• Journal of Preventive Medicine and Public Health
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• v.38 no.2
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• pp.132-140
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• 2005

Objectives: To propose a risk-adjustment model from insurance claims data, and analyze the changes in cesarean section rates of healthcare organizations after adjusting for risk distribution. Methods: The study sample included delivery claims data from January to September, 2003. A risk-adjustment model was built using the 1st quarter data, and the 2nd and 3rd quarter data were used for a validation test. Patients' risk factors were adjusted using a logistic regression analysis. The c-statistic and Hosmer-Lemeshow test were used to evaluate the performance of the risk-adjustment model. Crude, predicted and risk-adjusted rates were calculated, and compared to analyze the effects of the adjustment. Results: Nine risk factors (malpresentation, eclampsia, malignancy, multiple pregnancies, problems in the placenta, previous Cesarean section, older mothers, bleeding and diabetes) were included in the final risk-adjustment model, and were found to have statistically significant effects on the mode of delivery. The c-statistic (0.78) and Hosmer-Lemeshow test ($x^2$=0.60, p=0.439) indicated a good model performance. After applying the 2nd and 3rd quarter data to the model, there were no differences in the c-statistic and Hosmer-Lemeshow $x^2$. Also, risk factor adjustment led to changes in the ranking of hospital Cesarean section rates, especially in tertiary and general hospitals. Conclusion: This study showed a model performance, using medical record abstracted data, was comparable to the results of previous studies. Insurance claims data can be used for identifying areas where risk factors should be adjusted. The changes in the ranking of hospital Cesarean section rates implied that crude rates can mislead people and therefore, the risk should be adjusted before the rates are released to the public. The proposed risk-adjustment model can be applied for the fair comparisons of the rates between hospitals.

• Korean Journal of Childcare and Education
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• v.12 no.6
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• pp.79-102
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• 2016

The purpose of this study was to identify school adjustment groups by applying a Latent Profile Analysis(LPA) and to investigate the effects of children's emotional problems and study habits on determining the membership of these groups. LPA and multiple logistic regression were conducted using the data of 2,200 third-graders from the Korean Children and Youth Panel Study. The results are listed as follows. First, four school adjustment groups were identified: adjustment, approach to adjustment, maladjustment risk, and maladjustment group. Second, accomplishment value and mastery goal orientation were relatively strong predictors of membership of the school adjustment groups. Time management was also a significant variable that predicted the membership of maladjustment or the maladjustment-risk group. Third, attention problems and depression were the most consistent predictors of membership of maladjustment or the maladjustment-risk group. Physical symptoms and social withdrawal were also significant. Based on the results, implications for intervention to promote early school adjustment were discussed.

• Journal of the Korean Society of School Health
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• v.23 no.1
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• pp.41-52
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• 2010

Purpose: The objective of this study is to investigate the relationship between middle and high school students' internet addiction, social support, self-efficacy and school life adjustment. Data were collected by self-administered questionnaires at middle and high school students located in Seoul and the metropolitan areas. Methods: The response rate is 94.8% (474 cases). The internet addition was measured by K Scale. The various methods of analysis were used, for example, frequency analysis, t-test, analysis of variance, and multiple regression analysis. Results: First, the mean score of internet addiction level is 2.07 in 5 Likert scale. the internet addiction level of the male students are higher than female students (p<.05). Second, as a result of classification of internet addiction groups by K Scale, 11 students (2.3%) are included in high risk group, 27 students (5.7%) are in potential risk group, 436 students (92.0%) are in general group. Third, the level of social support and self-efficacy of middle and high school students are very high. The difference of social support by internet addiction groups was not statistically significant. But, the difference of self-efficacy by internet addiction groups was statistically significant. The level of self-efficacy of the students in general groups are more higher than in high risk group and in potential risk group (p<.01). Fourth, the difference of school adjustment by internet addiction groups was very statistically significant. The level of school life adjustment of the students in general groups are more higher than in high risk group and in potential risk group (p<.01). Fifth, the internet addiction have a negative correlation with school life adjustment. And the social support and self-efficacy have a positive correlation with school life adjustment (p<.01). Finally, in stepwise multiple regression analysis, the internet addiction affects negatively on the school adjustment. And the support of teacher among three types of them affects positively on the school life adjustment. And the social self-efficacy among two types of them affects positively on the school adjustment (p<.01). Conclusion: to adjust desirably the school environment of the middle and high school students, optimal and efficient management of internet addiction was needed in the future and the improvement and promotion of social support and social self-efficacy of the students was also demanded.

• Journal of Preventive Medicine and Public Health
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• v.39 no.1
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• pp.13-20
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• 2006

Objectives: To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. Methods: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. Results: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test ($x^2=6.92$, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971 patients) and 4 high-volume hospitals (1,087 patients) were identified. Significant differences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. Conclusions: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship.

• Journal of Digital Convergence
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• v.15 no.12
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• pp.59-70
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• 2017

The purpose of this study was to investigate whether there is a moderating effect of protective factors on risk factors in affecting school adjustment of immigrant youths. For this purpose, this study analyzed 69,720 youths who weighed 6,079 children of youths ages 9-24 among the 2015 National Survey of Multicultural Families. From the results of the analysis, first, the discrimination experience, school violence and depression, which are risk factors of immigrant youths, all had negative effects on school adjustment. Parental relations, self-esteem, Korean language ability, and nationality acquisition, which are protective factors, all had a positive effect on school adjustment. Second, among the three risk factors in the school adjustment of immigrant youths, self-esteem and nationality acquisition variables were analyzed as the protective factors moderating depression, and the protective factors controlling school violence were analyzed as parental relationship, self-esteem, Korean ability and nationality acquisition variables. Based on the results of the analysis, decrease in immigrant youths' depression, coping with academic violence, and development and support of various competency development programs were suggested as major social welfare practices.

• Journal of Preventive Medicine and Public Health
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• v.34 no.4
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• pp.337-346
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• 2001

Objective : To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. Methods Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. Results : The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. Conclusions : Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.

• 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.

• Journal of Music and Human Behavior
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• v.9 no.1
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• pp.55-71
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• 2012

The purpose of this study was to investigate the effect of group music therapy for at-risk Korean soldiers on the levels of adjustment and stress. The study was conducted at a division of the Korean Army with 7 participants who were classified as "at-risk soldiers" based on the results of a psychiatric evaluation, MMPI-II and a personal interview with a counselor. The participants received 12 hours of group music therapy for three weeks and their scores on stress and adjustment inventories were compared before and after the treatment. The pre and post scores were analyzed with the Wilcoxon test for repeated measures. The results revealed that the overall stress level was significantly decreased while there was no significant improvement in the adjustment levels at p < .05. The research findings and personal remarks from the participants suggest that group music therapy may provide effective support for at-risk Korean soldiers in coping with stress and adjustment to military life.

• Journal of the Korean Home Economics Association
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• v.38 no.6
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• pp.149-169
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• 2000

The purpose of this study was to examine the environmental characteristics of adolescents in low-income families, identify the high-risk & protective factors among environmental contexts surrounding adolescents, and investigate the relative importance of high-risk & protective factors to adolescents'psychological and behavioral adjustment separately. The present study was the primary research of developing prevention program for adolescents'deviant behaviors in low-income families. Subjects of this study consisted of 176 adolescents drawn from 8 social-welfare institutions in Chungbuk province. The pilot study was done to examine the applicability of survey instrument. Data were analyzed by the frequency, percentage, Pearson correlation, stepwise regression using SPSS/WIN program. The results were as followings: 1. There was statistically correlated with each other in environmental high-risk and protective factors except an housing environment. The results implies that environmental contexts itself surrounding adolescents in low-income families can be either high-risk factors or protective factors. 2. The adolescents in low-income families perceived that stresses from consumer and school environments were high-risk factors among other environmental contexts. 3. The adolescents in low-income families perceived that resources from friend and school were protective factors among other environmental contexts. 4. The stresses from friend and eating behaviors were significant factors predicting adolescents'relative psychological adjustment. However, the behavioral adjustment was not predicted by environmental contexts. 5. The resources from school, consumer, and eating behaviors were significant factors predicting adolescents'relative psychological adjustment. Also, the resources from school, eating behavior, and family were predictors of behavioral adjustment. This research implies that the findings can be based on the development of prevention program for adolescents deviant behaviors in low-income families.

• Journal of the Economic Geographical Society of Korea
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• v.12 no.4
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• pp.665-680
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• 2009

This study aims at analyzing the performance of Real Estate Investment Trusts(REITs) by Risk Adjustment Model. The main results are as follows. Firstly, most property types of REITs gain positive(+) excess overall returns at first and second period. On the contrary, most property types of REITs gain negative(-) excess overall returns and their standard deviations are larger at financial crisis period. Secondly, lodging, regional mall and commercial mortgage show lower risk-lower return, and freestanding, apartment and specialty show higher risk-higher return than average REITs, according to the CAPM results of . Moreover CAPM results of show the characteristics of REITs as investment commodities changes into higher risk-higher return for financial crisis period. Lastly, risk adjusted demanded returns of REITs are affected positively(+) by systemic risks and negatively(-) by unsystemic risks, according to the Risk Adjustment Model results of both and . Comparing risk adjusted demanded returns of REITs with their realized returns, healthcare reveals the largest outperformance.