Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. MATERIALS AND METHODS: We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558. RESULTS: In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. CONCLUSION: Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

Relationship between Perception for Appraisal of Perioperative Nurses and Performance and Organizational Commitment / 간호행정학회지

PURPOSE: This study was an analysis of the relationship between perception for appraisal of staff nurses in operating rooms and performance and organizational commitment. METHOD: The survey was conducted with 176 staff nurses in operating rooms in 2 hospitals in Seoul. Data were analyzed using frequency, one-way ANOVA, Pearson correlation analysis, and stepwise multiple regression. RESULT: 1. Perception for appraisal including accuracy and justice was significantly related to organizational commitment (r=.496, P=.000). Perception for appraisal including accuracy and justice was slightly related to performance (r=.220, P=.003). 2. In order to determine the percentage of the variance of performance and organizational commitment that could be predicted by perception for appraisal, perception for appraisal was entered in the regression equation. Accuracy accounted for 25% of the variance in the organizational commitment. To determine the percentage of the variance of performance that could be predicted by perception for appraisal and organizational commitment, the perception for appraisal and organizational commitment were entered in the regression equation. Organizational commitment accounted for 21% of the variance in the performance. Consequently accuracy predicted organizational commitment. Organizational commitment predicted performance. CONCLUSIONS: Findings indicate the need to increase accuracy of performance appraisal to promote organizational commitment and performance in perioperative nurses.

Impact of Registration Program after Hypertensive or Diabetic Patient Detection through Community Partnership on Compliance and Blood Pressure or Blood Sugar Control / 農村醫學 地域保健

OBJECTIVES: Incheon metropolitan city has set a model program of community partnership for hypertensive or diabetic patients detection and follow-up since 2005. This study examines the effects of the model on the compliance and the control of blood pressure or blood sugar level METHODS: Telephone-surveys were done for 140 persons selected from 408 patients who were detected newly as hypertensive or diabetic patients at Gangwha-Gun and Seo-Gu in Incheon between January 1st and August 31th in 2006, and finally completed in 110 patients(78.6%). Survey questionnaires included socio-demographic(age, gender, and educational level), health behavioral (smoking, drinking, physical activity, and diet), and therapy-related (registration state, compliance, blood pressure or blood sugar control) variables. Odds ratio and 95% CI were derived from logistic regression model. RESULTS: Registered group exhibited high compliance and well managed blood pressure or blood sugar level. The odds ratio of registration were 5.55(95% CI:1.83~16.89) for compliance and 3.78(95% CI:1.43~9.99) for blood pressure or blood sugar control after adjusting for age, gender, disease, and area CONCLUSIONS: It is independently related to compliance and blood pressure or blood sugar control whether the patient is registered or not. To control hypertension or diabetes mellitus in terms of compliance and control state, a community-based registration program through community partnership could be a powerful tool.

The association of elevated alanine aminotransferase activity with obesity in health screenig subjects / 대한내과학회지

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has recently been recognized to be one of the leading causes of chronic liver disease. Obesity and type 2 diabetes are associated strongly with NAFLD. Although often used to detect liver disease, sometimes the cause of elevated Alanine Transaminase (ALT) activity was unclear. In the absence of other causes, the author examined whether BMI and metabolic markers of NAFLD can explain the cause of abnormal ALT in Korean. METHODS: From April 2002 to November 2003, 9997 persons visited health promotion center of Kyungpook National University Hospital and took health screening. After excluding persons with excessive alcohol consumption, abnormal gamma-GTP, hepatitis B, hepatitis C, 8379 persons were included in this study. All patients underwent anthropometric measures, blood chemistry analysis and abdominal ultrasonographic exam. RESULTS: Elevated ALT levels were found in 10% (835 persons) of the all subjects. In univariate analysis, factors associated with elevated ALT levels (por=23 kg/m2) was 79% in abnormal ALT group. In multivariate logistic regression study, total cholesterol and blood pressure were eleminated but sex, BMI, triglyceride level, ultrasonographic fatty change were strongly associated with elevated ALT level (p<0.01). CONCLUSION: In this study, unexplained ALT elevation was strongly associated with obesity, adiposity and other features of metabolic syndrome, and thus may represent nonalcoholic fatty liver disease. However, more research is needed for the definite clinical determinants of nonalcoholic fatty liver disease in Korean.