• Health Policy and Management
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• v.26 no.2
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• Journal of Korean Foot and Ankle Society
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• v.23 no.3
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• pp.121-130
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• 2019

Purpose: To investigate the spatial distribution of diabetes-related lower limb amputations and analyze the relationship between the spatial distribution of diabetes-related lower limb amputations and regional factors. Materials and Methods: This study was performed based on the data from the Korean Health Insurance Review and Assessment Service, in 2016. The unit of analysis was the administrative districts of city·gun·gu. The dependent variable was the age- and sex-adjusted incidence of diabetes-related lower limb amputations and the regional variables were selected to represent two aspects: socioeconomic factors, and health and medical factors. Along with traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for spatial analysis. Results: The age- and sex-adjusted incidence of diabetes-related lower limb amputation varied according to region. OLS regression showed that the incidence of diabetes-related lower limb amputation had significant relationships with the health and medical factors (number of healthcare institution and doctors per 100,000 population). In GWR, the effects of regional factors were not consistent. Conclusion: The spatial distribution of the incidence of diabetes-related lower limb amputations and the effects of regional factors varied according to the regions. The regional characteristics should be considered when establishing health policy related to diabetic foot care.

• Health Policy and Management
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• v.26 no.4
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• pp.359-372
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• 2016

Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, $R^2$ values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.

• Korean Journal of Clinical Pharmacy
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• v.9 no.2
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• pp.109-118
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• 1999

The need for and components of a contemporary community pharmacy externship for pharmacy students have not been clearly identified in Korea. Mail survey was performed among 20 college of pharmacy deans and 800 community pharmacists to analyze the current status and develop a consensus regarding major focus area and criteria of community pharmacy externship to be implemented under the separation of dispensary from medical practice in year 2000. Mail survey yielded $80\%\;and\;23.5\%$ response rate for pharmacy school deans and community pharmacists, respectively. Of the 16 pharmacy schools that responded 14 said they have externship program in hospital pharmacy, and only 8 pharmacy schools responded of having externship program for community pharmacy. However, these community pharmacy programs lacked criteria and standard guideline for the externship. The results of survey revealed that community pharmacy externship program for students should be organized and directed toward developing expert knowledge and skills in pharmacy practice activities, clinical services, communications, pharmacy management, and professionalism. Pharmacy practice components should include competencies and skills in computer application, prescription processing, dispensing, pharmaceutical compounding, Narcotics Control Law application, maintenance and provision of drug information, and laws and regulations. Clinical service components should include the ability to identify patient's drug-related problems, provide long-term patient care and appreciate drug therapy services. Communication skills should be taught to effectively express his/her professional opinion, deduce the needs of others, utilize appropriate techniques and media to communicate ideas and conduct a patient interview and to obtain patient drug history. Pharmacy management skills should be taught to be efficient in medical insurance and drug control process. It was found that professionalism, morality, pharmacy practice experience, ability to provide clinical services, collect and provide drug information and regality are important criteria of preceptors. Externship sites should possess the ability to stock various drugs, access and provide diverse pharmacy services and should have private patient counseling area. Most pharmacists agreed that top 200 drugs' generic and brand name, indications, dosage, side effects, and contraindication should be instructed during the externship. It was also found that student and preceptor should be evaluated for their performances during the externship. This information will be incorporated into teaming objectives for students and to develop Academic Extemship Program Guidelines.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.326-335
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• 2015

Background: Asian dust is known to have harmful effects on the respiratory system. Respiratory conditions are also influenced by environmental conditions regardless of the presence of pollutants. The same pollutant can have different effects on the airway when the air is dry compared with when it is humid. We investigated hospital visits for chronic obstructive pulmonary disease (COPD) and asthma in relation to the environmental conditions. Methods: We conducted a retrospective study using the Korean National Health Insurance Service claims database of patients who visited hospitals in Chuncheon between January 2006 and April 2012. Asian dust, haze, mist, and fog days were determined using reports from the Korea Meteorological Administration. Hospital visits for asthma or COPD on the index days were compared with the comparison days. We used two-way case-crossover techniques with one to two matching. Results: The mean hospital visits for asthma and COPD were $59.37{\pm}34.01$ and $10.04{\pm}6.18$ per day, respectively. Hospital visits for asthma significantly increased at lag0 and lag1 for Asian dust (relative risk [RR], 1.10; 95% confidence interval [CI], 1.01-1.19; p<0.05) and haze (RR, 1.13; 95% CI, 1.06-1.22; p<0.05), but were significantly lower on misty (RR, 0.89; 95% CI, 0.80-0.99; p<0.05) and foggy (RR, 0.89; 95% CI, 0.84-0.93; p<0.05) days than on control days. The hospital visits for COPD also significantly increased on days with Asian dust (RR, 1.29; 95% CI, 1.05-1.59; p<0.05), and were significantly lower at lag4 for foggy days, compared with days without fog (RR, 0.85; 95% CI, 0.75-0.97; p<0.05). Conclusion: Asian dust showed an association with airway diseases and had effects for several days after the exposure. In contrast to Asian dust, mist and fog, which occur in humid air conditions, showed the opposite effects on airway diseases, after adjusting to the pollutants. It would require more research to investigate the effects of various air conditions on airway diseases.

• Child Health Nursing Research
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• v.21 no.1
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• pp.37-45
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• 2015

Purpose: In this study, a comparison was done of the extent of health-related quality of life (HRQoL) for preterm and fullterm children during early childhood, and factors affecting HRQoL in the early childhood of premature children were analyzed. Methods: Eighty mothers of children born prematurely and 83 mothers of children born at fullterm listed on two Internet cafes were sampled for this study. The major instrument used for the study was the TNO-AZL Preschool Quality Of Life (TAPQOL) questionnaire. Results: Total score for HRQoL in the premature group was 80.5 (${\pm}9.9$) and for the full term group, 85.0 (${\pm}8.3$), on a 100-point scale. A comparison of the premature group and full term group showed that the domains which scored relatively lower with respect to HRQoL included the stomach, motor function, anxiety, liveliness and communication. Among the factors that have an impact on HRQoL were 'length of stay in neonatal intensive care unit (${\geq}7$ days)' and 'birth weight (<1,000 gm)'. The explanation power of the model was 17%, which was statistically significant. Conclusion: These findings indicate that a differentiated premature infant follow-up program for children who are hospitalized over 7 days in NICU or weighed under 1,000g at birth is urgently needed.

• Korea Journal of Hospital Management
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• v.22 no.4
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• pp.33-49
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• 2017

Background: Health care utilizations and costs of the patients with degenerative lumbar spine disease in Korea increased dramatically. We analyzed whether hospital market competition is associated with charges and length of stay for patients with degenerative lumbar spine disease. Methods: We used Medical claims data of 2002 and 2010 from the nationwide representative sample of National Health Insurance Service of Korea. The study subjects were inpatients with degenerative lumbar spine disease (N=24,768) in 2002 and 2010. We employed a multilevel linear mixed model that included patient- and hospital-level variables in hierarchical data. Results: Higher hospital competition was associated with lower charges (${\beta}=57.5$, p<.0001 in 2002; ${\beta}=353.7$, p<.0001 in 2010) and shorter length of stay (${\beta}=0.3$, p<.0001 in 2002; ${\beta}=0.9$, p<.0001 in 2010) in both 2002 and 2010. Compared to 2002, the magnitude of such association became greater in 2010. However, subgroup analyses show that the influence of competition on charges and length of stay differed by hospital size. Conclusions: This study showed that hospital market structure (e.g., hospital competition) affects hospital efficiency (i.e., hospital charges and length of stay). It is necessary to continue to monitor how changing market structure influences hospital outcomes, including more detailed outcomes such as patient satisfaction.

• Clinical Psychopharmacology and Neuroscience
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• v.16 no.4
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• pp.398-406
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• 2018

Objective: Hospitalization of patients with delirium after visiting the emergency department (ED) is often required. However, the readmission risk after discharge from the ED should also be considered. This study aimed to explore whether (i) immediate hospitalization influences the readmission risk of patients with delirium; (ii) the readmission risk is affected by various risk factors; and (iii) the healthcare cost differs between groups within 28 days of the first ED visit. Methods: Using the National Health Insurance Research Database, the data of 2,780 subjects presenting with delirium at an ED visit from 2000 to 2008 were examined. The readmission risks of the groups of patients (i.e., patients who were and were not admitted within 24 hours of an ED visit) within 28 days were compared, and the effects of the severities of different comorbidities (using Charlson's comorbidity index, CCI), age, gender, diagnosis and differences in medical healthcare cost were analyzed. Results: Patients without immediate hospitalization had a higher risk of readmission within 3, 7, 14, or 28 days of discharge from the ED, especially subjects with more severe comorbidities ($CCI{\geq}3$) or older patients (${\geq}65years$). Subjects with more severe comorbidities or older subjects who were not admitted immediately also incurred a greater healthcare cost for re-hospitalization within the 28-day follow-up period. Conclusion: Patients with delirium with a higher CCI or of a greater age should be carefully considered for immediate hospitalization from ED for further examination in order to reduce the risk of re-hospitalization and cost of healthcare.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.34 no.1
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• pp.112-135
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• 2021

Objectives : To report a case of drug-induced xerostomia treated with Integrative Korean Medicine Visiting Care Service of a Public Health Center. Methods : Home visit treatment and telemedicine were provided by public health doctor(Korean medicine doctor) for person with physical disability who were diagnosed with Behcet's Disease. Palmul-tang(PMT) soft extract was provided steadily 3 times a day for 6 months, and acupuncture, electro-acupuncture, and electro-moxibustion were provided irregularly 6 times for 6 months. Yin-deficiency questionnaire(YDQ), oral health impact profile-14(OHIP-14), oral pain visual analogue scale(VAS), and xerostomia inventory(XI) were used 3 times(baseline, intermediate and termination) to evaluate the changes. Results : YDQ decreased from 620 to 375, OHIP-14 decreased from 34 to 6, VAS decreased from 70 to 40, and XI decreased from 44 to 34. Four scales all gradually decreased. Conclusions : Integrative Korean Medicine Treatments in health insurance including PMT soft extract through home visit treatment can improve drug-induced xerostomia and Quality of life(QoL) of person with disabilities.

• The Journal of the Korea Contents Association
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• v.22 no.3
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• pp.354-360
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• 2022

Metabolic disease is a disease with a prevalence of 26% in Korean, and has three of the five states of abdominal obesity, hypertension, hunger glycemic disorder, high neutral fat, and low HDL cholesterol at the same time. This paper links the consumer panel data of the Rural Development Agency(RDA) and the medical care data of the National Health Insurance Service(NHIS) to generate a classification model that can be divided into a metabolic disease group and a control group through food consumption characteristics, and attempts to compare the differences. Many existing domestic and foreign studies related to metabolic diseases and food consumption characteristics are disease correlation studies of specific food groups and specific ingredients, and this paper is logistic considering all food groups included in the general diet. We created a classification model using regression, a decision tree-based classification model, and a classification model using XGBoost. Of the three models, the high-precision model is the XGBoost classification model, but the accuracy was not high at less than 0.7. As a future study, it is necessary to extend the observation period for food consumption in the patient group to more than 5 years and to study the metabolic disease classification model after converting the food consumed into nutritional characteristics.