Prediction of Health Care Cost Using the Hierarchical Condition Category Risk Adjustment Model / 보건행정학회지

BACKGROUND: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. METHODS: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication- days plus model 3). We evaluated model performance using R² at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. RESULTS: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. R² values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding R² values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. CONCLUSION: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

A Case-Controlled Study of Cognitive Behavioral Therapy for Patients with Schizophrenia Having Violence-Related Crime / 대한정신분열병학회지

OBJECTIVES: Despite remarkable development of pharmacotherapy for schizophrenia, some patients continuously have had violence problems. The violence of psychotic patients is recently becoming the focus of the attention. The aim of this study is to investigate the influence of Cognitive Behavioral Therapy (CBT) on patients with schizophrenia having violence related history. METHODS: 15 Patients with schizophrenia spectrum disorder of crime history were treated with individual CBT for 12 sessions, and assessed with 4 scales (Korean version of Aggression Questionnaire, Korean version of the Barratt Impulsiveness Scale-11-Revised, Beck Cognitive Insight Scale and Positive and Negative Syndrome Scale) to evaluate anger, impulse, insight and clinical symptoms respectively at baseline and post treatment. The comparison group consisted of 15 patients with schizophrenia spectrum disorder of crime history. They were also assessed with the same scales during the same period. RESULTS: Although impulsivity is not changed significantly after treatment, but there was significant improvement in clinical symptom, insight and aggression, especially self-reflectiveness and anger respectively. CONCLUSION: CBT can be one of the good therapeutic tools for patients with schizophrenia having violence problems in that it reduces aggression and enhances insight of patients with schizophrenia spectrum disorder.

Effect of CORE Program on Cognitive, Social and Emotional Characteristics of Sex Offenders / 대한법의학회지

The purpose of this study was to develop the CORE Program for sex offenders and to determine its effectiveness. The CORE Program was designed with an aim to achieve cognitive restructuring, improve the ability to empathize in interpersonal relationships, and enhance self-esteem and intimacy. We conducted this program over 48 sessions for 28 sex offenders. The effectiveness of the program was evaluated using the Interpersonal Responsiveness Index (IRI), Self-esteem Questionnaire (SEQ), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI), Rape Myth Acceptance Scale (RMAS), and Wilson's Sex Fantasy Questionnaire (WSFQ). The data were analyzed using paired t-tests. Our results showed no significant changes in the SEQ, UCLALS, and IRI scores after the treatment program. However, the scores for the CUSI, RMAS, and WSFQ significantly improved after this program. In this paper, we demonstrate the effectiveness of the CORE Program for sex offenders. We also discuss the limitations of our study and provide suggestions for future research. Our findings indicate that this treatment program should be provided to sex offenders for preventing recidivism.

Legal Features of Mental Disorders among Sexual Offenders without Paraphilia / 대한법의학회지

The aim of this study was to evaluate the legal features of sexual offenders with mental disorders without paraphilia. Patients admitted to Korea Forensic Hospital from 1994 to 2012 (n = 193) were reviewed for diagnosis, crime, legal responsibility, readmission (number of admissions), hospitalizations, criminal record, and education level. Psychotic subjects were often declared not guilty because of insanity and avoided legal responsibility, but had long admission periods and fewer criminal records. Mentally retarded subjects also had long admission periods and fewer criminal records, but commited more sexual offenses against victims aged 13 and younger. The substance abuse group had extensive criminal records, shorter admission periods, and frequent admissions. Subjects with personality disorders and others committed relatively more violent crime with injuries, rather than simple sexual offenses. Treatment and social concerns suitable to each diagnosis are required to address sexual offenses associated with diverse legal characteristics.

The Characteristics of Recidivism in Sex Offenders by STATIC-99 and KSORAS / 대한법의학회지

OBJECTIVES: The aim of this study was to evaluate the risk of recidivism in sex offenders according to the sociodemographic factors, IQ, diagnosis by using Static-99 and KSORAS. METHODS: A total of 48 sex offenders were enrolled. Among them, 44 offenders were rated by Static-99, 41 offenders were evaluated by KSORAS. All the information was collected by reviewing medical records and written records of prosecutors or police retrospectively. RESULTS: In Static-99 and KSORAS, young adults tend to commit more recidivism than late adults. Single offenders have high rates of recidivism than married offenders in Static-99. In KSORAS, mental retardation patients have a tendency to commit more recidivism than schizophrenia patients. CONCLUSION: We should not overlook that specific condition of sex offenders (young adults, single, mental retardation) can have more possibility of recidivism.