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Direct and Indirect Costs of Chronic Obstructive Pulmonary Disease in Korea
Kim, Changhwan,Kim, Younhee,Yang, Dong-Wook,Rhee, Chin Kook,Kim, Sung Kyoung,Hwang, Yong-Il,Park, Yong Bum,Lee, Young Mok,Jin, Seonglim,Park, Jinkyeong,Hahm, Cho-Rom,Park, Chang-Han,Park, So Yeon,Jung The Korean Academy of Tuberculosis and Respiratory 2019 Tuberculosis and Respiratory Diseases Vol.82 No.1
Background: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. Methods: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. Results: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. Conclusion: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.
Direct and Indirect Costs of Chronic Obstructive Pulmonary Disease in Korea
( Changhwan Kim ),( Younhee Kim ),( Dong-Wook Yang ),( Chin Kook Rhee ),( Sung Kyoung Kim ),( Yong-Il Hwang ),( Yong Bum Park ),( Young Mok Lee ),( Seonglim Jin ),( Jinkyeong Park ),( Cho-Rom Hahm ),( 대한결핵 및 호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.1
Background: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. Methods: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. Results: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. Conclusion: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.
Yun Hee Park,고령은,강단비,JinKyeong Park,Kyeongman Jeon,Jeong Hoon Yang,Chi-Min Park,Joongbum Cho,Young Sook Park,Hyejung Park,조주희,Eliseo Guallar,서지영,Chi Ryang Chung 대한의학회 2020 Journal of Korean medical science Vol.35 No.15
Background: Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. Methods: A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. Results: During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30- day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65–0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77–0.88). Conclusion: In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.
Resuscitation Fluid Use in a Single Surgical Intensive Care Unit
Yong Dae Lee,Jeong-Am Ryu,Dae-Sang Lee,Jinkyeong Park,Joongbum Cho,Chi Ryang Chung,Yang Hyun Cho,Jeong Hoon Yang,Gee Young Suh,Chi-Min Park 대한외상중환자외과학회 2020 Journal of Acute Care Surgery Vol.10 No.1
Purpose: The aim of this study was to analyze the temporal change of resuscitation fluid use based on all fluids administered in a surgical intensive care unit (ICU). Methods: The administration of resuscitation fluid to all patients admitted to a surgical ICU of a tertiary referral hospital was investigated from 2008 to 2015. The types and volumes of fluid, and laboratory data taken within 7 days after ICU admission were evaluated. Resuscitation fluids were defined as fluids infused according to stat orders, rather than routine orders. Results: There were a total of 8,885 admissions to the ICU for 7,886 patients. The volumetric proportion of crystalloid to total resuscitation fluids increased significantly over the study period (p < 0.001; 79.6% in 2008; 93.7% in 2015). Although the proportion of 0.9% saline to crystalloids decreased, that of balanced solutions increased (p < 0.001; 29.5% in 2008; 55.6% in 2015). The use of colloids decreased from 20.4% in 2008, to 6.3% in 2015 (p < 0.001). Proportions calculated using the number of individual fluids administered revealed trends similar to those calculated using volumetric data. The amount of infused 0.9% saline was weakly correlated with the lowest blood pH and the highest serum chloride levels (ρ = -0.26 and 0.19, respectively). Conclusion: Changes in the trends of fluid resuscitation practice were noted in a single surgical ICU over the 8-year study period. Crystalloid use increased owing to a rise in the utilization of balanced solutions with a downward trend in colloid use.
Impact of Recipient Age on Mortality after Liver Transplantation: A Population-Based Cohort Study
( Eunmi Gil ),( Jong Man Kim ),( Jae-won Joh ),( Gee Young Suh ),( Dong Hyun Sinn ),( Kyeongman Jeon ),( Jeong Hoon Yang ),( Jinkyeong Park ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Mortality after liver transplantation (LT) depends on many factors. Our aim was to assess short-term outcomes after first LT in a cohort of adult recipients form the national wide database in Korea and identify predictors of in-hospital mortality that could avoid futile LT. Methods: We analyzed data from Health Insurance Review and Assessment Service (HIRA) which is a government-affiliated organization that reviews claim accuracy and assess the quality for the National Health Insurance (NHI) between Aug, 2009 and July, 2014. The patients who had procedural codes of the Korea NHI concerning LT (Q8040-Q8050, Q8140-Q8150) were categorized as patients who received LT. We analyzed the effect of several risk factors on survival by multivariable logistic models. Results: Total 5375 patients had first liver transplantation in this period (1433 received from deceased donor (DD) and 3942 received form living donor (LD)). Mean age was 52.3±8.9 years old and 72.8% (n = 3913) was male. Most common underlying cause of LT was viral hepatitis (46.9 %) due to hepatitis B or C virus, with or without malignant neoplasm of liver. Total 346 patients (6.4%) were died after liver transplantation before hospital discharge. DDLT recipients’ mortality was 14.0% (n = 200) and LDLT recipients’ mortality was 3.7% (n = 146) (p < 0.001). Multiple logistic analysis identified four variables associated with patient survival: recipient age older than 65 years old, recipient on mechanical ventilation more than 3 days, recipients on perioperative hemodialysis, and vasopressor support more than 2 days. Conclusions: Our data shows recipient age, mechanical ventilation, dialysis, and shock had an ability to predict short term outcome. Our results can be used to identify futile cases in which expected outcomes is too poor to justify transplantation.