Korean Healthcare System Research Articles

의사-한의사 복수면허자의 진로 선택, 학습 경험 및 업무 경험에 관한 질적 연구

This study investigates the experiences of individuals holding dual medical licenses, including both medical doctor and Korean Medicine (KM) doctor licenses. The study examines their motivations for obtaining dual licenses, their study and work experiences, and their relationships with fellow students and physicians. The objective of the study is to gain insight into how dual license holders establish their identities in the South Korean medical system, which is strictly divided into modern and traditional sectors. To achieve this objective, a qualitative interview survey was conducted with six multiple licensees of medical doctors and KM doctors. The data indicate that interview participants were interested in obtaining multiple licenses either before, immediately after, or long after completing their first medical schools. During the process of acquiring multiple licenses, respondents recognized differences between biomedicine and traditional Korean medicine, and encountered conflicts between medical doctors and KM doctors in their learning process and relationships with their professors and fellow physicians. In this process, it can be observed that dual license holders are often required to choose between their Western medical identity and their KM identity, in situations where conflicts arise between Western medical doctors and KM doctors. Consequently, they may face challenges in fully utilizing their medical skills within the South Korean healthcare system. Unlike previous studies that relied on quantitative analysis, this study provides a comprehensive understanding of how the lives and experiences of medical holders of both medical doctor and KM doctor licenses are linked to the characteristics of the Korean medical system, from the perspective of medical pluralism.

Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention: Results From the HOST-EXAM Study

BackgroundThe HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Disease–Extended Antiplatelet Monotherapy) trial showed superior efficacy and safety of clopidogrel monotherapy compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention (PCI). ObjectivesThe goal of this study was to investigate the cost-effectiveness of clopidogrel monotherapy compared with that of aspirin monotherapy. MethodsA Markov model was developed for patients in the stable phase after PCI. From the perspectives of the South Korean, UK, and U.S. health care systems, the lifetime health care costs and quality-adjusted life-years (QALYs) of each strategy were estimated. Transition probabilities were obtained from the HOST-EXAM trial, and health care costs and health-related utilities were obtained from data and literature for each country. ResultsFrom the perspective of the South Korean health care system, the base-case analysis showed that clopidogrel monotherapy was $3,192 higher in lifetime health care costs and 0.139 lower in QALYs compared with aspirin. This result was greatly influenced by the numerically but insignificantly higher cardiovascular mortality of clopidogrel compared with aspirin. In the analogous UK and U.S. models, clopidogrel monotherapy was projected to decrease health care costs by £1,122 and $8,920 per patient compared with aspirin monotherapy while reducing QALYs by 0.103 and 0.175, respectively. ConclusionsBased on empirical data from the HOST-EXAM trial, clopidogrel monotherapy was projected to lead to reduced QALYs compared with aspirin during the chronic maintenance period after PCI. These results were affected by a numerically higher rate of cardiovascular mortality in clopidogrel monotherapy reported from the HOST-EXAM trial. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Extended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part II Systemic Treatment.

Alopecia areata (AA) is a chronic disease with an unpredictable course and can have a severe psychological impact on an individual. To provide evidence and consensus-based statements regarding the treatment of patients with AA in Korea. We searched for relevant studies from inception to May 2021 regarding the systemic treatment of AA. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statement, and an agreement of 75% or greater was considered as having reached consensus. Current evidence supports the efficacy of systemic corticosteroids, oral cyclosporine monotherapy or combination with systemic corticosteroids, and oral Janus kinase inhibitors in severe AA patients. Systemic steroids may be considered for pediatric patients with severe AA. A consensus was achieved in three out of nine (33.3%), and one out of three (33.3%) statements pertaining to systemic treatment in adult and pediatric AA, respectively. The present study produced up-to-date, evidence-based treatment guidelines for AA associated with the consensus obtained by experts based on the Korean healthcare system.

Patient Perspectives of Chronic Disease Management and Unmet Care Needs in South Korea: A Qualitative Study.

Understanding and incorporating patients' perspectives are necessary to address the emerging challenge of chronic disease management. Our study examined patients' perceptions and experiences for the current chronic disease management system in South Korea. Focus group interviews were conducted on 23 patients and 11 themes emerged by qualitative content analysis. The participants experienced in terms of provider-patient interaction: doctors only prescribe medicine, doctors who provide conventional advice, doctors who do not respect the patients' opinion, long wait times and inadequate consultations, lack of personalized care, and freedom to select another doctor. They also experienced in their community and health system: struggling alone, commercial media and folk remedies, lack of IT technologies for care, demanding visiting services, and lack of collaboration in the community. We found that patients needed comprehensive and personalized care, respect from providers, and self-management support and collaborated care with the community using information technologies advancement. Our findings suggest that a fundamental change in the South Korean healthcare system paradigm is required for successful chronic care, including payment and healthcare delivery systems.

해방 이후 남북한 보건의료환경의 변화와 월남의사의 정착

North Korean doctors who chose to move to the South symbolized certain shifts that had earlier occurred in the respective environments of South and North Korean medical care systems. In case of North Korea, right after the Liberation the authorities nationalized healthcare, and implemented Thought control(Censorship) on doctors. That prompted them to consider breaking free from the regime, while their knowledge of the healthcare condition in the south also factored into their decision to move to South Korea.BR At the time, South Korean healthcare system was deteriorating. It was in dire need of professionally trained medical personnel. South Korean authorities chose not to authorize various (and more traditional) medical practitioners, causing the demand on regular doctors to rise, while the overall increase in medical cost ensured wealthy life for certified doctors. All these factors made the South Korean environment all the more appealing to the “liberalist” North Korean doctors, and in the post-Liberation period their exodus to the South continued. Ever since the end of the Korean War, somewhere between 300 and 400 doctors moved to the South, enriching the pool of authorized medical practitioners in South Korea.BR Yet the fate of North Korean doctors who arrived in the south varied, as even after they safely touched down in South Korea, their expertise had to be verified and their practices needed authorization. Even the ones who got certification as regular doctors experienced some difficulties. They pleaded the government through alumni meetings to resolve the issue of doctor qualification, while also applying for exams and successfully passing them. Other medical practitioners also tried to resolve their issues through group lobbies, but the ones who were never able to have their expertise and practices authorized, were only absorbed into the South Korean society.

DEVELOPMENT OF A TRANSITIONAL CARE PROGRAM FOR FRAIL OLDER ADULTS BETWEEN HOSPITAL AND HOME

Abstract Frail older adults particularly need transitional care between hospital and home due to physical function decline and psychological instability after discharge. This study aimed to develop a transitional care for frail older adults in Korea who are discharged home following hospitalization. The Returning Home (Rehome©) program was established through the three phases according to the Medical Research Council’s 2013 guidelines. 1) Identifying the evidence base phase included a systematic review of literature and needs assessments from interviews with frail older adults. The core intervention components (e.g., geriatric assessment, transitional care planning, home visits, phone follow-up, community service liaison, and family engagement) were determined. 2) At the phase of identifying theory, the transition theory was selected and modified to fit the target population in the context of the Korean healthcare system. 3) Phase three was for the modeling process and outcomes. Based on the result from phases 1 and 2, the Rehome program was developed considering clinically applicable strategies. The final Rehome program consisted of a comprehensive geriatric assessment at admission; structured discharge/transitional care planning (e.g., medication review, education for chronic disease management, emergencies, and geriatric syndromes, and community resource) at discharge; a home visit and six phone follow-up calls up to 12 weeks after discharge; and emotional support and engagement of the family during the entire period. The Rehome program showed good content validity. The Rehome as a frailty-focused transitional care program could improve the transition through implementing a tailored intervention that meets the care needs of these vulnerable populations.

Spadework for Establishing Integrative Enhanced Recovery Program After Spine Surgery: Web-Based Survey Assessing Korean Medical Doctors' Perspectives.

IntroductionEfforts are necessary to promote postoperative patient management to reduce complications or side effects, particularly those adapted to spinal surgery. Considering compatible medical system in Korea, the study objective is to report the opinions of Korean medical doctors regarding integrative enhanced recovery after spine surgery.MethodsFrom December 2020 to January 2021, members of the Korean Medical Association were asked to complete an online questionnaire regarding an integrative enhanced recovery program after spine surgery. A total of 726 participants responded to the survey.ResultsApproximately half of the respondents had more than 10 years of medical experience in the Korean health-care system, and 58.29% were affiliated with primary Korean medical clinics. The majority of respondents were not aware of the ERAS program (N = 412, 79.08%) but said that patient management would be advanced from the establishment of a postoperative medical program that reflected an integrated medical perspective (N = 505, 96.92%). Furthermore, Korean medical professionals believe that Korean medical interventions should play a major role in the pain management and digestive improvement sections of the upcoming postoperative program. Moreover, respondents claimed that Korean traditional medical modalities such as acupuncture, moxibustion, cupping, and herbal decoction should be included in the program.Discussion/ConclusionResponses collected from the present study can be used as a spadework for future studies. A study on the development of a comprehensive postoperative program that reflects the perspectives of patients and conventional medical doctors is needed.

Operation of an alternate care facility in Seoul, Korea: Responding to the third wave of COVID-19 pandemic

The third wave of the COVID-19 outbreak, in December 2020, overwhelmed the Korean healthcare system. In particular, the medical demand of residents in long-term care facilities, homeless shelters, group homes, and detention facilities surged. In this study, we described the experience from development and operation of an alternate care facility (ACF) against the COVID-19 pandemic. In this study, we describe our implementation strategy, including the layout plan, adequate staffing, admission criteria, and patient flow. Using the context of the existing guidelines and literature in the planning and construction process, the differences from the preceding alternative treatment facilities to respond to COVID-19 were also described. Under the time pressure, the old buildings used as office spaces by the US armies were converted into a 107-bed hospital that met infection prevention and clinical care standards. Since these hospitals were dedicated to caring for the patients with COVID-19, multiple challenges were posed to the standards of infection prevention and control, and patient care and safety. The approaches described here provide a potential roadmap for decision makers, who are coping with medical surges as a result of the current and potential future pandemics by implementing an ACF.

Incidence and prevalence of pressure ulcers in hospitals: 10-year cohort study.

Pressure ulcers (PUs) are a serious problem in patients with multiple comorbidities and are associated with a longer duration of hospital stay and higher medical costs. The aetiology and rate of PU occurrence in South Korea remains unclear. Therefore, we aimed to determine the incidence, prevalence, mortality and common comorbidities of hospitalised patients with PUs in the South Korean healthcare system. A 10-year cohort study using the healthcare insurance reimbursement claims from the South Korean National Health Insurance System database. Patients diagnosed with a PU on admission to hospital [ICD-10: L89 + procedure code] between January 2002 and December 2016 were included and their comorbidities evaluated. Patients <20 years of age and recurrent PU cases were excluded. Incidence, prevalence, survival rate and risk factors related to survival rate of patients with PUs were determined. The study population in 2006 was 36,195,121 (all patients admitted to hospital that year), which changed yearly because of the inclusion of additional patients who met the study inclusion criteria, and removal of patients who had died during the year. Standardised PU incidence rate decreased from 17.1 in 2006 to 14.9 in 2015 per 10,000 people. Standardised PU prevalence also showed a slightly decreasing trend from 20.2 in 2006 to 18.9 in 2015 per 10,000 people. This findings of this 10-year study showed that incidence and prevalence of PUs markedly increased with age after the seventh decade. Incidence of PUs increased in patients with pneumonia, cerebral infarction, sepsis, femoral neck fracture and malignant neoplasm of the bronchus. Patients with femoral neck fracture and cerebral infarction showed a higher rate of survival than those with other high-risk comorbidities.

Mirabegron has longer treatment persistence than antimuscarinics:Real-world data from a Korean national cohort database.

To descriptively evaluate treatment persistence among adults who received mirabegron or antimuscarinics in South Korea. This study involved a retrospective analysis of the Health Insurance Review and Assessment (HIRA) database. Patients (≥18 years) who had a new prescription for an overactive bladder (OAB) target medication (mirabegron/antimuscarinic) within an 8-month index period (July 1, 2015-February 29, 2016) were included. The date when the target (index) medication was dispensed was the index date. The 6-month period before the index date was used to assess patient eligibility. A 12-month post-index period was used to assess medication persistence, which was defined as the time to discontinuation. Overall data were analyzed and the results were also stratified by age group (≤65, >65 years), sex, or prior OAB medication experience. Persistence rates were calculated after the 1st, 3rd, 6th, 9th, and 12th months. A data set of 52 722 cases was obtained (mirabegron: 11 424, antimuscarinics: 41 298). The mean age was 60.9 ± 16.1 years and the majority of the patients were female (30 862 [58.5%] patients). Median persistence was longer with mirabegron (51 days) versus antimuscarinics (25 days). The persistence rate with mirabegron was higher throughout the study compared with all the antimuscarinics (12-month data: 13.5% and 4.9%, respectively). Longer treatment persistence was noted in older, male, and treatment-experienced patients. The results from the HIRA database showed that persistence was longer with mirabegron than with antimuscarinics in South Korea. This finding may help inform clinical decision-making within the South Korean healthcare system.

Mediating effects of achievement emotions between peer support and learning satisfaction in graduate nursing students

Graduate nursing students experience considerable stress due to their multiple responsibilities, including professional responsibilities, graduate coursework and family commitments. Peer support can help graduate students overcome stress and may heavily influence their learning satisfaction. However, the mechanisms underlying the influence of peer support on learning satisfaction in graduate students remain unclear. Thus, this cross-sectional study examined the relationship between peer support, achievement emotions (learner-specific emotions related to achievement activities) and learning satisfaction, as well as the mediating effects of achievement emotions among 225 graduate nursing students working in the Korean health care system. Participants completed a questionnaire assessing these variables. Pearson correlation was conducted to investigate the relationship between the variables and Baron and Kenny's regression analysis and Sobel test were conducted to examine the mediating effects of achievement emotions. Peer support correlated positively with positive achievement emotions and learning satisfaction and negatively with negative emotions. Positive emotions were positively and negative emotions were negatively, correlated with learning satisfaction. Achievement emotions mediated the relationship between peer support and learning satisfaction. Our findings indicate that peer support plays an important role in improving learning satisfaction, emphasizing the advantages of positive emotions and the disadvantages of negative emotions in graduate nursing students.

Strategies for reducing hospital nurse turnover in South Korea: Nurses' perceptions and suggestions.

To explore the South Korean nurses' perspectives on the current hospital working conditions in order to identify causes of persistent high turnover rates among the nurses. High turnover rates of hospital nurses continue to pose a serious challenge to South Korean health care system despite the government's recent efforts to improve working conditions. Many studies in the past had examined factors related to the turnover and provided only a partial understanding of turnover predictors. However, nurses' perceptions on the current working conditions must be considered to explore possible causes of continued high turnover, to identify solutions and to improve working conditions by addressing nurses' concerns. This study is a qualitative study using focus group interviews with 33 nurses from 11 South Korean hospitals. Three main themes and eight subthemes related to reducing hospital nurse turnover were identified. To address hospitals' nursing shortages in South Korea, it is important to address poor work environments. This study showed that more transformational policies should be developed and implemented to change working conditions by reducing excessive workloads and improve how nurses are treated and viewed so as to retain existing nurses and ease the nurse turnover rates.

Is Korea Prepared for an Alzheimer's Disease-Modifying Therapy? Assessing the Korean Healthcare System Infrastructure and the Effect of Blood-Based Biomarker Tests.

BackgroundWith the rapid demographic change in Korea, Alzheimer’s disease has become a primary concern. Recent developments in disease-modifying therapies provide hope that therapy may become available soon. The high disease prevalence and complex evaluation process will create challenges for the healthcare system already burdened by the current pandemic. This study examined the preparedness of the South Korean healthcare system to identify and treat patients when such a therapy becomes available.MethodsWe used a Markov model to simulate a stylized patient’s journey. Based on national data and expert input, we presented projections of the diagnosis and treatment wait times and respective queues of patients under treatment and no-treatment scenarios and further simulated the possible option of adopting a blood-based biomarker test. ResultsUnder the current system, we estimated a peak waiting time of 14 months when a treatment became available, largely because of the limited number of dementia specialists. Adopting a blood-based biomarker test dramatically reduced the initial wait times by more than half. A disease-modifying therapy was estimated to avert 575,000 incident cases in the first 10 years after the treatment entered the market, and a blood-based test further avoided 86,000 additional cases.ConclusionSouth Korea’s healthcare infrastructure requires more preparation for the introduction of a disease-modifying therapy, with the primary capacity limitation being the low number of dementia specialists. The utilization of a blood-based test for Alzheimer’s disease biomarkers may be an effective solution.

New Obligations of Health Insurance Review and Assessment Service: Taking Full-fledged Action Against the COVID-19 Pandemic.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to global health systems. The Korea has taken full-fledged actions against this novel infectious disease, swiftly implementing a testing-tracing-treatment strategy. New obligations have therefore been given to the Health Insurance Review and Assessment Service (HIRA) to devote the utmost effort towards tackling this global health crisis. Thanks to the universal national health insurance and state-of-the-art information communications technology (ICT) of the Korea, HIRA has conducted far-reaching countermeasures to detect and treat cases early, prevent the spread of COVID-19, respond quickly to surging demand for the healthcare services, and translate evidence into policy. Three main factors have enabled HIRA to undertake pandemic control preemptively and systematically: nationwide data aggregated from all healthcare providers and patients, pre-existing ICT network systems, and real-time data exchanges. HIRA has maximized the use of data and pre-existing network systems to conduct rapid and responsive measures in a centralized way, both of which have been the most critical tactics and strategies used by the Korean healthcare system. In the face of new obligations, our promise is to strive for a more responsive and resilient health system during this prolonged crisis.

Impact of Cardiovascular Risk Factors and Cardiovascular Diseases on Outcomes in Patients Hospitalized with COVID-19 in Daegu Metropolitan City.

BackgroundData regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system.MethodsPatients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained.ResultsOf all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age (P < 0.001). The number of patients requiring intensive care (P < 0.001) and invasive MV (P < 0.001) increased with age. The in-hospital death rate increased with age (P < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; P < 0.001) and invasive MV (4.3% vs. 1.7%; P < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; P < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07–3.01; P = 0.027) were independent predictors of in-hospital death after adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51–3.90; P < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06–5.87; P = 0.049) were independent predictors of in-hospital death.ConclusionBased on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage.

Should We Consider Value Frameworks for Cancer Drugs as Oncology's Landscape Evolves?; from an Oncologist Perspective in Korea.

BackgroundAs the role of immunotherapies and personalized medicine grow, cancer patients have faced many choices in treatments and have suffered financial toxicity. These challenges brought the need for the value framework (VF) to guide treatment decision making.MethodsA survey was taken to 102 oncologists about perception for VF. They were asked about priorities among several considerations when they prescribe cancer drugs. Their views on the need for development and potential implications of VF in Korea were assessed, also.ResultsThe survey shows that 90% of the respondents choose clinical efficacy as the most important value in cancer drugs selection, and the cost of drug was more weighted value in immune checkpoint inhibitors (13.7%). Approximately half (53.9%) answered that they were aware of the existing VFs. Over 90% of respondents agreed with the need for development of a VF for cancer drugs based on Korean healthcare system and further usefulness for decisions about reimbursement issues. Seventy-one percent answered that two representative VFs (American Society Clinical Oncology-VF and European Society for Medical Oncology-Magnitude of Clinical Benefit Scale) should be reflected in value measurement of cancer drugs in Korea.ConclusionThe Korean oncologists recognized the necessity for the clinical application of VF. Further discussion between the stakeholders should be followed to alleviate the financial burden through the value-based decision making of cancer drugs.

Implementing accountable care organizations with integrative medicine in Korean health care system

Implementing accountable care organizations with integrative medicine in Korean health care system

Cost-Effectiveness of Tiotropium in Elderly Patients with Severe Asthma Using Real-World Data

Tiotropium has the potential to alleviate asthmatic symptoms caused by the aging of lungs. However, few studies have focused on specific treatments for elderly patients with asthma. To estimate the cost-effectiveness of adding tiotropium to inhaled corticosteroids and long-acting beta-agonists in elderly patients with severe asthma using real-world data. Phase I was a retrospective cohort study using the National Health Insurance claims data to measure clinical and economic outcomes. In phase II, a Markov model was constructed to evaluate cost-effectiveness from Korean health care system perspective, based on phase I, including 2 health states, and an asthma exacerbation event. We estimated cost given in 2018 US dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Subgroup analyses for patients with poorly controlled symptoms (frequent short-acting beta-agonist users; frequent exacerbators) were performed. In elderly patients with severe asthma, the incremental cost and effectiveness in the tiotropium group compared with the inhaled corticosteroid and long-acting beta-agonist group were $2281 and 0.038 QALYs, respectively. The incremental cost-effectiveness ratio was $60,074/QALY, indicating that the addition of tiotropium is not a cost-effective alternative. Meanwhile, 2 subgroups with poorly controlled symptoms showed that adding tiotropium is a cost-effective alternative (frequent short-acting beta-agonist users $4078/QALY; frequent exacerbators $8332/QALY). Tiotropium shows a higher cost-effectiveness profile when applied to elderly patients with uncontrolled symptoms. These results using real-world evidence provide information beyond the clinical outcomes reported by randomized controlled trials, providing a complementary ground in establishing the reimbursement criteria of tiotropium for elderly patients with severe asthma.

Psychometric Evaluation of the Korean Version of Hospital Survey on Patient Safety Culture.

This study evaluated the psychometric properties of the Korean-language version of the Hospital Survey on Patient Safety Culture (HSOPSC) among Korean nurses. We analyzed secondary data from 801 direct care nurses working at a tertiary, private, nonprofit, teaching hospital in South Korea. Descriptive statistics, internal consistency coefficients, and intercorrelations were calculated. The latent factor structure of the HSOPSC was examined using exploratory structural equation modeling techniques, which account for the noncontinuous nature of ordinal data. Although a majority of subscales showed acceptable to good internal consistency, 4 dimensions (staffing, overall perceptions of patient safety, organizational learning-continuous improvement, and nonpunitive response to errors) had reliability levels less than 0.6. The HSOPSC items loaded somewhat diffusely on 3 subscales: staffing, teamwork across units, and organizational learning-continuous improvement. Correlations between the 12 HSOPSC factors indicated discriminant validity. Convergent validity was supported by correlations between the 12 subscales and a single-item outcome variable, namely, patient safety grade. Several items did not load well on their respective subscales, but most items fit the underlying theoretical model implied by the HSOPSC, resulting in an acceptable model fit (confirmatory fit index = 0.985, root mean square error of approximation = 0.034, weighted root mean square residual = 0.54). Despite the acceptable model fit of the Korean version of HSOPSC, the psychometric properties of this instrument require further investigation to ensure it is an effective tool to measure patient safety culture and identify areas for improvement in the Korean health care system.

Pandemic preparedness of an academic medical centre in the Republic of Korea

The Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in 2015 was an unprecedented challenge to academic medical centres in the Republic of Korea. It involved 186 confirmed cases and 38 fatalities across the country, and notably, nearly half of the cases were nosocomial infections [1]. This tragic outbreak led to a call for fundamental changes in the Korean health-care system to prepare for potential infectious disease outbreaks in the future [2,3]. Academic medical centres set out to transform their environment with two major goals of (i) preparedness for emerging infectious diseases, and (ii) reduction of nosocomial infections [4].