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Original Articles
Provider Perspectives, Barriers, and Improvement Strategies for Hospital Discharge Support Programs: A Focus Group Interview Study in Korea
Jae Woo Choi, Aejung Yoo, Hyojung Bang, Hyun-Kyung Park, Hyun-Ji Lee, Hyejin Lee
J Prev Med Public Health. 2024;57(6):572-585.   Published online October 4, 2024
DOI: https://doi.org/10.3961/jpmph.24.275
  • 762 View
  • 103 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Transitional periods, such as patient discharge, are notably challenging. This study aimed to explore the perceptions of providers involved in hospital discharge support programs, identify the primary obstacles, and propose strategies for improvement.
Methods
In this qualitative cross-sectional study, we interviewed 49 healthcare professionals, comprising doctors, nurses, and social workers, who participated in two pilot programs. We organized focus group interviews with 3-6 participants per group, segmented by the type of discharge support program and profession. For data analysis, we employed phenomenological analysis, a qualitative method.
Results
Participants recognized the importance of the discharge support program and anticipated its benefits. The Rehabilitation Hospital Discharge Patient Support program saw more active involvement from doctors than the Establishment of a Public Health-Medical Collaboration System program. Both programs highlighted the critical need for more staff and better compensation, as identified by the doctors. Nurses and social workers cited the heavy documentation burden, uncooperative attitudes from patients and local governments, and other issues. They also anticipated that program improvements could be achieved through the standardization of regional welfare services and better coordination by local governments serving as welfare service regulators. All groups—doctors, nurses, and social workers—underscored the significance of promoting these programs.
Conclusions
Discharge support programs are crucial for patients with functional impairments and severe illnesses, particularly in ensuring continuity of care. Policy support is essential for the successful implementation of these programs in Korea.
Summary
Korean summary
퇴원 지원 사업에 참여하는 의사, 간호사, 사회복지사 등 퇴원지원사업 담당자를 대상으로 시범사업 수행에 있어 주요 문제점과 개선방안을 인터뷰를 통해 조사하였을 때 참가자들은 퇴원 지원 사업이 필요하고 특히 기능 저하가 심한 환자들에게 도움이 될 것이라고 응답하였다. 그러나, 의사의 참여 부족, 연계 가능한 서비스의 부족, 다학제 팀구성이 어려운 보상 수준, 의료기관 간 의사소통의 문제 등 어려움을 지적하였다. 다학제팀 구성과 안정적인 운영을 위한 적절한 수가와 인센티브 구조 마련, 지역과의 네트워크와 지방정부 중심의 조정기능 강화가 문제 해결에 도움이 될 수 있을 것이다.
Key Message
Interviews with doctors, nurses, and social workers involved in discharge support programs revealed key challenges and improvement strategies during pilot projects. Participants acknowledged the necessity of discharge support programs, particularly for patients with severe functional impairments. However, they pointed out difficulties such as insufficient participation from doctors, a lack of available services, inadequate compensation hindering multidisciplinary team, and communication issues between medical institutions. Establishing appropriate reimbursement and incentive structures for stable multidisciplinary team operation, strengthening networks with local communities, and enhancing coordination led by local governments could help address these challenges.
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
  • 1,839 View
  • 82 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.
English Abstract
The Association Between Public Social Expenditure and Suicides: Evidence from OECD Countries.
Yoojin Park, Myoung hee Kim, Soonman Kown, Young jeon Shin
J Prev Med Public Health. 2009;42(2):123-129.
DOI: https://doi.org/10.3961/jpmph.2009.42.2.123
  • 5,659 View
  • 134 Download
  • 13 Crossref
AbstractAbstract PDF
OBJECTIVES
This study aimed to examine the association between public social expenditure (PSE) and suicides in the 27 countries of the Organization for Economic Cooperation and Development (OECD) from 1980 to 2003. METHODS: The age-standardized suicide rates and their annual change (%) were obtained from the OECD Health Data 2007. As a measure of social protection, the PSE (% GDP) was used. The covariates included the annual divorce rate (/100,000 population), fertility rate (number of children/woman aged 15 to 49 years), GDP per capita (US$PPP), male unemployment rate (%), life expectancy (years) and alcohol consumption (liter/capita) for each country, which were all obtained from the OECD Health Data 2007 and the OECD Social Indicators 2006. Using hierarchical linear models that included these covariates, the effects of PSE on suicides (Model 1) and the annual percent change (Model 2) were examined (Model 3). Also, sub-sample analyses were done for six countries that experienced political/economic transition. RESULTS: We could not find significant effects of PSE on suicides (Model 1), but we observed significantly negative effects on the annual percent change for men and women (Model 2). Such findings were replicated in the sub-sample analysis, and moreover, the effect size was much larger (Model 3). CONCLUSIONS: Our finding suggests that social welfare protection can be a pivotal factor for suicide epidemiology, and especially in countries experiencing a social crisis or transition.
Summary

Citations

Citations to this article as recorded by  
  • The Impact of Social Expenditure on Sustainable Human Development: Empirical Evidence on the Suicide Deaths in a Developing Country
    Mert Akyuz
    OMEGA - Journal of Death and Dying.2024;[Epub]     CrossRef
  • Effects of health-related quality of life and long-term care insurance infrastructure on suicidal ideation among older Korean adults
    Changsook Lee, Sun-Young Heo
    Asia Pacific Journal of Social Work and Development.2023; 33(2): 101.     CrossRef
  • Spatiotemporal clustering of suicide attempt in Kermanshah, West-Iran
    Alireza Zangeneh, Nahid Khademi, Naser Farahmandmoghadam, Arash Ziapour, Reyhane Naderlou, Somayyeh Shalchi Oghli, Raziyeh Teimouri, Komali Yenneti, Shahrzad Moghadam
    Frontiers in Psychiatry.2023;[Epub]     CrossRef
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    Seda Aydan, Gamze Bayin Donar, Cengiz Arikan
    Social Work in Public Health.2022; 37(5): 435.     CrossRef
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    A. Kung, K. G. Hastings, K. I. Kapphahn, E. J. Wang, M. R. Cullen, S. L. Ivey, L. P. Palaniappan, S. Chung
    Epidemiology and Psychiatric Sciences.2018; 27(1): 62.     CrossRef
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    Chungah Kim
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Original Articles
Burden of Disease in Korea: Years of Life Lost due to Premature Deaths.
Hyejung Chang, Jae Il Myoung, Youngsoo Shin
Korean J Prev Med. 2001;34(4):354-362.
  • 2,497 View
  • 37 Download
AbstractAbstract PDF
OBJECTIVES
The aim of this study was to estimate the burden of disease through an analysis of Years of Life Lost due to premature deaths, one component of the Disability-Adjusted Life Years (DALY). In addition, the cause of death statistics were adjusted to improve validity, and the results were compared with those of the Global Burden of Disease (GBD). METHODS: In closely following the approach taken in the original GBD study, most of the explicit assumptions and the value judgments were not changed. However, the statistics for some problematic concerns such as deaths of infants or those due to senility, were adjusted. Deaths, standard expected years of life lost (SEYLL), and potential years of life lost (PYLL) were computed using vital registration data compiled by the National Statistical Office. RESULTS: The burden for males is 1.8 and 2.3 times higher than that for females, according to SEYLL and PYLL, respectively. The proportions of deaths due to Group I, II, and III causes are 5.4%, 80.4%, and 14.3%, respectively, for PYLL, but in a major shift from Group II to III they are 6.3%, 66.2%, and 27.5%, respectively, for SEYLL. The proportion of Group III causes in Korea, 27.5%, is extremely high when compared to 10.1% for the world, 7.6% for developed countries, and 10.7% for developing countries. CONCLUSIONS: Estimation results showed that the total burden due to premature deaths is smaller than that for the entire world but larger than that for developed countries. The disease structure of Korea has changed to resemble that of developed countries. Also, an overly large portion of the total burden in Korea stems from injuries arising from car accidents.
Summary
Perspective on Population Characteristics and Health Problems of Koreans in 21st Century.
Joung Soon Kim
Korean J Prev Med. 1994;27(2):175-185.
  • 2,133 View
  • 23 Download
AbstractAbstract PDF
In order to anticipate disease pattern and health problems of Koreans in the 1st part of 21st century(by the year 2020), transition of population characteristics, mortality and morbidity data during the last 30 years Koreans have experienced were reviewed. On the actual basis of epidemiolgic transition process that has undergone during last 30 years since 1960 along with socioeconomic development and successful implementation of selective national health policies(family planning, medical insurance and etc.), following changes can be expected in the 21st century in Korea, under the assumption that the current rate of progress is maintained. The population of South Korea alone will be doubled the population of 1960 by the year 2013;aged population older than 65 years will be increased from 3.3% in 1960 to 11.4% in 2020 with increased average age of the population from 23.6 year in 1970 to 39.2 year in 2020;urban population from 28% in 1960 to 83% in 2005. GNP/capita has increased tremendously from U.S. $120 in 1970 to $6,749 in 1992, and the government estimated it would be $19,350 in 2010 and $29,460 in 2020. Growth and developmental indices of children, educational achievement and social status of women also showed a remarkable improvement and anticipated to make further progress. Leading causes of mortality and morbidity have shown a striking change during the last 30 years, from infectious diseases to chronic degenerative diseases and man-made injuries. Occurrence of communicable diseases may become minimal although viral hepatitis, venereal diseases including AIDS, and well adapted herpes virus infections will maintain their endemic level. Newly evolving infectious agents, however, should be carefully monitored because of rapidly changing environments and human behaviors. Tuberculosis may increase up to the epidemic level when AIDS prevails. Ischemic heart diseases may increase steadily with increasing occurrence of hypertension and diabetes mellitus whereas cerebrovascular diseases may be decreased slowly. Musculaskeletal diseases which contribute a lot to the disability of aged people may be a major health problems due to increased aged population. Mental diseases, particularly that caused by alcohol and drug abuse, and senile dementia may become a prominent health problem. On the other hand injuries caused by traffic and industrial accidents that have shown most striking increase till now may be decreased considerably by intensive intervention. The health policies in the 21st century will be oriented to the health promotion for good quality life rather than life-savings.
Summary
English Abstract
Preventive Medicine in Times of a Rapid Epidemiologic Transition in Korea.
Jung Han Park
J Prev Med Public Health. 2006;39(1):2-6.
  • 2,393 View
  • 41 Download
AbstractAbstract PDF
Ever since the foundation of the Korean Society for Preventive Medicine in 1947, members of the Society had made a remarkable contribution to the public health development and national health promotion. They had played key roles in establishing national health system, improving environmental hygiene, controlling infectious and chronic diseases, promoting family planning, improving industrial and environmental health, and developing health service management. However, the Society had less actively responded to the changes in health service needs of the population that were caused by a rapid epidemiologic transition in last a few decades. Early detection and treatment of chronic diseases including cancer and cardiovascular diseases and risk reduction by the life style modification are major approaches to the contemporary national health problems and they are the core contents of preventive medicine. The author proposed to develop the clinical preventive medicine specialist who will have additional training in clinical medicine for health screening and life style modification to the current preventive medicine training program and thus will be able to provide comprehensive preventive medical services. Another area that the Society may take the initiative is training preventive medicine specialist in the disaster, including bioterrorism, preparedness and management. The Society should be more active in proposing health policy and health service program and also participate collectively in a large scale health research project of the government. These approaches may not only contribute more effectively to the national health promotion but also improve the identity of the Society.
Summary
JPMPH : Journal of Preventive Medicine and Public Health
© Korean Society for Preventive Medicine.
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