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Purpose: Critical care medicine continues to evolve. However, critical care cases require increasing amount of medical resources. Intensive care unit (ICU) mortality significantly impacts the overall efficiency of healthcare resources within a system of limited medical resources. This study investigated the factors related to ICU mortality using long-term nationwide cohort data in South Korea. Materials and Methods: This retrospective cohort study used data of 14905721 patients who submitted reimbursement claims to the Korean Health Insurance Service between January 1, 2011 and December 31, 2015. A total of 1498102 patients who were admitted to all ICU types, except neonatal and long-term acute care hospitals, were enrolled. Results: Of the total 1498102 participants, 861397 (57.5%) were male and 636705 (42.5%) were female. The mean age at admission was 63.4±18.2 years; most of the subjects were aged over 60 years. During the 5-year period, in-hospital mortality rate was 12.9%. In Cox analysis, both in-hospital and 28-day mortality rates were significantly higher in male patients and those of lower socioeconomic status. As age increased and the number of nursing staff decreased, the mortality risk increased significantly by two or three times. The mortality risk was lower in patients admitted to an ICU of a tertiary university hospital and an ICU where intensivists worked. Conclusion: The number of nursing staff and the presence of an intensivist in ICU were associated with the ICU mortality rate. Also, increasing the number of nursing staff and the presence of intensivist might reduce the mortality rate among ICU patients. [ABSTRACT FROM AUTHOR]

Purpose: Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. Materials and Methods: We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002-2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used. Results: Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020-1.633; 1-year mortality: HR=2.168, 95% CI=1.415-3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561-5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072-36.02 for middle-volume beds & low-volume physicians). Conclusion: Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate associations between hospital volume, costs, and length of stay (LOS), and clinical and demographic outcome factors for five types of cancer resection. The main dependent variables were cost and LOS; the primary independent variable was volume. Methods: Data were obtained from claims submitted to the Korean National Health Insurance scheme. We identified patients who underwent the following surgical procedures: pneumonectomy, colectomy, mastectomy, cystectomy, and esophagectomy. Hospital volumes were divided into quartiles. Results: Independent predictors of high costs and long LOS included old age, low health insurance contribution, non-metropolitan residents, emergency admission, Charlson score > 2, public hospital ownership, and teaching hospitals. After adjusting for relevant factors, there was an inverse relationship between volume and costs/LOS. The highest volume hospitals had the lowest procedure costs and LOS. However, this was not observed for cystectomy. Conclusion: Our findings suggest an association between patient and clinical factors and greater costs and LOS per surgical oncologic procedure, with the exception of cystectomy. Yet, there were no clear associations between hospitals' cost of care and risk-adjusted mortality. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is a leading cause of death globally and is one of the most exigent health problems, especially in Korea. Individuals think about suicide first before they attempt and possibly complete suicide. If attempted or completed suicide affects suicidal ideation by family members or close individuals, suicide could spread like an infectious disease. We hypothesized that a suicide attempt by a family member could affect suicidal ideation. We analyzed the association between suicidal ideation and previous suicide attempts by family members. Methods: This study used data from the fourth and fifth Korea National Health and Nutrition Examination Survey (2007-2012). The independent variable of interest is the existence of a cohabitating family member who previously attempted suicide. The dependent variable is self-reported suicide ideation during past year. The data analysis was conducted using the chi-square test and survey logistic regression. Results: Suicidal ideation was reported by 14.3% of the total study population (9.5% of males, 19.0% of females), by 23.6% (22.8% of males, 31.3% of females) of individuals with a family member who attempted suicide, and by 14.1% (9.3% of males, 19.9% of females) of individuals without a family member who attempted suicide. Individuals with a family member who attempted suicide had increased odds of suicidal ideation compared with those without a family member who attempted suicide (odds ratio = 2.09, 95% Cl 1.48-2.49, p < 0.001). Conclusions: To prevent suicide spreading like an infectious disease, government and policy makers should give thought and consideration to individuals with a family member who attempts suicide. [ABSTRACT FROM AUTHOR]

Purpose: Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. Materials and Methods: Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. Results: Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. Conclusion: Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to investigate the effect that detection of chronic disease via health screening programs has on health behaviors, particularly smoking. Materials and Methods: We analyzed national health insurance data from 2007 and 2009. Subjects who were 40 years of age in 2007 and eligible for the life cycle-based national health screening program were included. The total study population comprised 153518 individuals who participated in the screening program in 2007 and follow-up screening in 2009. Multiple logistic regression analyses were conducted by sex, with adjustment for health insurance type, socioeconomic status, body mass index, diabetes, hypertension, hyperlipidemia, and family history of cardiovascular and/or neurovascular disease. Results: Among men with smoking behavior changes, those newly diagnosed with hyperlipidemia were more likely to show a positive health behavior change, such as smoking cessation, and were less likely to have a negative behavior change (e.g., smoking initiation). Additionally, men newly diagnosed with diabetes showed lower rates of negative health behavior changes compared to those without disease. Body mass index (BMI)=25, compared to BMI<23, showed higher rates of positive health behavior changes and lower rates of negative health behavior changes. Newly diagnosed chronic disease did not influence smoking behavior in women. Conclusion: Smoking behavior changes were only detected in men who participated in health screening programs. In particular, those newly diagnosed with hyperlipidemia were more likely to stop smoking and less likely to start smoking. [ABSTRACT FROM AUTHOR]

Purpose: This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. Materials and Methods: We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. Results: The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. Conclusion: We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending. [ABSTRACT FROM AUTHOR]

Purpose: A number of clinical decision tools for osteoporosis risk assessment have been developed to select postmenopausal women for the measurement of bone mineral density. We developed and validated machine learning models with the aim of more accurately identifying the risk of osteoporosis in postmenopausal women compared to the ability of conventional clinical decision tools. Materials and Methods: We collected medical records from Korean postmenopausal women based on the Korea National Health and Nutrition Examination Surveys. The training data set was used to construct models based on popular machine learning algorithms such as support vector machines (SVM), random forests, artificial neural networks (ANN), and logistic regression (LR) based on simple surveys. The machine learning models were compared to four conventional clinical decision tools: osteoporosis self-assessment tool (OST), osteoporosis risk assessment instrument (ORAI), simple calculated osteoporosis risk estimation (SCORE), and osteoporosis index of risk (OSIRIS). Results: SVM had significantly better area under the curve (AUC) of the receiver operating characteristic than ANN, LR, OST, ORAI, SCORE, and OSIRIS for the training set. SVM predicted osteoporosis risk with an AUC of 0.827, accuracy of 76.7%, sensitivity of 77.8%, and specificity of 76.0% at total hip, femoral neck, or lumbar spine for the testing set. The significant factors selected by SVM were age, height, weight, body mass index, duration of menopause, duration of breast feeding, estrogen therapy, hyperlipidemia, hypertension, osteoarthritis, and diabetes mellitus. Conclusion: Considering various predictors associated with low bone density, the machine learning methods may be effective tools for identifying postmenopausal women at high risk for osteoporosis. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated trends in organized and opportunistic gastric cancer screening in Korea from 2005 to 2009 based on a growth of consensus and increasing activities against cancer. The authors also aimed to identify some groups that may be experiencing a high burden of illnesses related to cancer. Data from the Korean National Cancer Screening Survey were used. It was concluded that there was progress toward socioeconomic disparity-related goals in organized screening.

Purpose: Using the RAND/UCLA methodology to create the appropriateness criteria, we assessed that the appropriate ratings in cataract surgery can be a better prognosis of outcomes in postoperative 12 months than uncertain or inappropriate ratings. In addition, we indentified the degree of the appropriate rating surgery associated with the outcome changes in postoperative 12 months. Materials and Methods: The patients in this study were followed up prospectively in preoperative and postoperative 12 months periods. The 20 ophthalmologists in 14 hospitals were asked to refer about 20 patients who were scheduled to undergo cataract surgery from March and June of 1997. A multiple regression analysis was used to identify the degree of the appropriate surgery associated with the changes of outcomes. The outcomes were designed as the clinical and functional outcomes (visual acuity, visual function, satisfaction with vision, and satisfaction with overall care). Results: The outcome changes of vision acuity (p < 0.001), vision function-14 (p < 0.001), and symptom score (p < 0.006) were significantly different between four appropriateness ratings (crucial, appropriate, uncertain, and inappropriate). There was a trend that the appropriate rating surgeries were related to the successful change of the vision function (2.29, p = 0.015) and satisfaction with vision (3.84, p = 0.014) in 12 month postoperative period. Conclusion: The crucial or appropriate rating surgeries may indicate better outcomes than uncertain or inappropriate rating surgeries do. The appropriate rating surgeries were more closely related to functional outcome vision function, VF-14 and subjective outcome (satisfaction with vision) in postoperative 12 months than inappropriate rating surgeries. [ABSTRACT FROM AUTHOR]

The article offers a study which evaluates the screening rates for gastric cancer by two different screening methods which are upper gastrointestinal (UGI) series and endoscopy. It details the preference for endoscopy testing as a gastric cancer screening method. It notes that providers' assessments of individuals' screening preferences with intervention strategies to push performance of the preferred test may boost patient compliance with gastric cancer screening recommendations.

The article discusses the result of a study concerning personal background and cognitive factors as predictors of the intention to be screened for stomach cancer. It was found that most of the personal background factors did not directly influence but intension but instead influenced cognitive elements in the theory of planned behavior model.