Korean Standard Classification Of Diseases Research Articles

The Effect of Residential Area and Hospital Bed Size on the Use of Hospital in Other Regions for Cancer Inpatients

Objectives The purpose of this study is, using the data of Korean National Hospital Discharge In-depth Injury Survey, to examine the characteristics of cancer patients’ medical care utilization rate and provide the baseline data for development of cancer policy. Methods This is a cross-sectional study using the data of Korean National Hospital Discharge In-depth Injury Survey provided by Korea Centers for Disease Control and Prevention every year since 2005. It used 9 years (2005-2013) of data finished with refinement after investigation. Based on the Korean standard classification of disease and cause of death, considering principal diagnosis, patients diagnosed with C00-C97 code, malignant neoplasm, were selected as research subjects. Results The medical care utilization rate in other regions was 31.7%, and there were statistically significant differences in the general characteristics including gender, age, hospital average length of stay (ALOS), and the scale of beds. There were changes in the medical care utilization rate and mortality in other regions depending on cancers, and there were differences in the medical care utilization rate and mortality in other regions depending on patients’ residential districts. The results of multivariate analysis using logistic-regression analysis also revealed that the scale of beds and residential districts should be the major factors for the medical care utilization rate in other regions. Conclusions In order to resolve regional inequality of cancer patients’ medical care utilization rate, the current supply-centered policy should be changed to a policy that can improve healthcare quality. Key words: Medical care utilization rates, Cancer policy, Cancer patients, Mortality

Evidence-Based Cutoff Threshold Values from Receiver Operating Characteristic Curve Analysis for Knee Osteoarthritis in the 50-Year-Old Korean Population: Analysis of Big Data from the National Health Insurance Sharing Service

We aimed to investigate the characteristics of patients with osteoarthritis (OA), using the data of all Koreans registered in the National Health Insurance Sharing Service Database (NHISS DB), and to provide ideal alternative cutoff thresholds for alleviating OA symptoms. Patients with OA (codes M17 and M17.1–M17.9 in the Korean Standard Classification of Disease and Causes of Death) were analyzed using SAS software. Optimal cutoff thresholds were determined using receiver operating characteristic curve analysis. The 50-year age group was the most OA pathogenic group (among 40~70 years, n = 2088). All exercise types affected the change of body mass index (p < 0.05) and the sex difference in blood pressure (BP) (p < 0.01). All types of exercise positively affected the loss of waist circumference and the balance test (standing time on one leg in seconds) (p < 0.01). The cutoff threshold for the time in seconds from standing up from a chair to walking 3 m and returning to the same chair was 8.25 (80% sensitivity and 100% specificity). By using the exercise modalities, categorized multiple variables, and the cutoff threshold, an optimal alternative exercise program can be designed for alleviating OA symptoms in the 50-year age group.

Prevalence of Psoriasis in Korea: A Population-Based Epidemiological Study Using the Korean National Health Insurance Database.

BackgroundAlthough psoriasis is universal in its occurrence worldwide, its prevalence varies by geographic location and race. A few hospital-based surveys have reported on the demographic characteristics in Korean patients with psoriasis. However, a nation-wide study on the prevalence of psoriasis in Korea remains uncompleted.ObjectiveThe purpose of this study was to determine the prevalence of psoriasis in Korea and to describe the demographic and social characteristics of afflicted individuals.MethodsWe identified patients with psoriasis using a relevant diagnostic code from the sixth revision of the Korean Standard Classification of Disease in the 2011~2015 claims database of the Health Insurance Review and Assessment Service of Korea. We estimated the annual prevalence of psoriasis and described the age and sex distribution of the patients, type and severity of psoriasis, comorbidities, type of health insurance, type of health-care institution and residence area. Patients with moderate-to-severe psoriasis were defined as those who had been treated with phototherapy, classical systemic agents, and/or biologic agents.ResultsThe standardized prevalence of psoriasis was 453 per 100,000 individuals of the database population in 2015. We found male preponderance with a 1.3:1 male-to-female ratio, and that the largest number of patients belonged to the age group of 50s. Of the patients diagnosed with psoriasis in 2015, 83.8% had plaque psoriasis and 22.6% had moderate-to-severe psoriasis.ConclusionThe annual standardized prevalence of psoriasis in Korea was 453 per 100,000 of the population in 2015.

The State-Centred Nosology

Since 1951, when the Medical Service Act was enacted in South Korea, traditional Korean medicine has been an independent part of a dual medical system along with biomedicine. Despite several attempts to subordinate Korean medicine to biomedicine, Korean medicine has managed to remain an institutionally-independent system of medical care. However, in the years since the launch of the South Korean National Health Insurance Service in 1977, official regulations have required Korean medical nosology to be linked to biomedical nosology. In particular, during the four times of revision from 1979 to 2015, the originally separated disease classification of Korean medicine was gradually integrated into the Korean Standard Classification of Diseases (kcd), which heavily relies on biomedical nosology. The present study uses this nosological shift as a window to illustrate the transformation of Korean medicine in South Korea since the 1970s.

Incidence of Adult In-Hospital Cardiac Arrest Using National Representative Patient Sample in Korea.

ObjectivesThis study analyzed the incidence and characteristics of in-hospital cardiac arrest (IHCA) in Korea based on a sample group of patients that is representative of the population.MethodsThe incidence of IHCA in adults was extracted from HIRA-NIS-2009, a sample of all patients using medical services in Korea. IHCA patients were analyzed according to gender, age, type of medical institute, and classification under the 6th revision of the Korean Standard Classification of Diseases (KCD-6). In addition, to assess the differences arising from the size of medical institutes, the IHCA incidence was analyzed in relation to the number of inpatient beds.ResultsBased on the sample data, the total incidence of IHCA in Korea was found to be 2.46 per 1,000 admissions (95% confidence interval [CI], 2.37–2.55). A higher incidence was found among men at 3.18 (95% CI, 3.03–3.33), compared to women at 1.84 (95% CI, 1.74–1.94). The incidence of IHCA was also higher in hospitals that had more than 600 inpatients beds at 5.40 (95% CI, 5.16–5.66) in comparison to those that had less than 600 inpatients beds at 4.09 (95% CI, 3.76–4.36) (p < 0.001). By primary disease, the incidence was the highest for infectious diseases.ConclusionsWe demonstrated that the IHCA incidence based on gender, age, diagnostic group, and number of beds could be analyzed using the insurance claim data from a national representative sample.

Abstract 11106: The Incidence of Sudden Cardiac Arrest Continues to Rise, but Outcome is at a Standstill in South Korea: Analyzed From National Health Insurance Database Cohort From 2003 to 2013

Introduction: Sudden cardiac arrest (SCA) is a major clinical and public health problem. South Korea is aging faster than any other country, and the disease spectrum has changed profoundly in the last few decades. The purpose of this study was to investigate the change of the incidence and outcome of SCA over the past ten years. Methods: With the use of the National Health Insurance Database Cohort (NHID-Cohort) consisting of one million patients from 2003 through 2013, we identified the patient with sudden cardiac arrest using Korean Standard Classification of Diseases, 6th Revision, code I46. Results: In all, 5,307 (0.52%) patients with SCA were identified between 2003 and 2013. SCA occurred more frequent in men (59.3%) than women (40.7%) (p&lt;0.001). The annual incidence of SCA increased by 116.3% from 28.9 in 2003 to 62.5 in 2013 (per 100,000 person-year, p&lt;0.001). The increase of SCA was particularly predominant in patients with ≥60 years of age (from 153.8 to 259.1 per 100,000 person-year, p&lt;0.001) and those with low economic status (from 27.5 to 85.2 per 100,000 person-year, p&lt;0.001). Health care cost per 100,000 person-year also increased from $65,866 in 2003 to $241,534 in 2013 (p&lt;0.001). However, there was no significant improvement in one-month survival rate during the same period (11.9% in 2003, 13.4% in 2013, p=0.526). Conclusions: The incidence of SCA in South Korea continues to rise over the past ten years, especially in elderly people. Despite the tremendous advances in the field of cardiovascular medicine, outcome of SCA is at a standstill.

Development of a template for classification of documented Traditional Korean Medical Knowledge

Purpose: Growing commercial and scientific interest in Traditional Medicine systems has led to calls for Traditional Medicine Knowledge (TMK) to be better recognized, respected, preserved and protected. Documentation is a good tool for protection of Traditional Korean Medical Knowledge (TKMK). However, there is no widely accepted template specialized to the attributes of TMK and the classification of the Attributes of TKMK. We aimed conducted to develop a template for classification of documented TKMK. Methods:Wedeveloped a template for classification of documented TKMK. The first version was developed and applied to documented TKMK data. Revision of the template were made based on the results of applying the first version of the template and input from experts. Results: We identified attributes of TKMK, and developed a template for classification of documented TKMK for making knowledge easily accessible to academic researcher and providing legal protection for Traditional Knowledge. Attributes of the template includes summary, tool/ingredient, indication/preparation/application, and international standard classification. Conclusion: We have demonstrated an effective way for classification of documented TKMK by developing a template. The template has 3 significant meaning as follows. First, this template is specialized to medicinal knowledge, summary in the template should involve the main elements of TKMK, which are ingredients, indications, and application. Second, we apply International Patent Classification, Korean Standard Classification of Diseases, and Classification of Korean Traditional Knowledge Resources for providing legal protection of TKMK and facilitating academic research. Lastly, wemade primary classification term on preparation, in order to provide TKMK information in ausable form, andboost interoperability. It is suggested that the template for classification of documented TKMK could take important roles in the preservation of TKMK and protection of intellectual property. Contact: Sungha Kim, bozzol@kiom.re.kr

Perception of pattern identification in traditional medicine: a survey of Korean medical practitioners

ObjectiveTo survey assesses the perception of pattern identification (PI) diagnosis of Traditional Medicine (TM) by Korean medical doctors (KMDs). MethodsA total of 14 485 KMDs affiliated with the Association of Korean Medicine were sent surveys via email, and 1646 (11.1%) responded to the questionnaire on their perception of PI diagnosis. ResultsOf the 1646 respondents, more than ninety percent (1562, 94.9%) reported that they treated patients using PI. The most critical problem with PI diagnosis was the lack of objective diagnostic indicators (561, 34.1%). Ninety percent had issues diagnosing patients because of different diagnoses between KMDs (1491, 90.5%). The majority of respondents thought herbal medicine was most related to PI (1528, 92.8%). Half of the respondents answered that PI of Ba Gang was the most commonly used PI system. Participants reported that it was most important to study standardisation of PI diagnosis and to develop standardised PI diagnoses using the classification system of the Korean Standard Classification of Diseases. The foremost PI type that physicians thought should be included in standardisation and objectification of PI of TKM was the PI of Ba Gang. ConclusionOur data suggest that we should focus on the standardisation of PI diagnosis and PI of Ba Gang in future research on PI diagnosis in TM. However, we cannot completely discount the possibility that a biased selection of subjects and a low response rate limit the generalisability of the findings.

Radiation exposure from computed tomography in blunt trauma patients

Introduction. Computed tomography (CT) has many diagnostic advantages, spurring growth in the number of CT exami-nations. As the use of CT increases, the potential for radiation-induced adverse effects has become an issue. The primary objective of this study was to assess the liberal use of CT induced radiation exposure in patients with multiple blunt traumas. The secondary objective was to investigate the factors affecting the estimated effective dose resulting from CTs unrelated to final diagnosis.Methods. Using data from our hospital information system, we selected patients assigned a trauma code, according to the Korean Standard Classification of Diseases, and with three or more body lesions assessed by CT at the same time in the emergency department. Each CT conducted was categorized into ‘CT related to the final diagnosis’ or ‘CT unrelated to final diagnosis’. The characteristics and estimated effective dose of CTs unrelated to the final diagnosis were analyzed. The factors affecting the estimated effective dose of CTs unrelated to final diagnosis were investigated.&nbsp;Results. More than half of all CT examinations were not associated with the final diagnosis. The additional estimated effec-tive dose due to CTs being unrelated to the final diagnosis in each patient was a sufficient amount of radiation exposure to increase the possibility of fatal cancer.Conclusion. A considerable number of CT scans were unrelated to the patient’s final diagnosis, which exposes the patient to additional radiation exposure.&nbsp;

Study on Clinical Diseases of Qi Deficiency Pattern

This article is a study on to which categories of modern diseases qi deficiency pattern types are assigned by reference to modern clinical papers to analyze and understand modern diseases with the perspective of Korean Medicine. Clinical papers were searched in China Academic Journals(CAJ) of China National Knowledge Infrastructure(CNKI) from 1994 to 2013. Conclusions are as follows. First, qi deficiency pattern types are roughly classified as qi deficiency pattern, qi-yin dual deficiency pattern and qi deficiency pattern related with viscera and bowels. Second, there are many patterns combined with static blood, qi stagnation, phlegm, dampness, heat, toxin, water or fluid deficiency and the level of pattern designation is more specific than pattern types in Korean Standard Classification of Diseases(KCD), which makes the pattern types more useful to clinical application. Third, static blood due to qi deficiency is the most frequent combined pattern and diseases related with blood circulation such as angina, atherosclerosis, hyperlipidemia and chronic obstructive pulmonary disease(COPD) were reported on that pattern. The detailed relation between modern diseases and pattern types can be an another topic.

Study on Clinical Diseases of Blood Deficiency Pattern

This article is a study on to which categories of modern diseases blood deficiency pattern types are assigned by reference to modern clinical papers. Clinical papers were searched in China National Knowledge Infrastructure(CNKI) from 1994 to 2013. Results are as follows. First, diverse diseases classified in qi-blood depletion pattern and pattern of blood deficiency and wind-dryness are reported and pattern types designated by the name of viscera are the minority. Second, among pattern types in Korean Standard Classification of Diseases(KCD), diseases classified in heart blood deficiency pattern, liver blood deficiency pattern and heart-liver blood deficiency pattern are a few. Third, the level of designation by the combined patterns such as qi deficiency, fluid deficiency, yin deficiency, kidney deficiency, essence deficiency, wind-cold, cold-dampness, dampness-heat, liver hyperactivity, liver depression and static blood is more specific than KCD, which makes pattern types more useful to clinical application. The detailed relation between modern diseases and pattern types can be an another topic.

정보 공개에 따른 지역별 항생제 처방률 변이에 영향을 미치는 요인 - 전국 시군구 의원을 중심으로 -

Objectives : This study examined the factors influencing variation by local areas of antibiotics prescription rate in upper respiratory infections (URI) according to the public reporting. Methods : We used the National Health Insurance Claims Data which the clinics claimed for URI (Korean Standard Classification of Disease, J00 ~ J06) in ambulatory care. The period of analysis was from the first quarter (from January to March) of 2005 to the first quarter of 2007. The number of samples was total 242 local areas that included all clinics (N = 7,942), which prescribed antibiotics for URI in ambulatory care. Results : None of the demographic and socioeconomic characteristic indicators was statistically significant. Among the provider factors, An increase in number of doctors and the average annual antibiotics prescription rate (from 2003 to 2004) for URI by local area were significantly related to an increase of antibiotics prescription rate according to the public reporting. And an increase in number of pediatric clinics, the proportion of clinics less than 5 years since has opened and the average annual fluctuation of antibiotics prescription rate (from 2003 to 2005) were significantly related to a decrease in antibiotics prescription rate by local area according to the disclosure of information. Conclusions : According to the public reporting, the antibiotics prescription rate in clinics had decreased sharply. However, the reduction of antibiotic prescription rate varied in different local areas. The factors influencing variation by local areas in antibiotics prescription rate can be used for establishing effective strategies to reduce variation by region in antibiotics prescription rate.

Prevalence of gastroesophageal reflux disease in Korea and associated health‐care utilization: A national population‐based study

Few studies have reported temporal trends in the prevalence of gastroesophageal reflux disease (GERD) and associated health-care utilization in Asia. The aim of this study was to investigate temporal changes in the prevalence of GERD and associated health-care utilization. Patients with a primary or secondary disease code for GERD, according to the Korean Standard Classification of Diseases, were defined as having "doctor-diagnosed GERD". The prevalence of GERD from 2005 to 2008 was evaluated using Korean National Health Insurance claim data. Claims for proton pump inhibitors (PPI) over this period were also evaluated. Complications of GERD and health-care utilization characteristics, such as the use of diagnostic tests and prescriptions, were investigated. The prevalence of doctor-diagnosed GERD increased rapidly from 4.6% to 7.3% between 2005 and 2008. Over the same period, the amount of PPI claims increased by 56%. People aged 30-39 years and females had a high frequency of GERD-related visits. Esophageal stricture was rare, and 23% of patients with GERD had peptic ulcers. Endoscopy was used as a diagnostic test in 34% of cases. Seventy-seven percent of patients with GERD were treated with PPI or H(2) receptor antagonists. The prevalence of GERD increased rapidly from 2005 to 2008. The rapid increase of PPI use reflects the real increase in the prevalence of GERD and demand for health care. Middle-aged people and women had a high frequency of GERD visits. Therefore, GERD might be a significant disease burden in Korea.

Clinical Classification of Colorectal Epithelial Tumors and Proposal for Diagnostic Coding

The Korean Standard Classification of Diseases (KCD), which reflects the International Classification of Diseases (ICD), is a fundamental coding system for the diagnosis of colorectal epithelial tumors. The KCD coding of colorectal lesions is entirely up to the clinician and is based on pathologic reports. However, coding discrepancies have arisen among physicians using the KCD and pathologists using the ICD for Oncology-3 (ICD-O-3). The Korean Society of Pathologists recently proposed a standardized pathology-reporting format and guidelines for the coding of colorectal cancer to decrease these discrepancies among pathologists. However, ICD and ICD-O are simple classification codes based on pathologic reports, and are neither intended nor suitable for indexing of distinct clinical entities. For appropriate diagnostic coding using the KCD, a corrected coding principle based upon pathologic reports is required, and unified coding between KCD and ICD-O is necessary. A standardized pathologic report format and communication with understanding between physicians and pathologists should be established. Additionally, the private medical insurance system for colorectal cancer should be revised to reduce conflicts among patients, clinicians, and insurance companies over the medical coding system.

A Study on the Sasang Constitutional Distribution and the Type of Diseases and Symptoms in Japan

1. Objectives: The purpose of this study was done to learn the Sasang constitutional distribution and to find out if there are differences in the type of diseases and symptoms according to the Sasang constitution in Japan. 2. Methods: We collected data from 366 patients who visited the Department of Oriental Medicine, Keio University and recruited 132 healthy persons in Tokyo, Japan. For sasang constitution diagnosis, they all have done SSCQ-P(Sasang Constitution Questionaire for Patients) questionnaire. and a sasang constitution specialist diagnosed the sasang constitution of them. And We classify the diseases and symptoms of 313 patients according to KCD(Korean Standard Classification of Diseases) and learn the prevalences of diseases and symptoms according to Sasang Constitution. 3. Results: 1) Among the total 498 subjects, distributional rate of Taeyangin, Soyangin, Taeeumin, and Soeumin were 2.0%, 26.3%, 29.9%, and 41.8%. Among the 366 patients, distributional rate of Taeyangin, Soyangin, Taeumin, and Soeumin were 0.8%, 27.3%, 28.7%, and 43.2%. Among the 132 healthy group, distributional rate of Taeyangin, Soyangin, Taeeumin, and Soeumin were 5.3%, 23.5%, 33.3%, and 37.9%. 2) The prevalences of 'V.Mental and behavioural disorders', 'XI.Diseases of the digestive system', 'XV.Pregnancy, childbirth and the puerperium' and 'feeling of coldness(X VIII.Symptoms, signs and abnormal clinical and laboratory findings, NEC)' of Soeumin were significantly higher than those of the other constitutions.(p-value

Analysis of Prescriptions of Alpha-Blockers and Phosphodiesterase 5 Inhibitors from the Urology Department and Other Departments

PurposeWe analyzed the prescriptions of alpha-blockers and phosphodiesterase 5 inhibitors (PDE5Is) in the urology department as well as in other departments of the general hospital.MethodsWe investigated the frequency of prescription of alpha-blockers and PDE5Is from 3 general hospitals from January 1, 2007 to December 31, 2009. For alpha-blockers, data were collected from patients to whom alpha-blockers were prescribed from among patients recorded as having benign prostatic hyperplasia according to the 5th Korean Standard Classification of Diseases. For PDE5Is, data were collected from patients to whom PDE5Is were prescribed by the urology department and by other departments. Alpha-blockers were classified into tamsulosin, alfuzosin, doxazosin, and terazosin, whereas PDE5Is were classified into sildenafil, tadalafil, vardenafil, udenafil, and mirodenafil.ResultsAlpha-blockers were prescribed to 11,436 patients in total over 3 years, and the total frequency of prescriptions was 68,565. Among other departments, the nephrology department had the highest frequency of prescription of 3,225 (4.7%), followed by the cardiology (3,101, 4.5%), neurology (2,576, 3.8%), endocrinology (2,400, 3.5%), pulmonology (1,102, 1.6%), and family medicine (915, 1.3%) departments in order. PDE5Is were prescribed to 2,854 patients in total over 3 years, and the total frequency of prescriptions was 10,558. The prescription frequency from the urology department was 4,900 (46.4%). Among other departments, the endocrinology department showed the highest prescription frequency of 3,488 (33.0%), followed by the neurology (542, 5.1%), cardiology (467, 4.4%), and family medicine (407, 3.9%) departments in order.ConclusionsA high percentage of prescriptions of alpha-blockers and PDE5Is were from other departments. For more specialized medical care by urologists is required in the treatment of lower urinary tract symptoms and erectile dysfunction.