사 방법 ····························································································· 38
3) 대상자 현황 및 일반적 특성 ···················································································· 39
4) 면접조사 결과 – 백내장 수술 적응증 관련 ························································· 40
라. 백내장의 객관적 판단을 위한 검사 방법 평가 ······················································· 43
1) 수술 연령 ····················································································································· 43
2) 세극등 현미경 검사 ··································································································· 44
3) 안저 검사 ····················································································································· 45
4) 대비감도 검사 ············································································································· 45
5) 시기능질분석검사(Otical Quality Analysis System; OQAS) ····························· 46
마. 백내장 수술의 적정성 제고 방안 ·············································································· 48
1) 현황 및 문제점 ··········································································································· 48
2) 선택적(elective) 수정체 수술의 구분 ····································································· 48
3) 적정성 제고 방안 ······································································································· 49
6. 백내장 수술의 질 관리를 위한 모니터링 방안 ····························································· 55
가. 국외 백내장 수술 질 관리 지표 ················································································ 55
1) 환자중심성 지표: Patient Reported Outcome Measures(PROM) ················ 55
나. 국내 백내장 수술 질 관리 지표 ················································································ 60
1) 표준진료지침(Critical Pathway;CP), 고려대 안암병원 사례 ····························· 60
2) 전문병원 분야별 의료 질 평가지표 개선 연구 ···················································· 62
다. 표적집단면접조사 결과 Ⅱ (질 관리 방안 등) ························································ 64
1) 면접조사 결과 - 백내장 수술 적정성 관리 관련 ················································· 64
2) 면접조사 결과 - 모니터링 지표 관련 ···································································· 68
라. 복잡 백내장 수술 ·········································································································· 70
1) 필요성 ··························································································································· 70
2) 정의 ······························································································································· 70
마. 백내장 수술의 질 관리를 위한 모니터링 지표 개발 ············································· 73
1) 질 평가 분류 방법: Donabedian 모델 ·································································· 73
2) 백내장 수술의 질 관리를 위한 모니터링 지표(안) ·············································· 74
3) 모니터링 지표 세부 ··································································································· 74
7. 제언 ······································································································································· 77
8. 참고문헌 ······························································································································· 79
[부록 1. 국외 백내장 수술 적응증 원문 자료] ·································································· 82
[부록 2. 백내장 분류법] ········································································································· 87
- Publisher
- 건강보험심사평가원
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- Citation
- 한국백내장굴절수술학회장. (2022-11). 백내장 수술의 적정성 및 질 관리방안.
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