How Do Patients Value the Benefit of Minimally Invasive Surgery in Cancer Treatment?

OBJECTIVES: Due to the increasing cost of cancer treatment, the demand for value-based healthcare is increasing. Although several value frameworks have been developed recently in the field of oncology, the nononcological benefits of minimally invasive surgery have not been addressed. This study aimed to estimate how patients value nononcological benefits in minimally invasive cancer surgery. METHODS: The value that patients placed on various benefits of cancer surgery was termed throughout the study as patient value (PV). To quantize PVs for the benefits of cancer surgery, a one-tiered analytic hierarchy process model was constructed. The model includes 6 well-known surgical outcomes, including nononcological benefits. The study participants included 303 patients with cancer and family caregivers who participated in a questionnaire survey. RESULTS: The PVs for "decreased operation time," "reduced length of hospital stay," and "improved cosmetic results" were 0.050, 0.044, and 0.045, respectively, whereas the PVs for "increased survival," "prevention of disease recurrence," and "avoidance of complications" were 0.366, 0.292, and 0.203, respectively. The PV placed on nononcological benefits from minimally invasive surgery was one-tenth (10.2%) of the total value. CONCLUSIONS: Nononcological benefits arising from minimally invasive surgery were relatively small but nonnegligible. This value should be considered in the process of developing a value framework for cancer surgery and shared decision making.

A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death.

OBJECTIVES: We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims' data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death. METHODS: An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined. RESULTS: The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants' components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components' distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases. CONCLUSIONS: Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients?

Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (<80 percentile), patient severity, and the residing region. Our findings show that time delay is an important factor that can influence the outcome of lung cancer patients, highlighting the importance of monitoring and providing appropriate and timely treatment.

Factors associated with poor sleep quality in the Korean general population: Providing information from the Korean version of the Pittsburgh Sleep Quality Index.

BACKGROUND: Recently, studies have been conducted to address the research gap in the understanding of poor-quality sleep and its relationship to health outcomes, through the evaluation of sleep quality. The aim of this study was to provide information regarding poor sleep quality based on a nationwide general population sample in Korea. METHODS: We conducted a cross-sectional study using data from a nationwide sample of 165,193 individuals (males: 44%) aged 19 years or older from the 2018 Korea Community Health Survey. The age range of the participants was 19-107 years (mean: 55.3 ± 17.5). The Korean version of the Pittsburgh Sleep Quality Index (PSQI) was used for assessing sleep quality. Poor sleep quality was defined as a total PSQI score of >5. RESULTS: The overall prevalence of poor sleepers was 41.0% (males: 35.6%; females: 46.2%). Poor sociodemographic status (illiteracy, low income, and unemployment), poor health behaviors (smoking, high-risk drinking, diabetes, hypertension, non-participation in walking, and obesity), and poor mental health (perceived poor health status, stress, depressive symptoms, and subjective cognitive decline) were all associated with poor sleep quality in both males and females. LIMITATIONS: As this study relies on self-reported and cross-sectional data, causal inferences cannot be made. CONCLUSIONS: Poor sleep quality is highly prevalent in females. In addition, poor socio-demographic status, poor health behaviors, and poor mental health were associated with poor sleep quality. The mechanisms underlying sex differences in sleep quality remain to be elucidated, and further studies are required to address this.

Self-reported campus alcohol policy and college alcohol consumption: a multilevel analysis of 4592 Korean students from 82 colleges.

BACKGROUND: Campus alcohol policy has been associated with student alcohol consumption in numerous studies. However, more information is required to assess the extent to which school policy affects student drinking behavior; especially when both individual-level sociodemographic characteristics of students and area-level characteristics of college campuses are controlled for. Thus, this paper explores the association between campus alcohol policy and student alcohol consumption among a nationally representative sample of college students in South Korea, while controlling for both individual and area-level characteristics. METHODS: We surveyed and analyzed the data of 4592 students from 82 colleges. Multilevel (hierarchical) linear modeling was used to identify the association between campus alcohol policy and alcohol consumption levels, measured via the AUDIT-C (Alcohol Use Disorders Identification Test - Consumption). Controlled individual-level characteristics included sex, year level, major, GPA (grade point average), pocket money, smoking status, stress level, depressive thoughts, suicidal thoughts, and number of clubs/organizations. Controlled area-level characteristics included college type, number of students, number of faculty members, number of workers/administrators, and region. RESULTS: Compared to students unaware of their school's campus alcohol policy, students who self-reported that their campuses allow drinking in outdoor spaces (ß = 0.755 p = 0.010) or in all areas (ß = 0.820, p = 0.044) had higher AUDIT-C scores. Students attending schools with a large number of students, males, freshmen, students with low GPA, students with high amounts of pocket money, and smokers also had higher alcohol consumption scores relative to their peers. Alcohol education experience in the form of lectures, mail, and/or campaigns were not associated with student alcohol consumption levels. CONCLUSION: Our results suggest an association between self-reported campus alcohol policy and student alcohol consumption. College educators and administrators must be aware that relative to students unaware of their school's campus alcohol policy, students at colleges that allow drinking in outdoor spaces or all areas consume higher amounts of alcohol than their peers; even when area-level factors are controlled for. TRIAL REGISTRATION: Yonsei IRB (IRB number: Y-2017-0084). https://irb.yonsei.ac.kr Date of registration: 01/2017. Date of enrolment of first participant to trial: 03/01/2017. Y-2017-0084.

The 30-day unplanned readmission rate and hospital volume: a national population-based study in South Korea.

OBJECTIVE: To examine the association between hospital volume and the unplanned 30-day readmission rate as a quality measure. DESIGN: A retrospective cross-sectional study. SETTING: The Korea healthcare system is operated by a single payer under the National Health Insurance Service. PARTICIPANTS: Using national health claims data of the Health Insurance Review and Assessment in South Korea, we examined 1 296 275 adult discharges (≥18 years old) from 90 hospitals (≥500 beds) in the 2013 calendar year. MAIN OUTCOME MEASURES: We analysed the 30-day, unplanned, observed-to-expected standardized readmission rate for hospitals and for five specialty cohorts: medicine, surgery/gynaecology, cardiovascular, cardiorespiratory, and neurology. We assessed the association between hospital volume by tertiles and the 30-day standardized readmission rates with and without adjustment for hospital characteristics. RESULTS: The rate for the lowest-volume hospitals was 6.10 compared with 6.20 for the highest-volume hospitals. We observed the standardized readmission rates did not differ significantly between the lowest- and highest-volume groups, except for the neurology cohort, which remained significant after adjusting for hospital characteristics. CONCLUSIONS: The standardized readmission rates were not associated with hospital volume, except for the neurology cohort, in which the standardized readmission rate was significantly higher in the highest-volume hospitals than in lowest- and intermediate-volume hospitals, which was not consistent with the typical association of greater hospital volume with better outcomes. This association was independent of hospital characteristics. Therefore, the rate of readmissions should be used with caution when gauging the quality of hospital care according to hospital volume.

Association between Continuity of Care and the Onset of Thyroid Disorder among Diabetes Patients in Korea.

Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07⁻1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01⁻1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07⁻1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.

Projection of Breast Cancer Burden due to Reproductive/Lifestyle Changes in Korean Women (2013-2030) Using an Age-Period-Cohort Model.

PURPOSE: The aim of this study was to estimate the burden of breast cancer that can be attributed to rapid lifestyle changes in South Korea in 2013-2030. MATERIALS AND METHODS: An age-period-cohort model was used to estimate the incidence and mortality. The Global Burden of Disease Study Group methodwas used to calculate the years of life lost and years lived with disability in breast cancer patients using a nationwide cancer registry. The population attributable riskswere calculated using meta-analyzed relative risk ratios and by assessing the prevalence of risk factors. RESULTS: Women's reproductive/lifestyle changes, including advanced maternal age at first childbirth (from 37 to 85 disability-adjusted life years [DALYs] per 100,000 person-years), total period of breastfeeding (from 22 to 46 DALYs per 100,000 person-years), obesity (from 37 to 61 DALYs per 100,000 person-years), alcohol consumption (from 19 to 39 DALYs per 100,000 person-years), oral contraceptive use (from 18 to 27 DALYs per 100,000 person-years), and hormone replacement therapy use (from 2 to 3 DALYs per 100,000 person-years) were identified as factors likely to increase the burden of breast cancer from 2013 to 2030. Approximately, 34.2% to 44.3% of the burden of breast cancer could be avoidable in 2030 with reduction in reproductive/lifestyle risk factors. CONCLUSION: The rapid changes of age structure and lifestyle in South Korea during the last decade are expected to strongly increase the breast cancer burden over time unless the risk factors can be effectively modified.

Do hospital characteristics influence Cesarean delivery? Analysis of National Health Insurance claim data.

Background: The rates of Cesarean delivery in South Korea are high among the Organization for Economic Cooperation and Development countries. We analyzed the relationship between hospital characteristics, in particular hospital volume and market competition and Cesarean delivery. Methods: We used data from National Health Insurance claims (n = 53 591) at 51 hospitals to analyze the relationship between hospital characteristics and Cesarean delivery between 2010 and 2013. We performed logistic regression analysis using generalized estimating equations models that included both inpatient and hospital variables to examine factors associated with Cesarean delivery. Results: Among 53 591 hospitalization cases, 14 425 (26.9%) patients underwent Cesarean delivery. Hospital volumes for deliveries were inversely associated with Cesarean delivery (per increases 100 deliveries = OR 0.896, 95% CI 0.887-0.905). Market competition had inverse relationship with Cesarean delivery (per increase in 10 Hirschmann-Herfindal index points; OR 0.982, 95% CI 0.979-0.985). Conclusions: Our findings suggest that hospital characteristics affect Cesarean delivery. These situations might be caused by maintaining profit with regard to survival or competition, and protecting themselves against unexpected delivery risks. Therefore, based on our findings, health policy makers must make an effort to implement effective strategies for the optimal management of excessive Cesarean rates in South Korea.

Are sleep disorders associated with increased mortality in asthma patients?

BACKGROUND: South Korea has experienced problems regarding poor management of symptoms of asthma patients and remarkable increases in sleep disorders. However, few studies have investigated these issues. We examined the relationship between sleep disorders and mortality in asthma patients to suggest effective alternatives from a novel perspective. METHODS: We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2004-2013, which included medical claims filed for 186,491 patients who were newly diagnosed with asthma during the study period. We performed survival analyses using a Cox proportional hazards model with time-dependent covariates to examine the relationship between sleep disorders and mortality in asthma patients. RESULTS: There were 5179 (2.78%) patients who died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio [HR]: 1.451, 95% confidence interval [CI]: 1.253-1.681). In addition, significant interaction was found between sleep disorders and Charlson comorbidity index. CONCLUSIONS: Our findings suggest that an increased prevalence of sleep disorders in asthma patients increases the risk of mortality. Considering the worsening status of asthma management and the rapid growth of sleep disorders in South Korea, clinicians and health policymakers should work to develop interventions to address these issues.

Sleep disorders and risk of hospitalization in patients with mood disorders: Analysis of the National Sample Cohort over 10 years.

Medical utilization due to organic sleep disorders has increased remarkably in South Korea, which may contribute to the deterioration of mental health in the population. We analyzed the relationship between organic sleep disorders and risk of hospitalization due to mood disorder. We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2002-2013, which included medical claims filed for the 15,537 patients who were newly diagnosed with a mood disorder in a metropolitan region, and employed Poisson regression analysis using generalized estimating equation (GEE) models. By the results, there was a 0.53% hospital admission rate among 244,257 patients with outpatient care visits. Patients previously diagnosed with an organic sleep disorder before specific outpatient care had a higher risk for hospitalization. Such associations were significant in females, patients with a longer duration of disease, or those who lived in the largest cities. In conclusion, considering that experiencing a sleep disorder by a patient with an existing mood disorder was associated with deterioration of their status, health policy makers need to consider insurance coverage for all types of sleep disorders in patients with psychological conditions.

Association between reduction in copayment and gastric cancer patient concentration to the capital area in South Korea: NHI cohort 2003-2013.

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients.