The effects of special nursing units in nursing homes on healthcare utilization and cost: A case-control study using propensity score matching.

BACKGROUND: Most nursing homes in South Korea lack professional nursing services, resulting in transporting residents to hospitals for mild health problems and nursing treatment needs. While the number of nursing homes has increased, the number of registered nurses working in nursing homes has declined. In 2019, the Korean Ministry of Health and Welfare and the National Health Insurance Service launched the Special Nursing Units in Nursing Homes, a pilot nurse-led model, to resolve the lack of health and nursing services in nursing homes by mandating registered nurses' minimum staffing levels and protecting their scope of practice. OBJECTIVE: This study explored the effects of the Special Nursing Units model in Nursing Homes on healthcare utilization and cost among nursing home residents. DESIGN: A comparative effectiveness research design using propensity score matching. SETTING(S): Eighteen nursing homes were selected based on the region and number of beds. PARTICIPANTS: There were 323 matched-pairs of residents from the case and control groups. METHODS: Nursing homes with more than 30 beds were recruited nationwide, with 18 nursing homes being selected based on the region and number of beds. The case group included 323 older adults receiving professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes for more than six months consecutively in 18 nursing homes between April and December 2019. We matched control participants using propensity score matching with health insurance and long-term care data. We analyzed the differences in healthcare utilization and cost changes between the case and control groups using generalized estimating equations. RESULTS: The groups were not statistically different in baseline demographic or health-related characteristics. There were 26 (8.1%) and 30 (9.3%) deaths in the case and control groups, respectively, during the six months of the model, which was not statistically different (p = .576). The case group showed statistically significant decreases in healthcare utilization and costs, including hospitalization frequency (p = .008), length of stay (p = .002), and hospitalization costs (p = .003); outpatient visit frequency (p = .003) and costs (p < .001); and home healthcare frequency (p < .001) and cost (p < .001) than the control group. CONCLUSIONS: Professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes decreased healthcare utilization and costs. A nurse-led model in nursing homes, which includes mandating the minimum staffing levels of registered nurses and protecting their scope of practice, promises to improve resident health outcomes.

Effects of registered nurse staffing levels, work environment, and education levels on adverse events in nursing homes.

This study examined the effects of nurse staffing levels, work environment, and education levels on adverse events in nursing homes. A cross-sectional study was conducted involving 216 nurses working in 62 nursing homes in South Korea, using self-reported questionnaires and data from the National Health Insurance Service of South Korea. A logistic regression model was used to investigate the effects of nurse staffing levels, work environment, and nursing education levels on the adverse events experienced by residents. An increase of one resident per nurse was significantly associated with a higher incidence of medication error, pressure ulcers and urinary tract infections. A poor work environment increased the incidence of adverse events. Compared to nurses with a bachelor's degree or higher, those with diplomas reported increased incidence rates of pressure ulcers. Improving the health outcomes of residents in nursing homes requires efforts that strengthen the nursing workforce in terms of numbers and educational level, and which improve their work environment at institutional and policy levels.

Effectiveness of Mobile Health-Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis.

BACKGROUND: Peripheral artery disease (PAD) affects over 236 million people worldwide, and exercise interventions are commonly used to alleviate symptoms of this condition. However, no previous systematic review has evaluated the effects of mobile health (mHealth)-based exercise interventions for patients with PAD. OBJECTIVE: This study aimed to assess the effect of mHealth-based exercise interventions on walking performance, functional status, and quality of life in patients with PAD. METHODS: A systematic review and meta-analysis were conducted. We searched in seven databases to identify randomized controlled trials of patients with PAD published in English up to December 4, 2020. Studies were included if patients participated in mHealth-based exercise interventions and were assessed for walking performance. We analyzed pooled effect size on walking performance, functional status, and quality of life based on the standardized mean differences between groups. RESULTS: A total of seven studies were selected for the systematic review, and six studies were included in the meta-analysis. The duration of interventions in the included studies was 12 to 48 weeks. In the pooled analysis, when compared with the control groups, the mHealth-based exercise intervention groups were associated with significant improvements in pain-free walking (95% CI 0.13-0.88), maximal walking (95% CI 0.03-0.87), 6-minute walk test (6MWT) distance (95% CI 0.59-1.24), and walking distance (95% CI 0.02-0.49). However, benefits of the interventions on walking speed, stair-climbing ability, and quality of life were not observed. CONCLUSIONS: mHealth-based exercise interventions for patients with PAD were beneficial for improving pain-free walking, maximal walking, and 6MWT distance. We found that exercise interventions using mHealth are an important strategy for improving the exercise effectiveness and adherence rate of patients with PAD. Future studies should consider the use of various and suitable functions of mHealth that can increase the adherence rates and improve the effectiveness of exercise.

Spatial and temporal trends of PCDD/Fs in sediment and bivalves along the Korean coasts during 2001-2012.

Concentrations of polychlorinated dibenzo-para-dioxins and dibenzofurans (PCDD/Fs) were measured in sediment and bivalves at 25 locations along the Korean coasts during 2001-2012. Concentrations of PCDD/Fs in sediment and bivalves ranged from 0.15 to 18.9 pg TEQ/g dry weight and from 0.06 to 7.70 pg TEQ/g wet weight, respectively. Elevated PCDD/F concentrations were found at locations close to largest industrial complexes and commercial harbors. A significant decreasing trend of PCDD/Fs in sediment was associated with strong regulation of PCDD/Fs, whereas levels in bivalves did not show a decreasing trend. Octachlorinated dibenzo-p-dioxin (OCDD) was predominant in sediment, while tetrachlorinated dibenzofuran and OCDD were predominant in bivalves. Almost half (46%) of sediment samples exceeded the threshold effect level suggested by the US National Oceanic and Atmospheric Administration, implying ecotoxicological risks to benthic organisms. Our findings support the effectiveness of legislative action on PCDD/Fs for coastal environments of Korea.

Polybrominated diphenyl ethers (PBDEs) in breast milk of Korea in 2011: current contamination, time course variation, influencing factors and health risks.

Breast milk is a valuable biological specimen to assess maternal and infant exposure to polybrominated diphenyl ethers (PBDEs). In this study, 208 breast milk samples were collected from 89 participants during lactation period, at <7, 15, 30, and 90 days postpartum, in four cities in Korea, and were determined for 19 PBDE congeners. The total PBDE concentrations (ΣPBDE) ranged from 0.23 to 68.4 (mean: 2.73) ng/g lipid weight, and were within the ranges reported for European and Asian countries. Within a month of lactation after delivery, no significant changes were found in the PBDE concentrations. The predominance of BDE 153 rather than BDE 47 was found in the most samples that BDE 153 was detected, and was likely to be associated with stepwise debromination of BDE 209. No associations were found between PBDE concentrations in breast milk and demographic parameters, except for ΣPBDE with maternal age and delivery mode. Certain types of diet such as corn, seafood and nut correlated significantly with PBDE levels in breast milk. The estimated daily intakes of ΣPBDE for breast-feeding infants were lower than the guidelines proposed by the US EPA, indicating limited health risk from PBDEs through breast feeding.