(P-PB-27) Single Unit Red Blood Cell Transfusion Rates Assessed by National Health Insurance Claims Data Increased Significantly in Korea

The implementation of a restrictive transfusion strategy involving single-unit red blood cell (RBC) transfusions has been validated as a safe and efficacious approach. After each unit transfused, a clinical and laboratory evaluation is recommended to assess the sufficiency of the transfusion and determine the necessity for additional units. The rate of single-unit transfusions can serve as an indicator of quality in institutional or national audits. Nonetheless, conducting objective audits on the clinical assessments performed by overseeing physicians presents practical challenges due to the complexity of clinical scenarios. In South Korea, the authors assessed the rates of single-unit RBC transfusions using claims data from the national health insurance provider, Health Insurance Review and Assessment Service (HIRA), which conducted its first national audit for transfusion appropriateness in 2020 and commenced a subsequent audit in 2023.

Study

Design/Methods: The claims data of HIRA from 2017 to September 2022 were analyzed, a total of 4,293,828 records. The single unit RBC transfusion was defined in two ways: 1) one unit of RBC was claimed for each order (Single unit transfusion per each order, STO), 2) one unit of RBC was claimed during entire hospitalization period (Single unit transfusion per admission, STA). STO and STA were analyzed according to the type of healthcare facility. Data analysis was conducted using SAS and R packages through the Remote Access Statistical Analysis System of HIRA. The study was exempted for review by the Inje University Ilsan Paik Hospital IRB.

Results/Findings:

STO were rapidly increasing from 38.0% in 2017 to 52.8% in 2022 for the total healthcare facilities, 36.8% to 46.3% for tertiary care hospitals, 41.2% to 60.2% for general hospital, 32.4% to 47.0% for regional hospitals. STO rate increase in 2022 comparing with 2017 was most significant for general hospitals with 19.0%p. Those for tertiary hospitals and regional hospitals were 9.5%p and 14.6%p, respectively. (Figure A)

STA were also rapidly increasing from 20.8% in 2017 to 30.2% in 2022 for the total healthcare facilities, 21.4% to 30.3% for tertiary care hospitals, 20.4% to 29.1% for general hospital, 20.4% to 33.7% for regional hospitals. STA increase in 2022 comparing with 2017 was most significant for regional hospitals with 13.3%p. Those for tertiary hospitals and general hospitals were 8.9%p and 8.7%p, respectively.

Conclusions:

transfusion management perspective. STO and STA in Korea showed a remarkable improvement. These could be attributed to the effectiveness of the HIRA's audits for blood transfusion appropriateness. Although HIRA data has the limitations of being solely based on claim information, the significant advantage of large-scale dataset enables the objective evaluation of transfusion quality in macroscopic level.