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http://dx.doi.org/10.22537/jksct.17.1.21

Comparison of Mortality Rate according to Hospital Level among Patients with Poisoning Based on Korean Health Insurance and Assessment Service  

Kim, Soyoung (Department of Emergency Medicine, Anyang Sam Hospital)
Choi, Sangchun (Department of Emergency Medicine, Ajou University School of Medicine)
Kim, Hyuk-Hoon (Department of Emergency Medicine, Ajou University School of Medicine)
Yang, Hee Won (Department of Emergency Medicine, Ajou University School of Medicine)
Yoon, Sangkyu (Department of Emergency Medicine, Anyang Sam Hospital)
Publication Information
Journal of The Korean Society of Clinical Toxicology / v.17, no.1, 2019 , pp. 21-27 More about this Journal
Abstract
Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.
Keywords
Poisoning; Mortality; Health facility size; Insurance; Health; Reimbursement;
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Times Cited By KSCI : 3  (Citation Analysis)
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1 Chung S, Lee M, Kang H, et al. Analysis of poisoning patients using 2016 ED based injury in-depth surveillance data. J Korean Soc Clin Toxicol 2017;15(2):86-93.   DOI
2 Hua A, Haight S, Hoffman RS, et al. Endotracheal intubation after acute drug overdoses: incidence, complications, and risk factors. J Emerg Med 2017;52(1):59-65.   DOI
3 Beauchamp GA, Hendrickson RG, Hatten BW, et al. Endotracheal intubation for toxicologic exposures: a retrospective review of toxicology investigators consortium (ToxIC) cases. J Emerg Med 2016;51(4):382-8 e11.   DOI
4 Poisoning Prevention and Management. World Health Organization. 2016. Available at: https://www.who.int/ipcs/poisons/en/. Accessed February 20, 2019.
5 Fareed N. Size matters: a meta-analysis on the impact of hospital size on patient mortality. Int J Evid Based Healthc 2012;10(2):103-11.   DOI
6 Lee H, Han J, Kim J, et al. Epidemiologic characteristics of intentional poisoning: emergency department based injury in-depth surveillance during 2011-2015. J Korean Soc Clin Toxicol 2017;15(2):131-9.   DOI
7 Jo H, Lee C, Park J, et al. Unintentional pharmaceutical poisoning in the emergency department. J Korean Soc Clin Toxicol 2018;16(2):116-23.   DOI
8 Kang B. Toxicants reported in research on fatal toxic exposure in Korea. J Korean Soc Emerg Med 2007;18(1):32-40.
9 2017 Causes of death and injury, Korea. Korea Institute for Health and Social Affairs. Available at: http://kostat.go.kr. Accessed November 25, 2018.
10 Burke LG, Frakt AB, Khullar D, et al. Association between teaching status and mortality in US hospitals. JAMA 2017;317(20):2105-13.   DOI
11 Shahian DM, Nordberg P, Meyer GS, et al. Contemporary performance of U.S. teaching and nonteaching hospitals. Acad Med 2012;87(6):701-8.   DOI
12 De la Garza Ramos R, Nakhla J, Nasser R, et al. The impact of hospital teaching status on timing of intervention, inpatient morbidity, and mortality after surgery for vertebral column fractures with spinal cord injury. World Neurosurg 2017;99:140-4.   DOI
13 Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? : a systematic review and methodologic critique of the literature. Ann Intern Med 2002;137:511-20.   DOI
14 Hsu BS, Meyer BD, Lakhani SA. Financial, resource utilization and mortality impacts of teaching hospital status on pediatric patients admitted for sepsis. Pediatr Infect Dis J 2017;36(8):712-9.   DOI
15 The public heath impact of chemicals: knowns and unknowns. World Health Organization. 2016. Available at: https://www.who.int/ipcs/publications/chemicals-publichealth-impact/en/. Accessed March 15, 2019.
16 Poison control center data snapshot American Association of Poison Control Centers. 2017. Available at: https://aapcc.org/. Accessed March 15, 2019.
17 Kim KH. Core strategy for establishment of Korean poison information center: Research Institute for Healthcare Policy; 2012. 87-93 p.