• Title/Summary/Keyword: Risk Adjustment

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The Presence of Diabetes Mellitus and Anemia in Korean Adults-based on Data from 2005 Korean National Health and Nutrition Examination Survey(KNHANES III) (한국 성인에서 당뇨병이 빈혈의 발생에 미치는 영향 - 2005년 국민건강영양조사 자료를 중심으로)

  • Kim, Ji-Hye
    • Journal of Nutrition and Health
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    • v.41 no.6
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    • pp.502-509
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    • 2008
  • Anemia is common in Diabetes Mellitus(DM) with chronic kidney disease. Recent research suggests that DM itself also may be a risk factor of anemia even though kidney failure causes anemia. However, it has not been reported that the impact of DM on anemia in representative data of Korean population. A total of 5,417 Korean adults aged 20 years and older(2,328 men, 3,089 women) were selected from the participants of the 2005 Korean National Health and Nutrition Examination Survey(KNHANES) for this study. Anemia was defined as hemoglobin(Hb) < 13 g/dL and hematocrit(Hct) < 39% for men or Hb < 12 g/dL and Hct < 36% for women. DM was defined as a fasting blood glucose $\geq$ 126 mg/dL. Korean adults with anemia had a higher prevalence of DM than in normal adults(11.4 vs 7.5%; p<0.0001). The unadjusted odds ratio(OR) for anemia was greater in Korean men with DM than in normal men(OR=4.25; 95% CI: 2.48-7.29). This results did not differ after adjustment for the putative risk factors for anemia including chronic disease(OR=2.64; 95% CI: 1.45-4.83). However, the presence of DM was not related with anemia in Korean women. In conclusion, this study revealed that DM might be an independent risk factor for anemia in Korean men. Identification and management for anemia are needed in Korean population with DM as well.

Nutritional Environment Influences Hypertension in the Middle-aged Korean Adults - based on 1998 & 2001 National Health and Nutrition Survey - (한국 중년성인의 고혈압과 영양환경요인의 관련성 - 1998년과 2001년 국민건강.영양조사 결과에 근거하여 -)

  • Lee, Hae-Jeung;Lee, Haeng-Shin;Lee, Yoon-Na;Jang, Young-Ai;Moon, Jae-Jin;Kim, Cho-Il
    • Korean Journal of Community Nutrition
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    • v.12 no.3
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    • pp.272-283
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    • 2007
  • This study was performed to delineate the relationship between lifestyle and nutritional risk factors associated with hypertension in representative middle-aged Korean population. Hypertension in this study is defined as hypertensive ($SBP{\geq}140mmHg\;or\;DBP{\geq}90mmHg$) adults without recognition of a disease state before a health exam. With data from the 1998 and 2001 National Health and Nutritional Survey, nutrient intakes of 6,112 adults, 40-64 years of age were calculated using food composition database and matched with health examination records by individual ID. After excluding those with extreme intake values, the number of final subjects included in the analysis was 5,200 (male 2,458, female 2,742). Using logistic regression method, socio-demographic data, lifestyle factors, and nutrient intakes were analyzed. Risky factors for hypertension revealed in this study were age, sex, BMI over 23, waist circumference, alcohol intake of more than 16g (male) or 8g (female). Regarding nutrient intakes, the intakes of highest quartile for energy (${\geq}2363.0kcal$) and protein (${\geq}90.2g$) were significantly associated with higher risk of hypertension after adjusting for age, sex, and other socio-demographic factors (OR=1.312(1.046-1.711), OR=1.488(1.194-1.854), respectively)). Although high intakes of sodium (${\geq}6604.0mg$) and phosphorus seemed to be risk factors of hypertension also before energy adjustment (OR=1.278(1.034-1.581), OR=1.280(1.024-1.600), respectively), only high intakes of energy and protein remained significant after adjustment. This study revealed that modifying risky lifestyles and dietary patterns, especially high energy intake, high protein intake, and high alcohol drinking, in middle-aged Korean adults could result in a prevalence decrease and/or prevention of hypertension.

Usefulness of medical review in the insurance claims

  • Lee, Eui-Kwan;Hwang, Jin-Sup;Lee, Sin-Hyung
    • The Journal of the Korean life insurance medical association
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    • v.28 no.1_2
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    • pp.31-35
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    • 2009
  • Background : Many of internists have been working for insurance industry. Insurance medicine is use of medical knowledge for insurance industry. There is social role of insurance medicine in terms of soundness of insurance administration. Recently social role of internists also have been being watched. Although theme of insurance medicine is medical risk selection, insurance claims administration also needs medical experts'opinion. There are not any corroborative study of medical consulting for insurance claims. Among insurance industry, someone called this medical review of insurance claims as 'medical claims review'. Aim : To investigate usefulness of medical review of insurance claims. Design : Questionnaire survey with claim staffs in one of insurance claim adjustment company in Korea. Methods : 265 claim staffs were divided into 4 groups and conducted survey using a questionnaire of 20 questions. Utility score, job satisfaction score, and difficult factors of claims administration were measured. Results : Utility score and job satisfaction score are highest in medical claims review group. The most difficult in claim administration to claim staffs was demonstrated to medical knowledge. Conclusion : Medical review of insurance claims is proved to be worthy. Document-based consulting method, namely medical claims review, is more useful than telephone-based simple query among claim staffs...Subjects of the medical claims review are medical record and it's principle is independent medical examination with evidence-based approach, it also has role of protecting fraud of insurance claims. Two main question types of medical claims review are verification and advice.

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Consideration of a structural-change point in the chain-ladder method

  • Kwon, Hyuk Sung;Vu, Uy Quoc
    • Communications for Statistical Applications and Methods
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    • v.24 no.3
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    • pp.211-226
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    • 2017
  • The chain-ladder method, for which run-off data is employed is popularly used in the rate-adjustment and loss-reserving practices of non-life-insurance and health-insurance companies. The method is applicable when the underlying assumption of a consistent development pattern is in regards to a cumulative loss payment after the occurrence of an insurance event. In this study, a modified chain-ladder algorithm is proposed for when the assumption is considered to be only partially appropriate for the given run-off data. The concept of a structural-change point in the run-off data and its reflection in the estimation of unpaid loss amounts are discussed with numerical illustrations. Experience data from private health insurance coverage in Korea were analyzed based on the suggested method. The performance in estimation of loss reserve was also compared with traditional approaches. We present evidence in this paper that shows that a reflection of a structural-change point in the chain-ladder method can improve the risk management of the relevant insurance products. The suggested method is expected to be utilized easily in actuarial practice as the algorithm is straightforward.

Forecasting Day-ahead Electricity Price Using a Hybrid Improved Approach

  • Hu, Jian-Ming;Wang, Jian-Zhou
    • Journal of Electrical Engineering and Technology
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    • v.12 no.6
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    • pp.2166-2176
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    • 2017
  • Electricity price prediction plays a crucial part in making the schedule and managing the risk to the competitive electricity market participants. However, it is a difficult and challenging task owing to the characteristics of the nonlinearity, non-stationarity and uncertainty of the price series. This study proposes a hybrid improved strategy which incorporates data preprocessor components and a forecasting engine component to enhance the forecasting accuracy of the electricity price. In the developed forecasting procedure, the Seasonal Adjustment (SA) method and the Ensemble Empirical Mode Decomposition (EEMD) technique are synthesized as the data preprocessing component; the Coupled Simulated Annealing (CSA) optimization method and the Least Square Support Vector Regression (LSSVR) algorithm construct the prediction engine. The proposed hybrid approach is verified with electricity price data sampled from the power market of New South Wales in Australia. The simulation outcome manifests that the proposed hybrid approach obtains the observable improvement in the forecasting accuracy compared with other approaches, which suggests that the proposed combinational approach occupies preferable predication ability and enough precision.

An Effect of Volatility of Crude Oil Price on Asymmetry of Domestic Gasoline Price Adjustment (국제 유가 변동성이 국내 휘발유 가격 비대칭성에 미치는 영향)

  • Nam-Jae Kim;Hyung-Gun Kim
    • Asia-Pacific Journal of Business
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    • v.14 no.1
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    • pp.351-364
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    • 2023
  • Purpose - This study examines the effects of Dubai oil price and the volatility on the asymmetry of domestic gasoline price adjustment. Additionally, the study investigates the effects of "Altteul" gas-station and tax-cut policies on asymmetry. Design/methodology/approach - Firstly, the study calculates proxies for asymmetry and volatility of each window(every 3-month) by error-correction model and GARCH(1, 1) using daily domestic gas price and Dubai oil price from 2008/04/15 to 2022/12/31. Secondly, the study investigates the effects of the increasing rate of Dubai oil price, volatility, "Altteul" gas-station and tax-cut policies on asymmetry. The autoregressive distributed lag regression model is employed for estimations. Findings - The study finds that changes in the increasing rate of Dubai oil price and both types of volatility of Dubai oil price increase asymmetry. While "Altteul" gas-station and tax-cut policies decrease asymmetry. Additionally, the study fails to find that asymmetry in the Korean gasoline market in the estimation with total observations. Research implications or Originality - An increase in Dubai oil price volatility means an increase in cost uncertainty for gas-station owners. Since cost uncertainty is a kind of financial risk, the increase in volatility reinforces the asymmetry. The study provides supporting evidence for the idea.

Severity-Adjusted Mortality Rates of Coronary Artery Bypass Graft Surgery Using MedisGroups (MedisGroups를 이용한 관상동맥우회술의 중증도 보정사망률에 관한 연구)

  • Kwon, Young-Dae
    • Quality Improvement in Health Care
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    • v.7 no.2
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    • pp.218-228
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    • 2000
  • Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

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Association of chairside salivary aMMP-8 findings with periodontal risk assessment parameters in patients receiving supportive periodontal therapy

  • Schmalz, Gerhard;Kummer, Max Kristian;Kottmann, Tanja;Rinke, Sven;Haak, Rainer;Krause, Felix;Schmidt, Jana;Ziebolz, Dirk
    • Journal of Periodontal and Implant Science
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    • v.48 no.4
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    • pp.251-260
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    • 2018
  • Purpose: The aim of this retrospective cross-sectional study was to evaluate whether salivary findings of active matrix-metalloproteinase 8 (aMMP-8) chairside (point of care; POC) tests were associated with periodontal risk assessment parameters in patients receiving supportive periodontal therapy (SPT). Methods: A total of 125 patients receiving regular SPT were included, and their records were examined. The following inclusion criteria were used: a diagnosis of chronic periodontitis, at least 1 non-surgical periodontal treatment (scaling and root planning) with following regular SPT (minimum once a year), at least 6 remaining teeth, and clinical and aMMP-8 findings that were obtained at the same appointment. In addition to anamnestic factors (e.g., smoking and diabetes), oral hygiene indices (modified sulcus bleeding index [mSBI] and approximal plaque index), periodontal probing depth simultaneously with bleeding on probing, and dental findings (number of decayed, missing, and filled teeth) were recorded. Salivary aMMP-8 levels were tested using a commercial POC test system (Periomarker, Hager & Werken, Duisburg, Germany). Statistical analysis was performed using the t-test, Mann-Whitney U test, Fisher's exact test, and ${\chi}^2$ test, as appropriate (P<0.05). Results: Only the mSBI was significantly associated with positive salivary aMMP-8 findings (aMMP-8 positive: $27.8%{\pm}20.9%$ vs. aMMP-8 negative: $18.0%{\pm}14.5%$; P=0.017). No significant associations were found between aMMP-8 and smoking, diabetes, periodontal parameters, or parameters related to the maintenance interval (P>0.05). Conclusions: Salivary aMMP-8 chairside findings were not associated with common parameters used for periodontal risk assessment in patients receiving SPT. The diagnostic benefit of POC salivary aMMP-8 testing in risk assessment and maintenance interval adjustment during SPT remains unclear.

Effects of calcium intake, milk and dairy product intake, and blood vitamin D level on osteoporosis risk in Korean adults: analysis of the 2008 and 2009 Korea National Health and Nutrition Examination Survey

  • Hong, Heeok;Kim, Eun-Kyung;Lee, Jung-Sug
    • Nutrition Research and Practice
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    • v.7 no.5
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    • pp.409-417
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    • 2013
  • This study was performed to determine the effects of dietary calcium (Ca) intake, milk and dairy product intake, and serum vitamin D level on bone mineral density. The survey data from the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES) for adults (3,819 males, 5,625 females) aged > 20 years were examined; osteoporosis was defined according to the standards for Asian populations (T-score < -2.5). The risk for osteoporosis significantly decreased as Ca intake increased; this effect persisted (quartile 4 vs. quartile 1 of Ca intake: odds ratio [OR] 0.66; 95% confidence interval [CI]: 0.50-0.87) even after adjustment for gender, age, and other factors (body mass index, serum vitamin D, menstruation, female hormone intake, menopausal status, and the number of days per week of muscular strength exercise). Additionally, the risk for osteoporosis significantly decreased as the Ca/P ratio increased (quartile 4 vs. quartile 1: OR 0.76; 95% CI: 0.58-0.98). The degree of risk was 0.96 (0.66-1.38) in those who consumed < 1 portion of milk or dairy products daily, and 0.71 (0.53-0.96) in those who consumed > 1 portion per day, compared with those who had zero intake. The risk for osteoporosis significantly decreased as the serum 25(OH) vitamin D level increased. From these results, we advocate an increase in Ca, milk, and dairy product intake, and that serum 25(OH) vitamin D levels be maintained within the normal range, for the maintenance of bone health and the prevention of osteoporosis in adults.

Association between ABO Genotype and Risk of Hepatocellular Carcinoma in Koreans

  • Shim, Hyung-Jeong;Lee, Ran;Shin, Min-Ho;Kim, Hee-Nam;Cho, Duck;Ahn, Hye-Ran;Kweon, Sun-Seog
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.7
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    • pp.2771-2775
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    • 2015
  • Background: Associations between ABO blood groups and risk of several malignancies have been reported, although there are limited data regarding hepatocellular carcinoma (HCC). The aim of this study was to investigate any possible association between the ABO genotype, especially blood group A, and HCC risk in Koreans. Materials and Methods: We conducted a case-control study of 1,538 patients with newly diagnosed HCC at Chonnam National University Hwasun Hospital and 1,305 randomly selected members of the general population. The ABO genotype was determined by multicolor real-time polymerase chain reaction (PCR) using displacing probes. Adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) were calculated using logistic regression models with adjustment for gender, age, smoking, alcohol drinking, and hepatitis B and C status. Results: The risk of HCC in genotype AA was significantly higher than in OO (aOR=1.773, 95% CI=1.161-2.705). The risk in blood group A was also higher than in blood group O (aOR=1.448, 95% CI=1.005 1.897). No significant difference was found for the AA, BO, BB, and AB genotypes, or blood group B and AB. Conclusions: Blood group A and genotype AA showed the highest risks of HCC in a Korean population. No significant difference was found for the AO, BO, BB, and AB genotypes, or blood group B and AB.