Exploring the effects of acceptable palliative care models on survival time and healthcare expenditure among patients with cancer: a national longitudinal population-based study.

OBJECTIVE: Hospice care ensures better end-of-life quality by relieving terminal symptoms. Prior research has indicated that hospice care could prolong survival and reduce end-of-life medical expenditures among patients with cancer. However, the dearth of studies on the effects of hospice care type and use sequence on survival time and end-of-life medical expenditures substantiates the need for investigation. DATA SOURCES AND STUDY SETTING: Two million random records were obtained from the National Health Insurance Research Database. STUDY DESIGN: We estimated the effects of the type and sequence of hospice care use on survival time and medical expenditures among advanced cancer patients. This was a cross-sectional study. DATA COLLECTION/EXTRACTION METHODS: Patient data were collected from 2 million random records provided by the National Health Insurance Research Database of Taiwan. We included people with cancer and excluded patients under 20 years of age; 2860 patients remained after matching. PRINCIPAL FINDINGS: The results indicated that the average survival time of patients who received inpatient palliative care (1022 days) was significantly shorter than that of patients who did not receive palliative care (P < 0.001), but the health care expenditure during the entire course of cancer therapy was not the lowest. Interestingly, patients who received inpatient palliative care had the lowest health care expenditure at 1 year or month before the end of life (P < 0.001). CONCLUSION: The type and sequence of palliative care affected the survival time and health care expenditures of cancer patients. Receiving palliative care did not prolong survival but rather reduced health care expenditures. The sequence of receiving palliative care significantly affected health care expenditures.

Risk of diabetes and hypertension in a population with alcohol use disorders.

BACKGROUND: A population-based follow-up study assessing the risk of developing hypertension and diabetes associated with alcohol use disorder (AUD) is crucial. We investigated this relationship by using insurance claims data from Taiwan. METHODS: From the claims data, an AUD cohort (N = 60,590) diagnosed between 2000 and 2006 and a non-AUD comparison cohort (N = 60,590) without the diagnosis of hypertension or diabetes at baseline were established and matched by propensity scores estimated by baseline demographic status and the Charlson comorbidity index (CCI). We assessed the incidence rates of hypertension and/or diabetes at the end of 2016 and used Cox's method to estimate the related hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Relative to the comparison cohort, the AUD cohort had an approximately 1.70-fold higher incidence of hypertension (35.1 vs. 20.7 per 1,000 person-years), with an adjusted HR (aHR) of 1.72 (95% CI: 1.68-1.76), 2.16-fold higher incidence of diabetes (20.2 vs. 9.36 per 1,000 person-years), with an aHR of 2.18 (95% CI: 2.11-2.24), and 1.91-fold higher incidence of both diabetes and hypertension (10.3 vs. 5.38 per 1,000 person-years) with an aHR of 2.02 (95% CI: 1.94-2.10). The incidence rates of all outcomes were greater in men than in women, whereas the HRs were greater for AUD in women than for AUD in men relative to the respective comparison patients. The risk increased further for subjects with CCI ≥ 1, which was higher in the AUD cohort. CONCLUSIONS: The increased risk of developing diabetes and hypertension in patients with AUD, especially the differences noted according to gender, indicates that clinicians should address potential comorbidities in these patients.

Association between 14 candidate genes, PM2.5, and affective disorders: a study of the Taiwan Biobank.

BACKGROUND: Most studies have focused on the risk factors, treatment, and care of affective psychosis, and several have reported a relationship between ambient air quality and this psychosis. Although an association has been reported between psychosis and genes, studies mainly explored the associations between one type of psychosis and one gene; few have identified genes related to affective psychosis. This study investigates the genetic and environmental factors of affective psychosis. METHODS: In this retrospective longitudinal study, 27 604 participants aged 30-70 were selected from Taiwan Biobank. The participants' propensity scores were calculated based on their demographic information, and propensity score matching was performed to divide the participants into an experimental (i.e., affective psychosis) and control group at a 1:5 ratio. Plink was used to analyze the major and minor types of gene expression related to affective psychosis, and PM2.5 exposure was incorporated into the analyses. RESULTS: According to the generalized estimating equation analysis results, 8 single nucleotide polymorphisms (SNPs) belonging to the ANK3, BDNF, CACNA1C, and GRID1 genotypes were significantly correlated with depressive disorder (P < .001), with the majority belonging to the ANK3 and CACNA1C. A total of 5 SNPs belonging to the CACNA1C, GRID1, and SIRT1 genotypes were significantly correlated with bipolar disorder (P < .001), with the majority belonging to the CACNA1C. No significant correlation was identified between ambient air pollution and affective psychosis. CONCLUSIONS: CACNA1C and GRID1 are common SNP genotypes for depressive disorder and bipolar disorder and should be considered associated with affective psychosis.

Disparities in the medical expenditures of patients with cancer and concomitant mental disorder: analyzing the effects of diagnosis sequence order.

BACKGROUND: Cancer is the leading cause of death in Taiwan. Medical expenditures related to cancer accounted for 44.8% of all major illness insurance claims in Taiwan. Prior research has indicated that the dual presence of cancer and mental disorder in patients led to increased medical burden. Furthermore, patients with cancer and concomitant mental disorder could incur as much as 50% more annual costs than those without. Although previous studies have investigated the utilization of patients with both diseases, the effects of morbidity sequence order on patient costs are, however, uncertain. This study explored medical expenditures linked with the comorbidity of cancer and mental disorder, with a focus on the impact of diagnosis sequence order. METHODS: This population-based retrospective matched cohort study retrieved patients with cancer and mental disorder (aged ≥ 20 years) from the Ministry of Health and Welfare Data Science Center 2005-2015 database. 321,045 patients were divided based on having one or both diseases, as well as on the sequence of mental disorder and cancer diagnosis. Study subjects were paired with comparison counterparts free of both diseases using Propensity Score Matching at a 1:1 ratio. Annual Cost per Patient Linear Model (with a log-link function and gamma distribution) was used to assess the average annual cost, covarying for socio-demographic and clinical factors. Binomial Logistic Regression was used to evaluate factors associated with the risk of high-utilization. RESULTS: The "Cancer only" group had higher adjusted mean annual costs (NT$126,198), more than 5-times that of the reference group (e^ß: 5.45, p < 0.001). However, after exclusion of patients with non-cancer and inclusion of diagnosis sequence order for patients with cancer and concomitant mental disorder, the post-cancer mental disorder group had the highest expenditures at over 13% higher than those diagnosed with only cancer on per capita basis (e^ß: 1.13, p < 0.001), whereas patients with cancer and any pre-existing mental disorder incurred lower expenditures than those with only cancer. The diagnosis of post-cancer mental disorder was significantly associated with high-utilization (OR = 1.24; 95% CI: 1.047-1.469). Other covariates associated with high-utilizer status included female sex, middle to old age, and late stage cancer. CONCLUSION: Presence of mental disorder prior to cancer had a diminishing effect on medical utilization in patients, possibly indicating low medical compliance or adherence in patients with mental disorder on initial treatments after cancer diagnosis. Patients with post-cancer mental disorder had the highest average annual cost. Similar results were found in the odds of reaching high-utilizer status. The follow-up of cancer treatment for patients with pre-existing mental disorders warrants more emphasis in an attempt to effectively allocate medical resources.

Association of health checkups with health-related quality of life among public servants: a nationwide survey in Taiwan.

BACKGROUND: Preventive health checkups have gained in importance over the last decade. The association of health checkups and the number of diseases with health-related quality of life (HRQoL), including physical and mental health, remains unclear. We sought to investigate the aforementioned association among Taiwanese public servants. METHODS: A cross-sectional survey was conducted using randomized and multistage stratified cluster sampling based on proportional probabilistic sampling. The questionnaires addressed demographics, job characteristics, health behaviors, health status, 3 types of health checkups during the preceding 3 years (government-paid health checkup [GPHC], self-paid health checkup [SPHC], and no health checkup [NOHC]), and physical component summary (PCS) and mental component summary (MCS) scores of the Short-Form Health Survey. In total 11,454 middle-aged public servants were analyzed. A multivariate general linear model (GLM) was used to estimate PCS and MCS scores by using least square means. RESULTS: Health checkup types were associated with a significant difference in PCS scores among the public servants. Scores of PCS and MCS were both significantly higher in the GPHC group than in the NOHC group for those with no chronic diseases (51.20 vs. 50.66 [P = 0.008] and 46.23 vs. 45.58 [P = 0.02], respectively). Compared with the NOHC group, both scores of GPHC and SPHC groups were significantly associated with higher PCS scores for public servants with ≥ 2 chronic diseases (46.93 vs. 45.13 [P = 0.002] and 46.52 vs. 45.13 [P = 0.009], respectively). CONCLUSION: In Taiwan, public servants undergoing GPHCs are more likely to report higher PCS scores than are those undergoing SPHCs. It is crucial that encourage periodically using the health checkup to improve health status and HRQoL.

Risk of mental illness after the diagnosis of occupational injury or disease: a retrospective cohort study.

OBJECTIVES: As studies on mental disorders in victims of occupational injury or disease are limited, this study aims to evaluate the risk of, and factors associated with, the development of mental illness in patients with occupational injury or disease using insurance claims data from Taiwan. METHODS: This retrospective cohort study analyzed insurance records in Taiwan to identify 18,285 adults who experienced occupational injury or disease in 2002-2013 and 18,285 adults without occupational injury or disease who were matched by propensity score. The risks of mental disorders during a follow-up period of up to 2 years were estimated and compared between the two cohorts. RESULTS: After controlling for other variables, the odds of mental illness in patients with occupational injury or disease was significantly higher compared to patients without occupational injury or disease. Additional factors associated with higher odds of mental disorders included female gender, age ≥ 30 years (vs. 20-29 years), Charlson comorbidity index ≥ 1, occupation category of labor union member, soldier, insured by social security, religious group member (vs. private or government employee), lower premium-based monthly salary (≤ 576 US$), treatment at a district hospital or clinic (vs. medical center), treatment at a publically-owned or consortium-owned hospital (vs. private hospital), and central or southeast geographic location (vs. Taipei). The main types of mental illness were anxiety disorder (2.79%) and other psychoses (3.29%). CONCLUSION: The risk of mental illness slightly increased during the 2-year period after the diagnosis of occupational injury or disease.

The pharmaceutical practice of mask distribution by pharmacists in Taiwan's community pharmacies under the Mask Real-Name System, in response to the COVID-19 outbreak.

BACKGROUND: Pharmacists hold to their promise to foster, implement and promote the health of the population and to prevent disease, given their knowledge, skills, and proximity to the locals. The objective of this study was to foster equality and cost-effectiveness in the distribution and sale of masks to all Taiwanese citizens, in response to the COVID-19 pandemic. METHODS: All 6336 special community pharmacies participating in the NHI (National Health Insurance) served as mask-selling sites. Access to masks by citizens was determined and controlled, based on the weekly rationing of the number of purchasable masks per citizen and the last digit of their NHI card number. Masks were available on different weekdays for holders of cards ending with odd and even numbers, except on Sundays, when everyone was eligible to buy a mask. RESULTS: Implementing the program has provided equal access to masks for all citizens across Taiwan. It has stabilized the pricing of masks and mitigated the public's anxiety of a perceived likely market shortage. CONCLUSION: The community pharmacy-based approach to the distribution of prevention face masks to citizens represents a new and innovative engagement of pharmacists in public health promotion and protection initiatives. Community pharmacies can greatly improve the efficiency, reliability, and cost-saving of the distribution of public health resources to local communities, especially in the face of an epidemic.

Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis.

BACKGROUND: The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization. METHODS: A total of 570,250 individuals identified from the 2002-2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4. RESULTS: PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05). CONCLUSION: Substance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.

Investigation of time-dependent risk of mental disorders after infertility diagnosis, through survival analysis and data mining: a nationwide cohort study.

OBJECTIVES: Infertile patients are vulnerable to mental disorders. However, a time-dependent model predicting the onset of mental disorders specific to infertile patients is lacking. This study examined the risk factors for the development of mental disorders in infertile patients and measured the duration until the occurrence of mental disorders after a diagnosis of infertility. METHODS: A total of 13,317 infertile patients in the 2002-2013 Taiwan National Health Insurance Research Database were observed. The 11 independent variables included in the hypothesised model, together with the dates of infertility and mental disorder diagnoses, were analysed using Cox proportional hazards. Data-mining methods using C5.0 and Apriori supplemented the statistical analyses. RESULTS: The total prevalence rate of mental disorders among infertile patients in Taiwan was 12.41%, including anxiety (4.66%), depression (1.81%) and other mental disorders (5.94%). The average time interval for onset of mental illness identified using survival analysis was 1.67 years. Income, occupation, treatment method, co-morbidity, region and hospital level and ownership were significant predictors of development of mental illness (all p < .05). CONCLUSIONS: The four categories of factors associated with time-dependent onset were demographics, health, health care provider and geographical characteristics. Certain patient characteristics may predict a higher likelihood of onset of a specific mental disorder. Clinical practitioners may use the findings to identify high-risk patients and make timely health interventions.

DMARD use is associated with a higher risk of dementia in patients with rheumatoid arthritis: A propensity score-matched case-control study.

BACKGROUND: Patients with rheumatoid arthritis (RA) exhibit an increased risk of dementia. Disease-modifying antirheumatic drugs (DMARDs) are commonly used to slow RA progression, but studies investigating the relationship between DMARDs and dementia in patients with RA are lacking. We investigated the relationship between DMARDs and dementia in patients with RA. METHODS: Using the National Health Insurance Research Database, patients aged ≥20years, who were newly diagnosed with RA between 2000 and 2011 were identified. Patients with RA who had dementia comprised the dementia group, and patients with RA who did not have dementia comprised the control group. The groups were matched at a 1:1 ratio by the propensity score. DMARDs were categorized into conventional synthetic DMARDs (csDMARDs) and biological DMARDs (bDMARDs). Logistic regression models were used to calculate the odds ratio and 95% confidence interval (CI) to evaluate the association between DMARD use and the risk of dementia in patients with RA. RESULTS: A total of 957 patients with RA and dementia, and 957 patients with RA but not dementia, were enrolled. The risk of dementia was determined to be 1.63-fold higher in patients with RA with csDMARD use than in those without csDMARD use (95% CI=1.33-2.00). No significant risk of dementia was observed in patients with RA who used bDMARDs compared with their counterparts. However, patients with RA who used hydroxychloroquine, methotrexate, and sulfasalazine exhibited significant risks of dementia, irrespective of cumulative exposure days. CONCLUSION: Patients with RA who used csDMARDs exhibit significant association with dementia.

Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients.

BACKGROUND: In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups. METHODS: The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model. RESULTS: The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four categories of independent variables were associated with the mean difference in the perceptions. CONCLUSIONS: Discrepant attitudes toward privacy and support among the three user groups are identified. Patients may require further education and communication regarding the system. Culturally fit e-Consent should be incorporated into the system to fully utilize the computing power of the Internet when also considering workload. The concern for misuse of EPRs might lead to low support among physicians. Highly readable EPR documents and managerial incentives for information exchange may improve system use.

Measurement equivalence and feasibility of the EORTC QLQ-PR25: paper-and-pencil versus touch-screen administration.

OBJECTIVE: We assessed the measurement equivalence and feasibility of the paper-and-pencil and touch-screen modes of administration of the Taiwan Chinese version of the EORTC QLQ-PR25, a commonly used questionnaire to evaluate the health-related quality of life (HRQOL) in patients with prostate cancer in Taiwan. METHODS: A cross-over design study was conducted in 99 prostate cancer patients at an urology outpatient clinic. Descriptive exact and global agreement percentages, intraclass correlation, and equivalence test based on minimal clinically important difference (MCID) approach were used to examine the equity of HRQOL scores between these two modes of administration. We also evaluated the feasibility of computerized assessment based on patients' acceptability and preference. Additionally, we used Rasch rating scale model to assess differential item functioning (DIF) between the two modes of administration. RESULTS: The percentages of global agreement in all domains were greater than 85% in the EORTC QLQ-PR25. All results from equivalence tests were significant, except for Sexual functioning, indicating good equivalence. Only one item exhibited DIF between the two modes. Although nearly 80% of the study patients had no prior computer-use experience, the overall proportion of acceptance and preference for the touch-screen mode were quite high and there was no significant difference across age groups or between computer-use experience groups. CONCLUSIONS: The study results showed that the data obtained from the modes of administration were equivalent. The touch-screen mode of administration can be a feasible and suitable alternative to the paper-and-pencil mode for assessment of patient-reported outcomes in patients with prostate cancer.

Associations among Health Status, Occupation, and Occupational Injuries or Diseases: A Multi-Level Analysis.

PURPOSE: The present study used a hierarchical generalized linear model to explore the effects of physical and mental health and occupational categories on occupational injuries and diseases. METHODS: The data were obtained from the Registry for Beneficiaries of the 2002-2013 National Health Insurance Research Database. The benefit categories involved adults with occupational injuries and diseases. Six major occupational categories and 28 subcategories were used. The main analysis methods were binary logistic regression (BLR) and hierarchical generalized linear model (HGLM). RESULTS: After adjustment for relevant factors, the three major occupation subcategories most likely to develop occupational injuries and diseases were Subcategory 12 "employees with fixed employers" of Category 1 "civil servants, employees in public or private schools, laborers, and self-employed workers"; Subcategory 2 "employees in private organizations" of Category 1; and "sangha and religionists" of Category 6 "other citizens." Conditions such as mental disorders and obesity increased the risk of occupational injuries and diseases. CONCLUSION: A portion of the occupational categories had a higher risk of occupational injuries and diseases. Physical and mental health issues were significantly correlated with occupational injuries and diseases. To the authors' knowledge, this is the first study to use HGLM to analyze differences in occupational categories in Taiwan.

Association between use of different long-term care services and risks of mental disorder and mortality as well as medical utilization.

Objective: This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors. Methods: This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score-matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50-60 years (10.47%), 61-70 years (14.48%), 71-80 years (35.59%), and 81 years and older (39.45%). The mean age was 70.18 years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM). Results: Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR) = 3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1 years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR = 1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users. Conclusion: Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization.

Psychometric evaluation of the Taiwan Chinese version of the EORTC QLQ-PR25 for HRQOL assessment in prostate cancer patients.

OBJECTIVE: To evaluate the psychometric properties of the Taiwan Chinese Version of the EORTC QLQ-PR25 health-related quality of life (HRQOL) questionnaire for patients with prostate cancer. METHODS: 135 prostate cancer patients were recruited in the urology outpatient clinic of a university teaching hospital. Each patient completed the EORTC QLQ-PR25 at every clinic visit between 2004 and 2008, totaling 633 assessments. Confirmatory factor analysis and Rasch analysis were used to evaluate the domain- and item-level psychometric properties. RESULTS: The results supported the unidimensionality of each of the four EORTC QLQ-PR25 domains (urinary, bowel, and hormonal-treatment-related symptoms, and sexual functioning). Item calibrations for each domain were found invariant across the three assessment time periods. The item-person maps showed 71.3% of item coverage for the urinary symptoms domain and 13-42.7% for the other three domains. CONCLUSIONS: The Taiwan Chinese Version of the EORTC QLQ-PR25 questionnaire is reliable and can be used to measure HRQOL over time. Adding new items to each domain may improve its clinical content coverage and measurement precision.

The Association between Medical Utilization and Chronic Obstructive Pulmonary Disease Severity: A Comparison of the 2007 and 2011 Guideline Staging Systems.

(1) Background: This study aimed to investigate the associations between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems, medical costs, and mortality among patients with chronic obstructive lung disease (COPD). Predictions of the effectiveness of the two versions of the staging systems were also compared. (2) Purpose: this study investigated the associations between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems, medical costs, and mortality among patients with COPD. Predicting effectiveness between the two versions of the staging systems was also compared. (3) Procedure: This study used a secondary clinical database of a medical center in central Taiwan to examine records between 2011 and 2017. A total of 613 patients with COPD were identified. The independent variables comprised the COPD GOLD Guideline staging of the 2007 and 2011 versions, demographic characteristics, health status, and physician seniority. The dependent variables included total medical cost, average length of hospital stay, and mortality. The statistical methods included binomial logistic regression and the general linear model (GLM). (4) Discussion: The total medical cost during the observation period for patients with COPD averaged TWD 292,455.6. The average length of hospital stay was 9.7 days. The mortality rate was 9.6%, compared with that of patients in Grade 1 of the 2007 version; patients in Grade 4 of the 2007 version had significantly higher odds of death (OR = 4.07, p = 0.02). The accuracy of mortality prediction for both the 2007 and 2011 versions of the staging was equal, at 90.4%. The adjusted GLM analysis revealed that patients in Group D of the 2011 version had a significantly longer length of hospital stay than those in Group A of the 2011 version (p = 0.04). No difference between the 2007 and 2011 versions was found regarding the total medical cost. Complications were significantly associated with the total medical cost and average length of hospital stay. (5) Conclusions: The COPD staging 2011 version was associated with an average length of hospital stay, whereas the COPD staging 2007 version was related to mortality risk. Therefore, the 2011 version can estimate the length of hospital stay. However, in predicting prognosis and mortality, the 2007 version is recommended.

Patterns of Systemic Disease Diagnoses among Medical Professionals in Taiwan: Statistical Analysis and Data Mining.

INTRODUCTION: Although high-risk work environments and heavy workload expose medical professionals to long-term risks of disease, no comprehensive analysis has been conducted on the corresponding risks of diseases to each type of medical professionals. This study pre-analyzed the risks of medical professionals in developing various systemic diseases in Taiwan to provide a comprehensive examination of the differences between each type of systemic disease. METHODS: From the secondary databases of 2002-2013, 15,407 medical professionals were selected for analysis. A chi-squared test and logistic regression were performed to identify the relationship between types of medical professionals and systemic diseases. The life trajectories of diagnosis sequence of the medical professionals were illustrated accordingly. RESULTS: The physicians were the most vulnerable to infectious, parasitic, and digestive diseases. This was possibly associated with their work characteristics and occupational risks. CONCLUSION: According to the life trajectories, all types of the medical professionals exhibited a similar trend in the orders of risks to each type of systemic disease, which suggests that their work environment exposes them to real risks of health hazard.

Spousal Concordance and Cross-Disorder Concordance of Mental Disorders: A Nationwide Cohort Study.

OBJECTIVE: Although both partners of a married couple can have mental disorders, the concordant and cross-concordant categories of disorders in couples remain unclear. Using national psychiatric population-based data only from patients with mental disorders, we examined married couples with mental disorders to examine spousal concordance and cross-disorder concordance across the full spectrum of mental disorders. METHODS: Data from the 1997 to 2012 Taiwan Psychiatric Inpatient Medical Claims data set were used and a total of 662 married couples were obtained. Concordance of mental disorders was determined if both spouses were diagnosed with mental disorder of an identical category in the International Classification of Diseases, Ninth Revision, Clinical Modification; otherwise, cross-concordance was reported. RESULTS: According to Cohen's kappa coefficient, the most concordant mental disorder in couples was substance use disorder, followed by bipolar disorder. Depressive and anxiety disorders were the most common cross-concordant mental disorders, followed by bipolar disorder. The prevalence of the spousal concordance of mental disorders differed by monthly income and the couple's age disparity. CONCLUSION: Evidence of spousal concordance and cross-concordance for mental disorders may highlight the necessity of understanding the social context of marriage in the etiology of mental illness. Identifying the risk factors from a common environment attributable to mental disorders may enhance public health strategies to prevent and improve chronic mental illness of married couples.

Investigating Medical Cost and Mortality Among Psychiatric Patients Involuntary Admissions: A Nationwide Propensity Score-Matched Study.

OBJECTIVE: Involuntary admission to psychiatric inpatient care can protect both patients with severe mental illnesses and individuals around them. This study analyzed annual healthcare costs per person for involuntary psychiatric admission and examined categories of mental disorders and other factors associated with mortality. METHODS: This retrospective cohort study collected 1 million randomly sampled beneficiaries from the National Health Insurance Database for 2002-2013. It identified and matched 181 patients with involuntary psychiatric admissions (research group) with 724 patients with voluntary psychiatric admissions (control group) through 1:4 propensity-score matching for sex, age, comorbidities, mental disorder category, and index year of diagnosis. RESULTS: Mean life expectancy of patients with involuntary psychiatric admissions was 33.13 years less than the general population. Average annual healthcare costs per person for involuntary psychiatric admissions were 3.94 times higher compared with voluntary admissions. The general linear model demonstrated that average annual medical costs per person per compulsory hospitalization were 5.8 times that of voluntary hospitalization. Survival analysis using the Cox proportional hazards model found no significant association between type of psychiatric admission (involuntary or voluntary) and death. CONCLUSION: This study revealed no significant difference in mortality between involuntary and voluntary psychiatric admissions, indicating involuntary treatment's effectiveness.

Information asymmetry and performance tilting in hospitals: a national empirical study.

OBJECTIVE: To test the performance tilting hypothesis using information asymmetry (IA) within the community oriented activities of prospective payment system (PPS) hospitals. DATA SOURCES: American Hospital Association (AHA) Annual Survey Database and Medicare Cost Report from the Centers for Medicare and Medicaid Services both in fiscal year 2000; Health maintenance organization (HMO) penetration from the Area Resource File. STUDY DESIGN: A cross-sectional analysis was performed, using a national sample of 3162 PPS hospitals merged from the AHA data set and Medicare profit data. The individual hospital serves as the unit of empirical analysis. General linear model, multiple and logistic regressions are utilized to examine the association between IA and hospital performance indicators. PRINCIPAL FINDINGS: A positive relationship between IA and Medicare profit margins was found. Higher IA was associated with decreased likelihood that the hospital would report having a long-term plan for the health of its host community, and with increased likelihood of performance tilting. CONCLUSION: Information asymmetry offers hospitals an advantageous position in achieving profit maximization. The study also documented the presence of performance tilting by health-care management. Whether increased information demands from a society accustomed to significant disclosure will reduce this agency problem is not yet clear.