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Brief Report
Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran
Afsoon Aeenparast, Ali Asghar Haeri Mehrizi, Farzaneh Maftoon, Faranak Farzadi
J Prev Med Public Health. 2024;57(3):298-303.   Published online April 4, 2024
DOI: https://doi.org/10.3961/jpmph.23.424
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  • 52 Download
AbstractAbstract AbstractSummary PDF
Objectives
The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities.
Methods
Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis.
Results
In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions.
Conclusions
In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.
Summary
Key Message
In present research all drug prescriptions in Iran Social Security outpatient facilities were assessed. In all 45,312,540 studied prescriptions, the average number of drug items per prescriptions was 3.33 items. 17.5% of prescriptions contained injection and 37.5% contained antibiotic. Patient sex and age, provider specialty, type of facility were associated with the risk of inappropriate prescriptions. It seems that correct policy making and proper supervision alongside health education will be core basis for improving drug prescription and use.
Original Articles
Risks for Readmission Among Older Patients With Chronic Obstructive Pulmonary Disease: An Analysis Using Korean National Health Insurance Service – Senior Cohort Data
Yu Seong Hwang, Heui Sug Jo
J Prev Med Public Health. 2023;56(6):563-572.   Published online November 10, 2023
DOI: https://doi.org/10.3961/jpmph.23.346
  • 1,036 View
  • 60 Download
AbstractAbstract AbstractSummary PDF
Objectives
The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services.
Methods
To apply transitional care services that are compatible with Korea’s circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service’s Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days.
Results
The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41).
Conclusions
Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.
Summary
Korean summary
국내 만성폐쇄성폐질환(COPD)의 위험도 표준화 재입원율은 12.7%로, 주요 진단군 가운데 재입원율이 가장 높다. 국민건강보험공단 노인코호트를 활용하여 COPD로 입원한 환자의 재입원 위험 요인을 파악한 결과 고령 환자, 국민건강보험 지역가입자, 300병상 미만 규모 병원 또는 도 지역 소재 병원 에 입원한 환자의 경우 재입원 위험이 높았다. 재입원 위험이 높은 환자에 대하여 우선적으로 퇴원환자관리 서비스가 제공될 필요가 있다.
Key Message
The risk-standardized readmission rate for COPD in Korea is 12.7%, the highest among major diagnostic groups. Using the National Health Insurance Service Senior Cohort to identify risk factors for the readmission of patients hospitalized with COPD, it was found that older patients, local health insurance subscribers, those hospitalized in facilities with fewer than 300 beds, or in hospitals located in provincial areas had a higher risk of readmission. It is necessary to prioritize transitional care services for patients at a high risk of readmission.
Construction of the Mobility to Participation Assessment Scale for Stroke (MPASS) and Testing Its Validity and Reliability in Persons With Stroke in Thailand
Jiraphat Nawarat, Kanda Chaipinyo
J Prev Med Public Health. 2022;55(4):334-341.   Published online June 13, 2022
DOI: https://doi.org/10.3961/jpmph.21.605
  • 2,853 View
  • 178 Download
AbstractAbstract PDF
Objectives
This study was conducted to develop the Mobility to Participation Assessment Scale for Stroke (MPASS) and assess its content validity, internal consistency, inter-rater and intra-rater reliability, and convergent validity in people with stroke living in the community.
Methods
The MPASS was developed using published data on mobility-related activity and participation timing in elderly individuals, and then reviewed by community physical therapists. Content validity was established by reaching a consensus of experienced physical therapists in a focus group. The MPASS was scored for 32 participants with stroke (mean age 61.75±4.92 years) by 3 individual testers. Reliability was examined using the intraclass correlation coefficient (ICC), internal consistency using the Cronbach alpha coefficient (α), and convergent validity using the Pearson correlation coefficient (r) to compare the MPASS to the Modified Rivermead Mobility Index as a referent test of mobility.
Results
The MPASS consists of 8 items, and its scoring system provides information on the ability of people with stroke to reach a movement level enabling them to live in society, including interactions with other people and safe living in the community. The inter-rater and intra-rater reliability were excellent (ICC, 0.948; 95% confidence interval [CI], 0.893 to 0.982 and ICC, 0.967; 95% CI, 0.933 to 0.989, respectively). Internal consistency was good (α=0.877). The convergent validity was moderate (r=0.646; p<0.001).
Conclusions
The newly developed MPASS showed acceptable construct validity and high reliability. The MPASS is suitable for use in people with stroke, especially those who have been discharged and live in the community with the ability to initiate sitting.
Summary
Association Between Cohabitation Status and Sleep Quality in Families of Persons With Dementia in Korea: A Cross-sectional Study
Seung Hoon Kim, Minah Park, Sung Hoon Jeong, Sung-In Jang, Eun-Cheol Park
J Prev Med Public Health. 2021;54(5):317-329.   Published online August 14, 2021
DOI: https://doi.org/10.3961/jpmph.21.077
  • 5,635 View
  • 158 Download
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs).
Methods
Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales.
Results
Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively.
Conclusions
The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.
Summary
Korean summary
2018년 지역사회건강조사를 이용하여 190 365명을 대상으로 가족 중 치매환자 유무 및 치매환자와의 동거여부와 수면의 질 사이의 연관성을 분석하였다. 치매환자와의 동거여부와 상관없이 가족 중 치매환자가 존재하는 것은 낮은 수면의 질과 유의한 연관성이 있었다. 가족 중 치매환자가 있지만 동거하지 않는 가족 구성원의 경우 치매환자가 혼자 살 때 낮은 수면의 질과의 연관성이 가장 높게 나타났다.

Citations

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  • Association Between Sleep Quality and Anxiety in Korean Adolescents
    Hyunkyu Kim, Seung Hoon Kim, Sung-In Jang, Eun-Cheol Park
    Journal of Preventive Medicine and Public Health.2022; 55(2): 173.     CrossRef
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    Ju An Byun, Tae Jun Sim, Tae Yoon Lim, Sung-In Jang, Seung Hoon Kim
    Scientific Reports.2022;[Epub]     CrossRef
Perspective
Dilemmas Within the Korean Health Insurance System
Donghwi Park, Min Cheol Chang
J Prev Med Public Health. 2020;53(4):285-288.   Published online July 1, 2020
DOI: https://doi.org/10.3961/jpmph.20.074
  • 4,337 View
  • 118 Download
  • 3 Crossref
AbstractAbstract PDF
The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.
Summary

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  • The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform
    Emmanuel Otieno, Josephine Namyalo
    Journal of Preventive Medicine and Public Health.2024; 57(1): 91.     CrossRef
  • Effect of Income Level on Stroke Incidence and Mediated Effects of Medication Adherence in Newly Diagnosed Hypertensive Patients: A Causal Mediation Analysis Using a Nationwide Cohort Study in South Korea
    Seungmin Jeong, So Yeon Kong, Seung-sik Hwang, Sung-il Cho
    Journal of Health Informatics and Statistics.2022; 47(4): 268.     CrossRef
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    Children.2021; 8(5): 377.     CrossRef
Original Articles
Patients’ and General Practitioners’ Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study
Christine Cohidon, Fabienne Imhof, Laure Bovy, Priska Birrer, Jacques Cornuz, Nicolas Senn
J Prev Med Public Health. 2019;52(5):323-332.   Published online September 17, 2019
DOI: https://doi.org/10.3961/jpmph.19.184
  • 5,168 View
  • 131 Download
  • 8 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to describe general practitioners (GPs)’ opinions and practices of preventive care and patients’ opinions, attitudes, and behaviors towards prevention.
Methods
The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices.
Results
Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role.
Conclusions
Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.
Summary

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    Daniel Gero, Vanessa Müller, Bálint File, Marco Bueter, Jeannette Widmer, Andreas Thalheimer
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Exploratory Study of Dimensions of Health-related Quality of Life in the General Population of South Korea
Seon-Ha Kim, Min-Woo Jo, Minsu Ock, Sang-il Lee
J Prev Med Public Health. 2017;50(6):361-368.   Published online November 2, 2017
DOI: https://doi.org/10.3961/jpmph.16.076
  • 9,078 View
  • 229 Download
  • 11 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
This study aimed to explore dimensions in addition to the 5 dimensions of the 5-level EQ-5D version (EQ-5D-5L) that could satisfactorily explain variation in health-related quality of life (HRQoL) in the general population of South Korea.
Methods
Domains related to HRQoL were searched through a review of existing HRQoL instruments. Among the 28 potential dimensions, the 5 dimensions of the EQ-5D-5L and 7 additional dimensions (vision, hearing, communication, cognitive function, social relationships, vitality, and sleep) were included. A representative sample of 600 subjects was selected for the survey, which was administered through face-to-face interviews. Subjects were asked to report problems in 12 health dimensions at 5 levels, as well as their self-rated health status using the EuroQol visual analogue scale (EQ-VAS) and a 5-point Likert scale. Among subjects who reported no problems for any of the parameters in the EQ-5D-5L, we analyzed the frequencies of problems in the additional dimensions. A linear regression model with the EQ-VAS as the dependent variable was performed to identify additional significant dimensions.
Results
Among respondents who reported full health on the EQ-5D-5L (n=365), 32% reported a problem for at least 1 additional dimension, and 14% reported worse than moderate self-rated health. Regression analysis revealed a R2 of 0.228 for the original EQ-5D-5L dimensions, 0.200 for the new dimensions, and 0.263 for the 12 dimensions together. Among the added dimensions, vitality and sleep were significantly associated with EQ-VAS scores.
Conclusions
This study identified significant dimensions for assessing self-rated health among members of the general public, in addition to the 5 dimensions of the EQ-5D-5L. These dimensions could be considered for inclusion in a new preference-based instrument or for developing a country-specific HRQoL instrument.
Summary

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    Sonia Berrih-Aknin, Kristl G Claeys, Nancy Law, Renato Mantegazza, Hiroyuki Murai, Francesco Saccà, Sarah Dewilde, Mathieu F Janssen, Emma Bagshaw, Hara Kousoulakou, Mark Larkin, Jon Beauchamp, Trevor Leighton, Sandra Paci
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Review
Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review
Minsu Ock, So Yun Lim, Min-Woo Jo, Sang-il Lee
J Prev Med Public Health. 2017;50(2):68-82.   Published online January 26, 2017
DOI: https://doi.org/10.3961/jpmph.16.105
  • 12,787 View
  • 357 Download
  • 42 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI).
Methods
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them.
Results
There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI.
Conclusions
The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.
Summary

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Special Article
Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention
Jong-Myon Bae, Marc Jamoulle
J Prev Med Public Health. 2016;49(6):343-348.   Published online October 13, 2016
DOI: https://doi.org/10.3961/jpmph.16.059
  • 10,028 View
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  • 5 Crossref
AbstractAbstract PDF
Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.
Summary

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Perspective
Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea
Jong-Myon Bae
J Prev Med Public Health. 2015;48(6):271-273.   Published online November 24, 2015
DOI: https://doi.org/10.3961/jpmph.15.059
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  • 3 Crossref
AbstractAbstract PDF
Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.
Summary

Citations

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  • Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde
    Fernanda Beatriz Melo Maciel, Hebert Luan Pereira Campos dos Santos, Nilia Maria de Brito Lima Prado
    Revista Brasileira de Medicina de Família e Comunidade.2020; 15(42): 2571.     CrossRef
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    Jong-Myon Bae
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Original Articles
Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings
Sun-Jin Jo, Hyeon Woo Yim, Hyunsuk Jeong, Hoo Rim Song, Sang Yhun Ju, Jong Lyul Kim, Tae-Youn Jun
J Prev Med Public Health. 2015;48(5):257-263.   Published online September 21, 2015
DOI: https://doi.org/10.3961/jpmph.15.009
  • 9,041 View
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  • 7 Crossref
AbstractAbstract PDF
Objectives
Although the prevalence of depressive disorders in South Korea’s general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities.
Methods
Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated.
Results
The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2), with major depressive disorder 5.4% (95% CI, 2.1 to 8.7), dysthymia 1.1% (95% CI, 0.0 to 2.6), and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5). Among the 26 patients with depressive disorder, 19 patients were newly diagnosed.
Conclusions
As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.
Summary

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Assessing Reliability of Medical Record Reviews for the Detection of Hospital Adverse Events
Minsu Ock, Sang-il Lee, Min-Woo Jo, Jin Yong Lee, Seon-Ha Kim
J Prev Med Public Health. 2015;48(5):239-248.   Published online September 11, 2015
DOI: https://doi.org/10.3961/jpmph.14.049
  • 9,377 View
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AbstractAbstract PDFSupplementary Material
Objectives
The purpose of this study was to assess the inter-rater reliability and intra-rater reliability of medical record review for the detection of hospital adverse events.
Methods
We conducted two stages retrospective medical records review of a random sample of 96 patients from one acute-care general hospital. The first stage was an explicit patient record review by two nurses to detect the presence of 41 screening criteria (SC). The second stage was an implicit structured review by two physicians to identify the occurrence of adverse events from the positive cases on the SC. The inter-rater reliability of two nurses and that of two physicians were assessed. The intra-rater reliability was also evaluated by using test-retest method at approximately two weeks later.
Results
In 84.2% of the patient medical records, the nurses agreed as to the necessity for the second stage review (kappa, 0.68; 95% confidence interval [CI], 0.54 to 0.83). In 93.0% of the patient medical records screened by nurses, the physicians agreed about the absence or presence of adverse events (kappa, 0.71; 95% CI, 0.44 to 0.97). When assessing intra-rater reliability, the kappa indices of two nurses were 0.54 (95% CI, 0.31 to 0.77) and 0.67 (95% CI, 0.47 to 0.87), whereas those of two physicians were 0.87 (95% CI, 0.62 to 1.00) and 0.37 (95% CI, -0.16 to 0.89).
Conclusions
In this study, the medical record review for detecting adverse events showed intermediate to good level of inter-rater and intra-rater reliability. Well organized training program for reviewers and clearly defining SC are required to get more reliable results in the hospital adverse event study.
Summary

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Nurse-perceived Patient Adverse Events and Nursing Practice Environment
Jeong-Hee Kang, Chul-Woung Kim, Sang-Yi Lee
J Prev Med Public Health. 2014;47(5):273-280.   Published online September 12, 2014
DOI: https://doi.org/10.3961/jpmph.14.019
  • 11,788 View
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AbstractAbstract PDF
Objectives
To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. Methods: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. Results: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, ‘physician- nurse relationship’ correlated with medication errors while ‘education for improving quality of care’ affected patient falls. Conclusions: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
Summary

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Selecting the Best Prediction Model for Readmission
Eun Whan Lee
J Prev Med Public Health. 2012;45(4):259-266.   Published online July 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.4.259
  • 12,259 View
  • 104 Download
  • 35 Crossref
AbstractAbstract PDF
Objectives

This study aims to determine the risk factors predicting rehospitalization by comparing three models and selecting the most successful model.

Methods

In order to predict the risk of rehospitalization within 28 days after discharge, 11 951 inpatients were recruited into this study between January and December 2009. Predictive models were constructed with three methods, logistic regression analysis, a decision tree, and a neural network, and the models were compared and evaluated in light of their misclassification rate, root asymptotic standard error, lift chart, and receiver operating characteristic curve.

Results

The decision tree was selected as the final model. The risk of rehospitalization was higher when the length of stay (LOS) was less than 2 days, route of admission was through the out-patient department (OPD), medical department was in internal medicine, 10th revision of the International Classification of Diseases code was neoplasm, LOS was relatively shorter, and the frequency of OPD visit was greater.

Conclusions

When a patient is to be discharged within 2 days, the appropriateness of discharge should be considered, with special concern of undiscovered complications and co-morbidities. In particular, if the patient is admitted through the OPD, any suspected disease should be appropriately examined and prompt outcomes of tests should be secured. Moreover, for patients of internal medicine practitioners, co-morbidity and complications caused by chronic illness should be given greater attention.

Summary

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English Abstract
The Effect of Outpatient Cost Sharing on Health Care Utilization of the Elderly.
Myunghwa Kim, Soonman Kwon
J Prev Med Public Health. 2010;43(6):496-504.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.496
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  • 19 Crossref
AbstractAbstract PDF
OBJECTIVES
The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. METHODS: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. RESULTS: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. CONCLUSIONS: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.
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JPMPH : Journal of Preventive Medicine and Public Health