Objectives: Very limited previous research has investigated the utility weights of prostate-related diseases in the general population in Korea. The purpose of this study was to calculate the utility of prostate-related health states in the Korean general public using the standard gamble (SG) method. Methods: Seven health states for hypothetical prostate cancers, 1 for benign prostate hyperplasia, and 1 for erectile dysfunction were developed based on patient education material and previous publications. In total, 460 responses from the Korean general population were used to analyze the utility of prostate-related health states. Computer-assisted personal interviews were conducted, and utility values were measured using a visual analogue scale (VAS) and SG. Mean utility values were calculated for each prostate-related health state. Results: The mean utility values of prostate cancer derived from SG ranged from 0.281 (metastatic castration-refractory prostate cancer) to 0.779 (localized prostate cancer requiring prostatectomy). The utility value of benign prostate hyperplasia was 0.871, and that of erectile dysfunction was 0.812. The utility values obtained using the SG method in all conditions were higher than the values obtained by VAS. There were no significant demographic variables affecting utility values in multivariate analysis. Conclusions Our findings might be useful for economic evaluation and utility calculation of screening and interventions for prostate-related conditions in the general population.

The hospital readmission rate has been widely used as an indicator of the quality of hospital care in many countries. However, the transferrability of this indicator that has been developed in a different health care system can be questioned. We reviewed what should be considered when using the risk-standardized readmission rate (RSRR) as a generic quality indicator in the Korean setting. We addressed the relationship between RSRR and the quality of hospital care, methodological aspects of RSRR, and use of RSRR for external purposes. These issues can influence the validity of the readmission rate as a generic quality indicator. Therefore RSRR should be used with care and further studies are needed to enhance the validity of the readmission rate indicator.
Delivery of Health Care ; Patient Readmission ; Quality Indicators, Health Care

In order to improve patient safety, it is important to manage and respond to patient safety incidents that have already occurred. Disclosure of patient safety incidents (DPSI) can be regarded as a prudent strategy, as it has the potential to decrease the number of medical disputes in advance. DPSI is defined as follows: “When a patient safety incident occurs, medical professionals preemptively explain the incident to the patients and their caregivers, express sympathy and regret for the incident, deliver apology and compensation appropriately if needed, and promise to prevent recurrence.” Although DPSI is known to be effective for reducing the number of medical lawsuits, it can be also viewed as reflecting important ethical and quality of care issues. In particular, medical professionals have an ethical imperative to conduct DPSI with the patient, if patient safety incidents have occurred. In this paper, we review the necessity of DPSI from ethical and quality of care perspectives. The ethical basis of DPSI includes autonomy, transparency, trust, and professional standards. Furthermore, DPSI will become inevitable as society comes to emphasize safer and more patient-centered care. In order to make DPSI a routine practice in South Korea, various efforts, such as the development of DPSI guidelines and educational programs, as well as the introduction of an apology law, will be required.
Caregivers ; Compensation and Redress ; Disclosure* ; Dissent and Disputes ; Humans ; Jurisprudence ; Korea ; Patient Safety* ; Patient-Centered Care

This paper reviewed structure and current status of laws related to patient safety using patient safety law matrix to promote systematic approach in legal system of patient safety. Laws related to patient safety can be divided into three areas: laws for preventing; laws for knowing about; and laws for responding. In the case of Korea, gaps are especially prominent in the areas of laws for knowing about and responding. Patient safety law which will be enacted in July 2016 will fill the gap in the area of laws for knowing about. This law will be comprehensive law, covering the full spectrum of laws related to patient safety. However, after reviewing current patient safety law in Korea, the following drawbacks were identified: absence of code for grasping the current patient safety level; absence of code for mandatory reporting in patient safety reporting system; and absence of code for privilege about patient safety work product. Furthermore we need wider discussions about covering issues of open disclosure, apology law, coroners system, and complaint management system in patient safety law.
Coroners and Medical Examiners ; Disclosure ; Hand Strength ; Humans ; Jurisprudence ; Korea* ; Mandatory Reporting ; Patient Safety* ; Risk Management

OBJECTIVES: This study aimed to explore dimensions in addition to the 5 dimensions of the 5-level EQ-5D version (EQ-5D-5L) that could satisfactorily explain variation in health-related quality of life (HRQoL) in the general population of South Korea. METHODS: Domains related to HRQoL were searched through a review of existing HRQoL instruments. Among the 28 potential dimensions, the 5 dimensions of the EQ-5D-5L and 7 additional dimensions (vision, hearing, communication, cognitive function, social relationships, vitality, and sleep) were included. A representative sample of 600 subjects was selected for the survey, which was administered through face-to-face interviews. Subjects were asked to report problems in 12 health dimensions at 5 levels, as well as their self-rated health status using the EuroQol visual analogue scale (EQ-VAS) and a 5-point Likert scale. Among subjects who reported no problems for any of the parameters in the EQ-5D-5L, we analyzed the frequencies of problems in the additional dimensions. A linear regression model with the EQ-VAS as the dependent variable was performed to identify additional significant dimensions. RESULTS: Among respondents who reported full health on the EQ-5D-5L (n=365), 32% reported a problem for at least 1 additional dimension, and 14% reported worse than moderate self-rated health. Regression analysis revealed a R2 of 0.228 for the original EQ-5D-5L dimensions, 0.200 for the new dimensions, and 0.263 for the 12 dimensions together. Among the added dimensions, vitality and sleep were significantly associated with EQ-VAS scores. CONCLUSIONS: This study identified significant dimensions for assessing self-rated health among members of the general public, in addition to the 5 dimensions of the EQ-5D-5L. These dimensions could be considered for inclusion in a new preference-based instrument or for developing a country-specific HRQoL instrument.
Cognition ; Hearing ; Korea* ; Linear Models ; Patient Outcome Assessment ; Quality of Life* ; Surveys and Questionnaires ; Visual Analog Scale

PURPOSE: The purpose of this study was to determine nurses' perceptions of the disclosure of patient safety incidents (DPSI), which is known to be effective in reducing medical litigation and improving the credibility of medical professionals. METHODS: Three focus group discussions were conducted with 20 nurses using semistructured guidelines. Transcribed content including a record of the progress of the focus group discussions and researchers' notes were analyzed using directed content analysis. RESULTS: Most participants thought that DPSI is necessary because of its effectiveness and for ethical justification. However, participants held varied opinions regarding the primary responsibility of DPSI. Participants agreed on the necessity of explaining the incident and expressing sympathy, apologizing, and promising appropriate compensation that are chief components of DPSI. However, they were concerned that it implies a definitive medical error. A closed organizational culture, fear of deteriorating relationships with patients, and concerns about additional work burdens were suggested as barriers to DPSI. However, the establishment of DPSI guidelines and improving the hospital organization culture were raised as facilitators of DPSI. CONCLUSION: Most nurse participants acknowledged the need for DPSI. To promote DPSI, it is necessary to develop guidelines for DPSI and provide the appropriate training. Improving the hospital organization culture is also critical to facilitate DPSI.
Compensation and Redress ; Disclosure ; Focus Groups ; Humans ; Jurisprudence ; Korea ; Medical Errors ; Organizational Culture ; Patient Rights ; Patient Safety

BACKGROUND: Quality-adjusted life expectancy (QALE) means life expectancy (LE) reflecting health-related quality of life and is one of the indicators of healthy LE. We determined the trends in QALE in Korea by age, gender, educational level, and subregion from 2005 to 2013. METHODS: We applied the Sullivan method to estimate QALE. We calculated QALE from 2005 to 2013 by gender and QALE for 2005 and 2010 by educational level at the national level. Furthermore, we estimated QALE for 2005, 2008, and 2011 by subregion according to metropolitan and provincial levels. RESULTS: Population health in Korea measured by LE and QALE at age 0 increased steadily from 2005 to 2013. Annual percent changes of LE and QALE in men were 0.52 and 0.73, respectively (P value < 0.05), and those in women were 0.47 and 0.71, respectively (P value < 0.05). Koreans with a higher educational level had longer LE and QALE than those with a lower educational level, but the differences in LE and QALE according to educational level narrowed from 2005 to 2010. The LE and QALE at age 0 for each of the 16 subnational regions in 2011 increased compared to 2005, but there was still a difference of up to 4.57 years in QALE between subnational regions. CONCLUSION We showed that QALE could be easily calculated and be an appropriate measure for tracking the overall population's health level. The results from this study are expected to aid the Ministry of Health of Republic of Korea in setting up a goal for the National Health Plan.

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.
Clinical Coding ; Korea* ; Mortality* ; Quality of Health Care ; Risk Adjustment

Summary measures of population health (SMPHs) have been used to estimate the burden of diseases. Among various type of SMPHs, disability adjusted life year (DALY) and healthy life expectancy (HALE) have been calculated in the global and national burden of disease studies. In order to calculate DALY and HALE, disability weight is an essential element. Disability weights quantify the level of disability for health states or diseases and have values between 0 (full health) to 1 (being dead). In this study, we reviewed the main disability weights studies and determined their meaning and limitations. Furthermore, we provided the whole process of typical disability weight study and reviewed key issues as follows: health state or disease description development, panel composition, valuation method, validation of disability weight, cross-cultural variability in health state or disease, and so on. The results from this study will be helpful to conduct future disability weight studies for adapting disability weights and developing new methodologies.
Life Expectancy ; Quality-Adjusted Life Years ; Weights and Measures