Inflow and outflow type analysis of emergency department patients of the Honam region

OBJECTIVE: This study examined the inflow and outflow patterns of emergency department patients with si-gun-gu in the Gwangju, Jeonbuk, and Jeonnam areas. METHODS: Data from the Gwangju, Jeonbuk, and Jeonnam were extracted from the National Emergency Department Information System in 2016. The extracted data (on 42 areas in Gwangju, Jeonbuk, and Jeonnam) using the variables of the patient's address (zip code) and the emergency medical institution code (emergency medical institution address) were used to calculate the relevance index and commitment index. The calculated indices were classified into the regional types by applying NbClust and cluster analysis (K-means) of the R package. RESULTS: The relevance indices ranged from 12.5% to 90.4%, and the commitment indices ranged from 9.2% to 90.3%. The results of cluster analysis with the relevance indices and commitment indices revealed three types for 39 areas. In cluster 1, the relevance indices ranged from 43.5% to 61.6%, and the commitment indices ranged from 9.2% to 49.5%. Three out of the thirty-nine areas were classified as the inflow type. In cluster 2, the relevance indices ranged from 12.5% to 56.0% and the commitment indices ranged from 62.5% to 90.3%; 12 areas were classified as the outflow type. The areas in cluster 3 were classified as the self-sufficient type, with relevance indices ranging from 60.1% to 90.4% and commitment indices ranging from 59.0% to 89.7% for 24 areas. CONCLUSION: Three area types and 11 out of 12 areas classified as outflow types were found to be emergency medical vulnerable areas. The results of this study can be used to establish local emergency medical policies.

Imbalance in Cardiovascular Surgery Medical Service Use Between Regions

BACKGROUND: This study uses the relevance index to understand the condition of regional medical service use for cardiovascular surgery and to identify the medical service use imbalance between regions. METHODS: This study calculated the relevance index of 16 metropolitan cities and provinces using resident registration address data from the Ministry of Government Administration and Home Affairs and the 2010–2014 health insurance, medical care assistance, and medical benefits claims data from the Health Insurance Review and Assessment Service. We identified developments over the 5-year time period and analyzed the level of regional imbalance regarding cardiovascular surgery through the relative comparison of relevance indexes between cardiovascular and other types of surgery. RESULTS: The relevance index was high in large cities such as Seoul, Daegu, and Gwangju, but low in regions that were geographically far from the capital area, such as the Gangwon and Jeju areas. Relevance indexes also fell as the years passed. Cardiovascular surgery has a relatively low relevance index compared to key types of surgery of other fields, such as neurosurgery and colorectal surgery. CONCLUSION: This study identified medical service use imbalance between regions for cardiovascular surgery. Results of this study demonstrate the need for political intervention to enhance the accessibility of necessary special treatment, such as cardiovascular surgery.

Pattern of Regional Emergency Medical Service Utilization and Its Determinants

PURPOSE: This study was performed to analyze the existing patterns of regional emergency medical service utilization and to identify their determinants. METHODS: The original data consisted of the Electronic Data Interchange (EDI) claims of the National Health Insurance about the utilization of emergency medical services in 2002. The relevance index and commitment index were calculated; Then, those indices were analyzed, by using clustering analysis, to categorize the regions. A multiple-regression test identified the determinants for the relevance index and the commitment index. RESULTS: Regional relevance indices were 91.8% for Jeonju-si, 91.4% for Seoul, 91.0% for Ulsan, and 90.9% for Gumi-si, while the commitment indices were 28.0% for Guri-si, 42.9% for Masan-si, 44.0% for Gangneung-si, and 45.3% for Uijeongbu-si. Regions were categorized into inflow-type (e.g., Seoul), mixed-type (e.g., Uijeongbu-si), and outflow-type (e.g., Pyeongtaek-si) by their relevance indices and commitment indices. The determinants for the relevance index and the commitment index were analyzed, and the significant variables affecting the relevance index were the number of emergency medical doctors per 100,000 population, the proportion of general hospitals, the proportion of local and regional emergency medical centers, and administrative districts while those affecting the commitment index were the number of emergency medical doctors per 100,000 population and the proportion of general hospitals. CONCLUSION: This study is the first trial to analyze nationwide data on the utilization of emergency medical services in Korea and to identify its determinants, and it can provide a practical evidence for policy planning for the allocation of emergency medical service resources.