• Journal of Korean Critical Care Nursing
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• v.17 no.2
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• pp.25-41
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• 2024

Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend<.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend<.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p <.05). Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

• The Korean journal of internal medicine
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• v.39 no.3
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• pp.469-476
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• 2024

Background/Aims: The reimbursement policy for cryptogenic stroke (CS) was expanded in November 2018 from recurrent strokes to the first stroke episode. No reports have demonstrated whether this policy change has affected trends in implantable loop recorder (ILR) utilization. Methods: We identified patients who received an ILR implant using the Korea Health Insurance Review and Assessment Service database between July 2016 and October 2021. Patients meeting all the following criteria were considered to have CS indication: 1) prior stroke history, 2) no previous history of atrial fibrillation or flutter (AF/AFL), and 3) no maintenance of oral anticoagulant for ≥4 weeks within a year before ILR implant. AF/AFL diagnosed within 3 years after ILR implant or before ILR removal was considered ILR-driven. Results: Among 3,056 patients, 1,001 (32.8%) had CS indications. The total ILR implant number gradually increased for both CS and non-CS indications and the number of CS indication significantly increased after implementing the expanded reimbursement policy. The detection rate for AF/AFL was 26.3% in CS patients over 3 years, which was significantly higher in patients implanted with an ILR within 2 months after stroke than those implanted later. Conclusions: The expanded coverage policy for CS had a significant impact on the number of ILR implantation for CS indication. The diagnostic yield of ILR for AF/AFL detection seems better when ILR is implanted within 2 months than later. Further investigation is needed to demonstrate other clinical benefits and the optimal ILR implantation timing.

• Journal of Preventive Medicine and Public Health
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• v.30 no.1 s.56
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• pp.195-207
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• 1997

High price equipment is one of the major factors that increases national health expenditure in developed countries. Computerized Tomography(CT), one of the important high price equipment, has been concerns of health service researchers and policy makers in many countries. In Korea, CT, first introduced in 1984, have spreaded nationwide with rapid speed. Though the Committee for Approving Import of High Price Medical Equipment, founded in 1981, tried to regulate the introduction of high price medical equipment including CT, the effort resulted in failure. The exact situation of diffusion of the high price equipment, however, was not yet investigated. We aimed at the description of the diffusion of CT in Korea and analysis of influencing factors on hospitals for the adoption of CT. We mainly used the database of CT, made in 1996 by the National Federation of Medical Insurance for the purpose of insurance payment for CT. Also characteristics of hospitals were gathered from yearbooks published by the central and local governments and by the Korean Hospital Association. We calculated the cumulative number of the CT per one million population year by year. In turn, multiple linear logistic regression was done to find out the contributing factors for the adoption of CT by each hospital. In the logistic regression model, it is regarded as dependent factor whether a hospital retained CT or not in 1988 and 1993. The major categories of the independent factors were hospital characteristics, environmental factors and competitive conditions of hospitals at the period of the adoption. The results are as follows: Number of CT scanners per one million persons in Korea marked more higher level compared with those of most OECD countries. Major influencing factors on the adoption of CT scanners were hospital characteristics, such as hospital referral level, and competitive condition of hospitals, such as number of CT scanners per 10,000 persons in each district where the hospital was located. In Korea, CT diffused with rather rapid speed, comparable with those of the United States and Japan. The major factors contributing on the adoption of CT for hospitals were competitive condition and hospital characteristics rather than regional health care need for CT. In conclusion, a kind of regulating mechanism would be necessary for the prevention of the indiscreet adoption and inefficient use of high price equipment including CT.

• International Journal of Contents
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• v.13 no.2
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• pp.14-20
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• 2017

The purpose of this study was to investigate the association of obesity with medical care use and costs according to overall diseases, cerebrovascular diseases (CVD), ischemic heart disease (IHD), hypertension (HTN) and diabetes mellitus (DM). The final sample was a group of persons who were free of diseases mentioned above and were not underweight. Their baseline screening program data and health insurance contribution data were connected with a 7-year medical claim database. The participants were classified according to their baseline BMI into normal, overweight, obese, and severely obese groups. Given the disease type, the total costs of DM showed the largest difference in each obesity group in both males and females. Also, the pharmacy costs for DM were more relevant than any other type of service to the obesity level. Considering the high prevalence of obesity and the relevantly increased medical care use and costs, there is a need for reduction in medical costs through obesity prevention efforts.

• Proceedings of the Korean Society of Computer Information Conference
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• 2017.07a
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• pp.397-398
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• 2017

정보 공유를 통해 국민들은 의료 기관 및 치료방법 등을 합리적으로 선택하려고 노력하고 있다. 의료 기관의 컴퓨터와 연결 기계의 사용으로 의료 관련 데이터는 규모가 급격히 늘어났다. 이에 따라 정부 3.0에 맞춰 공개되는 의료 데이터가 확대됨에 따라 의료 빅데이터를 통해 여러 정보들을 만들어내 의료 분야에 도움이 될 것이라는 기대가 커져가고 있다. 이 연구에서는 의료 빅데이터를 어떻게 활용하여 의료 기관, 국민, 정부, 보험사 등 여러 기관에게 제공할 수 있는 지에 대해 설명한다. 현재 빅 데이터를 사용해 연령 별 잘 걸리는 질병이나 질병 별 성비를 나타내는 것 등 단순 사실을 알아내는 정도가 아니라 실질적으로 다양한 목적으로 사용될 수 있는 정보를 만들어낼 수 있는 시스템을 구축하였다는 점에서 이 연구는 강점을 갖는다.

• Journal of East-West Nursing Research
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• v.15 no.2
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• pp.63-70
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• 2009

Purpose: The purpose of this study was to evaluate hospital service utilization by the types of hospitals in Type I Medicaid claims frequently cited by elderly beneficiaries. Methods: Three frequently claimed inpatient diseases were selected: cerebral infarction, hypertension and diabetes mellitus. Relevant data were collected for the year 2008 from the computer database of the National Health Insurance Corporation. The data was analyzed using SPSS by descriptive statistics, ANOVA and coefficient of variation. Results: The coefficient of variance of hospitalization per episode was higher than daily hospital expenditure among hospitals for all three diseases. The coefficient of variance of hospitalization per episode was highest for cerebral infarction. The coefficient of variation of hospital expenditure per hospital day was highest for hypertension. Conclusions: Evaluating of the volume and pattern of hospital service utilization and the appropriateness for hospital admission for Type-I Medicaid elderly beneficiaries is important for Medicaid-based case management.

• Journal of Oriental Neuropsychiatry
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• v.25 no.4
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• pp.389-400
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• 2014

Objectives: Though there are many studies about sleep disorder, no research has been performed on the utilization of oriental medicine as a treatment. Therefore, the oriental medical treatment pattern of Korean patients with sleep disorders was examined herein using the Health Insurance Review and Assessment Service (HIRAS). Methods: The medical records of patients with sleep disorders (G47) or nonorganic sleep disorders (F51) as a main diagnosis were adopted from the HIRAS database from 2011 to 2013. Analysis was performed on the number of patients and cost per patient, with comparison between oriental and western medicine in terms of gender, age, patient care service type, and hospital type. Results: 1) Regarding sleep disorders, the medical visits and insurance charges have been increasing. Western medicine was utilized 8 times more often than oriental medicine during 3 years. 2) There were 2.5 times more women than men. 3) Among all ages, the 50~59 year group had the highest representation. 4) In comparison of average portions of patient care type over 3 years, outpatients were the majority, while the number of visits of outpatients and hospitalization has been increasing. 5) Comparison of average portion of oriental hospital type over 3 years revealed oriental clinics to be used most. The use of general hospitals was higher in western medicine treatment, while public health centers used oriental medicine more. 6) Regarding average oriental medical cost per patient over 3 years, the total was 88,000 won, with 353,000 won for hospitalization and 85,000 won for outpatients. The outpatient cost has been increasing. 7) In line with 6, oriental medical hospitals cost 126,000 won, local clinics were 85,000 won, and etc. was 95,000 won. Average costs of all types have increased during 3 years, except oriental medical hospitals in 2013. Conclusions: This study provided objective information about the epidemiologic characteristic of oriental medicine used for treatment of sleep disorder. For expansion of oriental medical demand for sleep disorder, this study would be helpful in understanding the recent status.

• Health Policy and Management
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• v.14 no.2
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• pp.1-16
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• 2004

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

• Korean Journal of Clinical Pharmacy
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• v.21 no.3
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• pp.249-255
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• 2011

Objective: To examine the drug use (prescribing) pattern of serious drug-drug interactions (DDIs, contraindicated drug interactions) using real world data. Prescription patterns were examined in terms of dispensing types. Method: Retrospective drug utilization review (DUR) study was performed. One hundred and six datasets of serious DDIs (DDI pairs) were determined among DDI datasets that Ministry of Health & Welfare announced for the DUR system from 2004 to 2005. Electronically transacted ambulatory patients' prescription database to Health Insurance Assessment and Review Services (HIRA) from July, 2005 to June, 2006 was collected with personal information deidentified and analyzed in terms of types of dispensing as a contributing factor. Results: After prescription data analysis per each patient, total number of DDI cases using 95 DDI pairs was 5,511, which accounted for 2.6 cases per patients. DDI cases between two drugs from each of community pharmacy dispensing- type prescription were considerable (63% vs. 24% in those from each of in-institutional dispensing-type prescription and vs. 13% in those from a community pharmacy dispensing-type prescription and an in-institutional dispensingtype prescription). Conclusions: DDI cases from different prescribers were found to be significant. Thus, the concurrent DUR process between prescriptions from different physicians and institutions should be implemented for the safe drug use.

• The Journal of the Korea Contents Association
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• v.20 no.5
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• pp.236-242
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• 2020

Big data technology has been rising as a leading technology in the healthcare paradigm. As a world-class big data nation including National Health Insurance data, Korea has been focused on health policies and sustainability through database forecasting and policy establishment. So the need for education of big data by public officials in healthcare sector is increasing. However, there has not yet been National Competency Standards(NCS) or education modules, in this study, healthcare big data education module and content have been developed for the public servants with confidence.