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Concerns about the moral hazards and usage of universal health insurance require examination. This study aimed to analyze changes in lifestyle, metabolic syndrome-related health status, and individuals’ tendency to use healthcare services according to changes in the eligibility status of medical aid recipients. This paper reports a retrospective cohort study that involved analyzing data from 2366 medical aid recipients aged 40 years or older who underwent national health screenings in 2012 and 2014. Of the recipients, 1606 participants continued to be eligible for medical aid (the “maintained” group) and 760 changed from being medical aid recipients to National Health Insurance (NHI) enrollees (the “changed” group). Compared to the “changed” group, the “maintained” group was less likely to quit smoking, more likely to begin smoking, less likely to reduce binge drinking to moderate drinking, and had a significant increase in blood glucose and waist circumference. Annual total medical expenses also increased significantly in the “maintained” group. Since the mere strengthening of healthcare coverage may lead to moral hazards and the failure to link individuals’ tendency to use healthcare services and outcomes, establishing mechanisms is necessary to educate people about the health-related outcomes of maintaining a healthy lifestyle and ensure the appropriate use of healthcare services.

To examine the association of nursing hours given to patients with stroke with clinical characteristics to predict the nursing care needs.Twenty-four-hour observational study METHODS: Nursing hours per patient day (NHPPD) of 171 stroke patients were measured by 146 nursing personnel who worked on the day of the observation. Cognitive function, balance ability and dependency level were assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), the Korean version of the Berg Balance Scale (K-BBS) and the Korean version of the Modified Barthel Index (K-MBI), respectively.The NHPPD were moderately correlated with K-MMSE (r = -.450), K-BBS (r = -.529) and K-MBI (r = -.549). The worse the cognitive function, balance ability and dependency level, the more were the nursing hours given to the patients. Therefore, these factors can be considered to be factors that predict nursing care needs for patients with stroke.

This study aimed to identify the association between social frailty and health-related quality of life (HRQoL) and to identify the factors influencing HRQoL in community-dwelling older adults in South Korea. This was a secondary analysis of a cross-sectional survey study of 735 older adults. HRQoL was measured using the EuroQoL-5 Dimension, and social frailty was measured using five items. The differences in HRQoL according to sociodemographic characteristics, health-related characteristics, and social frailty of subjects were tested using the Mann–Whitney test, Kruskal–Wallis test, and χ2 test. A Tobit regression model was used to identify the influencing factor of HRQoL. About 31.0% of the older adults were in a social pre-frailty state, and 48.4% were in a social frailty state. Of the five components of social frailty, going out less compared to the previous year and being alone were frequently observed. Older adults who had social frailty had lower HRQoL scores than those who were robust after controlling for sociodemographic and health-related characteristics (BT = −0.04, p < 0.001). Researchers need to consider older adults’ social frailty as well as health status and sociodemographic status in future interventions to improve the HRQoL of older adults.

This study explores the importance of critical raw materials and minerals by analyzing the Republic of Korea&rsquo, s recent circular economy and resource security policy. Raw materials and rare metals are becoming increasingly significant to the Korean economy because the country is currently shifting away from fossil fuels and nuclear power towards renewable energy resources as well as transforming its industries towards decarbonization, digitization, and automation. Korea is a resource-poor country and is heavily dependent on imported minerals and rare earths, which are essential for its economy and new industry. Responding to these challenges and concerns, Korea is moving towards a sustainable circular economy and achieving greater resource security. Despite certain limitations, this transition would ultimately contribute in preparing Korea for current and future challenges in the areas of critical raw materials and minerals.

Background: Mild cognitive impairment (MCI) is a stage preceding dementia, and early intervention is critical. This study investigated whether multi-domain cognitive training programs, especially robot-assisted training, conducted 12 times, twice a week for 6 weeks can improve cognitive function and depression decline in community-dwelling older adults with mild cognitive impairment (MCI). Methods: A randomized controlled trial was conducted with 135 volunteers without cognitive impairment aged 60 years old or older. Participants were first randomized into two groups. One group consisted of 90 participants who would receive cognitive training and 45 who would not receive any training (NI). The cognitive training group was randomly divided into two groups, 45 who received traditional cognitive training (TCT) and 45 who received robot-assisted cognitive training (RACT). The training for both groups consisted of a daily 60 min session, twice a week for six weeks. Results: RACT participants had significantly greater post-intervention improvement in cognitive function (t = 4.707, p &lt, 0.001), memory (t = −2.282, p = 0.007), executive function (t = 4.610, p &lt, 0.001), and depression (t = −3.307, p = 0.004). TCT participants had greater post-intervention improvement in memory (t = −6.671, p &lt, 0.001) and executive function (t = 5.393, p &lt, 0.001). Conclusions: A 6-week robot-assisted, multi-domain cognitive training program can improve the efficiency of global cognitive function and depression during cognitive tasks in older adults with MCI, which is associated with improvements in memory and executive function.

Korea is moving toward a sustainable resource-circulating society to fight climate change and resource scarcity. To achieve this goal, the Framework Act on Resource Circulation (FRC) was enacted on May 29, 2016 and came into effect on January 1, 2018. This act not only acknowledges the importance of resource efficiency and the transition to a resource-circulating society, but also plays a significant role in the progress of important and relevant market and industry developments. This study primarily focuses on an analysis of the FRC. It aims to evaluate key concepts such as a resource-circulating society, circular resources, important provisions including major principles and allocation of responsibilities, and measures to be taken to promote resource circulation. In addition, it explores whether the FRC is sufficiently comprehensive and ambitious to contribute to the transition to a more resource-circulating society.

This study investigated the interaction effects of feedback content type (social comparison feedback vs. objective feedback) and two different performance levels (high vs. low) on work performance. One hundred fifty participants were recruited and asked to perform a simulated work task in a preliminary session. Based on their performance, the upper 40% (high performance) and lower 40% (low performance) groups were selected for the main experiment. Participants in each group were randomly assigned to the two different experimental conditions: objective feedback and social comparison feedback. For the participants in the objective feedback condition, information on the number of correctly completed work tasks was provided. For the participants in the social comparison feedback condition, rank information on their performance was provided. The results indicated that social comparison feedback was more effective than objective feedback for the high performers, but was less effective for the low perfor...

e18329 Background: Watson For Oncology (WFO) is an artificial intelligence (AI) tool that presents therapeutic options to oncologists and patients at 9 hospitals in Korea. The earliest user is Gachon University Gil Medical Center (GMC), where the tumor board (MDT) is fully integrated with WfO (MDT-WfO). GMC patients and oncologists may select one of the treatment choices presented by MDT-WfO or choose to follow recommendations of one or more oncologists at GMC augmented by WfO (non-MDT-WfO). This study is aimed at determining the satisfaction of patients who pursue shared decision-making through the MDT-WfO approach. Methods: Cancer patients enrolled in this IRB-approved study and treated at GMC between March and September of 2018 were surveyed. All patients rated satisfaction levels from 1-10 after treatment decision-making was completed, with 1 indicating the lowest level of satisfaction and 10 the highest. For each question, the average satisfaction score for patients in the MDT-WfO group was compared to the mean for patients in the non-MDT-WfO group, with a t-test for significance. Results: There were 9 cancer types treated at GMC from March through September of 2018. Of the of 290 patients enrolled in this study, 130 (44.8%) selected MDT-WfO and 160 (55.2%) did not. Overall, patients that interacted with MDT-WfO viewed GMT more positively (86.9%) after treatment decisions had been made than patients in the non-MDT-WfO group (71.3%).Although patients did not report significantly differing levels of satisfaction for most survey questions, there was a significant difference in terms of satisfaction with the explanation they received from the medical staff. Satisfaction level for this item was 9.52 with MDT-WfO and 9.22 points without ( p = 0.029). Conclusions: Patients reported greater satisfaction in the explanations they received in the MDT-WfO group, consistent with their more positive impression of GMT after treatment decisions were made. More studies are needed to determine if the increase in the level of satisfaction for this item is due to explanations from MDT unrelated or related to WfO. More studies on how WfO is used differently by the tumor board and individual oncologists may provide a unique perspective on how WfO is integrated into the MDT.

Purpose: This study was aimed to develop fee and a resource-based relative value scale (RBRVS) advanced nursing practices done by nurse anesthetists under the national health insurance. Methods: The classification of practices in Nurse Anesthetists was performed by clinical panel and then the RBRVS of nurse anesthetists for 16 advanced nursing practices was calculated by magnitude estimation method, based on their workload and working time survey in the context of the national health insurance. A cost analysis including direct labor cost and indirect cost for advanced nursing practice was performed to estimate the conversion factor (unit price) for the RBRVS of nurse anesthetists. The share of nurse anesthetists’ contribution to the feefor-service was also analyzed. Results: Calculation of the RBRVS for the 16 advanced nursing practices showed a range of points from 100 to 305.2 with an average of 175.3 points. The relevant conversion factor for advanced nursing practices of nurse anesthetists was estimated at 14.9∼19.4 Korean won. The nursing fee for 16 advanced nursing practice was calculated by multiplying the RBRVS of the each practice and the conversion factor. The contribution rate for advanced nursing practices of nurse anesthetists using the relative value scale of the national health insurance was estimated at 9.3%∼100.0% (indirect cost 10%) with the rate varying widely. Conclusion: In order to address the shortage of anesthetic staffs, the employment of nurses specializing in anesthesia is thought to bring the national interests. In addition, we believe the Nurse Anesthetist system is an effective way to prevent a shortage of anesthetic care providers in South Korea.

The purpose of this study is to develop an optimal allocation model of nursing workforce and apply it to outpatients at a tertiary hospital in Korea. A workload model that consists of average number of patients per day and nursing time per patient was used to estimate the optimal number of nursing workforce in each clinical department, considering the annual off days per nursing staff. The nursing time was classified into three stages(reception-treatment-consulting) and the data were collected by one-to-one observation for three years. It was analyzed by three scenarios: scenario 1 considered actual days spent on vacation and holiday, scenario 2 reflected all holidays and annual leaves under labor act, and scenario 3 included only mandatory holidays and off days. The average number of patients per day varied from 29 to 846 according to clinical department, and required nursing time per patient was from 5.1 to 14.2 minutes. The actual nursing staffs per clinical department were 7.6 persons. The optimal nursing workforce was 7.1, 6.4, and 6.0 persons, respectively in the scenario 1, 2, and 3. In scenario 1, it was analyzed that -3.6 to 7.9 additional nursing staffs should be employed and an average of 0.5 staffs can be reduced. In scenario 2, it was analyzed that -2.9 to 8.7 (average 1.3) additional nursing staffs need to be employed. Lastly, scenario 3 estimated that -2.5 to 9.2 (average 1.7) additional nursing staffs need to be employed. However, this study estimated an optimal nursing workforce to a decimal point, while the number of nurses employed in real world is a positive integer. With nursing manpower allocation rounded to the nearest decimal, nurse staffing condition and patient outcomes could be improved. Therefore, it is recommended to consider an integer model of nurse staffing level in the further detailed studies.* This study was supported by National Research Foundation of Korea.

Background/Objectives: There is a growing need of hospice palliative care for noncancerous diseases. This study analyzed the medical utilization for non-cancer terminal patients during the last year of their lives. Methods/Statistical analysis: This is a cross-sectional study, analyzing the National Health Insurance data of one year before death. The death data of the National Statistical Office (NSO) merged to the data of National Health Insurance (NHI). The cause of death is classified into cancer and 12 non-cancer diseases. Medical expenses are divided into total medical expenses and insurer contribution. Findings: By the cause of death, the disease with the highest medical expense per patient was kidney disease, Human Immunodeficiency Virus (HIV) came second, followed by Amyotrophic Lateral Sclerosis (ALS), cancer, Parkinson`s disease, Chronic Obstructive Pulmonary Disease (COPD), stroke, liver disease, Congestive Heart Failure (CHF), other lung disease, and dementia. On average the insurer contribution rate was 85.8% of the total medical expenses, but the rate of cancer and HIV covered by hospice palliative care was higher than the average. The disease with the highest out-pocket payment burden was dementia. Improvements/Applications: Considering the medical expenses of non-cancer terminal illness patients, the hospice palliative care should be extended to non-cancer patients as well as cancer patients in Korea.

The purpose of this study was to classify advanced nursing practices of Infection Control Nurse Practitioners (ICNPs) and measure workload of the practitioners' activities. The workload was measured with the Resource Based Relative Value Scale (RBRVS), the frequency and the nursing time. Nineteen practices were classified as advanced nursing practices of ICNPs. The calculated scores of the RBRVS for the 19 advanced nursing practices ranged from 100.0 to 386.1 points. The average of frequency and time for the practices were 2.45 and 78 minutes 74 seconds. The practices of ICNPs are considered to be an alternative to decrease healthcare related infection incidences and improve the quality of services in hospitals.

This study aimed to develop a nursing fee for advanced nursing practices done by critical care nurse specialists (CCNSs). The nursing fee for the 20 advanced nursing practices was calculated by multiplying the resource based relative value scale (RBRVS) of the each practice and the conversion factor. Most practices of CCNSs belonged to the category of less than 10,000 KRW. In order to improve efficient utilization of medical manpower in intensive care units, the employment of nurse specialists in hospitals is thought to have the national benefits.

Purpose: The purpose of this study was to perform an economic analysis and estimate the fee for the practices that carried out by Emergency Nurse Practitioner (ENP) using relative value scale (RVS) and its conversion factor. Methods: First, we developed ENP's RVS for 25 advanced nursing services based on ENP's workload and its time spent by survey. A cost analysis was performed to evaluate the conversion factor of ENP's RVS. The share of ENP's contribution to fee-for-service in emergency setting was also analyzed. Results: Calculation of the RVS of 25 advanced nursing practices showed a range of points from 73.4 to 296.3 and an average of 145.1 points. The relevant conversion factor for advanced nursing practices among ENP was estimated at 12.2~15.9 won. The contribution rate of ENP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 13.1~17.0%. Conclusion: The practices of ENP are not compensated separately and its reimbursement is usually included in physician fee. An estimation of nursing fee and an independent fee related to ENP's services shows the contribution rate to total revenue. It suggests that emergency nurse practitioners be considered as a revenue source the in emergency room.