Assessment of the Daily Living Activities of Older People (2004-2023): A Bibliometric and Visual Analysis.

With a rapidly aging global population, comprehending the risks associated with older people's activities of daily living is increasingly important; yet, interdisciplinary analyses remain rare. By providing a bibliometric overview of the capability risks associated with older people's activities of daily living, in order to identify prevailing trends and future directions in the field, the study aims to fill this gap. Using CiteSpace software to analyze data from 928 articles published between 2004 and 2023, the study results demonstrate the growing interest in the capability risks of older people's activities of daily living, with the United States leading in the number of publications, and geriatrics emerging as the dominant discipline. Notably, Institut National de la Sante et de la Recherche Medicale (Inserm) in France emerges as a pivotal contributor in the field. Key research topics encompass risk factors associated with a decline in daily activities and disease-related studies, with emerging trends in cognitive function and instrumental activity research. Future research should prioritize the development of predictive mechanisms for daily living trends, exploration of caregiving solutions, and promotion of interdisciplinary collaboration. This study highlights promising avenues for further research, emphasizing the importance of predictive modeling, innovative caregiving strategies, and interdisciplinary cooperation in addressing capability risks in the activities of daily living of older people.

The impact of the expanded health insurance coverage policy on healthcare spending: evidence from Korea.

BACKGROUND: South Korea's National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients' financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of "Moon Care" with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system's universality. METHODS: Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy's effect. RESULTS: Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy's effect, but only for non-payments. CONCLUSIONS: We observed the policy's intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.

Medical expenses and its determinants in female patients with urological disorder.

BACKGROUND: The rising older adult population has led to an increase in the prevalence of chronic diseases and medical expenses. Women tend to have a longer healthy life expectancy than men and are more likely to be exposed to urological disorders around the age of 50, resulting in substantial healthcare expenses throughout their lifetime. Urological disorders often require continuous treatment owing to their high risk of recurrence, contributing to an increased financial burden from medical costs. This study aimed to identify factors influencing medical expense in female patients with urological disorders and propose strategies to alleviate the associated financial burden. METHODS: We used data from the Korea Health Panel Survey conducted from 2011 to 2016. The final sample comprised 2,932 patients who visited hospitals for urological disorders. To identify the factors influencing medical expense among female patients with urological disorders, we employed a generalized estimating equation model. RESULTS: The results indicated that younger people and patients with middle-income levels tended to incur higher medical expenses. Furthermore, patients receiving treatment at tertiary hospitals and those enrolled in National Health Insurance also incurred higher health expenses. CONCLUSIONS: This study suggests that effective management of medical expenses related to urological disorders in women requires improvements in healthcare accessibility to facilitate early detection and continuous disease management. In addition, the findings highlight the potential benefits of digital health and non-face-to-face treatments in addressing these needs.

Gender differences in caregiver attitudes and unmet needs for activities of daily living (ADL) assistance among older adults with disabilities.

BACKGROUND: With a rapidly ageing population and a decline in the availability of family caregivers, the number of older adults with disabilities who have unmet long-term care needs is gradually increasing worldwide. However, whether there are gender differences in the association between primary caregivers or their attitudes and unmet needs for activities of daily living (ADL) assistance remains largely unknown. METHODS: This study used the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), containing the data of 1187 older adults with disabilities aged 65 and older, to identify gender differences in the attitudes of primary caregivers toward the unmet needs for ADL assistance among with disabilities adults in China. Binary logistic regression analysis was conducted to determine the effects of primary caregivers and their caregiving attitudes on the unmet care experiences of older adults with ADLs. In addition, a gender-stratified analysis was conducted to compare the differences based on older adults' gender. RESULTS: The results revealed that the lack of positive attitudes from primary caregivers might create a situation of unmet needs for ADL assistance among older adults. When family members carry the main burden of care, older adults with disabilities, especially older women, have a lower level of unmet needs for ADL assistance. Therefore, it is important to consider gender-specific interventions to improve ADL assistance among older adults. CONCLUSIONS: The findings suggest that the presence of a family member as a caregiver has a significant effect on unmet needs for ADL assistance in women, highlighting the importance of developing an emotional bond with the caregiver. Given that the availability of informal caregivers, such as family members, is declining, it is crucial to provide financial assistance and formal services, such as paid home services and community-based care services, and reduce the burden on family caregivers to address the unmet needs for ADL assistance among older adults with disabilities in China.

Analyzing the Effectiveness of Data-Linked Projects for Health Promotion in Public Health Centers of South Korea.

Purpose: The purpose of this study lies in verifying the effectiveness of the health promotion project which the public health center at the local level conducted by systematically linking the health examination results from the Health Insurance Corporation. We intend to emphasize the importance of linking the health-related public data. Methods: A survey was conducted to measure the effect of improving health behavior using EQ-5D-5L and demographic variables. Results: As a result of the analysis, the residents (3.13) who had experienced the use of public health centers recognized more necessity for the service linked systematically with health checkup data than those (2.93) who had not. In addition, the residents who had experienced the use of public health centers responded that their chronic diseases had improved compared to a year ago (2.78→2.93). Next, those (3.04) who had experienced the services linked with health checkup data recognized that their chronic diseases and health conditions had been improved compared to those (2.81) who had not. However, in EQ-5D-5L, after using the service, mobility showed no difference between those who had used the service and those who had not. Furthermore, even in terms of self-management, daily life, etc., the management ability was further improved compared to those who had not used it, before using the service. Conclusion: This study showed the improved health level when the health promotion service of the public health center was provided by systematically linking the health checkup data of the Health Insurance Corporation in Korea. In order to increase the effectiveness of health data-linked projects, it is necessary to prepare guidelines for linking the public health data and to expand the data-linked project. It will be needed to further subdivide the health checkup results to provide customized services, and to secure dedicated personnel to reinforce the system link.

Strategic management and organizational culture of medical device companies in relation to corporate performance.

AIMS: Strategies focus on securing the competitiveness of medical device corporations by strengthening their organizational capabilities, which, in turn, ensure their continuous development. This study aims to investigate both management strategies and organizational culture, which may affect the performance of these companies, and analyzes the influence of education and training investment. MATERIALS AND METHODS: We used data from the 3rd to 6th Human Capital Corporate Panel surveys by the Korea Research Institute for Vocational Education and Training as well as data from the Korea Information Service and 6,112 workers and 260 companies were analyzed. For the analysis, management strategy and organizational culture were set as independent variables, and corporation performance was set as the dependent variable. Additionally, investment in education and training was set as a control variable between the independent and dependent variables. Corporate performance was analyzed by dividing into organizational satisfaction and organizational commitment. RESULTS: Differentiation strategy and innovative culture had a positive (+) effect on organizational satisfaction, while cost leadership strategy and hierarchical culture had a negative (-) effect. On the other hand, in the case of interaction with education and training investment, cost leadership strategy and hierarchical culture had a positive (+) effect, while differentiation strategy and innovation culture had a negative (-) effect. In organizational commitment, innovation culture had a positive (+) effect, and hierarchical culture had a negative (-) effect. In the case of interaction with investment in education and training, only the hierarchical culture had a positive (+) effect. CONCLUSIONS: The innovation culture positively influenced the performance of medical device companies. Furthermore, cost leadership strategy, hierarchical culture, education and training investment improved the corporate performance of these companies. To enhance corporate performance, these companies should create an innovation culture and invest in education and training in accordance with the organizational culture.

COVID-19 has proven the excellence of Korea's medical devices, and the medical device industry is expected to continue to grow due to the increase in chronic disease and non-face-to-face treatment. However, the current medical device industry is monopolized by global companies with capital and technological prowess. To overcome this, Korean medical device companies are developing innovative medical devices centered on start-ups, but now is the time to strategically respond to them in order to compete with global companies. In general, companies establish management strategies for survival and growth by analyzing threats and opportunities based on the market environment to maintain the optimal organization according to market competition, government policies, and changes in consumer needs. Strategies are often established based on the culture of the organizations that make up the company. When it comes to strategy establishment, the medical device industry has special characteristics compared to other industries. The medical device industry is based on advanced technology and puts patient safety first, requiring continuous product upgrades. Therefore, it is an essential industry for employees to invest in education and training. The analysis shows the effectiveness of investment in education and training according to the management strategy and organizational culture of medical device companies. It was confirmed that when medical device companies create an Innovation culture, their performance improves. It also shows that when medical device companies adopt a cost leadership strategy, they need to increase their investment in education and training to improve corporate performance.

Spatial analysis of the relationship between out-of-pocket expenditure and socioeconomic status in South Korea.

The rapid increase in out-of-pocket expenditures regressively raises the issue of equity in medical access opportunities according to income class and negatively affects public health. Factors related to out-of-pocket expenses have been analyzed in previous studies using an ordinary regression model (Ordinary Least Squares [OLS]). However, as OLS assumes equal error variance, it does not consider spatial variation due to spatial heterogeneity and dependence. Accordingly, this study presents a spatial analysis of outpatient out-of-pocket expenses from 2015 to 2020, targeting 237 local governments nationwide, excluding islands and island regions. R (version 4.1.1) was used for statistical analysis, and QGIS (version 3.10.9), GWR4 (version 4.0.9), and Geoda (version 1.20.0.10) were used for the spatial analysis. As a result, in OLS, it was found that the aging rate and number of general hospitals, clinics, public health centers, and beds had a positive (+) significant effect on outpatient out-of-pocket expenses. The Geographically Weighted Regression (GWR) suggests regional differences exist concerning out-of-pocket payments. As a result of comparing the OLS and GWR models through the Adj. R² and Akaike's Information Criterion indices, the GWR model showed a higher fit. This study provides public health professionals and policymakers with insights that could inform effective regional strategies for appropriate out-of-pocket cost management.

Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009-2016.

This study analyzed the factors affecting the health-related quality of life of patients with benign prostatic hyperplasia (BPH) according to age. We also aimed to determine appropriate strategies to improve their quality of life. Data from the Korea Health Panel Survey (2009-2016) were used in this study. A total of 3806 patients with BPH were divided into 2 groups: younger adults (aged under 65 years) and older adults (aged over 65 years). In addition, a logistic regression analysis was conducted to identify factors affecting the quality of life of young and older patients with BPH. In younger adult patients with BPH, the higher the level of education, the higher the quality of life by a factor of 1.379, and the more intense the physical activity, the lower the quality of life by a factor of 0.791. Also, the longer the sitting time, the lower the quality of life by a factor of 0.765. In contrast, for older adult patients with BPH, the quality of life improved by factors of 1.601 and 2.921, respectively, for health insurance and higher income level. In addition, it was found that the quality of life decreased by a factor of 0.754 in patients who drink alcohol. In order to improve the quality of life of the middle-aged adult population with BPH, it is necessary to reduce sitting time through constant physical activity. Moreover, the cost of medical care should be reduced and the quality of life increased through reductions in surgical treatment, as the burden of medical expenses will degrade the quality of life for older adults.

Clinical application of the optimized X-ray parameter model through analysis of disease risk and image quality when combining the ion chamber of automatic exposure control of digital radiography.

OBJECTIVE: To present an optimized examination model by analyzing the risk of disease and image quality according to the combination of the ion chamber of automatic exposure control (AEC) with digital radiography (DR). METHODS: The X-ray quality was analyzed by first calculating the percentage average error (PAE) of DR. After that, when using AEC, the combination of the ion chambers was the same as the left and centre and right, right and centre, left and centre, centre, right, and left, for a total of six. Accordingly, the entrance surface dose (ESD), risk of disease, and image quality were evaluated. ESD was obtained by attaching a semiconductor dosimeter to the L4 level of the lumbar spine, and then irradiating X-rays to dosimeter centre through average and standard deviation of radiation dose. The calculated ESD was input into the PCXMC 2.0 programme to evaluate disease risk caused by radiation. Meanwhile, image quality according to chamber combination was quantified as the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) through Image J. RESULTS: X-ray quality of DR used in the experiment was within the normal range of±10. ESD of six ion chamber combinations was 1.363mGy, 0.964mGy, 0.946mGy, 0.866mGy, 0.748mGy, 0.726mGy for lumbar anteroposterior (AP), and the lumbar lateral values were 1.126mGy, 0.209mGy, 0.830mGy, 0.662mGy, 0.111mGy, and 0.250mGy, respectively. Meanwhile, disease risk analyzed through PCXMC 2.0 was bone marrow, colon, liver, lung, stomach, urinary and other tissue cancer, and disease risk showed a tendency to increase in proportion to ESD. SNR and CNR recorded the lowest values when three chambers were combined and did not show proportionality with dose, while showed the highest values when two chambers were combined. CONCLUSION: In this study, combination of three ion chambers showed the highest disease risk and lowest image quality. Using one ion chamber showed the lowest disease risk, but lower image quality than two ion chambers. Therefore, if considering all above factors, combination of two ion chambers can optimally maintain the disease risk and image quality. Thus, it is considered an optimal X-ray examination parameter.

Suicide among Older Adults with Dementia: Effects of Korea's Long-Term Care Insurance System.

South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a "dementia special grade" in 2014 to improve care service accessibility and extend health life for older adults with dementia. In this study, we propose a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of using the long-term care services (LTCS). A sample of 62,282 older adults was selected from the "Older Adults Cohort DB" of the National Health Insurance Service. We conducted Kaplan-Meier and Cox regression to represent the yearly survival curve from 2002 to 2015 according to the individual characteristics. Difference-in-difference estimation was conducted to identify the effect of LTCS on suicide rates by using LTCS before and after 2014. The suicide risk of older adults using LTCS was about 0.256-times lower than those who did not use it (OR = 0.296, 95% CI = 0.183-0.478), whereas it increased after the expansion of the dementia grading (OR = 2.131, 95% CI = 1.061-4.280). To prevent the risk of suicide among older adults with dementia, not only did the mortality rate vary depending on the sex, activities of daily living (ADL), and type of caregiver at the individual level but appropriate national intervention and management, such as improving the accessibility of LTCS, are also needed.

Self-Rated Health Status Based on the Type of Health Insurance: A Socioeconomic Perspective.

To investigate the effects of public and private health insurance on self-rated health (SRH) status within the National Health Insurance (NHI) system based on socioeconomic status in South Korea. The data were obtained from 10 867 respondents of the Korea Health Panel (2008-2011). We used hierarchical panel logistic regression models to assess the SRH status. We also added the interaction terms of socioeconomic status and type of health insurance as moderators. Medical aid (MA) recipients were 2.10 times more likely to have a low SRH status than those who were covered only by the NHI, even though the healthcare utilization was higher. When the interaction terms were included, those not covered by the NHI and had completed elementary school or less were 16.59 times more likely to have a low SRH status than those covered by the NHI and had earned a college degree or higher. Expanding healthcare coverage to reduce the burden of non-payment and unmet use to improve the health status of MA beneficiaries should be considered. Particularly, the vulnerability of less-educated groups should be focused on.

Medical service quality, patient satisfaction and intent to revisit: Case study of public hub hospitals in the Republic of Korea.

This study aimed to construct and test structural equation modeling of the causal relationship between quality of healthcare, patient satisfaction, and intent to revisit perceived by patients using regional hub public hospitals. In this study, data of 2,951 outpatients and 3,135 inpatients were collected using the "2018 Regional Hub Public Hospital Operational Evaluation." A structural equation model was used to understand the relationship between patient satisfaction and intent to revisit, and bootstrap analysis was performed. In the direct effect, outpatients were presented in the order of the physician's practice service, the hospital's environment, and patient satisfaction. Inpatients were in the order of the physician's practice service and, medical staff's kindness and consideration,; patient satisfaction was shown in this order. In the indirect effect, the outpatients were presented in the order of physician's practice service, medical staff's kindness and consideration, and hospital's physical environment. Inpatients were introduced in the order of medical staff's kindness and consideration, nurse's practice service, physician's practice service, and patient satisfaction. Regional hub public hospitals need high-quality medical services and efforts from all departments to treat patients with sincerity to improve patient satisfaction and increase intent to revisit.

Factors affecting revisit intention for medical services at dental clinics.

Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (ß = 0.364, p < 0.001), expertise (ß = 0.319, p < 0.001), communication by doctors (ß = 0.224, p < 0.001), and tangibility (ß = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (ß = 0.258, p < 0.001), tangibility (ß = 0.192, p < 0.001), communication by doctors (ß = 0.163, p < 0.001), and expertise (ß = 0.122, p < 0.01). Further, service value (ß = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (ß = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients' intention to revisit through patient-oriented communication.

Unmet Medical Needs of Patients with Benign Prostate Enlargement.

This study aimed to analyze the factors affecting the unmet medical needs of patients with benign prostate enlargement (BPE) based on Andersen's behavioral model. The data were taken from the 2009-2016 Korea Health Panel Study and 3003 participants were used for analysis. "Unmet medical needs" was used as a dependent variable. Independent variables were predisposing variables: age, educational attainment, and marital status; enabling factors: income, job type, and insurance type; and need factors: lying in a sickbed, activity limitation, subjective health status, and having chronic diseases. Results showed that younger patients experienced a higher probability of unmet medical needs. Those with higher educational attainment had a lower chance of experiencing unmet medical needs. Patients with national health insurance were less likely to experience unmet medical needs. In addition, patients who experienced lying in a sickbed had a higher probability of experiencing unmet medical needs. Therefore, in order to reduce the unmet medical needs of patients with BPE, it is necessary to allow patients to be treated early and give them accurate information about the disease. In addition, access to medical care should be strengthened through continuous care focused on primary care.

Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level.

The long-term care insurance (LTCI) has been implemented to help the government take responsibility for social prevention and protection measures to maintain and improve older adults' health and well-being since 2008. This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea. The data used from the national representative Elderly Cohort Database for 2009 to 2013. We analyzed longitudinal panel data from 61,235 persons aged 65 years and older. We generated Kaplan-Meier survival curves and Cox proportional hazard models by use and type of long-term care services (LTCSs) (e.g., non-user, facility, and in-home benefits) and income level. The covariate-adjusted approximate mortality rates by LTCSs type for facility and in-home benefits group compared to non-LTCS users were 0.761 and 0.803, respectively. The approximate mortality rates were higher in the middle low- (Hazard Ratio [HR] = 1.131, p < .001), low- (HR = 1.125, p < .001), and middle- (HR = 1.122, p < .001) than the high income group. In particular, the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. Consequently, these findings point to the need for program improvements to the quality and quantity of the in-home LTCSs for elderly Koreans. Ensuring a "continuum of care" through education for service providers and stronger relationships with the recipients' families could improve overall quality. There is a particular need to devote more attention to the needs of low-income elderly who currently lack sufficient the health coverage.

The Moderating Role of Social Activity on Age Norms and Subjective Health Status of Older Adults: A Two-Stage Cluster Korea National Survey.

OBJECTIVES: This study aimed to examine how social activity (SA) moderates the relationship between age norms (AN) and subjective health status (SHS) among older adults in Korea. Based on the theories of age-integrated structure and active aging, the proposed hypotheses were that SHS has a positive association with attitudes towards AN, and with the interactions between different types of AN and SA. METHODS: Cross-sectional data from a Korean national survey of older adults were analyzed. Participants were older adults N = 10,451, of whom 10,280 were used in the study sample. Multivariate linear regression including interaction terms, was used to examine the associations among SHS, AN, and SA. RESULTS: The results of multivariate linear regression examining learning (ß = 0.066, p < 0.001), working (ß = 0.063, p < 0.001), and remarriage (ß = 0.036, p < 0.001) showed that those who perceived AN more positively, were more likely to have a high SHS. With interaction terms, those who had a positive attitude towards AN for learning and volunteering (ß = 0.025, p < 0.05), and remarriage and engaged in friendship groups (ß = 0.032, p < 0.05) were more likely to have a high SHS. CONCLUSION: SA serves as a great moderator between AN and SHS.

The Effect of Usual Source of Care on the Association of Annual Healthcare Expenditure with Patients' Age and Chronic Disease Duration.

Along with rapid population aging, the importance of chronic disease management increases with high growth of national healthcare expenditures, and efficient spending on healthcare is required to reduce unnecessary utilizations. For that reason, this study examined the association of annual healthcare expenditure with age and disease duration of chronic patients. Furthermore, the study investigated the effect of usual source of care (USOC) to suggest directions for preventive management of chronic disease. Using Korean Health Panel Study data, this study selected 1481 outpatients, who had out-of-pocket costs for hypertension or diabetes, and their total healthcare and chronic disease management (CDM) costs were examined. With patient aging, CDM cost decreased while the total healthcare cost increased, but longer duration of hypertension or diabetes resulted in increases in both CDM and total healthcare costs. In addition, the moderating effect of USOC indicated that elderly patients had increased CDM costs when they had a regular site for healthcare. In contrast, patients with longer duration had reductions in both CDM and total healthcare costs while having a regular doctor increased CDM cost. The results of this study could be an evidence for future policies to suggest proper preventive management plans for specific subjects.

Private health insurance and catastrophic health expenditures of households with cancer patients in South Korea.

This study examines the effects of private health insurance (PHI) on the incidence of catastrophic health expenditures (CHE) for households with a patient with cancer. This study uses 1-year data from 2013 and households with cancer patients as the unit of research rather than individual household members. The sample thus includes 468 households with members with cancer who also used emergency, outpatient and hospitalisation services. Households with PHI had a lower incidence of CHE for all thresholds than those without did. At the 10% threshold, the incidence became significantly lower, by 0.59 and 0.60 times, respectively, if householders had higher education and income levels. Moreover, the incidence of CHE was higher by 8.71 times if the householders are female, and lower by 0.84 times if the householders did not have a spouse at the 20% threshold. From the analysis of households with cancer patients that hold PHI as the key variable, these households showed a lower incidence of CHE than the others did. PHI provides healthcare payments not secured through national health insurance (NHI) and protects households from health expenditures, thereby complementing NHI to a certain degree.

Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study.

OBJECTIVES: The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. METHODS: This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews. RESULTS: A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients. CONCLUSION: The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them.