Changes in cesarean section rate before and after the end of the Korean Value Incentive Program.

BACKGROUND: The Korean government implemented a value incentive program providing incentives to providers based on C-section rates, with the rates being publicized. The program ended in 2014 after the administration decided that the effects of the incentive program were limited. In this report, we analyzed changes in C-section rates with the value incentive program. METHODS: The analysis used claim data from Korea's National Health Insurance. The study period (2011-2016) was divided into two phases: before and after the program. This study included 95 providers that were tertiary or general hospitals having more than 200 deliveries per year during the study period. The dependent variable was the risk-adjusted C-section rate. Independent variables included time and hospital characteristics such as hospital type, district, and ownership. Interrupted time series analysis was performed to analyze the data. RESULTS: Our results showed that risk-adjusted C-section rates increased immediately after the end of the incentive program for C-sections. The immediate effect of intervention, a change of 1.73% (P < .05), was statistically significant, as was the trend after intervention, at 0.21% (P < .0001). The slope showed an increase after the intervention to 0.25% per medical institution, which was contrary to the trend of the preintervention decline (negative slope). CONCLUSION: Risk-adjusted C-section rates increased immediately after the discontinuation of a value incentive program. Tertiary hospitals showed greater increases in C-section rates than general hospitals after the intervention.

Digital Biomarkers in Living Labs for Vulnerable and Susceptible Individuals: An Integrative Literature Review.

PURPOSE: The study aimed to identify which digital biomarkers are collected and which specific devices are used according to vulnerable and susceptible individual characteristics in a living-lab setting. MATERIALS AND METHODS: A literature search, screening, and appraisal process was implemented using the Web of Science, Pubmed, and Embase databases. The search query included a combination of terms related to "digital biomarkers," "devices that collect digital biomarkers," and "vulnerable and susceptible groups." After the screening and appraisal process, a total of 37 relevant articles were obtained. RESULTS: In elderly people, the main digital biomarkers measured were values related to physical activity. Most of the studies used sensors. The articles targeting children aimed to predict diseases, and most of them used devices that are simple and can induce some interest, such as wearable device-based smart toys. In those who were disabled, digital biomarkers that measured location-based movement for the purpose of diagnosing disabilities were widely used, and most were measured by easy-to-use devices that did not require detailed explanations. In the disadvantaged, digital biomarkers related to health promotion were measured, and various wearable devices, such as smart bands and headbands were used depending on the purpose and target. CONCLUSION: As the digital biomarkers and devices that collect them vary depending on the characteristics of study subjects, researchers should pay attention not only to the purpose of the study but also the characteristics of study subjects when collecting and analyzing digital biomarkers from living labs.