scholarly journals Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251116
Author(s):  
Won Mo Jang ◽  
Juyeon Lee ◽  
Sang Jun Eun ◽  
Jun Yim ◽  
Yoon Kim ◽  
...  
Keyword(s):  
South Korea ◽  
Travel Time ◽  
Emergency Care ◽  
Claims Data ◽  
Change Point Analysis ◽  
Access Time ◽  
Optimal Time ◽  
National Health Insurance System ◽  
Cross Sectional ◽  
Hospital Access

Increase in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this study aimed to establish the optimal hospital access time (OHAT) for emergency care in South Korea. We used nationwide healthcare claims data collected by the National Health Insurance System database of South Korea. Claims data of 445,548 patients who had visited emergency centers between January 1, 2006 and December 31, 2014 were analyzed. Travel time, by vehicle from the residence of the patient, to the emergency center was calculated. Thirteen emergency care–sensitive conditions (ECSCs) were selected by a multidisciplinary expert panel. The 30-day mortality after discharge was set as the outcome measure of emergency care. A change-point analysis was performed to identify the threshold where the mortality of ECSCs changed significantly. The differences in risk-adjusted mortality between patients living outside of OHAT and those living inside OHAT were evaluated. Five ECSCs showed a significant threshold where the mortality changed according to their OHAT. These were intracranial injury, acute myocardial infarction, other acute ischemic heart disease, fracture of the femur, and sepsis. The calculated OHAT were 71–80 min, 31–40 min, 70–80 min, 41–50 min, and 61–70 min, respectively. Those who lived outside the OHAT had higher risks of death, even after adjustment (adjusted OR: 1.04–7.21; 95% CI: 1.03–26.34). In conclusion, the OHAT for emergency care with no significant increase in mortality is in the 31–80 min range. Optimal travel time to hospital should be established by optimal time for outcomes, and not by geographic time, to resolve the disparities in geographical accessibility to emergency care.

scholarly journals How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031882 ◽  
Author(s):  
Mi Young Kwak ◽  
Seung Mi Lee ◽  
Hyun Joo Kim ◽  
Sang Jun Eun ◽  
Won Mo Jang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Morbidity ◽  
Cross Sectional Study ◽  
Obstetric Complications ◽  
Access Time ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hospital Access ◽  
Maternal Morbidity And Mortality ◽  
Delivery Unit

ObjectivesAccess to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea.DesignNationwide cross-sectional study.SettingWe used the National Health Insurance System database of South Korea.ParticipantsWe analysed the data of 371 341 women who had experienced pregnancy in 2013.Primary and secondary outcome measuresAccess time to hospital was defined as the time required to travel from the patient’s home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT.ResultsThe OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41–50 min; preeclampsia, 51–60 min; placental abruption, 51–60 min; preterm delivery, 31–40 min; postpartum transfusion, 31–40 min; uterine artery embolisation, 31–40 min; admission to intensive care unit, 31–40 min; and caesarean hysterectomy, 31–40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT.ConclusionsOur results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality.

scholarly journals Emergency overcrowding and access block: A smaller problem than we think

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Grant D. Innes ◽  
Marco L.A. Sivilotti ◽  
Howard Ovens ◽  
Kirstie McLelland ◽  
Adam Dukelow ◽  
...  
Keyword(s):  
Emergency Care ◽  
Safety Concern ◽  
Cross Sectional Study ◽  
Or Efficiency ◽  
Average Delay ◽  
Cross Sectional ◽  
Hospital Access ◽  
High Acuity ◽  
Facility Level ◽  
Study Sites

ABSTRACTObjectivesEmergency department (ED) access block, the inability to provide timely care for high acuity patients, is the leading safety concern in First World EDs. The main cause of ED access block ishospital access blockwith prolonged boarding of inpatients in emergency stretchers. Cumulative emergency access gap, the product of the number of arriving high acuity patients and their average delay to reach a care space, is a novel access measure that provides a facility-level estimate of total emergency care delays. Many health leaders believe these delays are too large to be solved without substantial increases in hospital capacity. Our objective was to quantify cumulative emergency access blocks (the problem) as a fraction of inpatient capacity (the potential solution) at a large sample of Canadian hospitals.MethodsIn this cross-sectional study, we collated 2015 administrative data from 25 Canadian hospitals summarizing patient inflow and delays to ED care space. Cumulative access gap for high acuity patients was calculated by multiplying the number of Canadian Triage Acuity Scale (CTAS) 1-3 patients by their average delay to reach a care space. We compared cumulative ED access gap to available inpatient bed hours to estimate fractional access gap.ResultsStudy sites included 16 tertiary and 9 community EDs in 12 cities, representing 1.79 million patient visits. Median ED census (interquartile range) was 66,300 visits per year (58,700-80,600). High acuity patients accounted for 70.7% of visits (60.9%-79.0%). The mean (SD) cumulative ED access gap was 46,000 stretcher hours per site per year (± 19,900), which was 1.14% (± 0.45%) of inpatient capacity.ConclusionED access gaps are large and jeopardize care for high acuity patients, but they are small relative to hospital operating capacity. If access block were viewed as a “whole hospital” problem, capacity or efficiency improvements in the range of 1% to 3% could profoundly mitigate emergency care delays.

scholarly journals Vaccine-Related Errors in Reconstitution in South Korea: A National Physicians’ and Nurses’ Survey

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 117
Author(s):  
Young Hwa Lee ◽  
Rebecca C. Harris ◽  
Hong Won Oh ◽  
Yongho Oh ◽  
Juan C. Vargas-Zambrano ◽  
...  
Keyword(s):  
South Korea ◽  
High Frequency ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vaccine Preparation

Vaccine-related errors (VREs) result from mistakes in vaccine preparation, handling, storage, or administration. We aimed to assess physicians’ and nurses’ experiences of VREs in South Korea, focusing on reconstitution issues, and to understand the barriers to and facilitators of preventing them. This was a cross-sectional study using an internet-based survey to examine experiences of reconstitution-related errors, and experience or preference with regard to ready-to-use vaccines (RTU) by physicians and nurses. A total of 700 participants, including 250 physicians and 450 nurses, responded to the questionnaire. In total, 76.4% and 41.5% of the physicians and nurses, respectively, reported an error related to reconstituted vaccines. All errors had been reported as experienced by between 4.9% and 52.0% of physicians or nurses. The errors were reported to occur in more than one in 100 vaccinations for inadequate shaking of vaccines by 28.0% of physicians and 6.9% of nurses, incomplete aspiration of reconstitution vials by 28.0% of physicians and 6.4% of nurses, and spillage or leakage during reconstitution by 20.8% of physicians and 6.9% of nurses. A total of 94.8% of physicians had experience with RTU vaccines, and all preferred RTU formulations. In conclusion, this study highlights the high frequency and types of reconstitution-related errors in South Korea. RTU vaccines could help reduce the time needed for preparation and reduce the risk of errors in South Korea.

scholarly journals OP0073 RISK OF DEVELOPING RHEUMATIC DISEASES IN PATIENTS WITH PALINDROMIC RHEUMATISM IN SOUTH KOREA: A NATION-WIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 49.2-49
Author(s):  
J. K. Ahn ◽  
J. Hwang ◽  
J. Lee ◽  
H. Kim ◽  
G. H. Seo
Keyword(s):  
Health Insurance ◽  
South Korea ◽  
Rheumatic Diseases ◽  
Index Date ◽  
Claims Data ◽  
Population Based ◽  
Palindromic Rheumatism ◽  
Psoriatic Arthropathy ◽  
Increased Risk ◽  
The Mean

Background:Palindromic rheumatism (PR) has known to be three patterns of disease course: clinical remission of attacks, persistent attacks, and evolution to chronic arthritis or systemic disease. The spectrum in progression to chronic diseases of PR, however, is quite variable; rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren’s syndrome (SjS), ankylosing spondylitis (AS), relapsing polychondritis (RP), Behçet’s disease (BD), sarcoidosis, and psoriatic spondylitis and arthropathy. Because of the small numbers in case-control studies and too aged investigations, now we needs to shed new light on the fate of PR.Objectives:The aim was to investigate the epidemiology of PR and the risk of developing various rheumatic diseases compared with non-PR individuals, employing the National Health Insurance Service (NHIS) medical claims data, which covers all medical institutions of South Korea.Methods:The study used 2007-2018 claims data from the Korean Health Insurance Review and Assessment Service (HIRA). The identified 19,724 PR patients from 2010 to 2016 were assessed for the incidence rate (IR) compared with the population in the given year by 100,000 person-year (py). The date of diagnosis was the index date. After matching with non-PR individuals (1:10) for age, sex and the year of index date, we calculated the hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of developing the various rheumatic diseases and adult immunodeficiency syndrome (AIDS) as the outcome diseases in PR cohort was estimated. This risk was compared with that of matched non-PR cohort.Results:Of 19,724 PR patients (8,665 males and 11,059 females), the mean age was 50.2 ± 14.9 years (47.7 ± 14.4 years in males and 52.6 ± 14.9 years in females,p< 0.001). The ratio of male to female patients with PR was approximately 1:1.28. The annual IR of PR was 7.02 (6.92-7.12) per 100,000 py (6.22 (6.09-6.35) and 7.80 (7.66-7.95) per 100,000 py in males and females, respectively). The mean duration to develop the outcome diseases was significantly shorter in PR cohort compared that of non-PR cohort (19.4 vs. 35.8 months,p< 0.001). The most common outcome disease was RA (7.34% of PR patients; 80.0% of total outcome diseases), followed by AS, SLE, BD, SjS, MCTD, DM/PM, SSc, RP, psoriatic arthropathy, and AIDS in PR cohort. The patients with PR had an increased risk of RA (HR 46.6, 95% CI [41.1-52.7]), psoriatic arthropathy (44.79 [15.2-132.4]), SLE (24.5 [16.2-37.2]), MCTD (22.0 [7.7-63.3]), BD (21.0 [13.8-32.1]), SjS (12.4 [8.5-17.9]), AS (9.0 [6.7-12.2]), DM/PM (6.1 [2.6-14.8]), and SSc (3.8 [1.5-9.6]) but not of AIDS. The risk of developing RA was greater in male patients (HR 58.9, 95% CI [45.6-76.2] vs. 43.2 [37.4-49.8],pfor interaction = 0.037) while female patients encountered a higher risk of developing AS (15.8 [8.9-28.1] vs. 7.2 [5.0-10.3],pfor interaction = 0.023). The risk of developing RA, SLE, SjS, and BD were significantly more highly affected in younger age (pfor interaction < 0.001, = 0.003, 0.002, and 0.017, at each).Conclusion:This nationwide, population-based cohort study demonstrated that patients with PR had an increased risk of developing various rheumatic diseases, not only RA but also psoriatic arthropathy. Therefore, patients with PR needs to be cautiously followed up for their potential of diverse outcome other than RA: RA, SLE, SjS, and BD in younger patients, RA in males, and AS in females, in particular.Disclosure of Interests:None declared

scholarly journals Panic and Trust during COVID-19: A Cross-Sectional Study on Immigrants in South Korea

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 199
Author(s):  
Myeong Sook Yoon ◽  
Israel Fisseha Feyissa ◽  
So-Won Suk
Keyword(s):  
Public Health ◽  
South Korea ◽  
Pearson Correlation ◽  
Cross Sectional Study ◽  
Native Community ◽  
Cross Sectional ◽  
The Public ◽  
Marginalized Groups ◽  
Local Media ◽  
Effective Public Health

In the COVID-19 pandemic, marginalized groups like migrants are disproportionately affected. As panic, fear of neglect, and mistrusting institutions in these groups are presumed to be apparent, their detachment to health services still needs to be investigated. This study comparatively analyzed the level of panic and trust between South Koreans and immigrants who are living within highly affected areas of South Korea. Mann–Whitney-U-Test and Pearson correlation showed panic is more pronounced in the Korean group while having a similar panic display pattern with the immigrants. The immigrant group appears to highly trust the Korean health system, health institutions, local media, and the local native community. Beyond conventional expectations, participant’s average panic score showed a statistically significant positive correlation with items of the trust scale, indicating a level of individual reliance amid the pandemic panic. Thus, ascertaining institutional trust and matured citizenry are identified as factors for effective public health outcomes. During such a pandemic, this study also reminded the public health needs of immigrants as secondary citizens, and presumptions of immigrants’ mistrust in such settings might not always be true.

scholarly journals Cross-sectional association between long working hours and liver function: the Kangbuk Samsung Health Study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041595
Author(s):  
Eunchan Mun ◽  
Woncheol Lee ◽  
Min-Woo Nam ◽  
Hyun-Il Kim ◽  
Hyeongcheol Kim ◽  
...  
Keyword(s):  
General Population ◽  
Hepatitis B ◽  
Liver Function ◽  
South Korea ◽  
Hepatitis B Surface Antigen ◽  
Working Hours ◽  
Health Study ◽  
Health Examination ◽  
Cross Sectional ◽  
Long Working Hours

ObjectivesAlthough the effects of long working hours on liver function remain unclear, in South Korea, there is a social perception that long working hours are associated with poor liver function. Thus, long working hours have recently become a major issue. This study aimed to determine the association between long working hours and liver function, as indicated by the alanine transaminase (ALT) levels.DesignCross-sectional study.SettingLarge university hospitals in Seoul and Suwon, South Korea.ParticipantsWorkers in formal employment who underwent a comprehensive health examination at the Kangbuk Samsung Hospital Total Healthcare Centre clinics in Seoul and Suwon, South Korea, between January 2011 and December 2018. Of the 386 488 participants, 212 421 met the inclusion criteria and were included in the analysis.Primary outcome measureALT elevation.ResultsThe participants were predominantly well-educated (86.1%), male (69.3%) and in their 30s (49.6%). In total, 13.4% of the participants presented ALT elevation (>40 IU/L). There was no significant association between working hours and ALT elevation in the general population and in the hepatitis B surface antigen (HBsAg)-negative group. Conversely, in the HBsAg-positive group, working >60 hours per week compared with 35–40 hours per week was significantly associated with ALT elevation. The association was more pronounced in those with ALT levels >80 IU/L (OR 1.94, 95% CI 1.24 to 3.01) than in those with ALT levels >40 IU/L (OR: 1.45, 95% CI 1.20 to 1.75). The p values for trend were <0.05.ConclusionsLong working hours were associated with ALT elevation only in hepatitis B virus carriers and not in the general population. Provided that there is adherence to the legal working hours, there is no need to further restrict working hours for liver health, irrespective of HBsAg status.

scholarly journals Preferences for life-sustaining treatment in Korean adults: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e039470
Author(s):  
HyunChul Youn ◽  
Suk-young Lee ◽  
Han-yong Jung ◽  
Shin-Gyeom Kim ◽  
Seung‑Hyun Kim ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Left Ventricular ◽  
Self Report ◽  
Ventricular Assist Devices ◽  
Optimal Time ◽  
Left Ventricular Assist Devices ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ventricular Assist ◽  
Life Sustaining Treatment

ObjectivesLife-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical conditions, and includes cardiopulmonary resuscitation, mechanical ventilation, haemodialysis and left ventricular assist devices. This study aimed to investigate the thoughts on life-sustaining treatment of Koreans and to assess the factors associated with deciding to not receive life-sustaining treatment if they develop a terminal disease.DesignCross-sectional study.SettingGuro-gu centre for dementia from 1 May 2018 to 31 December 2019.ParticipantsIn total, 150 individuals participated in this study.Outcome measuresThe questionnaire consisted of self-report items with some instructions, demographic characteristics, thoughts on life-sustaining treatment and psychosocial scales. The preferences of the participants were investigated on the assumption that they develop terminal cancer. The psychosocial scales included the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Connor–Davidson Resilience Scale and Multidimensional Scale of Perceived Social Support (MSPSS).ResultsWe classified our participants into two groups: individuals who wanted to receive life-sustaining treatment (IRLT) and individuals who wanted to not receive life-sustaining treatment (INLT). There were twice as many participants in the INLT group than there were in the IRLT. In making this decision, the INLT group focused more on physical and mental distress. Additionally, 32.7% of participants responded that terminal status was an optimal time for this decision, but more participants want to decide it earlier. The GAD-7 and PHQ-9 scores were significantly higher in the INLT group than in the IRLT group. However, the INLT group had significantly lower MSPSS family scores.ConclusionOur findings can help assess issues regarding advance directives and life-sustaining treatment, and will be a reference for designing future studies on this issue.

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

2021 ◽  
pp. 1-7
Author(s):  
Bethany A. Wattles ◽  
Kahir S. Jawad ◽  
Yana Feygin ◽  
Maiying Kong ◽  
Navjyot K. Vidwan ◽  
...  
Keyword(s):  
Claims Data ◽  
Inappropriate Prescribing ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Pharmacy Claims ◽  
Medicaid Children

Abstract Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children. Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. Participants: Population-based sample of pediatric Medicaid patients and providers. Methods: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. Results: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33). Conclusions: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

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