• 보건행정학회지
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• 제21권4호
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• pp.541-564
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• 2011

This study aimed to investigate health outcome of acute myocardial infarction (AMI) patients such as mortality and length of stay in hospital and to identify factors associated with the health outcome according to the comorbidity index. Nation-wide representative samples of 3,748 adult inpatients aged between 20-85 years with acute myocardial infarction were derived from the Korea National Hospital Discharge Injury Survey, 2005-2008. Comorbidity index was measured using the Charlson Comorbidity Index (CCI). The data were analyzed using t-test, ANOVA, multiple regression, logistic regression analysis in order to investigate the effect of comorbidity on health outcome. According to the study results, the factors associated with length of hospital stay of acute myocardial infarction patients were gender, insurance type, residential area scale, admission route, PCI perform, CABG perform, and CCI. The factors associated with mortality of acute myocardial infarction patients were age, admission route, PCI perform, and CCI. CCI with a higher length of hospital stay and mortality also increased significantly. This study demonstrated comorbidity risk adjustment for health outcome and presented important data for health care policy. In the future study, more detailed and adequate comorbidity measurement tool should be developed, so patients' severity can be adjusted accurately.

• 보건행정학회지
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• 제21권4호
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• 한국산학기술학회논문지
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• 제13권6호
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• pp.2672-2679
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• 2012

본 연구는 급성심근경색증 환자의 사망률 측정을 위한 중증도 보정 모형을 개발하여 의료의 질 평가에 필요한 기초자료를 제공하고자 수행되었다. 이를 위해서 질병관리본부의 2005-2008년 퇴원손상환자 699,701건의 자료를 분석하였다. Charlson Comorbidity Index 보정 방법을 이용한 경우와 새롭게 개발된 중증도 보정 모형의 예측력 및 적합도를 비교하기 위해 로지스틱 회귀분석을 실시하였다. 새롭게 개발된 모형에는 연령, 성, 입원경로, PCI 유무, CABG 유무, 동반질환 12가지 변수가 포함되었다. 분석결과 CCI를 이용한 중증도 보정 모형보다 새롭게 개발된 중증도 보정 사망 모형의 C 통계량 값이 0.796(95%CI=0.771-0.821)으로 더 높아 모형의 예측력이 더 우수한 것으로 나타났다. 본 연구를 통하여 중증도 보정 방법에 따라 사망률, 유병률, 예측력에도 차이가 있음을 확인하였다. 향후에 이모형은 의료의 질 평가에 이용하고, 질환별로 임상적 의미와 특성, 모형의 통계적 적합성 등을 고려한 중증도 보정모형이 계속해서 개발되어야 할 것이다.

• 정신신체의학
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• 제24권1호
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• pp.74-82
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• 2016

연구목적 자살시도자는 일반적인 경우에 비해 의사결정 능력이 떨어지며, 다시 자살을 시도할 위험성이 높기 때문에 재시도 전에 정신건강의학과 치료로 연계하는 것이 중요하다. 특히 신체적 질병이 있는 사람은 자살시도를 할 확률이 높고, 사망률 역시 높아진다. 이 연구는 자살시도자의 특성을 조사하고, 자살시도 후 응급실에 방문하여 정신건강의학과 치료를 받기로 결정하는 데 신체적 질병이 어떤 영향을 주는지 분석하였다. 방 법 2012년 1월부터 12월까지 경기도의 일 종합병원 응급실에 내원한 132명의 자살시도자를 대상으로 하였다. 환자의 의무 기록을 후향적으로 검토해 인구통계학적, 임상적 요인을 조사하였고 정신건강의학과 치료 연계여부에 따라 분석하였다. 결 과 입원과 외래 상관 없이 정신건강의학과 치료를 받는 것에 영향을 주는 요인은 정신건강의학과 진단 유무, 직업 유무, 정신건강의학과 치료 과거력, 자살시도 과거력이었다. 정신건강의학과 치료 형태를 입원과 외래로 나누어 동반된 의학적 질병의 심각도(Charlson comorbidity index)를 비교했을 때, 입원을 통해 정신건강의학과 치료를 받은 자살시도자와 치료 자체를 거부한 자살시도자는 외래에서 치료를 받은 자살시도자보다 동반된 의학적 질병의 심각도가 높게 나타났다. 결 론 이 연구 결과 응급실에 내원한 자살시도자에게 동반된 의학적 질병의 심각도(Charlson comorbidity index)가 정신건강의학과 치료 형태에 영향을 미친다는 점을 알 수 있었다. 따라서 정신건강의학과 의사는 응급실에 내원한 자살시도자에 대해 의학적 동반질병의 여부 및 심각도를 평가하여 동반된 의학적 질병이 상대적으로 심각함에도 불구하고 자의퇴원을 진행하려고 하는 자살시도자에게 좀 더 합리적인 의사결정을 할 수 있도록 도움을 줄 수 있어야 한다.

• The Korean Journal of Pain
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• 제37권2호
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• pp.91-106
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• 2024

The mechanisms of the chronic pain and depression comorbidity have gained significant attention in recent years. The complement system, widely involved in central nervous system diseases and mediating non-specific immune mechanisms in the body, remains incompletely understood in its involvement in the comorbidity mechanisms of chronic pain and depression. This review aims to consolidate the findings from recent studies on the complement system in chronic pain and depression, proposing that it may serve as a promising shared therapeutic target for both conditions. Complement proteins C1q, C3, C5, as well as their cleavage products C3a and C5a, along with the associated receptors C3aR, CR3, and C5aR, are believed to have significant implications in the comorbid mechanism. The primary potential mechanisms encompass the involvement of the complement cascade C1q/C3-CR3 in the activation of microglia and synaptic pruning in the amygdala and hippocampus, the role of complement cascade C3/C3a-C3aR in the interaction between astrocytes and microglia, leading to synaptic pruning, and the C3a-C3aR axis and C5a-C5aR axis to trigger inflammation within the central nervous system. We focus on studies on the role of the complement system in the comorbid mechanisms of chronic pain and depression.

• 한국임상약학회지
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• 제28권3호
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• pp.174-180
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• 2018

Objective: Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, the proper treatment has been emphasized. We investigated the risk factors associated with CDI unimprovement in elderly patients. Furthermore, we performed drug use evaluation of old CDI patients and oldest-old CDI patients. Methods: It was a retrospective study using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventy three patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and they were assessed for risk factors regarding unimprovement status. We also evaluated drug use evaluation in old patients ($65{\leq}age$<80) and oldest-old patients ($80{\leq}age$) by assessing the use of initial therapy, severity, dose, route, treatment course, days of use, total days of use and treatment outcome of initial therapy. Results: Out of 73 patients aged over 65 years, four patients were excluded because they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. We were able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more risk of becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDI was generally fair, but vancomycin as initial therapy is more recommended than metronidazole. Conclusion: Although age, antibiotics exposure, use of antacids are all important risk factors for CDI, our result did not show statistical significance for these risk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updated guideline suggests the use of vancomycin as drug of choice for CDI.

• International Journal of Advanced Culture Technology
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• 제7권2호
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• pp.13-18
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• 2019

Comorbidity isthe simultaneous presence of two chronic diseases or conditions in a patient. As part of a larger research study, the aims of this study were to explore comorbid conditions in intensive care unit (ICU) patients and to compare the comorbidity across different demographic groups, and to determine what comorbid health problems coexisted in the patients with hospital-acquired pressure injury (HAPI). The average number of comorbid conditions was 6.4 with range from 0-20 in the ICU patients. African American patients had significantly more comorbid health problems than other race/ethnicity groups. Asian and Hispanic female patients showed higher comorbidity than male patients across age. The patients with HAPIs had significantly more comorbid health problems than the patients without HAPIs -- the average numbers were almost two-fold. We found comorbid health problems that existed with HAPI in ICU patients. 'Other diseases of lung' and 'Disorders of fluid, electrolyte, and acid-base balance' were most frequently coexisting health problems in the ICU patients with HAPI. Exploratory plots are helpful to discover patterns or hypotheses relevant to clinical management in critical care. Inclusion of patients' comorbid health problems to ICU HAPI risk assessment may be helpful. Identification of patients at a high risk for the development of HAPI and the early preventative interventions can help reduce length of stay as well as costly complications.

• 한국콘텐츠학회논문지
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• 제16권3호
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• pp.22-32
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• 2016

인구구조의 급속한 고령화로 뇌졸중 질환의 발생빈도와 진료비가 지속적으로 증가하고 있다. 이에 본 연구는 대표성이 있는 퇴원손상심층조사 자료를 이용하여 뇌졸중 환자의 Charlson comorbidity index에 따른 사망률 현황을 살펴보고, 뇌졸중 환자의 사망에 영향을 미치는 요인을 분석해 보고자 시행하였다. 2005년에서 2010년까지의 6년간 퇴원손상심층조사 자료를 이용하였으며, 연령이 20세 이상이며 주진단명이 뇌졸중으로 분류된 21,494건을 대상으로 분석하였다. 분석대상자의 동반상병 분포와 CCI에 따른 사망률 현황을 파악하기 위해 기술통계를 실시하였으며, 뇌졸중 환자의 사망에 영향을 미치는 요인을 파악하기 위해서는 로지스틱 회귀분석 기법을 이용하였다. 분석 결과, 뇌졸중 환자의 사망에 유의한 영향을 미치는 독립변수는 연령, 보험유형, 거주지 도시규모, 병상규모, 의료기관 소재지, 입원경로, Physical therapy 유무, 뇌수술 시행 유무, 뇌졸중 유형, CCI로 나타났다. 이는 뇌졸중 환자의 연령, 뇌졸중 유형, 동반상병의 위험요인에 따른 좀 더 효율적인 접근법과 모니터링이 필요하며, 의료급여 환자의 지원 확대가 개선되어야 함을 시사해준다. 이러한 결과들은 향후 뇌졸중 환자들의 의료의 질 평가와 보건의료 정책 수립에 기초자료로 의미 있게 활용되어질 수 있으리라 여겨진다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권3호
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• pp.827-831
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• 2012

To determine the relationship between comorbidity and outcome after radical cystectomy in Chinese patients by using the Adult Comorbidity Evaluation (ACE)-27 index. Two-hundred-and-forty-six patients treated with radical cystectomy at the Second Xiangya Hospital of Central South University, Hunan Province, China between 2000 and 2010 were retrospectively analyzed. Medical records were reviewed for age, gender, delayed time of radical cystectomy, urinary diversion type, pelvic lymphadenectomy status, TNM stage, and pathological grade. Comorbidity information was assessed by the ACE-27 index. The outcome measurement was overall survival. Univariate and multivariate Cox proportional hazards regression analyses were used to determine the association between comorbidity and outcome. The study population consisted of 215 (87.40%) males and 31 (12.60%) females with a mean age of $62{\pm}11$ years. Median duration of follow-up was $47{\pm}31$ months. A total of 151 (61.38%) patents died during follow-up. Of those, 118 (47.97%) had at least one comorbidity. According to the ACE-27 scores, 128 (52.03%) patients had no comorbidity, 79 (32.11%) had mild, 33 (13.41%) had moderate, and 6 (2.45%) had severe comorbidities. Multivariate analysis indicated that moderate (p=0.002) and severe (p<0.001) comorbidity was significantly associated with decreased overall survival. In addition, age ${\geq}70$ years (p=0.002), delayed time of radical cystectomy >12 weeks (p=0.044), pelvic lymphadenectomy status (p=0.014), and TNM stage >T3 (p<0.001) were determined to be independent risk factors of overall survival. Increasing severity of comorbidity statistically correlated with decreased overall survival after radical cystectomy.

• 한국병원경영학회지
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• 제22권4호
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• pp.113-122
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• 2017

The purpose of the study was to investigate the patient, disease and hospital characteristics which affect treatment result and early complication for inpatients with psychiatric comorbidity. We analyzed data on 19,806 patients of the Korea Centers for Disease Control and Prevention from 2012 to 2014, Korea National Hospital discharge in-depth data. Frequency, chi-square and logistic regression analysis was performed, using STATA 12.0. According to logistic regression analysis, gender(Odds ratio(OR)=0.776, 95% confidence interval(CI)=0.686-0.878), insurance type(OR=0.853, CI=0.731-0.995), operation(OR=0.424, CI=0.350-0.513), disposition(OR= 39.307, CI=34.394-44.923), beds(300-499, OR=0.470, CI=0.377-0.585; 500-999, OR=0.462, CI=0.395-0.541; 1000 over, OR=0.598, CI=0.480-0.745) were significant predictors of treatment result. And insurance type(OR=1.527, CI=1.241-1.879), CCI(3 over, OR=1.865, CI=1.534-2.266), operation(OR=5.399, CI=4.562-6.389), disposition(OR=1.279, CI=1.013-1.614), district(Metropolitan city, OR=0.519, CI=0.407-0.661; Non-metropolitan OR=0.469, CI=0.383-0.574), beds(500-999, OR=2.799, CI=1.986-3.944; 1000 over, OR=2.109, CI=1.429-3.113) were significant predictors of early complication. This research would be used as a basic data of high quality of medical care and efficient resource utilization in order to detect and minimize the negative medical treatment results of inpatients with psychiatric comorbidity.