A Review of COVID-19 Initial Response Systems and A Proposal to Adjust the Operation of Residential treatment centers

Objective: The COVID-19 pandemic has caused a periodic shortage of quarantine beds, medical personnel, and medical equipment in South Korea. Asthe pandemic is expected to continue, a need existsto readjust the capacities of residentialtreatment centersfor asymptomatic ormild cases. Thisstudy aimed to identify howother countriestreat asymptomatic or have mild COVID-19 patients, and suggest a effective operation plan of residential treatment centers.Methods: A literature review was conducted to examine how policies on asymptomatic or mild COVID-19 cases have changed at different phases of the pandemic in different countries. A reviewwas also conducted on the epidemiological characteristics of Korean patients, including clinicalstatus and treatment period, and public opinion on residential treatment centers. A plan to improve how residential treatment centers operate during the pandemic was derived based on expert advice, and discussion within the research team.Results: Home care is being recommended for asymptomatic or mild cases of COVID-19 in many countries. In Korea, despite the increase in the number of newly confirmed cases, fatality rate of COVID-19 shows a decreasing and vaccination rate an increasing trend. Three-fourths of the public recognized that home care may be more appropriate for asymptomatic or mild cases. Assuch,we recommend a reduction in length ofstay in residential treatment centers, from 10 to 3 or 5 days, and ensuring patient’s participation in decision‒making of hospitalization.Conclusions: A need existsto prepare a systematic response system, including patient education, virtual treatment and transfersystem in orderto shorten patients’ admission period in residential treatment centers and expand home care. A functioning emergency response system should also be prepared concurrently.

Current status of quality of care for public hospitals in Korea : Comprehensive comparison with private hospitals

Objective: This ecological study aims to perform a comprehensive comparison and evaluation of the quality of care in public and private hospitals according to hospital type.Methods: Thisstudy compared and analyzed the results of the National Quality Assessment Program (NQAP) of Health Insurance Review and Assessment Service (HIRA) and Incentive Scheme for Quality Evaluation of Hospital Services. The NQAP results published on the HIRA website, as of the end of May 2021, and the internal data of HIRA for the 2020 Incentive Scheme for Quality Evaluation of Hospital Services were used as data collection sources.Results: The NQAP analysisrevealed that the overall average scores were higher for public rather than private hospitals, while the Incentive Scheme for Quality Evaluation of Hospital Services analysis reported that the proportion of higher grades (i.e., grades 1 and 2) was higher in public hospitals. Therefore, it was revealed that public hospital quality levels were notlowerthan that of private hospitals.However, itis necessary to improve the quality levelsin terms ofthe quality distribution.Conclusions: The quality levels of public hospitals are notlowerthan that of private hospitals. However,the high average quality level, we identified certain areas that required improvement in their quality level throughout the distribution. Currently, public hospitals that are particularly located in the lower ranks should strive to achieve the average quality level demonstrated by same level private hospitals, thereby, achieving progressive quality levels and minimizing the between institutions. Thus, furtherresearch should focus on identifying the trends of differencesin quality levels, and they should determine the causes by controlling for the characteristics of medical institutions.

Changes in Acute Respiratory Infection Before and After COVID-19

Objective: During the outbreak of COVID-19,several coping strategies were implemented including strengthened social distancing, wearing masks and hand hygiene. Thisinfection control method might have been effective for other respiratory infections; however, it had not yet been clearly revealed. Therefore,we investigatedwhetherthe incidence of infectious respiratory diseases has reduced after excluding the effect of decreased medical utilization because of COVID-19 control measures.Design or methods: We used the Korean national claims data and analyzed incidences of acute respiratory infections (ARI) and diseases except ARI. The incidence rates of winter 2019 and 2020 were compared.Results: Excluding ARI,the reduction in overall hospital visits decreased by only 2%; however,the number of visits due to ARI decreased by 13%, and the number of visits due to influenza particularly decreased by 26%.Conclusions: Using national database, this study confirmed that a significant reduction in ARI, including influenza, occurred during the COVID-19 pandemic. Infection control measures including nationally enforced social distancing may be effective in controlling the transmission of other respiratory infections. Further studies are necessary to clarify the causal relationship.

A large-scale health survey for a pilot project to reduce the health disparity in Samho-dong, Ulsan Metropolitan City: Results and implications

Introduction: This study conducted a large-scale health survey in Namg-gu, Ulsan Metropolitan City. In specific, the survey results of Samho-dong, one of the 14 dongs in Nam-gu, and the rest of Nam-gu were compared. Also, the results were compared with the Community Health Survey results for implications.Methods: A total of 2,036 people participated in the large-scale survey. Descriptive analysis was performed to examine the socio-demographic characteristics of these two participant groups. The Chi-Square test or Fisher’s exact test was executed to identify differences between the two groups and the results were compared to the 2014-2019 Community Health Surveys results.Results: The exposure rate of secondhand smoke in public areas and the subjective obesity awareness rate were statistically significantly higher in Samho-dong residents than non-Samho-dong residents in Nam-gu. The same patterns of statistical significance were also observed in the rate of high mental stress, the rate of hypertension diagnosis (≥30), and the annual rate of unmet healthcare needs. Compared with the six-year cumulative data of Community Health Surveys, the rate of hypertension diagnosis (≥30) and the rate of diabetes diagnosis (≥30) of Samho-dong residents were lower than that of Community Health Surveys.Conclusions: It is suggested to prioritize designating smoking zones, strengthening mental health services, and operating chronic disease management programs in Samho-dong. The findings of this study support the need for large-scale surveys on the health status of local areas to reduce health disparities and serve as a foundation to reduce them.

Nationwide Acute Stroke Care Quality and Disparity in Korea: Focusing on the Type of Healthcare Facilities and the Socioeconomic Status of Patients

Background: The quality ofstroke care has a significantimpact onmortality and complications. The purpose ofthisstudy wasto investigate the difference in the quality of acute stroke treatment according to the type of healthcare facility and the socioeconomic status of patients.Methods: Thisstudy used Health Insurance Review and Assessment Service’s Healthcare Quality Assessment for Stroke 2013 data and included 10,399 cases from 201 healthcare facilities. Quality of care was categorized from grade 1 (best group) to grade 5 (worst group) according to performance scores using 10 processindicators.Results: The mean performance score was 91.5. Only 31% of all patients received treatment at grade 1 hospitals while 10% received treatment at grade 3 or lower hospitals. The difference in performance score by the type of healthcare facility existed (tertiary hospitals: 94.3, general hospitals: 88.7).Ofthe 159 general hospitals, 66 hospitals provided grade 3 orlower quality care.NHI patients used more tertiary hospitalsthan MA patients(51% vs. 38%), and MA patientswere more likely to use general hospitals providing grade 3 or lower quality care (11% vs. 21%).Conclusions: This study showed that some general hospitals provided low quality stroke care, and MA patients were more likely to use those hospitals. In order to increase the quality and equity of stroke treatment, a strategy to gather patients at healthcare facilitiesthat provide appropriate medicalservices will be needed.

Demand for Competence-based Education for Worker of Public Health Care Service in Ulsan Metropolitan City

Introduction: In order to strengthen the core competencies of workers, systematic education tailored to their needs is necessary. In this study, a survey was conducted on workers in public health care service in Ulsan Metropolitan City (Ulsan) to investigate the demand for education according to core competencies.Methods: A total of 70 workers who work for public health care service in Ulsan participated in this online survey. The questionnaire consisted of socio-demographic factors, work ability, education demand, and preference of education form.Results: The core competency with a high level of work ability is ‘Expertise on health and disease’ (41, 58.6%). On the other hand, the core competency with a low level of work ability was found to be the ‘Evaluation-related theories of public health care service’ (57, 81.4%). The core competencies with the highest demand for education were “Resident-centered service implementation” and “Public health care service strategy development” (64, 91.4%), followed by ‘Public health care service cases review’ and ‘knowledge of public health service plan’ (63, 90.0%). The preferred form of education is offline education (49, 40.8%). The most important factor in education was ‘work utilization’ (Offline: 57, 81.4%; Online: 48, 68.6%), both online and offline.Conclusions: Through the research results, it was possible to find out education demand according to core competencies and preference of education form. Based on these results, we will develop a core competency education program tailored to actual demand. In the future, it is necessary to continuously conduct research on such education demand.