Review Article

주요국의 임산부 및 신생아 진료협력체계 구축 현황 비교

The number of births in South Korea is continuously decreasing, while the proportion of high-risk pregnancies is increasing. The South Korean government has implemented various policies to address the issue of declining childbirth-related infrastructure, which remain unresolved. In response, the need for an innovative maternal health delivery system has been raised. This study aimed to derive implications for the introduction of policies to activate the delivery system by establishing a domestic maternal and newborn care cooperation systems. The performance and limitations of the maternal and child healthcare cooperation systems in Japan, the United Kingdom, Australia, and Canada were analyzed in this study. Regular meetings were conducted among medical institutions associated with local governments in each region in Japan along with efforts to maintain cooperation between medical institutions and local governments. A maternal and child health network that categorized pregnant women based on case severity and enabled management from the prenatal to postnatal period was established in the UK. Hospitals participating in the Australian network were providing clinical advice, training, and education as well as developing clinical guidelines; however, no separate compensation was allocated for network activities. In Canada, the principal operator of networks were general practitioners, and incentives were provided as a means to encourage their participation. Reflecting on the foreign cases, South Korea will be able to maintain continuous support for integrated treatment centers for managing high-risk pregnancies and neonates while considering ways to initiate treatment cooperation between institutions based on the type of medical institution. This will help in securing subsidies for treatment cooperation networks and compensation for participation, similar to that available in the global scenario.

HIRA Research 2024; 4(2): 125-136

Review Article

국외 응급의료정보시스템 고찰을 통한 국내 시사점

Rapid and accurate exchange of medical information is essential for saving patients’ lives during medical emergencies. However, in Korea, a lack of data standardization, limited interoperability between systems, and restrictive data protection regulations significantly hinder the smooth sharing of information, posing a major challenge in emergency situations. The inability to access the patients’ prior medical records leads to treatment delays and adversely affects the quality of care provided. In contrast, countries such as the United States, the United Kingdom, and Singapore have established integrated data standards and real-time information-sharing systems to enhance the accessibility of emergency medical data. This study investigates the status of emergency medical information systems and access to information in the United Kingdom, France, Taiwan, Singapore, the Netherlands, Finland, the United States, Australia, and Sweden, aiming to find solutions that could promote emergency medical information sharing in Korea. The results of this analysis indicate that data standardization, the establishment of a centralized system, and the revision of laws regarding the use and sharing of emergency medical information are necessary to facilitate the exchange of medical data in emergency situations.

HIRA Research 2024; 4(2): 137-148

Original Article

국내 의료기관 수술실에서 발생한 환자안전사고의 위해정도 관련 요인

Background: Patient safety is a crucial aspect of healthcare quality and has received increased attention recently. However, safety incidents in operating rooms (ORs) remain common due to unique risk factors. Despite the higher risks in ORs compared to other departments, research on OR-specific patient safety incidents in South Korea is still limited.
Methods: This study analyzed 1,131 patient safety incidents reported to the Korea Institute for Healthcare Accreditation from 2018 to 2022 to categorize incident types and frequencies in ORs, assess variations in severity based on patient, hospital, and incident characteristics, and conduct subgroup analyses by sex and hospital grade.
Results: Among the 1,131 incidents, patients aged ≥80 years experienced a high frequency of sentinel events. Incidents related to infections, anesthesia/sedation, injuries, and procedures had higher adverse event rates, while burn-related incidents resulted in both adverse and sentinel outcomes. Thoracic surgeries showed a greater likelihood of sentinel events compared with general surgeries, and the incidence of sentinel events increased from 2018 to 2022.
Conclusion: Factors such as patient age, incident type, surgical specialty, and year were associated with the severity of OR patient safety incidents. These findings offer valuable insights for developing preventive strategies to enhance patient safety in ORs and serve as a foundation for further research on OR-specific patient safety issues.

HIRA Research 2024; 4(2): 149-166

Original Article

국내 중등증 의료서비스 제공 방법에 대한 전문가 의견 조사: 포커스 그룹 인터뷰와 델파이 조사를 활용하여

Background: With the increasing and diverse demand for critical care services in Korea, providing appropriate medical services to patients is becoming challenging due to limited resources. Consequently, a healthcare delivery system needs to be developed for effectively managing patients with severe and moderately severe conditions.
Methods: Focus group interviews were administered using the Delphi survey questionnaire. The focus group comprised three nurses and three physicians working in critical and intermediate care units. For the Delphi survey, 15 experts who had substantial experience in and consideration of healthcare policies and systems related to critical care were recruited. The survey was conducted in two rounds.
Results: Key findings in providing medical services for patients requiring intermediate levels of care in Korea are summarized as follows. First, the need for an independent ward dedicated to close monitoring of moderately severe patients is required. Second, intermediate care units should cater to a wide range of conditions rather than being limited to specific disease groups. Third, intermediate care units are crucial for independent operation, with their own staffing standards and necessary equipment. Fourth, limiting the operation of intermediate care units as well as the number of beds was proposed for healthcare facilities capable of maintaining quality control. Fifth, there was consensus that the admission criteria for intermediate care units should be established to ensure their appropriate utilization.
Conclusion: This study imparts critical insights into the demand for and approaches to healthcare delivery systems for patients needing intermediate levels of care using critical care resources, offering evidence to enhance efficiency.

HIRA Research 2024; 4(2): 167-194

Original Article

자율형 분석심사 선도사업의 효과평가 연구

Background: This study evaluated the Autonomous Analysis and Review Pilot Project within the Health Insurance Review & Assessment Service, focusing on its efficiency and potential for improvement. The fee-for-service model increases medical utilization, necessitating balanced reviews to ensure appropriate care. To address this concern, an autonomous analysis and review system that enabled healthcare institutions to manage care quality and costs using data-driven analysis, particularly in specialized medical fields, was introduced.
Methods: This study assessed changes in healthcare quality and efficiency using indicators such as healthcare quality metrics, claim amounts, and hospitalization days. A control group was established to which participating and non-participating institutions were compared before and after the system’s implementation. The analytical methods included the ARIMA (autoregressive integrated moving average) model, propensity score matching, and difference-in-differences for time series analysis, comparative analysis, and quantitative evaluation, respectively.
Results: For stroke, healthcare quality indicators—such as imaging test rates, anticoagulant prescription rates, rehabilitation assessment rates, and 30-day mortality rates—showed positive changes after implementation, though statistical significance was limited. Efficiency indicators, including average medical cost per patient and length of stay, exhibited a decreasing trend. In cases of severe trauma, significant reductions in average medical cost per patient and length of stay were observed, along with improved efficiency metrics.
Conclusion: The pilot project showed potential for improving healthcare quality and efficiency. Our results suggest that the autonomous analysis and review system enables healthcare institutions to effectively manage healthcare quality and resource expenditure. Nonetheless, further studies with extended durations and more participating institutions are needed for a precise evaluation.

HIRA Research 2024; 4(2): 195-213

Original Article

Association between Types of Diabetes and Amniotic Fluid Disorders during Pregnancy: A Cohort Study in South Korea

Background: As the prevalence of maternal diabetes (both pre-pregnancy- and pregnancy-related) is rising, studies on amniotic fluid disorders related to maternal diabetes are necessary. This study aimed to examine whether the type of diabetes affects the risk of amniotic fluid disorders during pregnancy.
Methods: Data from the South Korean NHIS-NHID (National Health Insurance Service National Information Database) from 2010 to 2015 were used in this study. Participants were classified into the following five groups: type 1 diabetes, type 2 diabetes, other types of diabetes, gestational diabetes, and without diabetes. Amniotic fluid disorders included polyhydramnios and oligohydremia. Logistic regression analysis was performed to examine the significance of the association between the types of diabetes and amniotic fluid disorders.
Results: A total of 1,526,365 women gave birth between 2011 and 2015. Those with gestational diabetes, type 1 diabetes, and type 2 diabetes were more likely to develop amniotic fluid disorders compared to those with no diabetic history (gestational diabetes: odds ratio [OR] 1.19, 95% confidence interval [CI] 1.16–1.21; type 1 diabetes: OR 1.30, 95% CI 1.12–1.51; type 2 diabetes: OR 1.26, 95% CI 1.21-1.31). Furthermore, there was an increased probability of developing type 1 diabetes among pregnant women younger than 20 years of age (OR 6.62, 95% CI 2.11–20.83).
Conclusion: Our findings suggest that regardless of the type of diabetes, those with type 1 diabetes, type 2 diabetes, or gestational diabetes were more likely to develop amniotic fluid disorders. Therefore, monitoring diabetes in pregnant women is necessary as it is vital for the health of the fetus and the pregnant woman.

HIRA Research 2024; 4(2): 214-224

Brief Communication

OECD 보건통계로 바라본 보건의료 환경 변화와 전망

Background: There has been a rapid increase in the older adults population due to increased life expectancy and healthy life expectancy, resulting in growing societal attention toward and policy intervention for healthcare services and expenditures among the older adults. Korea is anticipated to become an super-aged society by 2025. Therefore, Korea’s healthcare system’s response to the aging population is becoming increasingly important.
Methods: We analyze the indicators from the OECD (Organization for Economic Cooperation and Development) Health at Glance published between 2001 and 2023, particularly on four areas directly affecting an individual’s health—health status, risk factors for health, access, and quality of care. From the four domains to study historical trends through 2022 (or the most recent year available), we select the nine longest-standing indicators and then forecast from 2022 to 2032.
Results: The period of population aging is divided into 2000–2016 (aging society) and 2017–present (aged society). The trend shows an increase in life expectancy, number of outpatient visits, and ALOS (average length of stay) over the years, and this trend is expected to continue in the future. Moreover, the proportion of people with good health and an ischemic stroke mortality rate is expected to improve; meanwhile, the proportion of overweight and obese people is expected to grow at a rapid pace.
Conclusion: Societies must focus on the sustainability of healthcare systems because healthcare demand is expected to rise with an aging population. Meanwhile, practical policy measures, such as obesity control, need to be implemented to promote health. Furthermore, a comprehensive healthcare system that ensures quality services for older people with high health needs must be established.

HIRA Research 2024; 4(2): 225-234

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