Over- and under-supply of inpatient rehabilitation after stroke without a post-acute rehabilitation system: a nationwide retrospective cohort study.

Introduction: This study aimed to investigate the utilization of post-ischemic stroke rehabilitation prior to the introduction of the post-acute rehabilitation system in South Korea in 2017. Methods: Medical resources utilized for patients with cerebral infarction hospitalized at Regional Cardio-Cerebrovascular Centers (RCCVCs) of 11 tertiary hospitals were tracked until 2019. Stroke severity was classified according to the National Institutes of Health Stroke Scale (NIHSS), and multivariate regression analysis was performed to analyze factors influencing the length of hospital stay (LOS). Results: This study included 3,520 patients. Among 939 patients with stroke with moderate or greater severity, 209 (22.3%) returned home after RCCVC discharge without inpatient rehabilitation. Furthermore, 1,455 (56.4%) out of 2,581 patients with minor strokes with NIHSS scores ≤4 were readmitted to another hospital for rehabilitation. The median LOS of patients who received inpatient rehabilitation after RCCVC discharge was 47 days. During the inpatient rehabilitation period, the patients were admitted to 2.7 hospitals on average. The LOS was longer in the lowest-income group, high-severity group, and women. Conclusion: Before the introduction of the post-acute rehabilitation system, treatment after stroke was both over- and under-supplied, thus delaying home discharge. These results support the development of a post-acute rehabilitation system that defines the patients, duration, and intensity of rehabilitation.

Association Between Initiation of Rehabilitation and Length of Hospital Stay for Workers with Moderate to Severe Work-Related Traumatic Brain Injury.

Background: In workers with moderate to severe work-related traumatic brain injury (wrTBI), this study aimed to investigate the effect of the timing of rehabilitation therapy initiation on the length of hospital stay and the factors that can influence this timing. Methods: We used data obtained from the Republic of Korea's nationwide Workers' Compensation Insurance. In the Republic of Korea, between the years 2010 and 2019, a total of 26,324 workers filed a claim for compensation for moderate to severe wrTBI. Multiple regression modeling was performed to compare the length of hospital stay according to the timing of rehabilitation therapy initiation following wrTBI. According to the timing of the initiation of rehabilitation therapy following TBI, the proportions of healthcare institutions that provided medical care during each admission step were compared. Results: The length of hospital stay for workers who started rehabilitation therapy within 90 days was significantly shorter than that for workers who started rehabilitationment were first admitted to tertiary hospitals. Approximately 39% of patients who received delayed rehabilitation treatment were first admitted to general hospitals, and 28.5% were first admitted to primary hospitals. Conclusions: Our findings demonstrate the importance of early rehabilitation initiation and that the type of healthcare institution that the patient is first admitted to after wrTBI may influence the timing of rehabilitation initiation. The results of this study also emphasize the need to establish a Worker's Compensation Insurance-specialized rehabilitation healthcare delivery system.

Epidemiology of Work-Related Traumatic Spinal Cord Injury: An Analysis of Workers' Compensation Claims in Korea, 2011-2019.

OBJECTIVE: We aimed to identify the incidence and burden of work-related traumatic spinal cord injury (wrTSCI) in Korea in the 10-year period from 2010 to 2019. METHODS: We used nationwide workers' compensation insurance data. The study population comprised industrially injured workers with TSCI diagnosis codes. The annual incidence of wrTSCI (number per million workers) was calculated. RESULTS: The mean annual incidence of wrTSCI was 22.8/1,000,000 (95% confidence interval, 20.5 to 25.0), and the mean total cost per claim was 231.40 million KRW. The incidence of TSCI in the cervical region was the highest (13.1/1,000,000; 95% confidence interval, 11.4 to 14.9), and most cases were in the construction industry (47.3%). CONCLUSION: These findings can help identify specific at-risk groups and facilitate the development of prevention strategies.

Frequency and Cost of Claims by Injury Type From the Korea Workers' Compensation Insurance Between 2016 and 2019.

OBJECTIVE: This study aimed to examine the frequency of worker injuries by affected body part(s) and the associated costs. Methods : We performed a secondary analysis of national workers' compensation claims data from the Korean workers' compensation insurance. The main outcome measures were frequency and cost of claims by injury type. Results : Multiple injuries were ranked as the highest injury type in the number of annual claims and percentage of the total cost/total medical cost. Hand/wrist/finger was the most common single-injury type. The frequency of injury type and the cost amount payable as a percentage of the total cost were the highest for multiple injuries, hand/wrist/finger injuries, and knee/lower leg injuries. Conclusions : Regarding frequency and costs, hand/wrist/finger injuries were highest in cost, by single-injury type. Therefore, these injuries should be recognized as intervention targets.

Prediction Model for Job Retention According to the Type of Return to Work Among Industrially Injured Workers in Korea.

OBJECTIVES: This study aimed to investigate how the type of return to work after an industrial accident affects job retention. METHODS: Using data from the panel study of workers' compensation insurance first-third, and hazard ratios (HRs) and 95% confidence intervals were calculated for workers leaving their jobs. RESULTS: The HR leaving their jobs were higher in the "reemployed" compared with that in the "returned to original work," with HR of 2.69 (2.33-3.10). According workers' status, the HRs leaving their jobs were higher among the "reemployed" than among those who "returned to original work." Regular and daily workers' HRs were 1.70 (1.37-2.11) and 3.55 (2.96-4.26), respectively. CONCLUSIONS: The findings suggest that to increase job retention rate, protection policies for reemployed workers or support for employers who hire reemployed workers should be considered.

Incidence of Traumatic Brain Injury by Severity Among Work-Related Injured Workers From 2010 to 2019: An Analysis of Workers' Compensation Insurance Data in Korea.

OBJECTIVE: This study aimed to investigate the status of work-related traumatic brain injury (wrTBI) in Korea between 2010 and 2019. METHODS: This study used Korea Workers' Compensation Insurance data, and the sample comprised workers who claimed compensation for wrTBI from 2010 to 2019. The annual incidence of wrTBI was calculated as the rate per 100,000 workers. Time trends over the 10-year period were assessed using Poisson regression. RESULTS: The mean incidence of wrTBI was 28.4/100,000. Regarding the incidence rate of wrTBI by severity, mild TBI and moderate-to-severe TBI were 12.9/100,000 and 15.5/100,000, respectively. The incidence of mild TBI among workers was higher in 2010, but moderate-to-severe TBI was higher after 2011. CONCLUSIONS: Our findings highlight the need for providing information on mild TBI to workers as part of occupational safety and health education.

Satisfying medical and rehabilitation needs positively influences returning to work after a work-related injury: an analysis of national panel data from 2018 to 2019.

BACKGROUND: This study examined how meeting the medical needs of injured workers after initial treatment may affect their return to work, using data from the Panel Study of Workers' Compensation Insurance. METHODS: This study was designed as a longitudinal study, which used data from the second-year, follow-up survey conducted in the secondary cohort of the Panel Study of Workers' Compensation Insurance. The odds ratio (OR) and 95% confidence interval were estimated through binomial and multinomial logistic regression analyses to examine the effects of unmet medical needs on workers' return to original work and return to work overall (including reemployment). RESULTS: The returned to original work OR of workers whose rehabilitation needs were met was 1.35 (1.12-1.63) while the return to work OR was 1.20 (1.03-1.41). The returned to original work OR of workers whose medical needs were met was 1.64 (1.18-2.27) while the return to work OR was 1.39 (1.07-1.80). In terms of disability rating, the return to work ORs of workers with mild disabilities whose medical/rehabilitation needs were not met and those of workers without disabilities were 1.71 (1.17-2.49) and 1.97 (1.27-3.08), respectively. In the case of regular/temporary workers, the returned-to-work ORs of workers whose medical/rehabilitation needs were not met were 1.54 (1.12-2.13) and 1.27 (1.03-1.56), respectively. CONCLUSIONS: For workers who sustained work-related injuries, providing medical accessibility and meeting rehabilitation needs were found to be important predictors of return to work after initial treatment.

Relationship between workers' return to work, job retention and income in industrial accidents in Korea: a longitudinal study.

OBJECTIVE: This study aims to compare workers' income before and after an occupational injury, with regard to return to work and job retention, over a period of 5 years. DESIGN: This study was designed as a longitudinal study. SETTING: The Panel Study of Workers' Compensation Insurance (PSWCI) survey targeted workers involved in industrial accidents for which medical care was terminated in the year 2012. PARTICIPANTS: The panel study was conducted on a final sample of 2000 workers who were selected proportionally by region (nine regions) after priority assignment by disability rating (six levels). A total of 1458 workers were finally included in this study. METHODS: This study used data from the first to fifth PSWCI. To identify the effect on income after occupational injury considering return to work and job retention, we used the generalised estimating equation. RESULTS: In regard to workers' return to work, the OR that income after an occupational injury would be higher than that before an occupational injury was 3.17 (2.41-4.17) for those who returned to original work and 2.32 (1.81-2.97) for those re-employed as compared with who did not return to work and 1.27 (1.07-1.15) for those who retained their job as compared with those who did not. The ORs were 2.91 (2.26-3.75) for those who were re-employed and retained jobs and 2.96 (2.15-4.08) for those who returned to original work and did not retain jobs as compared with those who did not return to work and did not retain jobs. CONCLUSIONS: It is important for accident victims to retain their jobs to maintain their economic status.

Effect of professional certification on employees' return-to-work rate after occupational injuries in Korea: focusing on vulnerable groups.

BACKGROUND: One effective way to improve return-to-work (RTW) performance may be to convince the employer that the worker has the necessary skills. The aim of this paper is to investigate the effect of having a professional certification among workers injured in occupational injuries on their return to work. METHODS: The Panel Study of Workers' Compensation Insurance (PSWCI) targets workers who completed medical care in 2012 after an occupational injury. The study population (n = 2000) was stratified by gender, age, region, disability grade, and rehabilitation service use. A total of 1458 workers were finally selected for this study. The effect of having a certification on RTW status was calculated with an odds ratio and 95% confidence intervals using binomial and multinomial logistic regression analyses. In the binomial logistic regression analysis, the RTW group was made up as a combination of the return to original work and the reemployment groups. RESULTS: The ORs of RTW among those with a certification compared to those without certification were 1.38 (1.16-1.65) in Model 1, 1.25 (1.05-1.50) in Model 2, and 1.22 (1.01-1.47) in Model 3. Among female workers with a certification, the OR of RTW was 4.60 (2.68-7.91), that of return to original work was 3.21 (1.74-5.91), and that of reemployment was 5.85 (3.34-10.27). Among daily workers with a certification, the OR of RTW was 1.32 (1.03-1.69) and that of reemployment was 1.37 (1.07-1.76). CONCLUSION: In conclusion, injured workers with a certification generally had a higher RTW rate. In particular, the RTW rate was higher among female workers and daily workers with a certification than among those without.

Changes in Income after an Industrial Accident According to Industry and Return-to-Work Status.

Objective: To investigate changes in the incomes of workers, particularly those in the construction sector, who experienced industrial accidents according to their status of return to work. Methods: We used data from the fifth Panel Study of Workers' Compensation Insurance. A repeated measures ANOVA was used to compare annual differential incomes before and after the industrial accident, and a linear mixed model was used to investigate the changes in income from before to after the industrial accident according to the industry and return-to-work status. Results: A comparison of the industrial categories revealed that construction industry workers exhibited the greatest incomes before the accident and the greatest decrease in income after the industrial accident. Regression analysis for assessing changes in income after the industrial accident showed that a comparison by industry revealed a significantly greater reduction in income in the construction than service industry. A comparison by work status revealed significantly greater decreases in income in the reemployment and non-return to work groups than among those who returned to their original work. Conclusions: The economic statuses of the victims of industrial accidents decreased relative to the pre-accident statuses in all industries. The ability to return to original work is important for preserving the accident victim's economic status.

Gender Discrimination in the Workplace: Effects on Pregnancy Planning and Childbirth among South Korean Women.

Introduction: This study aims to investigate the association between gender discrimination in the workplace and pregnancy planning/childbirth experiences among working women in South Korea. Methods: We analyzed data from the Korean Longitudinal Survey of Women and Families (KLoWF) for the years 2007 to 2016. The study population consisted of 7996 working women, between the ages of 19 and 45. Gender discrimination was measured through the 6-item Workplace Gender Discrimination Scale, evaluating discrimination in terms of recruitment, promotions, pay, deployment, training and lay-offs. Multiple logistic regression analysis was employed to measure the association between gender discrimination and the pregnancy planning/childbirth experience. Results: Compared to individuals experiencing no discrimination in the workplace, those experiencing low [odds ratio (OR): 0.78, 95% confidence interval (95% CI) 0.61-0.99] or medium (OR: 0.69, 95% CI: 0.54-0.89) levels of discrimination had decreased odds of pregnancy planning. Likewise, individuals scoring low (OR: 0.70, 95% CI 0.54-0.92), medium (OR: 0.68, 95% CI: 0.51-0.92), or high (OR: 0.47, 95% CI: 0.27-0.80) levels of discrimination also had decreased odds of childbirth experience when compared to the no-experience group. When stratified by income, compared to individuals experiencing no discrimination in the workplace, those experiencing gender discrimination had decreased odds of pregnancy planning for low income (low OR: 0.64, 95% CI: 0.45-0.92; medium OR: 0.55, 95% CI: 0.52-0.97; high OR: 0.45, 95% CI: 0.24-0.87), medium income (medium OR: 0.53, 95% CI: 0.37-0.77; high OR: 0.29, 95% CI: 0.14-0.63), and high income groups (low OR: 0.64, 95% CI: 0.49-0.84; medium OR: 0.69, 95% CI: 0.52-0.92). Conclusions: The present study finds that gender discrimination in the workplace is associated with decreased odds of pregnancy planning/childbirth experience among working South Korean women. Furthermore, low and medium income groups were especially more likely to be affected by the level of gender discrimination in the workplace when planning pregnancy.

The Relationship between Free Press and Under-Reporting of Non-Fatal Occupational Injuries with Data from Representative National Indicators, 2015: Focusing on the Lethality Rate of Occupational Injuries among 39 Countries.

The epidemiology of occupational injuries is reported worldwide, but suspicions of under-reporting prevail, probably associated with free press. We examined the association between freedom of the press and lethality rate of occupational injuries based on the most comprehensive International Labour Organization database on labour statistics (ILOSTAT) among 39 countries. The occupational injury indices, national indicators, and information on freedom of the press in 2015 were sourced from ILOSTAT, World Bank open data, World Health Organization and Freedom House. The lethality rate was the number of fatal occupational injuries per 10,000 total occupational injuries. The relationship among fatal and total occupation injury rates, lethality rate, and national statistics were analysed using Spearman's rank correlation coefficients. Multivariable linear regression models with bootstrap estimation to manage non-normality determined freedom of the press associated with lethality rate. Freedom of the press was significantly correlated with fatal and total occupational injury rate and lethality rate of occupational injuries. Adjusting for national indicators, only freedom of the press was associated with lethality rate per 10,000 occupational injuries in the report of ILOSTAT. The lethality rate of occupational injury reported by each country might not reflect the actual lethality, but under-reported nonfatal occupational injuries, probably relating to freedom of the press.

Income Changes Due to Disability Ratings and Participation in Economic Activities Caused by Industrial Accidents: A Population-Based Study of Data from the Fourth Panel Study of Workers' Compensation Insurance (PSWCI).

Industrial accidents cost a huge amount of money, but they also have negative consequences in many respects. We analyzed the data of the first to fourth panel study of workers' compensation insurance (PSWCI). Repeated measures ANOVA was used to compare the annual income before and after the industrial accident, and a general linear model was used to identify changes in income due to disability ratings and participation in economic activities. The wages before the industrial accident and the annual income varied among the disabilities ratings. In addition, for affected workers, the average income during four years post-accident was lower than the average income before the accident. Regression analysis to see changes in income after the industrial accident showed that the group with a disability rating of 11⁻14 and no injuries had a suffered a greater income decrease than those with a disability rating of 1⁻3, and the unemployment group saw a greater decrease in income than the employment group. Workers who were affected by industrial accidents received lower incomes than before the accident, and even considering different disability ratings, there was a greater decrease in income among the unemployed group than in the working group.