Building Linked Big Data for Stroke in Korea: Linkage of Stroke Registry and National Health Insurance Claims Data

Abstract

Background Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. Methods Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006–2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. Results Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1–7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. Conclusion We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.

Medical Insurance Information Systems in China: Mixed Methods Study

“…France built its national database EGB (Echantillon Generaliste des Beneficiaires) [ 34 ], conducts research on the effects of drugs, and conducts research and development on new drugs through claims data [ 35 ]. South Korea built its National Health Insurance Research Database, which functions to make secondary compensation for catastrophic expenditures; it also provides specific datasets to researchers for scientific research, especially for public health governance and infectious disease monitoring through data correlation [ 36 ]. The medical insurance database of Taiwan is used for research on cancer treatment [ 37 ].…”

Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea

“…By contrast, three institutions with dedicated neurointensivisits already had stroke units for stroke patients, and the patients who need real ICU care were admitted to the NICU. Therefore, the baseline characteristics of the patients admitted to the ICU (using only AJ code) (n = 7,410) were not comparable, and more severe patients are in the NICU at the institutions with dedicated neurointensivists (initial NIHSS 14 IQR [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in centers with neurointensivists [n = 473, 6.4%] vs. 6 IQR [2][3][4][5][6][7][8][9][10][11][12][13] in centers without neurointensivists [n = 6,937, 93.6%]) (Supplementary Table 1). Given that respiratory failure is the most common, but important complication in patients with NICU, we selected 1,045 patients with the support of mechanical ventilator among acute ischemic stroke (with neurointensivists group, n = 303 [64.1%, 303 out of 473] and without neurointensitivsts group, n = 1,102 [15.9%, 1,102 out of 6,937]), and then the baseline characteristics were comparable between the two groups ( Table 1).…”

“…Detailed information on the study population has been described previously. 12 We initially included ischemic stroke patients with 3-month modified Rankin scale (mRS) information (n = 27,479) available from the linking of the CRCS registry data with the HIRA data between January 2007 and December 2014. We excluded patients who visited the hospital before July 2007 (n = 2,511) for updating risk factors and medication information using the linked dataset, and those with missing data regarding the stroke mechanism (n = 61).…”

10th Anniversary of the Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia-Pacific

“…There were large, comprehensive national registries on stroke: the China National Stroke Registry (CNSR) [ 18 , 52 ], Korean Stroke Registry (KSR) [ 53 ], and the Taiwan Stroke Registry (TSR) [ 54 ]. These are collaborative national registries that collect clinical data on acute stroke and TIA which serve to assess stroke care quality and provide feedback on evidence-based performance measures.…”