• Journal of Preventive Medicine and Public Health
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• v.34 no.3
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• pp.244-252
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• 2001

Objective : Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. Methods : The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHE III and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. Results : The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and $R^2$ than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. Conclusion : These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.

• Journal of agricultural medicine and community health
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• v.23 no.1
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• pp.51-64
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• 1998

This study was carried out during 3 years from March 1992 to March 1995, 140 healthy people and 140 C.V.A patients were investigated, at an oriental clinic in Taejon. The data collected was analysed using a SAS. The results are as follows. 1. The Relationships between patients who have undergone one or more abortion procedures and C.V.A occurrence. A statistical significant difference was recorded between the control group and the outpatients group of P<0.05 2. Number of years after initial C.V.A diagnosis before C.V.A symptom onset. within 1 years 52% (2-3 years, 3-4 years, 4-5 years, 5 years and over) 3. Additional diseases occurring after initial stroke 1 disease 50.7% (2, 3, 4, 5 or more) 4. Alcohol Consumption "A statistical significant difference was recorded between the control group and the outpatients group of" P<0.01 5. Previous Treatment Experience for stoke outpatients Oriental Hospital, clinic 64.3% (General Hospital, clinic, a public health center drug store, home remedies, etc) 6. Exercise Frequency Outpatients Regular 28.6%, Irregular 71.4% Control sample Regular 27%, Irregular 72.9% 7. Degree of Appetite "A statistical significant difference was recorded between the control group and the outpatients group of" P<0.01 8. People who include fish in their diet "A statistical difference was recorded between the control group and the outpatients group of" P<0.01.

• The Journal of Advanced Prosthodontics
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• v.16 no.3
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• pp.151-162
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• 2024

PURPOSE. This study aimed to analyze factors influencing the success and failure of implant prostheses and to estimate the lifespan of prostheses using standardized evaluation criteria. An online survey platform was utilized to efficiently gather large samples from multiple institutions. MATERIALS AND METHODS. During the one-year period, patients visiting 16 institutions were assessed using standardized evaluation criteria (KAP criteria). Data from these institutions were collected through an online platform, and various statistical analyses were conducted. Risk factors were assessed using both the Cox proportional hazard model and Cox regression analysis. Survival analysis was conducted using Kaplan-Meier analysis and nomogram, and lifespan prediction was performed using principal component analysis. RESULTS. The number of patients involved in this study was 485, with a total of 841 prostheses evaluated. The median survival was estimated to be 16 years with a 95% confidence interval. Factors found to be significantly associated with implant prosthesis failure, characterized by higher hazard ratios, included the 'type of clinic', 'type of antagonist', and 'plaque index'. The lifespan of implant prostheses that did not fail was estimated to exceed the projected lifespan by approximately 1.34 years. CONCLUSION. To ensure the success of implant prostheses, maintaining good oral hygiene is crucial. The estimated lifespan of implant prostheses is often underestimated by approximately 1.34 years. Furthermore, standardized form, online platform, and visualization tool, such as nomogram, can be effectively utilized in future follow-up studies.

• Clinical Endoscopy
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• v.56 no.3
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• pp.340-352
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• 2023

Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

• Journal of Preventive Medicine and Public Health
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• v.53 no.2
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• pp.82-88
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• 2020

Objectives: The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.

• Korean Journal of Social Welfare
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• v.63 no.2
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• pp.179-205
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• 2011

Recently, problems regarding marital adjustment of cancer patients are recognized as serious matter of concern for it had been reported that these issues have severe negative effects on relationship stability within marriage. It is noteworthy how marital adjustment is found to be critical for the cancer patient's mental stability, healing process and chances of survival as reported in the research. Thus, the ultimate goal of this research is to contribute to improvement of the stable relationship and also to formulate the social service related strategy for marriage adjustment for married cancer patient married couples in Korea. Actor and Partner Interdependence Model was formed in order to observe how the communication of the married couple affects marital adjustment and how this has an actor effect as well as partner effect. In order to authenticate this research model, dyadic data which sample the cancer patient and the spouse as a pair. Survey was conducted as the cancer patients who had been diagnosed with cancer and their respective spouses. The survey was taken from 160 married couples which totals to 320 people all together. Results indicated the cancer patient and the spouse have a significant relationship in marital adjustment. Through this, it had been concluded that marital adjustment is not separated but co-dependent with dynamic relationship. And the mutual constructive communication had proven to have a significant positive effect on one's marital adjustment. In demand-withdrawal communication, its negative effect on the self effect was found to be significant in both the patient and the spouse to both of their marital adjustment. Mutual avoidance communication had shown to only cause significant negative effect on self effect to the patient. In verifying the partner effect, significant negative effect was caused by patient's demand-withdrawal communication in partner effect on the spouse's marital adjustment. The results of this study are discussed in term of their implications for clinical interventions for the betterment of marital adjustment among cancer patients and their spouses. The suggestions for future research are discussed also.

• Korean Circulation Journal
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• v.52 no.11
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• pp.814-825
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• 2022

Background and Objectives: Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation. Methods: We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018. Results: Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies. The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p<0.001), while those of TMT, SPECT, and direct ICA have decreased (p<0.001, p=0.03, and p<0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p<0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p<0.001) and CABG (3.5% vs. 1.0%; p<0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001). Conclusions: Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.

• Health Policy and Management
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• v.25 no.4
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• pp.256-263
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• 2015

Background: Initial treatment of acute upper respiratory infection (AURI) should not include antibiotics because most AURIs are caused by virus. However, the prescription rate of antibiotics in Korea is higher than in any other countries. Inappropriate use of antibiotics in Korea accelerated the emergence of antibiotics resistance and increased the social and economic burden. The objective of this study was to investigate the factors related to antibiotics use for the AURI among children-adolescents and adults. Methods: This study analyzed the Health Insurance Review and Assessment Service-National Patient Sample data which was nationally representative sampling stratified by sex and age. Results: The influencing factors of antibiotics use for AURI are gender, age, types of medical security, primary disease, existence of concomitant disease, treatment seasons, first visit or revisit, indicated specialty, types of medical institution, and location of medical institution. Conclusion: The results showed health policy makers are required to place more efforts to resolve inappropriate antibiotics use. Especially they need to establish a health policy to reduce the gap between areas and specialties and recommend standardized clinical guidelines according to the subgroup code of AURI and the age group of patients.

• Korea Journal of Hospital Management
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• v.21 no.2
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• pp.37-49
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• 2016

The purpose of this study is to investigate the level of competition between Public Health Centers (PHCs) and private clinics (PCs) by examining the number of patients that used PHCs vs. PCs, estimating the total amount of revenue generated from outpatient services at both PHCs and PCs, thereby analyzing the financial impacts on PCs derived from the PHCs. We utilized 2011 National Inpatient Sample data (NIS). Using the 20 table containing general information on each individual claims, we integrate it with the 40 table which contains all the diagnostic codes for each claim. Then, we disaggregate the bundled claims into the original individual claims. Overall, 3.1% of outpatient visits are made at PHCs while the rest was made at the PCs (96.9%). Among the total claim costs of 6.34 billion USD (as of 2011), PHCs occupy 2.0% (124 million USD), and 98.0% are contributed to PCs (6.21 billion USD). The estimated economic losses of PCs due to PHCs are summarized as follow; the maximum potential loss is estimated at 198 million USD in total and 7,099 USD per clinic when we include all patient types; the minimum loss is estimated at 71 million USD in total and 2,540 USD per clinic where Medical Aid recipients and the elderly (aged 65 and over) are excluded. Our results confirm the potential economic effect on PCs due to PHCs providing outpatient services. PCs and PHCs are the most important players providing primary care in Korea. Unnecessary competition between PCs and PHCs is not desirable. Health authorities should carefully examine the healthcare services currently provided by PHCs and their impacts on PCs.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.1
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• pp.12-20
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• 2020

Purpose: This study was designed to analyze the relationship between the presence and severity of depression and chewing problems (CPs) in a representative sample of the general population. Materials and Methods: Health surveys and examinations were conducted on a nationally representative sample (n = 8150) of Korean was conducted. CPs was determined by a simple survey response concerning "Do you feel uncomfortable about chewing your food because of problems with your mouth such as teeth, dentures and gums?" Depression was defined as individuals with a total score ≥ 10 on the Patient Health Questionnaire (PHQ)-9 survey. Data regarding demographics, socioeconomic history and comorbid health conditions were used to analyze adjusted logistic regression models. Results: In the Korean population, the prevalence of depression was significantly greater in individuals with CP (17.2%) than in those without CP (10.2%). On multivariate logistic regression analysis, the presence of depression was significantly associated with CPs (adjusted odd ratio [aOR]: 1.90, P < 0.001). The risk of CPs increased with increasing severity of depression as follows: severe depression (OR: 2.62, P < 0.001), moderately severe depression (OR: 2.19, P < 0.001). Conclusion: The presence of depression was significantly associated with CPs, especially in severely depressed individuals. Depression screening should be considered in treating CP patients.