Mapping Korean National Health Insurance Reimbursement Claim Codes for Therapeutic and Surgical Procedures to SNOMED-CT to Facilitate Data Reuse.

South Korea has a public and single-payer system for healthcare services based on fee-for-service payments. The National Health Insurance (NHI) reimbursement claim codes are used by all healthcare providers for reimbursement. This study mapped NHI reimbursement claim codes for therapeutic and surgical procedures to the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to facilitate semantic interoperability and data reuse for research. The Source codes for mapping were 2,500 reimbursement claim codes for therapeutic and surgical procedures such as surgery, endoscopic procedures, and interventional radiology. The target terminology for mapping was the 'Procedure' hierarchy of the international edition of SNOMED-CT released in July 2019. We translated Korean terms into English, clarified their meaning, extracted characteristics of the source codes, and mapped them to pre-coordinated concepts. If a source concept was not mapped to a pre-coordinated concept, we mapped it to a post-coordinated expression. The mapping results were validated internally using dual independent mapping and group discussion by trained terminologists, and by two physicians with experience of SNOMED-CT mapping. Out of 2,500 source codes, 1,298 (51.9%) codes were mapped to pre-coordinated concepts, and 1,202 (48.1%) codes were mapped to post-coordinated expressions. The mapping of the NHI reimbursement claim codes for therapeutic and surgical procedures to SNOMED-CT is expected to support clinical research by facilitating the utilization of health insurance claim data.

Effect of a mobile app-based cultural competence training program for nurses: A pre- and posttest design.

BACKGROUND: Importance of providing culturally competent nursing care and cultural competence training for nurses has increased due to diversification of the cultural backgrounds of patients in South Korea. Currently there is little cultural competence training provided to nurses in South Korea. OBJECTIVES: This study aimed to develop and evaluate a mobile app-based cultural competence training program for nurses working at a tertiary teaching hospital in South Korea. DESIGN: A one group pre- and posttest intervention design. SETTINGS: A tertiary teaching hospital in South Korea. PARTICIPANTS: A total of 49 nurses participated in the study. METHODS: A mobile app-based cultural competence training program for nurses was developed using the five stages of the ADDIE instructional model. Cultural competence scores were compared between pre- and posttest using the paired t-test. The differences in cultural competence scores between pre- and posttests were also compared by participant characteristics using analysis of variance, the Kruskal-Wallis test, and the Mann-Whitney-Wilcoxon test. RESULTS: The mean total score of the nurses increased significantly after participating in the program, from 63.00 to 81.06 (p < 0.001). Comparisons of differences in cultural competence scores between pre- and posttests by participant characteristics revealed that the improvement in cultural competence was greater in those with no experience abroad for longer than 1 month compared to those who had experience abroad for longer than 1 month (p < 0.001) and in those who had never cared for a foreign patient compared to those who had cared for more than three foreign patients per week (p < 0.05). CONCLUSIONS: The mobile app-based cultural competence training program developed in this study was demonstrated to be effective in improving the cultural competence of nurses in South Korea. Our novel training program can be applied as on-the-job training to improve the cultural competence of nurses.

International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study.

BACKGROUND: Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare. OBJECTIVES: This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country. METHODS: The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators. RESULTS: Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden. CONCLUSION: Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.

Comparison of the predictive validity of three fall risk assessment tools and analysis of fall-risk factors at a tertiary teaching hospital.

AIMS AND OBJECTIVES: The main purpose of this study was to identify the best fall-risk assessment tool, among the Morse Fall Scale, the Johns Hopkins fall-risk Assessment Tool and the Hendrich II fall-risk Model, for a tertiary teaching hospital. The study also analysed fall-risk factors in the hospital, focusing on the items of each fall assessment tool. METHODS: Data on falls were obtained from the patient safety reports and electronic nursing records of a tertiary teaching hospital. A retrospective study was conducted to compare the sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, Youden index and accuracy of the Morse Fall Scale, the Johns Hopkins fall-risk Assessment Tool and the Hendrich II fall-risk Model. This study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology guideline for reporting case-control studies. RESULTS: By analysing the association between falls and the items included in the three tools, we identified significant fall-risk factors such as gait, dizziness or vertigo, changes in mental status, impulsivity, history of falling, elimination disorder, drugs affecting falls, and depression. CONCLUSIONS: The Hendrich II fall-risk Model had the best predictive performance for falls of the three tools, considering the highest in the area under the curve and the Youden index that comprehensively analysed sensitivity and specificity, while the Johns Hopkins fall-risk Assessment Tool had the highest accuracy. The most significant fall-risk predictors are gait, dizziness or vertigo, change in mental state, and history of falling. RELEVANCE TO CLINICAL PRACTICE: To improve the fall assessment performance of the Morse Fall Scale at the study hospital, we propose that it be supplemented with four most significant fall-risk predictors identified in this study.

Perceived cultural differences in healthcare for foreign patients visiting South Korea: tool development and measurement.

BACKGROUND: We developed a 41-item tool measuring cultural differences in healthcare as perceived by foreign patients visiting South Korea. METHODS: The tool was tested on 256 foreign patients who visited three tertiary hospitals in Seoul, South Korea. Content validity was explored by two physicians and eight nurses working in an international healthcare department. Structural validity was tested via exploratory factor analysis and by testing two hypotheses: (1) there are perceived cultural differences between the South Korean healthcare and those of foreign patients' home countries (one-sample t-test); and, (2) Perceived cultural differences vary among language groups (analysis of variance). We also calculated Cronbach's alpha. RESULTS: The content validity index of the tool was 0.97. Exploratory factor analysis identified seven significant factors: hospital care and services, food, the healthcare system, communication, the healthcare facility, religion, and cultural values. The overall Cronbach's alpha for the tool was 0.96, indicating very high internal consistency. We found that foreign patients visiting South Korean hospitals perceived that the healthcare culture differed significantly from that of their home country. The perceived cultural differences varied significantly by language group. CONCLUSIONS: Nurses can use our new tool to understand the cultural differences of foreign patients and provide them with culturally competent nursing care.

Patient safety incident-reporting items in Korean hospitals.

OBJECTIVE: To examine incident-reporting items in tertiary hospitals using the framework of the World Health Organization's International Classification for Patient Safety (ICPS). DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Forty acute-care tertiary hospitals in Korea (response rate = 90.9%). METHODS: Data were collected using a semistructured questionnaire during on-site interviews or via e-mail. Items were extracted from incident-reporting forms that required a reporter's input, and were analyzed using the ICPS framework. After removing redundant items, unique reporting items were mapped onto ICPS elements. The data are summarized using descriptive statistics. RESULTS: On average, hospitals used 2.4 incident-reporting forms (range = 1-9) and 136.7 reporting items (range = 31-310). All of the hospitals had incident-reporting items that described 'incident type' and 'incident characteristics'; however, only 7 hospitals (17.5%) had reporting items on incident 'detection', and 18 hospitals (45.0%) collected information on the 'organizational outcomes'. Of the 1145 unique reporting items, 297 (25.9%) were completely mapped onto ICPS elements at different levels of granularity, and 12.7% (n = 145) were mapped onto ICPS elements that had more granular subcategories. CONCLUSIONS: The ICPS framework is a useful reference model for the classification of incident-reporting items. However, further refinements to both the ICPS framework and incident-reporting items are needed in order to better represent data on patient safety. Furthermore, the use of a common reporting form at the national level is recommended for reducing variations in reporting items and facilitating the efficient collection and analysis of patient safety data.

Development of data models for nursing assessment of cancer survivors using concept analysis.

OBJECTIVES: Sharing of cancer-related information among healthcare professionals is crucial to ensuring the quality of long-term care for cancer survivors. Appropriate distribution of the essential facts can be achieved using data models. The purpose of this study was to develop and validate suitable data models for use in the nursing assessment of cancer survivors. METHODS: The models developed in this study were based on a modification of concept analysis developed by Walker and Avant. Our approach involved determining the purpose of the analysis, identifying data elements, defining these elements and their uses, determining critical attributes, value sets, and cardinalities, and ultimately constructing data models which were examined externally by domain experts. RESULTS: We developed 112 data models with 112 data elements, 29 critical attributes, 102 value sets, and 6 data types for the assessment of cancer survivors. External validation revealed that the data elements, critical attributes, and value sets proposed were comprehensive, relevant, and sufficiently useful to encompass nursing issues related to cancer survivors. CONCLUSIONS: Data models developed in this study will contribute to ensuring the semantic consistency of data collected from cancer survivors, which will improve the quality of nursing assessments and in turn translate to improved long-term patient care.

Strategy development for the implementation of telenursing in Korea.

This study aimed to evaluate the feasibility of telenursing, to analyze the issues that should be considered for the development of telenursing in the future, and to provide efficient strategies for the implementation of telenursing in Korea. The authors used the Delphi survey method and a strengths, weaknesses, opportunities, and threats analysis. A total of 30 experts and specialists in the field of nursing informatics and telemedicine contributed to a three-round Delphi survey. The results of the study suggest that telenursing can potentially be implemented in Korea. However, to implement telenursing in Korea, it is necessary to identify telenursing specialties, to construct an infrastructure within which telenursing can function, to develop a business model, and to integrate strategies with government plans to develop the e-health industry. The issues that emerged as important requirements for the successful introduction of telenursing were classified as systematic, economic, societal, or technical. Issues such as driving force, target market, and expense sharing were examined in detail from both ideal and realistic points of view. The results of this study will enable health professionals to appreciate the feasibility of implementing telenursing in Korea. In addition, the study suggests that telenursing could be used efficiently in a variety of environments as a practical strategy to improve healthcare in Korea.

Decision-tree model of treatment-seeking behaviors after detecting symptoms by Korean stroke patients.

PURPOSE: This study was performed to develop and test a decision-tree model of treatment-seeking behaviors about when Korean patients visit a doctor after experiencing stroke symptoms. METHODS: The study used methodological triangulation. The model was developed based on qualitative data collected from in-depth interviews with 18 stroke patients. The model was tested using quantitative data collected from interviews and a structured questionnaire involving 150 stroke patients. The predictability of the decision-tree model was quantified as the proportion of participants who followed the pathway predicted by the model. RESULTS: Decision outcomes of the model were categorized into immediate and delayed treatment-seeking behavior. The model was influenced by lowered consciousness, social-group influences, perceived seriousness of symptoms, past history of hypertension or stroke, and barriers to hospital visits. The predictability of the model was found to be 90.7%. CONCLUSIONS: The results from this study can help healthcare personnel understand the education needs of stroke patients regarding treatment-seeking behaviors, and hence aid in the development of educational strategies for stroke patients.

Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory.

OBJECTIVE: The aim of this study was to validate the Korean version of the Brief Pain Inventory (BPI-K), a pain assessment tool that has been validated in several languages. METHODS: The sample consisted of 132 patients in Seoul who had recurrent or metastatic cancer and who expressed pain. The Korean version of the Beck Depression Inventory (BDI-K), the Eastern Cooperative Oncology Group (ECOG) performance status score, the Pain Management Index (PMI), and the PMI-Revised (PMI-R) were used to further validate the BPI-K. RESULTS: Cronbach alphas, computed for the pain interference and pain severity item, were 0.93 and 0.85, respectively. Confirmatory factor analysis of the BPI-K items showed a two-common-factor solution for the BPI-K, consistently demonstrated in other language versions of the BPI. The mean pain interference score was more correlated with the BDI-K scale (r = 0.44) and ECOG (r = 0.39) than the mean pain severity score. Seventy-four percent of the patients in the Seoul sample had inadequate analgesia using the PMI. CONCLUSION: The BPI-K is a valid and useful instrument for assessing cancer pain and pain impact in Korea.

Decision tree model of the treatment-seeking behaviors among Korean cancer patients.

The purpose of this study was to develop and test a decision tree model of the treatment-seeking behaviors among Korean cancer patients. The study used methodological triangulation, applying the cognitive ethnographic decision tree modeling approach. The model was developed based on qualitative data collected from in-depth interviews with 29 cancer patients. The model was tested using qualitative and quantitative data collected from interviews and a structured questionnaire involving 165 cancer patients. The predictability of the decision tree model was quantified as the proportion of participants who followed the pathway predicted by the model. Two models were developed, the first for decision making about when to visit a doctor after detecting symptoms, and the second for decision making about treatment type following the diagnosis. Decision outcomes for the first model were categorized into immediate visit and delayed visit. The first model was influenced by the perceived seriousness of symptoms, the experiences of visiting a doctor previously with similar symptoms, social-group influences on visiting a doctor, and barriers to visiting a doctor. Decision outcomes for the second model were hospital treatment only, and a mixture of hospital treatment and alternative therapies. The second model was influenced by curability, social-group influences on alternative therapies, and confidence in alternative therapies. The predictabilities of the 2 models were 90.3% and 94.5%, respectively. This study result can help nurses understand the treatment-seeking behaviors of cancer patients, and hence develop nursing intervention strategies.