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Published on: December 19, 2025
Validation of Stroke and Thrombolytic Therapy in Korean National Health Insurance Claim Data
Tai Hwan Park1, Jay Chol Choi2
1Department of Neurology, Seoul Medical Center, Seoul, Korea.
Insights
Korean National Health Insurance claims data accurately identify hemorrhagic stroke and thrombolytic therapy use. Ischemic stroke identification showed substantial agreement, validating NHI data for stroke research.
Area of Science:
- Health Services Research
- Medical Informatics
- Neurology
Background:
- The Korean National Health Insurance (NHI) claims database is a valuable resource for epidemiological research.
- Validating administrative data for specific clinical conditions like stroke is crucial for research accuracy.
Purpose of the Study:
- To assess the accuracy of hospital discharge data from the NHI system in identifying acute stroke events.
- To evaluate the reliability of NHI claims data in capturing the use of thrombolytic therapy for stroke patients.
Main Methods:
- Retrieved hospital discharge data for 1,811 patients with stroke-related diagnoses from two centers.
- Tested three algorithms using diagnosis codes to identify acute stroke (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage).
- Used medical record reviews as the gold standard for validation.
Main Results:
- Algorithms using more diagnosis codes (up to nine or primary/secondary) showed higher agreement for identifying stroke types compared to using only the primary diagnosis.
- High accuracy (>90% sensitivity and specificity) and agreement (κ=0.83-0.84) were observed for ischemic stroke and subarachnoid hemorrhage in one dataset.
- Intracranial hemorrhage identification showed near-perfect agreement with specific algorithms.
- Thrombolytic therapy use was identified with very high reliability (κ=0.91-0.99) across both datasets.
Conclusions:
- Administrative discharge data reliably identify hemorrhagic stroke and thrombolytic therapy use.
- NHI claims data demonstrate substantial agreement for identifying ischemic stroke, supporting its utility in stroke research.
- Algorithm choice impacts accuracy, but overall, NHI data are valuable for stroke research.
Background And Purpose:
The claims data of the Korean National Health Insurance (NHI) system can be useful in stroke research. The aim of this study was to validate the accuracy of hospital discharge data used for NHI claims in identifying acute stroke and use of thrombolytic therapy.
Methods:
The hospital discharge data of 1,811 patients with stroke-related diagnosis codes were obtained from Jeju National University Hospital (JNUH) and Seoul Medical Center (SMC). Three algorithms were tested to identify discharges with acute stroke [ischemic stroke (IS), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH)]: 1) all diagnosis codes up to nine positions, 2) one primary diagnosis and one secondary diagnosis, and 3) only one primary diagnosis code. Reviews of medical records were considered the gold standards.
Results:
Overall, the degree of agreement (κ) was higher for algorithms 1 and 2 than for algorithm 3, and the sensitivity and specificity of the first two algorithms for IS and SAH were both >90%, with almost perfect agreement (κ=0.83-0.84) in the JNUH data set. Regarding ICH, only algorithm 1 yielded an almost perfect agreement (κ=0.82). In the SMC data set, almost perfect agreement was found for both ICH and SAH in all three algorithms. In contrast, the three algorithms yielded a range of agreement levels, though all substantial, for IS. Almost perfect agreement was obtained for use of thrombolytic therapy in both data sets (κ=0.91-0.99).
Conclusions:
Discharge with hemorrhagic stroke and use of thrombolytic therapy were identified with high reliability in administrative discharge data. A substantial level of agreement was also obtained for IS, despite variation between the algorithms and data sets.
