Journal of Preventive Medicine and Public Health

Original Articles

Cancer Patients’ Utilization of Tertiary Hospitals in Seoul Before and After the Benefit Expansion Policy: Sanghyun Cho, Youngs Chang, Yoon Kim; J Prev Med Public Health. 2019;52(1):41-50. Published online January 4, 2019; DOI: https://doi.org/10.3961/jpmph.18.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to investigate cancer patients’ utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013.
Methods
This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul).
Results
The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect.
Conclusions
The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

Summary

Korean summary
2014년부터 2016년까지 암 발생자 입원의 34.9%가 서울 소재 상급종합병원에서 이루어졌으며, 그중 73.9%가 5대 상급종합병원에서 이루어졌다. 4대 중증질환 보장성 강화 정책 후에 암환자의 서울 소재 상급종합병원 이용은 6.1%(2% 포인트) 증가하였으며, 5대 상급종합병원 이용률은 증가(정책 전: 23.6%, 정책 후: 25.8%), 그 외 서울 소재 상급종합병원 이용률은 감소하였다(정책 전: 9.3%, 정책 후: 9.1%).

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Dong-Woo Choi, Seungju Kim, Sun Jung Kim, Dong Wook Kim, Kwang Sun Ryu, Jae Ho Kim, Yoon-Jung Chang, Kyu-Tae Han
Journal of Geriatric Oncology.2024; 15(2): 101685. CrossRef
Impact of Disability Status on Mortality in Patients with Gastric Cancer: A Nationwide Study Focusing on Regional Disparities
Woo-Ri Lee, Kyu-Tae Han, Mingee Choi, Seojin Park, Woorim Kim
Healthcare.2023; 11(5): 641. CrossRef
Descriptive Analysis of Gastric Cancer Mortality in Korea, 2000-2020
Tung Hoang, Hyeongtaek Woo, Sooyoung Cho, Jeeyoo Lee, Sayada Zartasha Kazmi, Aesun Shin
Cancer Research and Treatment.2023; 55(2): 603. CrossRef
A 6-year nationwide population-based study on the current status of gastric endoscopic resection in Korea using administrative data
Jae Yong Park, Mi-Sook Kim, Beom Jin Kim, Jae Gyu Kim
Scientific Reports.2023;[Epub] CrossRef
Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data
Dong‐Woo Choi, Sun Jung Kim, Seungju Kim, Dong Wook Kim, Wonjeong Jeong, Kyu‐Tae Han
Cancer Medicine.2023; 12(13): 14707. CrossRef
Changes in the Utilization of Health Care Services by Cancer Patients during the COVID-19 Pandemic
Seung Hee Seo, Sooyoung Cho, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin
Yonsei Medical Journal.2023; 64(7): 463. CrossRef
Impact of Cardiovascular Diseases on Mortality in Gastric Cancer Patients with Preexisting Chronic Disease
Kyu-Tae Han, Dong Wook Kim, Woorim Kim
Yonsei Medical Journal.2022; 63(11): 1043. CrossRef
Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients?
Kyu-Tae Han, Woorim Kim, Areum Song, Yeong Jun Ju, Dong-Woo Choi, Seungju Kim
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Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea?
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Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

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Abstract PDF

Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Summary

Citations

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Development and Evaluation of Rehabilitation Service Areas for the United States
Timothy A. Reistetter, Julianna M. Dean, Allen M. Haas, John D. Prochaska, Daniel C. Jupiter, Karl Eschbach, Yong-Fang Kuo
BMC Health Services Research.2023;[Epub] CrossRef
Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population
Agnus M. Kim, Yoon Kim
Journal of Aging & Social Policy.2023; : 1. CrossRef
Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang
Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef

The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim; J Prev Med Public Health. 2016;49(4):230-239. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.034

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Abstract PDF Supplementary Material

Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Summary

Citations

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Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study
In Gyu Song, You Sun Kim, Min Sun Kim, Ji Weon Lee, Yoon-Min Cho, Youna Lim, Seong Keun Kwon, Dong In Suh, June Dong Park
BMJ Paediatrics Open.2024; 8(1): e002377. CrossRef
Geographic Distribution of Central Nervous System Rehabilitation Treatment in Korea and Its Associated Factors
Dong-Gyun Sohn, Jaehong Yoon, Jun-Soo Ro, Ja-Ho Leigh
Journal of Korean Medical Science.2023;[Epub] CrossRef
Defining Referral Regions for Inpatient Trauma Care: The Utility of a Novel Geographic Definition
Cheryl K. Zogg, Robert D. Becher, Michael K. Dalton, Sameer A. Hirji, Kimberly A. Davis, Ali Salim, Zara Cooper, Molly P. Jarman
Journal of Surgical Research.2022; 275: 115. CrossRef
High Level of Unwarranted Clinical Variation in the Use of Lower Extremity Revascularisation Procedures in Hungary (2013–2017)
Endre Kolossváry, Tamás Ferenci, Tamás Kováts, Péter Sótonyi, Zoltán Szeberin, Balázs Nemes, Edit Dósa, Katalin Farkas, Zoltán Járai
European Journal of Vascular and Endovascular Surgery.2022; 63(6): 874. CrossRef
Healthcare utilization among children and young people with life-limiting conditions: Exploring palliative care needs using National Health Insurance claims data
Cho Hee Kim, In Gyu Song, Min Sun Kim, Jin Yong Lee, Nam Gu Lim, Hee Young Shin
Scientific Reports.2020;[Epub] CrossRef
Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Yoon Kim
International Journal of Environmental Research and Public Health.2020; 17(4): 1244. CrossRef
A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Pulmonary Medicine.2019;[Epub] CrossRef
Regional Differences in Years of Life Lost in Korea from 1997 to 2015
Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
Journal of Korean Medical Science.2019;[Epub] CrossRef
Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply
Agnus M. Kim, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Health Services Research.2019;[Epub] CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef
Geographic variation in health insurance benefits in Qianjiang District, China: a cross-sectional study
Yue Wu, Liang Zhang, Xuejiao Liu, Ting Ye, Yongfei Wang
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Dan Peng, Xuan Li, Pin Liu, Mei Luo, Shuai Chen, Kewen Su, Zhongshuang Zhang, Qiang He, Jingfu Qiu, Yingli Li
American Journal of Infection Control.2018; 46(12): e81. CrossRef
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Sergei Muratov, Justin Lee, Anne Holbrook, Andrew Costa, J. Michael Paterson, Jason R. Guertin, Lawrence Mbuagbaw, Tara Gomes, Wayne Khuu, Jean-Eric Tarride
BMC Geriatrics.2018;[Epub] CrossRef
Regional Differences in Years of Life Lost in Korea from 1997 to 2015
Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
Journal of Korean Medical Science.2018;[Epub] CrossRef
A framework for the identification and classification of homogeneous socioeconomic areas in the analysis of health care variation
Ludovico Pinzari, Soumya Mazumdar, Federico Girosi
International Journal of Health Geographics.2018;[Epub] CrossRef

The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments: Hyemin Jung, Young Kyung Do, Yoon Kim, Junsoo Ro; J Prev Med Public Health. 2014;47(6):309-316. Published online November 24, 2014; DOI: https://doi.org/10.3961/jpmph.14.044

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Abstract PDF: Objectives
This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits.
Methods
We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions.
Results
The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes.
Conclusions
A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.; Summary

Variations in the Hospital Standardized Mortality Ratios in Korea: Eun-Jung Lee, Soo-Hee Hwang, Jung-A Lee, Yoon Kim; J Prev Med Public Health. 2014;47(4):206-215. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.206

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Abstract PDF

Objectives
The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care.
Methods
All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities.
Results
For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR.
Conclusions
We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

Summary

Citations

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Differences in trends in discharge location in a cohort of hospitalized patients with cancer and non-cancer diagnoses receiving specialist palliative care: A retrospective cohort study
Michael Bonares, Kalli Stillos, Lise Huynh, Debbie Selby
Palliative Medicine.2023; 37(8): 1241. CrossRef
Functional training and timed nutrition intervention in infectious medical patients
M Holst, L N Søndergaard, M D Bendtsen, J Andreasen
European Journal of Clinical Nutrition.2016; 70(9): 1039. CrossRef

A New Disability-related Health Care Needs Assessment Tool for Persons With Brain Disorders: Yoon Kim, Sang June Eun, Wan Ho Kim, Bum-Suk Lee, Ja-Ho Leigh, Jung-Eun Kim, Jin Yong Lee; J Prev Med Public Health. 2013;46(5):282-290. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.282

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Abstract PDF: Objectives
This study aimed to develop a health needs assessment (HNA) tool for persons with brain disorders and to assess the unmet needs of persons with brain disorders using the developed tool.
Methods
The authors used consensus methods to develop a HNA tool. Using a randomized stratified systematic sampling method adjusted for sex, age, and districts, 57 registered persons (27 severe and 30 mild cases) with brain disorders dwelling in Seoul, South Korea were chosen and medical specialists investigated all of the subjects with the developed tools.
Results
The HNA tool for brain disorders we developed included four categories: 1) medical interventions and operations, 2) assistive devices, 3) rehabilitation therapy, and 4) regular follow-up. This study also found that 71.9% of the subjects did not receive appropriate medical care, which implies that the severity of their disability is likely to be exacerbated and permanent, and the loss irrecoverable.
Conclusions
Our results showed that the HNA tool for persons with brain disorders based on unmet needs defined by physicians can be a useful method for evaluating the appropriateness and necessity of medical services offered to the disabled, and it can serve as the norm for providing health care services for disabled persons. Further studies should be undertaken to increase validity and reliability of the tool. Fundamental research investigating the factors generating or affecting the unmet needs is necessary; its results could serve as basis for developing policies to eliminate or alleviate these factors.; Summary

Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data: Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(2):74-81. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.74

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Abstract PDF

Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

Citations

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Estimating postoperative mortality in colorectal surgery- a systematic review of risk prediction models
Alexios Dosis, Jack Helliwell, Aron Syversen, Jim Tiernan, Zhiqiang Zhang, David Jayne
International Journal of Colorectal Disease.2023;[Epub] CrossRef
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Kwangil Yim, Won Mo Jang, Sung Hak Lee
Cancers.2021; 13(14): 3405. CrossRef
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J.M. García Torrecillas, M. Ferrer Márquez, Á. Reina Duarte, F. Rubio-Gil
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Jon Helgeland, Doris Tove Kristoffersen, Katrine Damgaard Skyrud, Anja Schou Lindman, Alanna M Chamberlain
PLOS ONE.2016; 11(5): e0156075. CrossRef
Model for risk adjustment of postoperative mortality in patients with colorectal cancer
K Walker, P J Finan, J H van der Meulen
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The Relationship Between the Social Network of Community-living Elders and Their Health-related Quality of Life in Korean Province: Jun Tae Lim, Jong-Heon Park, Jin-Seok Lee, Juhwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(1):28-38. Published online January 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.1.28

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Abstract PDF

Objectives

This study aimed to collect information that will help enhance the social networks and improve the quality of life among elderly people by observing the relationship between their social network and health-related quality of life (HRQoL) and by analyzing social network factors affecting HRQoL.

Methods

This study was based on the 2008 Community Health Survey in Yeoncheon County. Three hundred elders were included in the study population. We compared the revised Lubben Social Network Scale (LSNS-R) score and Euro quality of life-5 dimensions health status index by demographic characteristics and chronic disease prevalence. We analyzed the data using multiple regression and tobit regression by setting the HRQoL as the dependent variable and social network and other characteristics as the independent variables. We analyzed social network factors by using factor analysis.

Results

The LSNS-R score differed significantly according to age and existence of a spouse. According to the results from the hierarchical multiple regression analysis, the LSNS-R explained 0.10 of the variance and LSNS-R friends factor explained 0.10 of the variance. The tobit regression indicated that the contribution of the LSNS-R family size factor to the regression coefficient of the independent variable that affected the HRQoL was B_T=2.96, that of the LSNS-R family frequency factor was B_T=3.60, and that of LSNS-R friends factor was B_T=5.41.

Conclusions

Social networks among elderly people had a significant effect on HRQoL and their networks of friends had a relatively higher effect than those of family members.

Summary

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Ben Lennox Kail, Dawn C Carr, Deborah Carr
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Shan Lu, Yupan Wu, Zongfu Mao, Xiaohui Liang
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Mónica Machón, Isabel Larrañaga, Miren Dorronsoro, Kalliopi Vrotsou, Itziar Vergara
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Heather Douglas, Andrew Georgiou, Johanna Westbrook
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Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea: Moo-Kyung Oh, Hyeongap Jang, Yong-Ik Kim, Belong Jo, Yoon Kim, Jong-Heon Park, Jin-Seok Lee; J Prev Med Public Health. 2012;45(4):211-218. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.211

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Abstract PDF

Objectives

The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities.

Methods

Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis.

Results

People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities.

Conclusions

These results show that people with physical disability have a higher vulnerability to obesity.

Summary

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Research Support, Non-U.S. Gov't

Effect of Repeated Public Releases on Cesarean Section Rates.: Won Mo Jang, Sang Jun Eun, Chae Eun Lee, Yoon Kim; J Prev Med Public Health. 2011;44(1):2-8.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.2

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Abstract PDF

OBJECTIVES
Public release of and feedback (here after public release) on institutional (clinics and hospitals) cesarean section rates has had the effect of reducing cesarean section rates. However, compared to the isolated intervention, there was scant evidence of the effect of repeated public releases (RPR) on cesarean section rates. The objectives of this study were to evaluate the effect of RPR for reducing cesarean section rates. METHODS: From January 2003 to July 2007, the nationwide monthly institutional cesarean section rates data (1 951 303 deliveries at 1194 institutions) were analyzed. We used autoregressive integrated moving average (ARIMA) time-series intervention models to assess the effect of the RPR on cesarean section rates and ordinal logistic regression model to determine the characteristics of the change in cesarean section rates. RESULTS: Among four RPR, we found that only the first one (August 29, 2005) decreased the cesarean section rate (by 0.81 percent) and continued to have an impact period through the last observation in May 2007. Baseline cesarean section rates (OR, 4.7; 95% CI, 3.1 to 7.1) and annual number of deliveries (OR, 2.8; 95% CI, 1.6 to 4.7) of institutions in the upper third of each category at before first intervention had a significant contribution to the decrease of cesarean section rates. CONCLUSIONS: We could not found the evidence that RPR has had the significant effect of reducing cesarean section rates. Institutions with upper baseline cesarean section rates and annual number of deliveries were more responsive to RPR.

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English Abstracts

The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty.: Won Mo Jang, Sang Jun Eun, Pilyoung Sagong, Chae Eun Lee, Moo Kyung Oh, Juhwan Oh, Yoon Kim; J Prev Med Public Health. 2010;43(6):523-534.; DOI: https://doi.org/10.3961/jpmph.2010.43.6.523

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Abstract PDF

OBJECTIVES
We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. METHODS: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume(over 16 operations in a year) and low volume institutions, after performance reporting (december 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. RESULTS: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p=0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25-0.95) and 10% (beta=-0.102 p<0.01) and cost was not changed (beta=-0.01, p<0.27). The high volume institutions were more decreased than low volume in length of stay. CONCLUSIONS: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginal shifted from low volume institutions to high volume institutions.

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The factors influencing variation by local areas in antibiotics prescription rate according to the public reporting
Yu-Jin Chun, Chang-Yup Kim
Health Policy and Management.2012; 22(3): 427. CrossRef

Patterns of Unintentional Domestic Injuries in Korea.: Eun Jung Lee, Jin Seok Lee, Yoon Kim, Kunhee Park, Sang Jun Eun, Soo Kyung Suh, Yong Ik Kim; J Prev Med Public Health. 2010;43(1):84-92.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.84

5,203 View
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Abstract PDF

OBJECTIVES
To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

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Associations between traumatic dental injuries due to violence and various drinking behaviors in Korea: A cross‐sectional study
Ji‐Young Son, Jaehyung Lim, Dong‐Hun Han
Dental Traumatology.2024;[Epub] CrossRef
Relationships between trauma death, disability, and geographic factors: a systematic review
Bona Hwang, Taewook Jeong, Jiyeon Jo
Clinical and Experimental Emergency Medicine.2023; 10(4): 426. CrossRef
The Relationship between Injury and Socioeconomic Status in Reference to the Fourth Korean National Health and Nutrition Examination Survey
Sung-Kyung Kim, Hyocher Kim, Kyungsuk Lee, Hee-Tae Kang, Sung-Soo Oh, Sang Baek Ko
Annals of Occupational and Environmental Medicine.2014;[Epub] CrossRef
The Relationship between Waist Circumference and Work-related Injury in Reference to the Fourth Korea National Health and Nutrition Examination Survey
Sung-Kyung Kim, Ji-Min Son, Jae-Young So, Hyocher Kim, Kyungsuk Lee, Sung-Soo Oh, Sang Ko
Annals of Occupational and Environmental Medicine.2013; 25(1): 29. CrossRef
Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury
Young Eun Choi, Kang Suk Lee
Health Policy and Management.2013; 23(3): 233. CrossRef
Spring cleaning as a safety risk: results of a population-based study in two consecutive years
Soheil Saadat, Mojgan Karbakhsh
BMC Public Health.2011;[Epub] CrossRef

Medical Care Utilization Status and Associated Factors with Extended Hospitalization of Psychiatric Patients in Korea.: Soo Kyung Suh, Yoon Kim, Jong Ik Park, Myung Soo Lee, Hong Suk Jang, Sun Young Lee, Jin Seok Lee; J Prev Med Public Health. 2009;42(6):416-423.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.416

4,973 View
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Abstract PDF

OBJECTIVES
This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. METHODS: Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. RESULTS: The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. CONCLUSIONS: The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

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A Study on the Characteristics of People With Severe Mental Illness in Seoul
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Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul
Jee Hoon Sohn, Sung Joon Cho, Hae Woo Lee, Hyun Kim, Seung Yeon Lee, Yoomi Park, Hwo Yeon Seo, Eun Soo Kim, Jee Eun Park, Bong Jin Hahm
Psychiatry Investigation.2023; 20(12): 1133. CrossRef
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Continuation of schizophrenia treatment with three long-acting injectable antipsychotics in South Korea: A nationwide population-based study
Sung Woo Joo, Seung-Hyun Shon, GumJee Choi, MinJung Koh, Seung Woo Cho, Jungsun Lee
European Neuropsychopharmacology.2019; 29(9): 1051. CrossRef
The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges
Keun-Ho Joe, Jeong-Ho Seok, Woon Jin Jeong, Boung Chul Lee, Ae Ryun Kim, Eun kyoung Choi, Boyoon Won, Chung-Suk Lee
Journal of Korean Neuropsychiatric Association.2017; 56(1): 10. CrossRef
A Study on Factors Related to Long-term Hospitalization in Patients with Chronic Schizophrenia
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Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study
Jee Hoon Sohn, Seung-Hee Ahn, Su Jeong Sung, Ji Min Ryu, Ji Eun Park, Maeng Je Cho
Journal of Korean Neuropsychiatric Association.2015; 54(4): 578. CrossRef
Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries
Un-Na Kim, Yeon-Yong Kim, Jin-Seok Lee
Journal of Preventive Medicine and Public Health.2015; 49(1): 53. CrossRef
The Current Situation of Treatment Systems for Alcoholism in Korea
Jee Wook Kim, Boung Chul Lee, Tae-Cheon Kang, Ihn-Geun Choi
Journal of Korean Medical Science.2013; 28(2): 181. CrossRef
Psychosocial Correlates of Length of Stay of Institutionalized Patients with Mental Illness
Jung Kyoo Choi, Hong-Suk Jang, Myung-Soo Lee, Jin Pyo Hong, Jong-Ik Park
Journal of Korean Neuropsychiatric Association.2013; 52(2): 98. CrossRef

Evaluation Studieses

The Socioeconomic Cost of Injuries in South Korea.: Kunhee Park, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Jaiyong Kim; J Prev Med Public Health. 2009;42(1):5-11.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.5

5,300 View
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Abstract PDF

OBJECTIVES
This study was conducted to estimate the socioeconomic cost of injuries in South Korea. METHODS: We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance (IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients' unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. RESULTS: The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW (Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6% (3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0% (1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4% (8.6 trillion KRW). CONCLUSIONS: In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

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Relationships between trauma death, disability, and geographic factors: a systematic review
Bona Hwang, Taewook Jeong, Jiyeon Jo
Clinical and Experimental Emergency Medicine.2023; 10(4): 426. CrossRef
Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey
Hyo Jung Lee, Yeong Jun Ju, Eun-Cheol Park
CJEM.2017; 19(06): 450. CrossRef
Characteristics and Outcomes of Trauma Patients via Emergency Medical Services
Dae Hyun Cho, Jae Gil Lee
Journal of Trauma and Injury.2017; 30(4): 120. CrossRef
Disability-Adjusted Life Years (DALYs) for Injuries Using Death Certificates and Hospital Discharge Survey by the Korean Burden of Disease Study 2012
Won Kyung Lee, Dohee Lim, Hyesook Park
Journal of Korean Medical Science.2016; 31(Suppl 2): S200. CrossRef
Current status and future perspective of regional trauma center in Korea
Kang Hyun Lee
Journal of the Korean Medical Association.2016; 59(12): 917. CrossRef
Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database
Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong-Cheol Yoon, Jungnam Lee, Byungchul Yoo
Journal of Trauma and Injury.2016; 29(4): 155. CrossRef
Analysis of KTDB Registered Trauma Patients from a Single Trauma Center in Korea
Byungchul Yu, Min Chung, Giljae Lee, Mina Lee, Jaejeong Park, Kangkook Choi, Sungyeol Hyun, Yangbin Jeon, Daesung Ma, Young-cheol Yoon, Jungnam Lee
Journal of Trauma and Injury.2015; 28(3): 123. CrossRef
The costs of hepatitis A infections in South Korea
Kyohyun Kim, Baek-Geun Jeong, Moran Ki, Mira Park, Jin Kyung Park, Bo Youl Choi, Weon-Seob Yoo
Epidemiology and Health.2014; 36: e2014011. CrossRef
Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury
Young Eun Choi, Kang Suk Lee
Health Policy and Management.2013; 23(3): 233. CrossRef
Trend of Mortality Rate and Injury Burden of Transport Accidents, Suicides, and Falls
Ki Sook Kim, Soon Duck Kim, Sang Hee Lee
Journal of Preventive Medicine and Public Health.2012; 45(1): 8. CrossRef

Association between the Pattern of Prophylactic Antibiotic Use and Surgical Site Infection Rate for Major Surgeries in Korea.: Pilyong Sakong, Jin Seok Lee, Eun Jung Lee, Kwang Pil Ko, Cheol Hwan Kim, Yoon Kim, Yong Ik Kim; J Prev Med Public Health. 2009;42(1):12-20.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.12

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OBJECTIVES
The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS: We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS: The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS: These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.

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