Understanding Regional Trauma Centers and managing a trauma care system in South Korea:a systematic review

The Korean government initiated a plan to designate and establish Regional Trauma Centers to reduce the preventable trauma death rate to <20% so as to be on par with advanced countries by 2020. This initiative was undertaken because the reported preventable trauma death rate was close to 40% in South Korea from 1997 to 2009. This review aimed to provide an overview of these Regional Trauma Centers and discuss further development of the trauma care system to assess its performance. As of September 2021, 15 Regional Trauma Centers had been established through a metropolitan-based designation process. Each center has been equipped with Level-I facilities. These Regional Trauma Centers have had 2 positive effects; namely, an increase in the number of severely injured patients attending these centers and a decrease in the national preventable trauma death rate from 30.5% in 2015 to 19.9% in 2017. The establishment of Regional Trauma Centers can lead to improved performance, maximal efficiency, and reduction of preventable deaths in trauma patients.They can also play a key role in prehospital triage and transportation in the trauma care system.

A Review of Quality Management and Improvement of Trauma Fee Schedule in Regional Trauma Center / 보건행정학회지

The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

Analysing the Effects of Regional Factors on the Regional Variation of Obesity Rates Using the Geographically Weighted Regression / 보건행정학회지

BACKGROUND: This study purposed to analyze the relationship between regional obesity rates and regional variables. METHODS: Data was collected from the Korean Statistical Information Service (KOSIS) and Community Health Survey in 2012. The units of analysis were administrative districts such as city, county, and district. The dependent variable was the age-sex adjusted regional obesity rates. The independent variables were selected to represent four aspects of regions: health behaviour factor, psychological factor, socio-economic factor, and physical environment factor. Along with the traditional ordinary least square (OLS) regression analysis model, this study applied geographically weighted regression (GWR) analysis to calculate the regression coefficients for each region. RESULTS: The OLS results showed that there were significant differences in regional obesity rates in high-risk drinking, walking, depression, and financial independence. The GWR results showed that the size of regression coefficients in independent variables was differed by regions. CONCLUSION: Our results can help in providing useful information for health policy makers. Regional characteristics should be considered when allocating health resources and developing health-related programs.

Spatial Distribution of Diabetes Prevalence Rates and Its Relationship with the Regional Characteristics / 보건행정학회지

This study purposed to analyze the relationship between spatial distribution of Diabetes prevalence rates and regional variables. The unit of analysis was administrative districts of city·gun·gu. Dependent variable was the age- and sex- adjusted diabetes prevalence rates and regional variables were selected to represent three aspects: demographic and socioeconomic factor, health and medical factor, and physical environment factor. Along with the traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for the spatial analysis. Analysis results showed that age- and sex-adjusted diabetes prevalence rates were varied depending on regions. OLS regression showed that diabetes prevalence rates had significant relationships with percent of population over age 65 and financial independence rate. In GWR, the effects of regional variables were not consistent. These results provide information to health policy makers. Regional characteristics should be considered in allocating health resources and developing health related programs for the regional disease management.

The Effects of Hospital Resources on the Service Uses: Hospital Service Area Approach / 보건행정학회지

BACKGROUND: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hospital service area (HSA) in Korea. METHODS: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the degree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by summing the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and number of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly premium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index. RESULTS: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also localization index was found to have positive significant relationships with service uses. CONCLUSION: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.

Difference in Healthcare Utilization for Percutaneous Transluminal Coronary Angioplasty Inpatients by Insurance Types: Propensity Score Matching Analysis / 보건행정학회지

BACKGROUND: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). METHODS: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. RESULTS: Tertiary hospitals didn't show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. CONCLUSION: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.

Regional Disparities of Suicide Mortality by Gender / 보건행정학회지

BACKGROUND: Suicide is one of important health problems in Korea. Previous studies showed factors associated with suicide in individual levels. However, suicide was influenced by society that individuals belong to, so it was required to analyze suicide in local levels. The purpose of this study was to analyze the regional disparities of suicide mortality by gender and the association between local characteristics and suicide mortality. METHODS: This study included 229 city.county.district administrative districts in Korea. Age- and sex-standardized suicide mortality and age-standardized suicide mortality (male/female) were used as dependent variables. City.county.district types, socio-demographics (number of divorces per 1,000 population, number of marriages per 1,000 population, and single households), financial variable (financial independence), welfare variable (welfare budget), and health behavior/status (perceived health status scores and EuroQol-5 dimension [EQ-5D]) were used to represent the local characteristics. We used hot-spot analysis to identify the spatial patterns of suicide mortality and negative binomial regression analysis to examine factors affecting suicide mortality. RESULTS: There were differences in distribution of suicide mortality and hot-spot regions of suicide mortality by gender. Negative binomial regression analysis provided that city.county.district types (city), number of divorces per 1,000 population, financial independence, and EQ-5D had significant influences on the age- and sex-standardized suicide mortality per 100,000. Factor influencing suicide mortality was the number of divorces per 1,000 population in both male and female. CONCLUSION: Study results provided evidences that suicide mortality among regions was differed by gender. Health policy makers will need to consider gender and local characteristics when making policies for suicides.