OBJECTIVES: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. METHODS: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. RESULTS: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. CONCLUSIONS: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.
Age Factors ; Aged ; Cost Sharing/*economics ; Health Services/*economics ; Humans ; Insurance Claim Review ; Middle Aged ; Office Visits/economics

No abstract available.
Alopecia ; Humans ; Male

The purpose of this study was to compare the dietary status of elderly people according to the degree of obesity and mid-arm circumference in order to provide individualized and efficient nutrition management according to the physical condition of the elderly. Among the total 328 subjects, 72.2% were female, and the mean age and body mass index of the subjects were 76.5 years and 23.4 kg/m₂, respectively. The distribution of obesity degree was 47.9% for the normal group, 23.5% for the overweight group, and 28.7% for the obesity group. The distribution of mid-arm circumference was 18.0% for the under-21 cm group, 37.2% for the 21~22 cm group, and 44.8% for the over-22 cm group. About 82.9% of the subjects were consumed at least three meals a day, and 67.8% of the subjects regularly ate alone. The responses for meal time, regular meal, and meal reduction for 3 months were highest in the 10~20 min. (43.4%), yes (79.3%), and no (58.5%) group, respectively. The responses for eating alone were significantly highest in the overweight group (97.4%), followed by the normal group and obesity group according to the degree of obesity (P<0.05). There were no significant differences in preference for five flavors according to the degree of obesity and mid-arm circumference. Among the dietary habits, 31.1% of all subjects ate milk and dairy products more than once a day, and the response for eating vegetables and fruits more than three times a day was highest in the over-22 cm group (61.9%) while the drinking rate was highest in the under-21 cm group (27.1%; P<0.05). In conclusion, the degree of obesity was related to eating ability, and mid-arm the circumference was related with fruit and vegetable consumption and drinking rate.
Aged* ; Body Mass Index ; Dairy Products ; Diet ; Drinking ; Eating ; Female ; Food Habits ; Fruit ; Humans ; Meals ; Milk ; Obesity* ; Overweight ; Vegetables

BACKGROUND: As the number of dermatologic surgical procedures increases, home care wound management is growing in frequency. OBJECTIVE: The aim of this study was to evaluate the efficacy and surgical site infection rate of home care wound management according to the use of oral antibiotics and the characteristics of the wound and of the patient. METHODS: Our study included 207 patients that had undergone a dermatologic surgical procedure and the subsequent management of their wounds in the home. We checked overall infection rate of home care wound management and compared the result according to the use of oral antibiotics. We evaluated surgical site infection rate after we classified each surgical wound based on age, sex, surgical method, site, size, and depth. In addition, we surveyed efficacy of home care wound management. RESULTS: Overall surgical site infection rate was 1.86%, and the infection rate was not significantly different between the group that utilized home care wound management without oral antibiotics and the group with oral antibiotics (p>0.05). There was no statistically significant difference of surgical site infection rate according to sex, age, wound's size and depth (p>0.05). However, patients with younger age, male sex, greater size, and depth of wounds showed a numerical increase in surgical site infection rate. Staged partial excision for nevus sebaceous in scalp showed significantly higher rate of surgical site infection (p<0.05). In our survey, most patients preferred home care wound management after dermatologic surgical procedures and patients were able to perform the wound care well. CONCLUSION: We expect to utilize home care wound management after dermatologic surgical procedures, provided that physicians appropriately educate patients and their caretakers on proper dressings.
Anti-Bacterial Agents ; Bandages ; Dermatologic Surgical Procedures ; Home Care Services ; Humans ; Male ; Nevus ; Scalp

Purpose: This study analyzed and evaluated qualitative studies of nurses' experiences with cardiopulmonary resuscitation (CPR) to understand their awareness and develop effective strategies. Methods: This study used an integrated literature review method developed by Whittemore and Knafl (2005). The scope of the literature search was broad and encompassed qualitative research exploring the experiences of nurses involved in CPR in hospitals.This search was conducted on March 27, 2023. For domestic literature, databases such as KOREAMed, KMBASE, and RISS were used, while foreign literature was sourced from PubMed, EMBASE, CINAHL, and COCHRANE databases. Results: After careful analysis, nine relevant literature pieces were selected, leading to the derivation of four key themes: “Perception of CPR,” “Positive Experiences during CPR,” “Barriers Impacting CPR Execution,” and “Strategies for Enhancing CPR Effectiveness.” Conclusion To positively reinforce the CPR experiences of nurses, it is necessary to establish educational programs and debriefings that reflect situations for effective coping with sufficient consideration of the medical environment of individual hospitals. Future research should consider comparative analyses of nurses' CPR experiences based on cultural factors and their respective working departments to identify areas for improvement.

Purpose: This study analyzed and evaluated qualitative studies of nurses' experiences with cardiopulmonary resuscitation (CPR) to understand their awareness and develop effective strategies. Methods: This study used an integrated literature review method developed by Whittemore and Knafl (2005). The scope of the literature search was broad and encompassed qualitative research exploring the experiences of nurses involved in CPR in hospitals.This search was conducted on March 27, 2023. For domestic literature, databases such as KOREAMed, KMBASE, and RISS were used, while foreign literature was sourced from PubMed, EMBASE, CINAHL, and COCHRANE databases. Results: After careful analysis, nine relevant literature pieces were selected, leading to the derivation of four key themes: “Perception of CPR,” “Positive Experiences during CPR,” “Barriers Impacting CPR Execution,” and “Strategies for Enhancing CPR Effectiveness.” Conclusion To positively reinforce the CPR experiences of nurses, it is necessary to establish educational programs and debriefings that reflect situations for effective coping with sufficient consideration of the medical environment of individual hospitals. Future research should consider comparative analyses of nurses' CPR experiences based on cultural factors and their respective working departments to identify areas for improvement.

Purpose: This study analyzed and evaluated qualitative studies of nurses' experiences with cardiopulmonary resuscitation (CPR) to understand their awareness and develop effective strategies. Methods: This study used an integrated literature review method developed by Whittemore and Knafl (2005). The scope of the literature search was broad and encompassed qualitative research exploring the experiences of nurses involved in CPR in hospitals.This search was conducted on March 27, 2023. For domestic literature, databases such as KOREAMed, KMBASE, and RISS were used, while foreign literature was sourced from PubMed, EMBASE, CINAHL, and COCHRANE databases. Results: After careful analysis, nine relevant literature pieces were selected, leading to the derivation of four key themes: “Perception of CPR,” “Positive Experiences during CPR,” “Barriers Impacting CPR Execution,” and “Strategies for Enhancing CPR Effectiveness.” Conclusion To positively reinforce the CPR experiences of nurses, it is necessary to establish educational programs and debriefings that reflect situations for effective coping with sufficient consideration of the medical environment of individual hospitals. Future research should consider comparative analyses of nurses' CPR experiences based on cultural factors and their respective working departments to identify areas for improvement.

Purpose: This study analyzed and evaluated qualitative studies of nurses' experiences with cardiopulmonary resuscitation (CPR) to understand their awareness and develop effective strategies. Methods: This study used an integrated literature review method developed by Whittemore and Knafl (2005). The scope of the literature search was broad and encompassed qualitative research exploring the experiences of nurses involved in CPR in hospitals.This search was conducted on March 27, 2023. For domestic literature, databases such as KOREAMed, KMBASE, and RISS were used, while foreign literature was sourced from PubMed, EMBASE, CINAHL, and COCHRANE databases. Results: After careful analysis, nine relevant literature pieces were selected, leading to the derivation of four key themes: “Perception of CPR,” “Positive Experiences during CPR,” “Barriers Impacting CPR Execution,” and “Strategies for Enhancing CPR Effectiveness.” Conclusion To positively reinforce the CPR experiences of nurses, it is necessary to establish educational programs and debriefings that reflect situations for effective coping with sufficient consideration of the medical environment of individual hospitals. Future research should consider comparative analyses of nurses' CPR experiences based on cultural factors and their respective working departments to identify areas for improvement.

Pseudoxanthoma elasticum is a multiorgan disorder, characterized by ectopic mineralization of elastic fibers of skin, eyes, and cardiovascular system. The dermatologic manifestations include laxity of skin, as well as cutis laxa-like wrinkling especially on both axillae. The classic forms of pseudoxanthoma elasticum are due to mutations in the ATP-binding cassette subfamily C member 6 (ABCC6) gene, a presumed transmembrane transporter expressed primarily in the liver and the kidneys. Recent case reports of mutations of gamma-glutamyl carboxylase (GGCX) gene describe associations with vitamin K-dependent coagulation factor deficiency and pseudoxanthoma elasticum as well. A 23-year old woman presented with laxity on both axillae and trunk and a history of vitamin K-dependent coagulation factor deficiency, diagnosed 2 years ago. Fragmented and markedly degenerated elastic fibers with calcium deposition were identified on biopsy specimens. Herein, we report a case of autosomal recessive pseudoxanthoma elasticum combined with vitamin K-dependent coagulation factor deficiency.
Axilla ; Biopsy ; Blood Coagulation Factors ; Calcium ; Carbon-Carbon Ligases ; Cardiovascular System ; Elastic Tissue ; Eye ; Female ; Genes, vif ; Humans ; Kidney ; Liver ; Pseudoxanthoma Elasticum ; Skin ; Vitamins

BACKGROUND: The purpose of this study was to propose a method for developing a measure of hospital-wide all-cause risk-standardized readmissions using administrative claims data in Korea and to discuss further considerations in the refinement and implementation of the readmission measure. METHODS: By adapting the methodology of the United States Center for Medicare & Medicaid Services for creating a 30-day readmission measure, we developed a 6-step approach for generating a comparable measure using Korean datasets. Using the 2010 Korean National Health Insurance (NHI) claims data as the development dataset, hierarchical regression models were fitted to calculate a hospital-wide all-cause risk-standardized readmission measure. Six regression models were fitted to calculate the readmission rates of six clinical condition groups, respectively and a single, weighted, overall readmission rate was calculated from the readmission rates of these subgroups. Lastly, the case mix differences among hospitals were risk-adjusted using patient-level comorbidity variables. The model was validated using the 2009 NHI claims data as the validation dataset. RESULTS: The unadjusted, hospital-wide all-cause readmission rate was 13.37%, and the adjusted risk-standardized rate was 10.90%, varying by hospital type. The highest risk-standardized readmission rate was in hospitals (11.43%), followed by general hospitals (9.40%) and tertiary hospitals (7.04%). CONCLUSION: The newly developed, hospital-wide all-cause readmission measure can be used in quality and performance evaluations of hospitals in Korea. Needed are further methodological refinements of the readmission measures and also strategies to implement the measure as a hospital performance indicator.
Comorbidity ; Dataset ; Diagnosis-Related Groups ; Hospitals, General ; Korea* ; Medicaid ; Medicare ; National Health Programs ; Patient Readmission ; Quality Indicators, Health Care ; Tertiary Care Centers ; United States