Enhancing physical activity and reducing obesity through smartcare and financial incentives: A pilot randomized trial.

OBJECTIVE: A pilot randomized trial assessed the feasibility and effectiveness of an intervention combining Smartcare (activity tracker with a smartphone application) and financial incentives. METHODS: A three-arm, open-label randomized controlled trial design involving traditional education, Smartcare, and Smartcare with financial incentives was involved in this study. The latter group received financial incentives depending on the achievement of daily physical activity goals (process incentive) and weight loss targets (outcome incentive). Male university students (N = 105) with body mass index of ≥27 were enrolled. RESULTS: The average weight loss in the traditional education, Smartcare, and Smartcare with financial incentives groups was -0.4, -1.1, and -3.1 kg, respectively, with significantly greater weight loss in the third group (both Ps < 0.01). The final weight loss goal was achieved by 0, 2, and 10 participants in the traditional education, Smartcare, and Smartcare with financial incentives groups (odds ratio for the Smartcare with financial incentive vs. Smartcare = 7.27, 95% confidence interval: 1.45-36.47). Levels of physical activity were significantly higher in this group. CONCLUSIONS: The addition of financial incentives to Smartcare was effective in increasing physical activity and reducing obesity.

Variations in pain management outcomes among palliative care centers and the impact of organizational factors.

BACKGROUND: The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (ß, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy.

Variations in process and outcome in inpatient palliative care services in Korea.

PURPOSES: Hospice programs in Korea have been largely based on volunteer activity, religious services, or social services. Recent government policy of designating medically based inpatient palliative care services and per diem payment system made it necessary to monitor the quality of these services. We examined the variation in the process and outcomes of palliative care services, using 2009 data obtained from the Korean Terminal Cancer Patient Information System. METHODS: Data were collected from 3,867 patients with terminal cancer who were registered in 34 inpatient palliative care centers designated by the Ministry of Health and Welfare. We used the mean length of stay and the subsequent place of care as process indicators, and change in average pain score as an outcome indicator. The data were analyzed using descriptive statistics, and analysis of covariance for the case-mix adjustment. RESULTS: There were considerable variations among services with regards to the mean length of stay (i.e., 10.5 to 32.6 days for each admission) and subsequent place of care (i.e., 39.8% to 92.6% ended in death at the first admission), even after stratification by service level. The mean change in average pain score varied from -1.48 to 2.16, and remained significant after case-mix adjustment. CONCLUSION: We found considerable variations among palliative care services with regard to the mean length of stay, subsequent place of care, and change in average pain score. Continued assessment of the variations in process and outcomes will assist in developing the national benchmarking system and the evaluation of the government policy.

Cost-effectiveness of recombinant tissue plasminogen activator in the management of acute ischemic stroke: a systematic review.

BACKGROUND AND PURPOSE: This work was undertaken to review the current cost-effectiveness analysis data on thrombolysis by intravenous (IV) therapy with recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke. METHODS: PubMed was searched for articles published between 1995 and 2008. The cost-effectiveness analysis data from eight eligible studies were reviewed, paying particular attention to their modeling assumptions and the quality of the source data. RESULTS: THE REVIEWED STUDIES WERE FROM SIX COUNTRIES: USA (n=2), UK (n=2), Canada (n=1), Australia (n=1), Spain (n=1), and Denmark (n=1); most were performed from the healthcare-system and/or societal perspectives. IV rtPA was associated with an acceptable increase in short-term cost [range: US$ 36-236/patient; US$ 29,148-55,591/quality-adjusted life-years (QALYs)], and a net long-term cost saving that was higher from a societal perspective (range: -US$ 12,043 to -US$ 630/patient; -US$ 207,253 to -US$ 21,938/QALYs) than from a healthcare-system perspective (range: -US$ 5,811 to -US$ 5,415/patient; -US$ 41,137 to -US$ 4,662/QALYs). CONCLUSIONS: IV rtPA seems to be a cost-effective strategy for the management of acute ischemic stroke, and might reduce the associated healthcare costs as well as patients' disabilities. Further cost-effectiveness research and the development of a public health strategy are warranted to optimize the use of rtPA in Korea.

Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study.

BACKGROUND: Korea achieved universal health insurance coverage in only 12 years; however, insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI). Supplementary PHI provides a fixed amount of benefits in the event of critical illness (e.g., cancer or stroke), surgery, or hospitalization. In this study, we tried to identify factors that influence the decision to purchase supplementary PHI and investigate the impacts of PHI on various aspects of cancer care. METHODS: In a cross-sectional study of 391 patients with gastric cancer, we collected data on demographic and clinical variables, coverage by PHI at the time of diagnosis, and patients' cancer care experiences from surgery databases and patient questionnaires. Two separate multivariate logistic regression models were used 1) to determine whether various sociodemographic and clinical variables influence the purchase of supplementary PHI, and 2) to determine if there is a difference in various outcome measures between individuals with and without PHI. RESULTS: We studied 187 subjects (49.6%) who were covered under PHI at the time of diagnosis. Subjects who purchased PHI tended to be younger (aOR = 5.01, 95% C.I. = 2.05 - 12.24), and more educated (aOR = 2.67, 95% C.I. = 1.04 - 6.86). Supplementary PHI coverage was significantly associated with financial independence (aOR = 2.07, 95% CI = 1.19 - 3.61), but not with other aspects of cancer care, such as access to healthcare, quality of care, communication and patient autonomy. CONCLUSION: Our findings demonstrate that supplementary PHI neither serves as a safety net for vulnerable patients nor improves cancer care experience, except for maintaining the financial independence of beneficiaries.