Korean National Hospital Discharge In-depth Research Articles

국내 병원의 주요 환자안전지표 적용에 대한 연구: 2017-2021 퇴원손상심층조사 자료를 이용하여

국내 병원의 주요 환자안전지표 적용에 대한 연구: 2017-2021 퇴원손상심층조사 자료를 이용하여

Mortality and Discharge Outcome in Acute Myocardial Infarction Patients: A Study Based on Korean National Hospital Discharge In-Depth Injury Survey Data.

The aim of this study was to analyze hospital-discharged acute myocardial infarction (AMI) patients in Korea (2006-2020) to understand how pre-existing conditions affect mortality rates. This study utilized the 2006-2020 Korean National Hospital Discharge In-depth Injury Survey data. A weighted frequency analysis estimated discharged AMI patients and calculated age-standardized discharge and mortality rates, Charlson Comorbidity Index (CCI) score distribution, and general patient characteristics. Weighted logistic regression analysis examined influencing mortality factors. There were 486,464 AMI patients (143,751 female), with AMI-related mortality rates at 7.5% (36,312): 5.7% for males (19,190) and 11.8% for females (17,122). The highest mortality rate was among individuals aged 70-79 years (25%). Factors influencing mortality included sex, insurance type, admission route, hospital bed count, region, operation status, and CCI score. Mortality risk at discharge was 1.151 times higher in females than males (95% CI: 1.002-1.322), 0.787 times lower among those with national health insurance than Medicaid recipients (95% CI 0.64-0.967), 2.182 times higher among those admitted via the emergency department than the outpatient department (95% CI 1.747-2.725), and 3.402 times higher in patients with a CCI score of 3 points than those with 0 points (95% CI 1.263-9.162). The number of discharged AMI patients and related mortality rates increased, underscoring the need for proactive management of chronic diseases, particularly for those with higher CCI scores.

Comorbidity Patterns and Management in Inpatients with Endocrine Diseases by Age Groups in South Korea: Nationwide Data.

This study aimed to examine comorbidity associations across age groups of inpatients with endocrine diseases as the primary diagnosis throughout the life cycle to develop an effective management strategy. Data were obtained from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) from 2006 to 2021, involving 68,515 discharged patients aged ≥ 19 years with a principal diagnosis of endocrine disease. A database was constructed for analysis, extracting general characteristics and comorbidities. Employing R version 4.2.3, the Chi-squared test and the Apriori algorithm of ARM (association rule mining) were used for analyzing general characteristics and comorbidity associations. There were more women (53.1%) than men (46.9%) (p < 0.001, with women (61.2 ± 17.2) having a higher average age than men (58.6 ± 58.6) (p < 0.001). Common comorbidities include unspecified diabetes mellitus; essential (primary) hypertension; unspecified diabetes mellitus; and other disorders of fluid, electrolyte, and acid-base balance. Notably, type 2 diabetes mellitus, disorders of lipoprotein metabolism and other lipidemia, polyneuropathy in diseases classified elsewhere, retinal disorders in diseases classified elsewhere, and essential (primary) hypertension prevail across all age groups. Association rules further highlight specific comorbidities appearing selectively in certain age groups. In conclusion, establishing a management strategy for comorbidities in patients with a primary diagnosis of an endocrine disorder is necessary.

The Usefulness of Present-on-Admission Data as an Indicator of Healthcare Quality Evaluation Using the Korean National Hospital Discharge in-Depth Injury Survey Data from 2006 to 2019.

Comorbidities of a principal diagnosis have varying impacts on disease and require different management depending on the onset timing. This study investigated the usefulness of present-on-admission (POA), specifically focusing on decubitus ulcers, delirium, and hypokalemia, as an indicator of healthcare quality. We analyzed patient discharge data for 14 years from 2006 to 2019 using Korean National Hospital Discharge In-Depth Injury Survey (KNHDIS). Out of 3,231,731 discharged patients, 19,871 had secondary diagnosis codes for decubitus ulcers (n=10,390, 52.3%), delirium (n=6103, 30.7%), or hypokalemia (n=3378, 17.0%). Analysis of patients with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia revealed notable differences in demographics, including gender distribution, mean age, admission route, insurance type, surgical intervention rates, mortality rates, and length of stay (LOS). Among patients with one of the top 20 principal diagnoses, those with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia exhibited higher odds of surgery, increased mortality risks, and longer LOS compared to those without these secondary diagnoses. All three of these diseases commonly occur postoperatively or during treatment and thus should be designated as potentially preventable complications that require special attention, and should also be considered as quality-of-care indicators.

Estimated trends in hospitalizations due to occupational injuries in Korea based on the Korean National Hospital Discharge In-depth Injury Survey (2006-2019).

In recent years, occupational injuries have sparked a huge social and political debate. Thus, in this study, we focused on the characteristics and trends of occupational injuries requiring hospitalization in Korea. The Korea National Hospital Discharge In-depth Injury Survey was designed to estimate the annual number and characteristics of all injury-related hospitalizations in Korea. The annual number of hospitalizations due to occupational injuries and the age-standardized rates (ASRs) were estimated from 2006 to 2019. The annual percentage change (APC) and average annual percentage change (AAPC) of ASRs and their 95% confidence intervals (CIs) were calculated using joinpoint regression. All analyses were stratified by gender. In men, the APC of the ASRs of all-cause occupational injuries was -3.1% (95% CI, -4.5 to -1.7) in 2006-2015. However, a non-significant upward trend was observed after 2015 (APC, 3.3%; 95% CI, -1.6 to 8.5). In women, the APC of all-cause occupational injuries was -8.6% (95% CI, -12.1 to -5.1) in 2006-2012. However, a non-significant upward trend was observed after 2012 (APC, 2.1%; 95% CI, -0.9 to 5.2). A recent upward trend in stabbing injuries was observed after 2012 (APC, 4.7%; 95% CI, -1.8 to 11.8) in women. A non-significant overall increasing trend was also observed for occupational injuries caused by exposure to extreme temperatures (AAPC, 3.7%; 95% CI, -1.1 to 8.7) in women. A recent upward trend in all-cause injury hospitalizations and hospitalizations caused by stabbing injuries was observed. Therefore, active policy interventions are required to prevent occupational injuries.

Factors Affecting Inpatients' Mortality through Intentional Self-Harm at In-Hospitals in South Korea.

This study aimed to identify the patient characteristics, comorbidities, risk factors, and means of the self-harm of patients who attempt self-harm in and outside of a hospital, and to determine the characteristics of death by suicide among survival and death patient groups in South Korea. This study used data from the Korean National Hospital Discharge In-depth Injury Survey conducted from 2007 to 2019. In total, 7192 outpatient participants and 43 inpatient participants performed self-harm. Frequency analysis, chi-square tests, Fisher's exact test, and logistic regression analysis were performed using STATA, version 15.0 (StataCorp), and statistical significance was set at 5%. Thirty-one inpatients who performed self-harm survived, and 12 died. Among male inpatients, the older they were, the higher the rates of self-harm and mortality rates due to falls and poisoning if they had comorbidities and financial problems. In addition, the rate of self-harm attempts within a short period after hospitalization was high. Our evidence of the characteristics of patients who performed self-harm in the hospital and the influencing factors of self-harm can be used as primary data for predicting patients at a high risk of self-harm and for creating preventative policies to reduce the risk of self-harm among inpatients in South Korea.

출산 및 산후 합병증 행태의 특성과 변화 분석 : 퇴원손상심층조사자료를 이용하여

Objectives: The purpose of this study was to assess the incidence of delivery and puerperium complications in South Korea and analyze the correlations between the patient’s characteristics and delivery and complications before and after 10 years. Methods: This study used the data from an Korean National Hospital Discharge In-depth Injury Survey. Cases of which the principal diagnosis and second diagnoses were disease classification ICD code O00-O99(Pregnancy, childbirth and the puerperium) were defined as the study subjects, and the first study group was divided as the year of discharge from 2005 to 2007, and the second study group from 2015 to 2017. Results: The number of patients discharged whose principal diagnosis or second diagnoses was O00-O99 was 21,598(Weighted 423,306) from 2005 to 2007 and 19,028(Weighted 364,384) from 2015 to 2017, which decreased by 13.9% compared to 10 years ago. The average age of discharged patients increased by about 2 years and was statistically significant (p<.0001). Factors associating spontaneous delivery, caesarean section and puerperium complication were hospitalization route, bed size, maternal age, length of hospital stay, and the year of discharge. Conclusion: Based on the results of this study, health and education policies and economic support for medical care for high-risk pregnancy and delivery management would be necessary continuously. In addition, policies to strengthen the medical system for high-risk pregnancy management in non-metropolitan areas with high fertility rates would also be needed.

Comparison of mortality prediction models for road traffic accidents: an ensemble technique for imbalanced data

BackgroundInjuries caused by RTA are classified under the International Classification of Diseases-10 as ‘S00-T99’ and represent imbalanced samples with a mortality rate of only 1.2% among all RTA victims. To predict the characteristics of external causes of road traffic accident (RTA) injuries and mortality, we compared performances based on differences in the correction and classification techniques for imbalanced samples.MethodsThe present study extracted and utilized data spanning over a 5-year period (2013–2017) from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS), a national level survey conducted by the Korea Disease Control and Prevention Agency, A total of eight variables were used in the prediction, including patient, accident, and injury/disease characteristics. As the data was imbalanced, a sample consisting of only severe injuries was constructed and compared against the total sample. Considering the characteristics of the samples, preprocessing was performed in the study. The samples were standardized first, considering that they contained many variables with different units. Among the ensemble techniques for classification, the present study utilized Random Forest, Extra-Trees, and XGBoost. Four different over- and under-sampling techniques were used to compare the performance of algorithms using “accuracy”, “precision”, “recall”, “F1”, and “MCC”.ResultsThe results showed that among the prediction techniques, XGBoost had the best performance. While the synthetic minority oversampling technique (SMOTE), a type of over-sampling, also demonstrated a certain level of performance, under-sampling was the most superior. Overall, prediction by the XGBoost model with samples using SMOTE produced the best results.ConclusionThis study presented the results of an empirical comparison of the validity of sampling techniques and classification algorithms that affect the accuracy of imbalanced samples by combining two techniques. The findings could be used as reference data in classification analyses of imbalanced data in the medical field.

Clinical Characteristics of Adolescents Hospitalized Through Emergency Room for Intentional Self-Harm or Suicide Attempts

ObjectivesThis study aimed to investigate the clinical characteristics of adolescents hospitalized through the emergency room for intentional self-harm or suicide attempts.MethodsThis retrospective study used data from the Korean National Hospital Discharge In-depth Injury Survey conducted between 2006 and 2018 for individuals aged 10–24 years. The clinical characteristics of the patients were analyzed and compared across sex and age groups using the Rao-Scott chi-square tests and multiple logistic regression analysis for complex survey data.ResultsThe most common psychiatric diagnosis was mood disorder (22.0%), and more female patients were diagnosed with it than male patients (p=0.010). The 19–24 years age group was diagnosed with mood disorder the most compared to other younger groups (p=0.012). Male patients used lethal methods more than female patients (p=0.008), and the 19–24 years age group used more drug poisoning and cutting or piercing (p<0.001) for intentional self-harm or suicide attempts than younger groups.ConclusionAdolescents hospitalized for intentional self-harm or suicide attempts showed significant differences in clinical characteristics across sex and age groups. These findings suggest that measures for preventing self-harm or suicide attempts need to be differentiated according to the sex and age of adolescents.

Lung Cancer Patients’ Characteristics and Comorbidities Using the Korean National Hospital Discharge In-depth Injury Survey Data

BackgroundThe aim of this study was to assess the incidence of lung cancer and comorbidities in Korea and analyze the lung cancer patient’s characteristics and their comorbidities over the past 12 years. This study also aimed to investigate factors related to death as treatment outcome in discharged lung cancer patients.MethodsThis study analyzed the data obtained from the Korean National Hospital Discharge In-depth Injury Survey from 2006 to 2017. The quantity of discharged lung cancer patients was assessed by year. Comorbidities were limited to those included in the Elixhauser Comorbidity Index (ECI). A Chi-square test was performed to determine statistically significant differences in the distributions of the ECI and ECI scores according to the presence or absence of metastatic cancer. Logistic regression analysis was used to analyze factors related to death as treatment outcome.ResultsFrom 2006 to 2017, the number of discharged male and female patients with lung cancer increased from 31,720 to 42,016 and 10,897 to 18,197, respectively. The increase in the number of lung cancer patients was greater in women than in men (67.0% vs. 32.5%, respectively). The most common associated comorbidities were hypertension, diabetes, and chronic pulmonary disease. The factors related to death as treatment outcome were found to include sex, admission route, number of hospital beds, length of stay, presence or absence of metastatic cancer, and ECI score.ConclusionThe number of lung cancer patients in Korea has increased, and a high proportion of these patients have chronic diseases, which negatively would impact the treatment and outcome of lung cancer patients as well as their quality of life. Thus, the management of chronic diseases needs to be prioritized in patients with lung cancer.

Factors Associated with Hospital Length of Stay among Women’s Cancer Patients: Based on the In-depth Injury Patient Surveillance System Data

Objectives: This study sought to evaluate factors associated with hospital length of stay (LOS) in four women’s cancer (ovarian, breast, uterine cervix and uterine corpus cancer) patients.Methods: The Korean National Hospital Discharge In-depth Injury Survey Data (2006-2017) collected by the Korea Centers for Disease Control and Prevention were used. We extracted 74,641 inpatients who were diagnosed with women’s cancer. We conducted a frequency analysis to analyze general characteristics of the study subjects for the four women’s cancers, and used the analysis of variance to compare the difference in the average LOS according to these characteristics. In addition, we performed Poisson regression analysis to evaluate the effects of demographic characteristics, medical institutions, medical use characteristics, and disease characteristics on the LOS in women’s cancer patients.Results: During the study period, the average LOS for each women’s cancer patients were 6.9 days for ovarian cancer, 6.0 days for breast cancer, 8.6 days for uterine cervical cancer, and 7.8 days for uterine corpus cancer. Among women’s cancers, cervical cancer patients had the longest average hospital stay. According to the Poisson regression analysis, it was found that pay method for medical expense (relative risk [RR] range: 1.019-1.498), admission route (RR range: 1.908-2.133), hospital residence (RR range: 0.698-1.068), the number of beds (RR range: 0.546-0.920), the Charlson Comorbidity Index (CCI) severity (RR range: 1.139-1.529), and comorbidities have a significant influence on LOS for all women’s cancer patients.Conclusions: It is necessary to efficiently manage the LOS for women’s cancer patients in the future by considering the determinants of each women’s cancer identified in our study.

Association between Principal Diagnosis with Mental Diseases among Inpatients

Objectives: The purpose of this study was to determine the prevalence of the principal diagnosis among hospitalized patients with mental disorders and to investigate the association between the principal diagnosis and mental diseases as comorbidity.Methods: The subjects of this study were patients with mental disorders, regardless of the main diagnosis, among the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) from 2006 to 2018. Frequency analysis was performed on the general characteristics, principal diagnosis, and mental disorders of the study subjects. The association between the principal diagnosis and mental diseases was analyzed for patterns using association rule mining (ARM).Results: The main result is that liver diseases are fairly associated with behavioral disorders due to psychoactive substance use. And then organic, including symptomatic, and mental disorders are associated with cerebrovascular diseases, Influenza and pneumonia, and other degenerative diseases of the nervous system. Mood disorders are linked to poisoning by drugs, medicaments, and biological substances.Conclusions: It is necessary to raise awareness of mental diseases and to build a care cooperative system between diseases that are highly associated. It will be possible to monitor key association rules and apply them to clinical decision-making systems.

Comorbidity Patterns of Mood Disorders in Adult Inpatients: Applying Association Rule Mining.

This study explored physical and psychiatric comorbidities of mood disorders using association rule mining. There were 7709 subjects who were patients (19 years old) diagnosed with mood disorders and included in the data collected by the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) between 2006 and 2018. Physical comorbidities (46.17%) were higher than that of psychiatric comorbidities (27.28%). The frequent comorbidities of mood disorders (F30–F39) were hypertensive diseases (I10–I15), neurotic, stress-related and somatoform disorders (F40–F48), diabetes mellitus (E10–E14), and diseases of esophagus, stomach, and duodenum (K20–K31). The bidirectional association path of mood disorders (F30–F39) with hypertensive diseases (I10–I15) and diabetes mellitus (E10–E14) were the strongest. Depressive episodes (F32) and recurrent depressive disorders (F33) revealed strong bidirectional association paths with other degenerative diseases of the nervous system (G30-G32) and organic, including symptomatic and mental disorders (F00–F09). Bipolar affective disorders (F31) revealed strong bidirectional association paths with diabetes mellitus (E10–E14) and hypertensive diseases (I10–I15). It was found that different physical and psychiatric disorders are comorbid according to the sub-classification of mood disorders. Understanding the comorbidity patterns of major comorbidities for each mood disorder can assist mental health providers in treating and managing patients with mood disorders.

Characteristics and Epidemiology of Discharged Pneumonia Patients in South Korea Using the Korean National Hospital Discharge In-Depth Injury Survey Data from 2006 to 2017

Despite the use of vaccines and various antibiotics, approximately 30% of the South Korean population is treated for pneumonia each year, and the number of deaths from pneumonia continues to increase. The present study used information on discharged patients in South Korea to investigate the number and characteristics of discharged pneumonia patients across 12 years. Using the Korean National Hospital Discharge In-Depth Injury Survey data, information on discharged patients from 2006 to 2017 were collected. The number of discharged pneumonia patients for each year and their age group was assessed, and the Charlson Comorbidity Index was used to assess the risk of comorbidities in these patients. The number of discharged pneumonia patients varied every year in South Korea. In particular, the total number of patients increased substantially in 2011, with a large increase in the number of infants and children. In addition, the number of discharged pneumonia patients increased in the elderly group compared to the other age groups. Moreover, a recent increase in the severity of comorbidities in pneumonia patients was noted. Given the continued increase in the number of elderly patients with pneumonia, chronic diseases, such as hypertension and diabetes, should be managed first in the elderly. Moreover, appropriate treatment methods should be selected based on the presence of comorbidities.

Discovery of Association Rules Patterns and Prevalence of Comorbidities in Adult Patients Hospitalized with Mental and Behavioral Disorders.

The objectives of this study were to identify the prevalence of comorbidities of mental and behavioral disorders and to identify the association rules related to comorbidities as a way to improve patient management efficiently. We extracted comorbidities of 20,690 patients (≥19 years old) whose principal diagnosis was a mental disorder from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) between 2006 and 2016. Association rules analysis between comorbid diseases using the Apriori algorithm was used. The prevalence of comorbidities in all patients was 61.98%. The frequent comorbidities of mental and behavioral disorders were analyzed in the order of hypertensive diseases (11.06%), mood disorders (8.34%), diabetes mellitus (7.98%), and diseases of esophagus, stomach, and duodenum (7.04%). Nine major association pathways were analyzed. Significant pathways were analyzed as diabetes mellitus and hypertensive diseases (IS scale = 0.386), hypertensive diseases, and cerebrovascular diseases (IS scale = 0.240). The association pathway of diabetes mellitus and hypertensive diseases was common in subgroups of mental and behavioral disorders, excluding mood disorders and disorders of adult personality and behavior. By monitoring related diseases based on major patterns, it can predict comorbid diseases in advance, improve the efficiency of managing patients with mental and behavioral disorders, and furthermore, it can be used to establish related health policies.

Factors Affecting Length of Stay and Death in Tuberculosis Patients(2008-2017): Focus on the Korean National Hospital Discharge In-depth Injury Survey

Factors Affecting Length of Stay and Death in Tuberculosis Patients(2008-2017): Focus on the Korean National Hospital Discharge In-depth Injury Survey

Epidemiologic characteristics of hospitalised patients after suicidal acts from 2005 to 2016 in Korea: Analysis of the Korean National Hospital Discharge Survey

BackgroundSuicide is a major cause of death in many countries, and previous suicidal attempt is known to be the predictor of future suicide. Korea is considered one of the countries with the highest suicide rate among the Organisation for Economic Co-operation and Development (OECD) members for over a decade. We aimed to investigate the epidemiologic characteristics of hospitalised patients after suicidal acts in Korea. MethodsData from the Korean National Hospital Discharge In-depth Injury Survey were analysed, and patients older than 9 years admitted to nationwide hospitals after suicidal acts from 2005 to 2016 were included. Their epidemiologic characteristics were explored, and we divided them into groups according to suicidal means (injury vs. poisoning) and treatment outcome (good vs. poor). The association of each characteristic with injury as suicidal means and with poor treatment outcome were explored. ResultsThe sample included 7609 patients (corresponding to 227,571 in national population). More patients were female than male, and most were in their 40s in both sexes. Hospitalisation rate peaked in patients older than 80 years for both sexes. Male and young patients aged 10–19 years and capital residents showed relatively higher odds of choosing injury as suicidal means. Males and patients aged 40–64 and ≥65 years showed relatively higher odds of poor treatment outcome. LimitationsSome suicide attempters were excluded from the survey such as those who did not visit a hospital after the suicide attempt. ConclusionsThis epidemiologic feature of suicide attempters might serve as baseline data for preventive policies regarding suicide.

Discharge rates and treatment outcomes of injured patients in South Korea, 2005-2016: Findings from the Korean National Hospital Discharge In-depth Injury Survey

Discharge rates and treatment outcomes of injured patients in South Korea, 2005-2016: Findings from the Korean National Hospital Discharge In-depth Injury Survey

A Study on Database Construction for Efficient Utilization of Korean National Hospital Discharge In-depth Injury Survey Data

Objectives The present study is focused on extracting various data such as diseases, surgical operations and treatments of the Korean National Hospital Discharge In-depth Injury Survey Data to construct an effective database that can be widely used in development of policies and research. Methods The database construction methodology was applied to construct an effective database using the Korean National Hospital Discharge In-depth Injury Survey Data from 2006 to 2016. And for the data integration, the items and properties of data for each year were checked. As for the software to construct the database, the Relational Database Management System (RDBMS) MySql was used. And through normalization, the Entity Relationship Diagram was designed to record the DDL and DML to conduct physical modeling. Results As a result of checking the collected items per year, there were no problems in constructing the database. There were total of 68 items and 2,253,001 cases of sample patients. Through the normalization process, they were divided into 3 different entities and each entity was issued a primary key consisting of the year and patient number. Finally, the integrated database construction was completed by compiling the SQL for physical modeling. Conclusions The integrated database model of the Korean National Hospital Discharge In-depth Injury Survey Data was produced. In the future, its usage will increase as it enables effective data extraction for various researches related to diseases, surgical operations, and treatments. Furthermore, it could also be used in constructing the web-based supplying system for the Korean National Hospital Discharge In-depth Injury Survey Data. Key words: Database construction, DBMS (Database Management System), KNHDS (Korean National Hospital Discharge In-depth Injury Survey), MySql

Determinants of Length of Stay in Ischemic Heart Disease Patients

Objectives Considering the limited resources, identification of the factors affecting length of stay (LOS) is of great value to determine the efficiency and optimal use of hospital resources. This study aimed to identify the LOS and the factors affecting the LOS for patients with ischemic heart disease. Methods The Korean National Hospital Discharge In-depth Injury Survey Data (2017) collected by the Korea Centers for Disease Control and Prevention were used. We extracted 5,845 inpatients who principal diagnosis is ischemic heart disease. The factors affecting the LOS were identified through multiple regression analyses based on demographic, medical use, and disease characteristics. Results The mean of the LOS was 4.27 days (standard deviation=7.97). The LOS was longer in women, elderly people, and medical aids recipients. Also, the results showed that the LOS has a significant relationship with the variables of type of admission (emergency), hospital residence (Seoul & metropolitan city), the number of beds (100 to 499 beds), surgery status (patients who underwent coronary procedure including coronary artery bypass grafting), the CCI severity and Primary diagnosis (acute myocardial infarction). Conclusions This study found determinants of LOS for patients with ischemic heart disease include demographic, medical use, and disease characteristics. The identification of such factors could assist in optimizing patient LOS. Key words: Ischemic heart disease, Length of stay, Patients