Abstract
Background
The recent rising health spending intrigued efficiency and cost-based performance measures. However, mortality risk adjustment methods are still under consideration in cost ...estimation, though methods specific to cost estimate have been developed. Therefore, we aimed to compare the performance of diagnosis-based risk adjustment methods based on the episode-based cost to utilize in efficiency measurement.
Methods
We used the Health Insurance Review and Assessment Service–National Patient Sample as the data source. A separate linear regression model was constructed within each Major Diagnostic Category (MDC). Individual models included explanatory (demographics, insurance type, institutional type, Adjacent Diagnosis Related Group ADRG, diagnosis-based risk adjustment methods) and response variables (episode-based costs). The following risk adjustment methods were used: Refined Diagnosis Related Group (RDRG), Charlson Comorbidity Index (CCI), National Health Insurance Service Hierarchical Condition Categories (NHIS-HCC), and Department of Health and Human Service-HCC (HHS-HCC). The model accuracy was compared using R-squared (R
2
), mean absolute error, and predictive ratio. For external validity, we used the 2017 dataset.
Results
The model including RDRG improved the mean adjusted R
2
from 40.8% to 45.8% compared to the adjacent DRG. RDRG was inferior to both HCCs (RDRG adjusted R
2
45.8%, NHIS-HCC adjusted R
2
46.3%, HHS-HCC adjusted R
2
45.9%) but superior to CCI (adjusted R
2
42.7%). Model performance varied depending on the MDC groups. While both HCCs had the highest explanatory power in 12 MDCs, including MDC P (Newborns), RDRG showed the highest adjusted R
2
in 6 MDCs, such as MDC O (pregnancy, childbirth, and puerperium). The overall mean absolute errors were the lowest in the model with RDRG ($1,099). The predictive ratios showed similar patterns among the models regardless of the subgroups according to age, sex, insurance type, institutional type, and the upper and lower 10th percentiles of actual costs. External validity also showed a similar pattern in the model performance.
Conclusions
Our research showed that either NHIS-HCC or HHS-HCC can be useful in adjusting comorbidities for episode-based costs in the process of efficiency measurement.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Decreased mitochondrial number and dysfunction in skeletal muscle are associated with obesity and the progression of obesity-associated metabolic disorders. The specific aim of the current study was ...to investigate the effects of rutin on mitochondrial biogenesis in skeletal muscle of high-fat diet-induced obese rats. Supplementation with rutin reduced body weight and adipose tissue mass, despite equivalent energy intake (p < 0.05). Rutin significantly increased mitochondrial size and mitochondrial DNA (mtDNA) content as well as gene expression related to mitochondrial biogenesis, such as peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), nuclear respiratory factor-1 (NRF-1), transcription factor A (Tfam), and nicotinamide adenine dinucleotide (NAD)-dependent deacetylase, sirtulin1 (SIRT1) in skeletal muscle (p < 0.05). Moreover, rutin consumption increased muscle adenosine monophosphate-activated protein kinase (AMPK) activity by 40% (p < 0.05). Taken together, these results suggested at least partial involvement of muscle mitochondria and AMPK activation in the rutin-mediated beneficial effect on obesity.
Evidence suggests that mental health is associated with multiple factors such as physical activity, sedentary behavior, and physical function in older adults. The present study used latent profile ...analysis to identify classes of older adults based on their health profile among a representative sample of Korean older adults with hypertension. Differences in mental health between these classes were also examined.Seven hundred and sixty seven participants (mean age = 70.23, SD = 6.08; men 45.6%) were included in the analysis.There were 3 latent classes (class 1: a physically inactive lifestyle with low physical function and body perception; class 2: a physically moderate lifestyle with moderate physical function and low body perception; class 3: a physically active lifestyle with high physical function and body perception). According to class comparisons, older adults in class 3 had significantly lower anxiety/depression levels than classes 1 and 2. Older adults in class 3 had significantly lower stress levels than class 1.It is possible that among older adults, having a positive attitude of one's body shape may also be important for improving anxiety/depression along with having a physically active lifestyle and maintaining physical function.
The biomass and lipid/carbohydrate production by a green microalga Scenedesmus obliquus under mixotrophic condition using food wastewater and flue gas CO2 with municipal wastewater was investigated. ...Different dilution ratios (0.5–2%) of municipal wastewater with food wastewater were evaluated in the presence of 5, 10 and 14.1% CO2. The food wastewater (0.5–1%) with 10–14.1% CO2 supported the highest growth (0.42–0.44 g L−1), nutrient removal (21–22 mg TN L−1), lipid productivity (10–11 mg L−1day−1) and carbohydrate productivity (13–16 mg L−1day−1) by S. obliquus after 6 days of cultivation. Food wastewater increased the palmitic and oleic acid contents up to 8 and 6%, respectively. Thus, application of food wastewater and flue gas CO2 can be employed for enhancement of growth, lipid/carbohydrate productivity and wastewater treatment efficiency of S. obliquus under mixotrophic condition, which can lead to development of a cost effective strategy for microalgal biomass production.
•Mixotrophic microalgal cultivation using food wastewater and CO2 was investigated.•Food wastewater and CO2 improved the high quality FAME production of Scenedesmus obliquus.•Carbohydrate production by S. obliquus was enhanced by food wastewater and CO2.•Biofuel feedstock production with wastewater treatment was demonstrated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Although much health services research has been conducted using national health insurance claims data in Korea, the validity of this method has not been ascertained. The objective of this study was ...to validate the use of claims data for health services research by comparing incidence rate of cancers found using insurance claims data against rates of the national cancer registry of Korea. An algorithm to estimate incidence rates using claims data was developed and applied. The claims data from 2005-2008 were acquired and the patients admitted to hospitals due to cancer in 2008 without admission to hospital from 2005- 2007 by the same diagnosis code were regarded as incident cases. The acquired results were compared with the values from the National Cancer Registry of Korea. The incidence rate of all cancers found using claims data was 363.1 per 100,000 people, which is very similar to the 361.9 per 100,000 rate of the national cancer registry. Also the age-, gender- and disease-specific rates between the two data sources were similar. Therefore, national health insurance claims data may be a worthwhile resource for health services research if appropriate algorithms are applied, especially considering the cost effectiveness of this method.
This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was ...calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients' medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.
In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for ...readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.
Purpose
Few studies have been conducted on the association between oral cavity cancer and metabolic diseases. This study aimed to investigate the relationship between oral cavity cancer and metabolic ...diseases.
Methods
This cohort study used the database of the Korean National Health Insurance Service, which contains medical data of 97% of the Korean population. Oral cavity cancer occurred in a total of 2718 patients. Metabolic syndrome was defined according to IDF criteria. The Cox proportional hazard regression model was used.
Results
The HR for oral cavity cancer in patients with metabolic syndrome was 1.113(95% CI 1.006–1.232), which was significantly higher than that in normal patients, especially in males (
p
= 0.0386). When the number of metabolic syndrome factors was ≥ 3, the HR of oral cavity cancer was 1.191(95% CI 1.026–1.383), which was significantly higher than that of 0 metabolic syndrome factors, especially in males (
p
= 0.0218). When the number of metabolic syndrome factors was ≥ 3, the HR for oral cavity cancer was 1.439(95% CI 1.066–1.942), which was significantly higher than that of 0 metabolic syndrome factors, especially in males aged < 50 years (
p
= 0.0173).
Conclusion
Metabolic syndrome increases the risk of oral cavity cancer only in males. In addition, the incidence of oral cavity cancer increased as the number of factors constituting metabolic syndrome increased, only in young males aged < 50 years. Thus, metabolic syndrome is an important risk factor for oral cavity cancer, particularly in young males.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Boosting the performance of rechargeable lithium‐ion batteries (LIBs) beyond the state‐of‐the‐art is mandatory toward meeting the future energy requirements of the consumer mass market. The ...replacement of conventional graphite anodes with conversion‐type metal‐oxide anodes is one progressive approach toward achieving this goal. Here, a LIB consisting of a highcapacity spinel NiMn2O4 anode and a high‐voltage spinel LiNi0.5Mn1.5O4 cathode was proposed. Polyhedral‐shaped NiMn2O4 powder was prepared from a citrate precursor via the sol‐gel method. Electrochemical tests showed that the NiMn2O4 in a half‐cell configuration could deliver reversible capacities of 750 and 303 mAh g−1 at 0.1 and 3 C rates. Integrating the NiMn2O4 anode into a full‐cell configuration provided an estimated energy density of 506 Wh kg−1 (vs. cathode mass) upon 100 cycles and excellent cycling performance over 150 cycles at the 0.1 C rate, which can be considered promising in terms of satisfying the demands for high energy densities in large‐scale applications.
The full picture: A conversion‐type NiMn2O4 anode is used for the first time to construct a Li‐ion battery full cell. The proposed battery was found to deliver an unprecedentedly high energy density of 280 Wh kg−1 (cell) upon 40 cycles, which certifies the feasibility of a conversion‐type anode in practical batteries.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
We studied fullerene-free organic solar cells based on electron-donating (BDT3TR) and -accepting (O-IDTBR) small molecules. Bulk heterojunction devices comprising BDT3TR:O-IDTBR showed an excellent ...power conversion efficiency exceeding 7% and much better thermal stability than BDT3TR:PC70BM devices after ageing at 120 degree C for 300 hours.
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