Feasibility of Capturing Adverse Events From Insurance Claims Data Using International Classification of Diseases, Tenth Revision, Codes Coupled to Present on Admission Indicators

Objective: The aim of the study was to investigate the feasibility of using administrative data to screen adverse events in Korea. Methods: We used a diagnosis-related groups claims data set and the information of the checklist of healthcare quality improvement (a part of the value incentive program) to verify adverse events in fiscal year 2018. Adverse events were identified using patient safety indicator (PSI) clusters and a present on admission indicator (POA). The PSIs consisted of 19 clusters representing subcategories of adverse events, such as hospital-acquired infection. Among the adverse events identified using PSI clusters, "POA = N," which means not present at the time of admission, was only deemed as the case in the final stage. We compared the agreement on the occurrence of adverse events from claims data with a reference standard data set (i.e., checklist of healthcare quality improvement) and presented them by PSI cluster and institution. Results: The cases of global PSI for any adverse event numbered 27,320 (2.32%) among all diagnostic codes in 2018. In terms of institutional distribution, considerable variation was observed throughout the clusters. For example, only 13.2% of institutions (n = 387) reported any global PSI for any adverse event throughout the whole year. The agreement between the reference standard and the claims data was poor, in the range of 2.2% to 10.8%, in 3 types of adverse events. The current claims data system (i.e., diagnostic codes coupled to POA indicators) failed to capture a large majority of adverse events identified using the reference standard. Conclusions: Our results imply that the coding status of International Classification of Diseases, Tenth Revision, codes and POA indicators should be refined before using them as quality indicators.ope

Challenges and Strategies for Unified Health System of South and North Korea

This paper aims to make a step-by-step strategy to formulate an unified health system by clarifying and overcoming challenges facing South and North Korea and to estimate costs needed for South Korea to assist North Korea to recover to normal health delivery system. We explored implications through literature review and estimated costs under the assumption that supportive activities be provided for 5 years in three ways: support for the development of health and medical care manpower; support for health and medical facilities; and support for the provision of both preventive and primary health care. Step-by-step strategy is formulated for a unified health system with the cost estimation resulting as follows: in case of basic scenario, a total of 3 trillion and 341 billion won (at present value of the year 2017) is in need for the 5-year period at the initial ‘recovery support stage’ with 135.9 billion won for the development of health and medical care manpower, approximately 2 trillion won for health and medical facilities, and 1.2 trillion won for the provision of both preventive and primary health care. Step-by-step approach is more realistic and applicable in formulating unified health system. Suggested stages are ‘recovery support stage,’ ‘system homogenization stage,’ and ‘unified system stage.’ Strategies at ‘recovery support stage’ suggested in this paper need to be pursued and followed by those at ‘system homogenization stage’ and ‘unified system stage.’ope

Use of Western Medicine and Traditional Korean Medicine for Joint Disorders: A Retrospective Comparative Analysis Based on Korean Nationwide Insurance Data

This study aimed to compare the usage of Western medicine and traditional Korean medicine for treating joint disorders in Korea. Data of claims from all medical institutions with billing statements filed to HIRA from 2011 to 2014 for the four most frequent joint disorders were used for the analysis. Data from a total of 1,100,018 patients who received medical services from 2011 to 2014 were analyzed. Descriptive statistics are presented as type of care and hospital type. All statistical analyses were performed using IBM SPSS for Windows version 21. Of the 1,100,018 patients with joint disorders, 456,642 (41.5%) were males and 643,376 (58.5%) were females. Per diem costs of hospitalization in Western medicine clinics and traditional Korean medicine clinics were approximately 160,000 KRW and 50,000 KRW, respectively. Among costs associated with Western medicine, physiotherapy cost had the largest proportion (28.78%). Among costs associated with traditional Korean medicine, procedural costs and treatment accounted for more than 70%, followed by doctors' fees (21.54%). There were distinct differences in patterns of medical care use and cost of joint disorders at the national level in Korea. This study is expected to contribute to management decisions for musculoskeletal disease involving joint disorders.ope

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul

Background/Aims The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. Methods We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). Results The mean hemoglobin in subjects was 10.5 ± 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 ± 1.9 mg/dL and the proportion of patients with Ca × P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca × P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). Conclusions Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.ope

Medicolegal Consideration to Prevent Medical Malpractice Regarding Opioid Administration: An Analysis of Judicial Opinion in South Korea

Purpose: Although the use of opioids is increasing in South Korea, there have been no studies on the serious complications caused by the opioids. The aim of this study was to investigate the rare but serious complications through medicolegal analysis. Materials and methods: From January 1994 to December 2019, we retrospectively reviewed the closed cases of lawsuits involving the complications of opioids using the database of judgments of the Supreme Court of Korea. General characteristics, opioid-induced complications, and judicial characteristics were analyzed. Results: Of the 46 cases, 31 cases of complications were finally included in the analysis. There were 28 (90.3%) cases of opioid administration for acute pain and 3 (9.7%) cases for chronic pain. The most commonly prescribed opioid was pethidine (n = 13, 41.9%), and the most common complication was respiratory depression (n = 17, 54.8%). All except two cases were associated with permanent injuries, including 18 (58%) deaths. Twelve (38.7%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of United States dollar (USD) 126,346 (IQR: USD 77,275-379,219). Of these cases, the most frequently admitted complaint by the court was the neglect of observation (n = 10, 32.3%), followed by the inappropriate drug choice (n = 4, 12.9%). Eleven (36.7%) cases were plaintiffs' claims for violating explanation obligations, of which 2 (6.7%) were recognized in the court. Conclusion: Our results suggest that physicians must be aware of the serious complications related to opioids and health policies to prevent such complications and malpractice should be adopted.ope

Neuroscience is ready for neuroethics engagement

Neuroscience research has been expanding, providing new insights into brain and nervous system function and potentially transformative technological applications. In recent years, there has been a flurry of prominent international scientific academies and intergovernmental organizations calling for engagement with different publics on social, ethical, and regulatory issues related to neuroscience and neurotechnology advances. Neuroscientific activities and outputs are value-laden; they reflect the cultural, ethical, and political values that are prioritized in different societies at a given time and impact a variety of publics beyond the laboratory. The focus on engagement in neuroscience recognizes the breadth and significance of current neuroscience research whilst acknowledging the need for a neuroethical approach that explores the epistemic and moral values influencing the neuroscientific agenda. The field of neuroethics is characterized by its focus on the social, legal, and philosophical implications of neuroscience including its impact on cultural assumptions about the cognitive experience, identity, consciousness, and decision-making. Here, we outline a proposal for neuroethics engagement that reflects an enhanced and evolving understanding of public engagement with neuroethical issues to create opportunities to share ideation, decision-making, and collaboration in neuroscience endeavors for the benefit of society. We demonstrate the synergies between public engagement and neuroethics scholarship and activities that can guide neuroethics engagement.ope

Discussions and Implications of the Recent Enactment & Revision of the Healthcare Law

Recently, there have been many changes in the area of healthcare. There is no certainty how these changes will affect the healthcare system and public health. However, to at least have these changes positively implemented, it is clear that evaluation through continuous monitoring is necessary. The enforcement of the Medical Institution Accreditation and Medical Dispute Mediation Law as well as legal revisions regarding the public healthcare system are changes to improve the quality of healthcare, while at the same time, provide penalties for infractions of the new law such as medicine/medical device rebates; moreover, legal revisions regarding telemedicine are anticipated to impartially vitalize technical development as well as the pharmaceutical industry. For these changes to have a positive effect on the medical field and people's lives, an accurate comprehension of the system and understanding of the details is necessary to be able to respond sensitively to any changes in the future. Therefore, this paper examined the background information on the current discussion on the changes in the healthcare system, examined the detailed content of the system, and reviewed the areas that were in dispute as well as the main issues to contemplate the expected effects of the changes and future tasks that may be generated as a result. These considerations will act as foundation for an in depth understanding of recent trends in the healthcare system.ope

Overview of healthcare system in North Korea

In this study, we analyzed the healthcare system of North Korea using Kleczkowski's model which categorizes national healthcare infrastructure into five components: health resources, organization, healthcare delivery system, economic support, and management. It was found that the healthcare system in North Korea, which provides clinical medicine, Koryo medicine and preventive medicine, is constituted of a physician system of independent geographic sectors and centralized delivery system while maintaining free universal health coverage. These systems are all managed by the government and the People's Committee Party. However, North Korea has been confronted with severe economic difficulties since the 1990s, such that we question whether the healthcare system has been able to function properly despite of the lack of resources in general throughout the country.ope

Public health law coverage in support of the health-related sustainable development goals (SDGs) among 33 Western Pacific countries

BACKGROUND: A resilient health system is inevitable in attaining the health-related Sustainable Development Goals (SDGs). One way of strengthening health systems is improving the coverage of public health laws for better health governance. The aim of this study is to describe the public health law situation in the Western Pacific Region and analyse the association of public health law coverage with health-related SDGs statistics. METHODS: A total of 33 Western Pacific countries were selected and analysed using a multi-group ecological study design. Public health law coverage was measured from April 2013 to October 2016 based on the public health law coverage module in the 'Tool to Assess Health Law' developed by the WHO Western Pacific Regional Office and Asian Institute for Bioethics and Health Law of Yonsei University. The health-related SDGs status were examined using health statistics data from World Health Statistics 2017 and 2018 by WHO and SDGs index scores of previous research. RESULTS: Countries with high public health law coverage were Vietnam, Republic of Korea, Hong Kong, and Singapore. Low coverage countries were mainly Pacific Island countries. High public health law coverage issues were health care organisation, communicable diseases, and substance abuse, whereas those of low coverage were human reproduction, family health, and oral health. Public health law coverage was associated with health-related SDGs statistics such as life expectancy at birth (r = 0.47, p = 0.03), health life expectancy at birth (r = 0.47, p = 0.04), health-related SDGs index (r = 0.43, p = 0.05). Among the SDG 3 indicators, maternal mortality ratio (r = - 0.53, p = 0.01), neonatal mortality rate (r = - 0.44, p = 0.02), new HIV infections (r = 0.78, p = 0.04), total alcohol consumption (r = 0.45, p = 0.02), adolescent birth rate (r = - 0.40, p = 0.04), UHC service coverage index (r = 0.50, p = 0.02), and IHR average core capacity score (r = 0.54, p = 0.004) were statistically meaningful. However, there was no association of public health law coverage with health statistics in other SDGs. CONCLUSIONS: This study proved the importance of public health law in supporting the attainment of health-related SDGs. These results should be used as the basis for review and action at country level in improving public health law for better health systems, consequently achieving health-related SDGs.ope

Effect of online education on the knowledge on, attitudes towards, and skills in patient safety for nursing students in Korea: a mixed-methods study

Purpose: The purpose of this study was to evaluate the impact of synchronous online education on the patient safety competency (knowledge, attitudes, and skills) of nursing students in Korea and to explore what they thought about this educational method. Methods: A single-group pre-and post-test design and summative content analysis were implemented. On November 14th, 2020, 110 nursing students completed synchronous online patient safety education. Patient safety competency was measured before and after the intervention using the revised Patient Safety Competency Self-Evaluation tool. The descriptive statistics, paired t-test, and Wilcoxon signed-rank test were used to analyze the data. Students also expressed their opinions about this education based on open-ended questions. Results: All the patient safety competency scores significantly increased after intervention. A summative content analysis of the open-ended questions yielded 5 categories: educational materials, education level, education time, interaction, and educational media. Conclusion: This study found that synchronous online patient safety education improves nursing students’ knowledge on, attitudes towards, and skills in patient safety. Nursing students also expressed a variety of positive aspects of the online education method. To improve the efficacy of synchronous online patient safety education, there is a need for further empirical studies on the appropriate class duration and difficulty of the content. It is essential to find a way to combine online education with various learning activities.ope