Determinants of Healthy Living Practice: County Approach / 보건행정학회지

Background@#The purpose of this study is to investigate the factors affecting the healthy living practice rate such as non-smoking, moderate drinking, walking, and low-salt diet by elementary municipality (so called, ‘si-gun-hu’). @*Methods@#The 2016 Korean Community Health Survey was used for the analysis. The theoretical model is founded upon the Anderson model, and both the multiple linear regression analysis and the beta regression analysis was performed for estimation. @*Results@#As a result of the beta regression analysis, healthy living practice rate was found to be significantly higher in the areas with a less number of cigarette retailers, participating in healthy city projects, a low proportion of people who perceive their body type as obesity, a higher proportion of women, and a lower proportion of spouses. @*Conclusion@#In order to improve healthy living practices, the regulations on health risk businesses, the spread of Healthy City project, and policy efforts awaring obesity are recommended.

Impact of Continuous Care on Health Outcomes and Cost for Type 2 Diabetes Mellitus: Analysis Using National Health Insurance Cohort Database

BACKGROUND: The objective of the study was to determine the impact of continuous care on health outcomes and cost of type 2 diabetes mellitus (T2DM) in Korea.METHODS: A nationwide retrospective, observational case-control study was conducted. Continuity of treatment was measured using Continuity of Care (COC) score. Information of all patients newly diagnosed with T2DM in 2004 was retrieved from the National Health Insurance database for the period of 2002 to 2013. The study examined 2,373 patients after applying exclusion criteria, such as for patients who died from conditions not related to T2DM. Statistical analyses were performed using frequency distribution, simple analysis (t-test and chi-squared test), and multi-method analysis (simple linear regression, logistic regression, and survival analysis).RESULTS: The overall COC score was 0.8±0.24. The average incidence of diabetic complications was 0.39 per patient with a higher COC score, whereas it was 0.49 per patient with a lower COC score. In both survival and logistic analyses, patients who had high COC score were significantly less likely to have diabetic complications (hazard ratio, 0.69; 95% confidence interval, 0.54 to 0.88). The average medical cost was approximately 3,496 United States dollar (USD) per patient for patients with a higher COC score, whereas it was 3,973 USD per patient for patients with a lower COC score during the 2006 to 2013 period, with a difference of around 477 USD, which is statistically significant after adjusting for other factors (β=−0.152).CONCLUSION: Continuity of care for diabetes significantly reduced health complications and medical costs from patients with T2DM.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea / 예방의학회지

OBJECTIVES@#This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea.@*METHODS@#In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared.@*RESULTS@#The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively.@*CONCLUSIONS@#Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea / 예방의학회지

OBJECTIVES: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. METHODS: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. RESULTS: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. CONCLUSIONS: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Utilization of Hospitals Located Outside Patients' Residential Areas among Those with Acute Cerebral Infarction / 보건행정학회지

BACKGROUND: The current study evaluated the hospital utilization and characteristics of patients who received health care services for acute cerebral infarction outside their own residential area. METHODS: Using the 2014 national patient survey data, information on 2,982 patients diagnosed with acute cerebral infarction through emergency department were retrieved for the analyses. Multiple logistic regression was performed to investigate the characteristics associated with using hospitals outside residential area among patients diagnosed with acute cerebral infarction. RESULTS: Fifteen point nine percent of patients admitted for acute cerebral infarction utilized hospitals outside their residential area. Patients residing in a province were 7.7 times more likely to utilize hospitals located outside their residential areas compared to those living in Seoul metropolitan city. Patients living in Gangwon and Jeolla were 0.26 times and 0.48 times more likely to go to hospitals in different geographical areas. Also, patients within the age group of 80 years and over were 0.65 times less likely to be admitted to hospitals outside their residential area compared to those in their 40s–50s. CONCLUSION: The use of hospitals outside patient's residential area is shown to be substantial, given that the acute cerebral infarction requires immediate recognition and treatment. The findings on the geographical differences in the hospital utilization suggest further investigation.

Hospital Admission Rates for Ambulatory Care Sensitive Conditions in South Korea: Could It Be Used as an Indicator for Measuring Efficiency of Healthcare Utilization? / 보건행정학회지

BACKGROUND: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. METHODS: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. RESULTS: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (β=0.986, p<0.05), and for private corporate institutions than public institutions (β=0.271, p<0.05). CONCLUSION: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.

Comparing physicians' reporting propensity with active and passive surveillance systems in South Korea

Passive surveillance (PS) is a traditional approach to communicable disease surveillance. To complement the approach, several countries have adopted active surveillance (AS) systems that involve the voluntary participation of physicians. This study compares AS versus PS systems in Korea based on the systems' reporting propensity of chickenpox. A mail questionnaire survey was conducted with a random sample of physicians involved in the PS system (N=1,955) and all sentinel physicians of the AS system (N=193). Multiple regression analysis was conducted to identify factors associated with reporting propensity. The reporting propensity of physicians in the AS system was significantly higher than that in the PS surveillance system, 2.7 versus 1.9 on a 5-point Likert scale (p<0.05). Multiple regression analysis showed that, in addition to the type of the surveillance system, physician knowledge of chickenpox as a notifiable disease and the type of institution with which a physician was affiliated were significant factors for a physician's reporting propensity. For both systems, the common barriers for reporting were 'lack of confidence in diagnosis,' 'burden from interference by the public health department following reporting,' and 'complexity of the reporting system.' In conclusion, AS of communicable diseases appeared to have a significantly better performance compared to PS in Korea in the case of chickenpox reporting. These findings would be useful for countries concerned with developing more effective strategies for improving the reporting rate of notifiable diseases.

Benchmarking leading countries' accreditation programs for ambulatory healthcare organizations

Healthcare accreditation, which in the Republic of Korea is based on Article 58 of the Medical Service Act of July 2010, is an evaluation system designed to improve the quality of medical services and secure patient safety. Although ambulatory health organizations such as clinics comprise the majority of all health facilities, because they are not currently evaluated, securing quality and patient safety nationwide is not possible under the existing system. This article reviewed the accreditation programs of ambulatory health organizations in leading countries such as the United States and Australia in order to propose a successful model for Korea. The Accreditation Association for Ambulatory Health Care of the Unites States is a private, non-profit organization established in 1979. Similarly, Australian General Practice Accreditation Limited is a non-profit organization established in 1997 to deliver services to support general practices in Australia. Both are independent professional organizations and perform accreditation programs by a self-regulatory system. As healthcare quality improvement and accreditation have the characteristics of professional service activities, a self-regulatory approach rather than a government-controlled one, and process-oriented evaluation rather than structure-focused evaluation, are known to be effective. We expect an accreditation program for clinics in Korea to be established using a self-regulatory approach by an independent professional organization, not by the government, in the near future.

Patient satisfaction versus political support: Korea's drug-dispensing law revisited

In 2000, Korea enacted a controversial law prohibiting doctors from dispensing drugs. Doctors have opposed this law, and in theory, the law inconveniences patients. We assessed the relationship between patients' satisfaction with drug dispensation and their overall support for the law by using a logit model to determine the effects of the law on patients and which patients are likely to support the law. We employed random digit dialing and obtained a sample of 540 adults who had used drugs since the law was enacted. We collected the data through phone interviews. The results indicate that the respondents were generally dissatisfied with the law regardless of sociodemographic or regional characteristics. However, with other factors controlled for, those respondents from the same region as the ruling political party were significantly more likely to support the law. This implies that regional politics influenced the policymaking process through which the law was crafted and enacted.

Mutual recognition policy of medical license for medical professionals under Free Trade Agreement

Discussion on movement of medical personnel arises as a main issue when contracting free trade agreement between two countries. It is sensitive issue for both developed and developing country in terms of their own interest; developed country requires movement of medical personnel in order to solve aging population and manpower shortage problems in certain medical fields, whereas developing countries approache this issue with the purpose of exporting health professionals and improving the quality of medical care. We have not settled mutual recognition for medical professional's license, including that of medical doctors in Free Trade Agreement. However, as the opening of service sector expands is gradually, labor exchange of medical professionals at international level is expected to be more active in the future. Therefore, preparing quality of license at developed countries' standards and post management system is urgently required. Also, we have to strive for modification of law as well as global-level qualification to assist domestic professionals to enter overseas market.

Socioeconomic Costs of Alcohol Drinking in Korea

BACKGROUND: The purpose of this study was to estimate socioeconomic costs caused by alcohol drinking in Korea as of 2004 in an effort to raise the awareness of the gravity of problems associated with alcohol drinking and the necessity of active intervention by family physicians. METHODS: The costs were classified as direct costs, indirect costs and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by the reduction and loss of productivity and the loss of workforce. Other costs consisted of property loss, administration costs and costs of alcohol beverage. RESULTS: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 200,990 hundred million won (2.9% of GDP). In the case of the former, the amount included 38.83% for reduction of productivity, 26.92% for loss of the workforce, 22.24% for alcoholic beverage, 5.34% for direct medical costs, 2.29% for loss of productivity, 1.87% for direct non- medical costs, 1.54% for administration costs and 0.97% for loss of property. CONCLUSION: Our study confirms that compared with the cases of Japan (1.9% of GNP), Canada (1.09% of GDP), France (1.42% of GDP) and Scotland (1.19% of GDP), alcohol drinking incurs substantial socioeconomic costs to Koreans. An active intervention by family physicians is suggested.

Reporting of National Notifiable Infectious Diseases (NNIDs) and Related Characteristics / 한국역학회지

communicable diseases. The purposes of the study is to estimate reporting proportion of National Notifiable Infectious Diseases(NNIDs) and investigate characteristics related to reporting using KAP(knowledge, attitude, practice) model. METHOD: We surveyed randomly selected 2,185 physicians (speciality: internal medicine, family medicine, pediatrics, dermatology, general physicians) of their knowledge, attitude, and practice of NNIDs reporting through self-administered mail questionnaires. Of them, 231 physicians responded (response proportion: 10.6%). RESULT: The reporting proportion was estimated to 27.0%. Recognition level (knowledge) of NNIDs was relatively high with proportion of 69.4%, and attitude (public health importance) of reporting was 65.8%. Multiple logistic regression analysis showed that knowledge, attitude significantly affected physicians' reporting in a positive direction (O.R. 6.2, 6.2 respectively). Whereas, senior age group, specialty (family medicine, pediatrics, dermatology) showed significantly lower reporting. General (tertiary care) hospital level of care showed significantly higher reporting practice (alpha=0.05). CONCLUSION: The NNIDs reporting proportion, 27.0% is similar with those studied recently. Continuous efforts to increase the performance level of communicable diseases surveillance system. Of those, restructuring surveillance systems considering characteristics of notifiable diseases classes must be stressed. Educational approach of physicians needs to be tailored specially to newly-designated diseases such as Group II, Designated Group NNIDs.

A Forecasting Model for the Epidemic of Nationally Notifiable Communicable Diseases in Korea / 한국역학회지

PURPOSES: The authors derived two forecasting models which can be used as objective tools for detecting epidemics and predicting the future frequencies of communicable diseases. METHODS: In this study, regression analysis using trigonometric functions, Box and Jenkins's seasonal ARIMA model were applied to the monthly accumulated data of five nationally notifiable communicable diseases from January 1987 to December 1998 in Korea. RESULTS: Between two forecasting models, seasonal ARIMA model gives more precise predicted frequencies than regression model in the neighborhood of the current time points and future time, but the regression model is better in overall agreement between the predicted and observed frequencies during 7 years(1992-1998). CONCLUSIONS: These forecasting models can be usefully applied in deciding and carrying out a national policy in preventing epidemics in the future, and graphic program is much helpful to understand the present status of disease occurrence.

Incorrect Disease Coding in Medical Insurance Claims and the Effect of Official Intervention: Based on Medical Insurance Claims of 6 Notifiable Acute Communicable Diseases / 한국역학회지

BACKGROUND: Because of their large size and excellent computerized records of illness and services rendered, the importance of national insurance program is getting much attentions from the public health researchers and the national and local health authorities. In reality, however, most health records from medical insurance program suffer very much from inaccurate disease coding, and therefore, they are practically in no use. METHODS: Pattern of incorrect disease coding of 6 Notifiable Acute Communicable Diseases that believed not to have been occurred in Korea lately was reviewed. The reasons of such incorrect codings in different level of medical institutions were studied. This study also attempted to see how an official intervention asking the medical institutions to correct their coding behavior works by comparing the frequencies of incorrect disease coding before and after the intervention. RESULTS: Study results showed that more incorrect disease codings came from clinics than hospitals, and non-physician personnel in clinics and hospitals seemed to be responsible for most of the incorrect disease codings. Most frequent diseases coded incorrectly such as cholera and poliomyelitis were the ones that physicians and non-physician personnel in the clinics and hospitals had been familiar with for a long time period. CONCLUSION: Even a simple official intervention asking the clinics and hospitals to correct their coding behavior was very effective : total number of incorrect disease codings before intervention (398 cases from 144 institutions) dramatically decreased (14 cases from 8 institutions) after intervention. Significant decrease in incorrect disease coding was found more in small institutions such as clinics and public health facilities than large institutions.

Estimation of Disease Code Accuracy of National Medical Insurance Data and the Related Factors / 예방의학회지

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows: 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I.: 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (47.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and forties age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

Health risks related to shift work among female workers of major manufacturing industries in Korea / 예방의학회지

Much of the working population in developing countries are engaged in shift work now and the number of shift workers is not expected to decrease in the future mostly because the need for continuity of production is increasing. Therefore, the possible effects of shift work on health are of particular interest, and in fact, there have been many epidemiological studies on shift work since the first world war. However, no studies on health effects of shift work have been reported in Korea, and the existing studies in western world have arrived at quite different conclusions mainly because the conditions of work other than shift work, such as age and selection of workers, work environment, and labor conditions also influence the health of workers. This study was firstly carried out in Korea to investigate the health risks related to shift work with 2,093 female workers randomly selected from three major manufacturing industries in proportion to total number of female workers in those industries. Differences of work conditions other than shift work in this study were adjusted by multivariate analysis. Major findings obtained from this study are as follows: 1. There were significant differences between shift and day workers in the distribution of age, type of industry, condition of noise and dust, regularity of mealtime, working position, and working duration. Shift workers tended to be younger, to have shorter working duration, to have more irregular mealtime, to work in standing position, and to work under more noisy and dusty environment than day workers. 2. Univariate analysis showed that shift work increased the Todai Health Index (THI) scores of digestive tract, respiratory tract, and mental instability symptom categories. Shift work also increased days of sickness absence and number of industrial accident per 100 workers per month. 3. Multivariate analysis that adjusted the differences of demographic, occupational and non-occupational health-related working conditions showed that digestive tract symptoms and mental instability symptom scores were significantly higher in shift workers than those in day workers. Based on those study results, it is concluded that the shift work has significant effects on some psychophysiological conditions of the workers and the effects are also influenced by several other personal and working conditions.

Variation in resource utilization for inpatients among university teaching hospitals in city / 예방의학회지

The variation in resource utilization for hospitalized patients who had a group of similar disease -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utilization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs: the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs; the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs; the ratio of the maximum and the minimum among the mean LOS of hospitals was greater than 2 in 82 KDRGs; the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.