Developing a framework for performance assessment of the public long-term care system in Korea: methodological and policy lessons

Background Limited evidence exists on how to assess long-term care system performance. This study aims to report on the process and results of developing a performance assessment framework to evaluate the long-term care system financed by the public long-term care insurance in South Korea. Methods The framework was developed through a six-step approach, including setting the goals and scope of performance assessment in the given policy context, reviewing existing performance frameworks, developing a framework with a wide range of potential indicators, refining the framework through a series of Delphi surveys and expert meetings, examining the feasibility of generated indicators through a pilot test, receiving the comments of stakeholders, and finalising the performance framework. Results The finalised framework has 4 domains – coverage, quality of care, quality of life and system sustainability – and 28 indicators, including 10 core indicators to monitor long-term care system performance. Usability and feasibility along with policy relevance were important criteria in selecting these indicators. The proposed framework can be used to assess the performance of the long-term care system in Korea, and the framework and its methodological approach can be benchmarks for other countries developing their own framework. Conclusions It is critical to reconcile and prioritise various stakeholders views and information needs as well as to balance methodological rigor with practical usefulness and feasibility in the development and implementation of a long-term care performance monitoring system.This work was supported by the Korean National Health Insurance Service (No. 2014–2-0010) and a 2016 AXA Award from the AXA Research Fund [HK]

A robust calibration-assisted method for linear mixed effects model under cluster-specific nonignorable missingness

We propose a method for linear mixed effects models when the covariates are completely observed but the outcome of interest is subject to missing under cluster-specific nonignorable (CSNI) missingness. Our strategy is to replace missing quantities in the full-data objective function with unbiased predictors derived from inverse probability weighting and calibration technique. The proposed approach can be applied to estimating equations or likelihood functions with modified E-step, and does not require numerical integration as do previous methods. Unlike usual inverse probability weighting, the proposed method does not require correct specification of the response model as long as the CSNI assumption is correct, and renders inference under CSNI without a full distributional assumption. Consistency and asymptotic normality are shown with a consistent variance estimator. Simulation results and a data example are presented

Fabrication and Characterization of Magnetic Microrobots for Three-Dimensional Cell Culture and Targeted Transportation

Magnetically manipulated microrobots are demonstrated for targeted cell transportation. Full three‐dimensional (3D) porous structures are fabricated with an SU‐8 photoresist using a 3D laser lithography system. Nickel and titanium are deposited as a magnetic material and biocompatible material, respectively. The fabricated microrobots are controlled in the fluid by external magnetic fields. Human embryonic kidney 239 (HEK 239) cells are cultivated in the microrobot to show the possibility for targeted cell transportation

Implementation fidelity of the Systems for Person-Centered Elder Care (SPEC): a process evaluation study

Background The Systems for Person-Centered Elder Care (SPEC), a complex intervention, was conducted to examine its effectiveness as a technology-enhanced, multidisciplinary, and integrated care model for frail older persons among ten nursing homes (NHs) in South Korea where formal long-term care has recently been introduced. The purpose of this study was to evaluate the implementation fidelity of the SPEC intervention and to identify moderating factors that influence the implementation fidelity. Methods This study was a process evaluation based on an evidence-based framework for implementation fidelity using a mixed-methods design. Quantitative data from consultant logbooks, NH documentations, an information and communications technology (ICT) system, and a standardized questionnaire were collected from April 2015 to December 2016 and analyzed by calculating the descriptive statistics. Semi-structured focus group interviews were held with multidisciplinary teams from the participating NHs. Qualitative data from a semi-structured questionnaire and the focus group interviews were analyzed using content analysis. Results The SPEC program demonstrated good implementation fidelity, and adherence to the SPEC program was strong in all aspects, such as content, coverage, frequency, and duration. Of the participating on-site coordinators, 60% reported that the SPEC model positively impacted needs assessment and the reporting system for resident care. The important facilitating factors were tailored facilitating strategies, assurance of the quality of delivery, and recruitment strategies. Conclusion The effectiveness of the SPEC program was driven by good implementation fidelity. The key factors of good implementation fidelity were tailored delivery of evidence-based interventions over process evaluation work, facilitating strategies, and ICT support. Larger implementation studies with a more user-friendly ICT system are recommended. Trial registration ISRCTN registry, ISRCTN11972147 . Registered on 16 March 2015This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea [HI13C2250]; a 2016 AXA Award funded by AXA Research Fund [900-2017006 to HK]; and the National Research Foundation of Korea funded by the Korean Government [NO.4199990514025]. The funding sources had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit the manuscript for publication

Urinary Phthalate Metabolites and Slow Walking Speed in the Korean Elderly Environmental Panel II Study

Background: Previous epidemiological studies have suggested that phthalate exposure may contribute to neurocognitive and neurobehavioral disorders and decreased muscle strength and bone mass, all of which may be associated with reduced physical performance. Walking speed is a reliable assessment tool for measuring physical performance in adults age 60 y and older. Objective: We investigated associations between urinary phthalate metabolites and slowness of walking speed in community-dwelling adults ages 60-98 y. Methods: We analyzed 1,190 older adults [range, 60-98 y of age; mean ± standard deviation (SD), 74.81 ± 5.99] from the Korean Elderly Environmental Panel II study and measured repeatedly up to three times between 2012 and 2014. Phthalate exposure was estimated using the following phthalate metabolites in urine samples: mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-n-butyl phthalate (MnBP), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), and mono-benzyl phthalate (MBzP). Slowness was defined as a walking speed of < 1.0 meter/second. We used logistic and linear regression models to evaluate the association between each urinary phthalate metabolite and slowness or walking-speed change. We also used Bayesian kernel machine regression (BKMR) to examine overall mixture effects on walking speed. Results: At enrollment, MBzP levels were associated with an increased odds of slowness [odds ratio (OR) per doubling increase: 1.15, 95% confidence interval (CI): 1.02, 1.30; OR for the highest vs. lowest quartile: 2.20 (95% CI: 1.12, 4.35) with p-trend across quartiles = 0.031]. In longitudinal analyses, MEHHP levels showed an increased risk of slowness [OR per doubling increase: 1.15 (95% CI: 1.02, 1.29), OR for the highest vs. lowest quartile: 1.47 (95% CI: 1.04, 2.06), p−trend=0.035]; whereas those with higher MnBP showed a reduced risk of slowness [OR per doubling increase: 0.84 (95% CI: 0.74, 0.96), OR in the highest (vs. lowest) quartile: 0.64 (95% CI: 0.47, 0.87), p−trend=0.006]. For linear regression models, MBzP quartiles were associated with slower walking speed (p−trend=0.048) at enrollment, whereas MEHHP quartiles were associated with slower walking speed, and MnBP quartiles were associated with faster walking speed in longitudinal analysis (p−trend=0.026 and <0.001, respectively). Further, the BKMR analysis revealed negative overall trends between the phthalate metabolite mixtures and walking speed and DEHP group (MEHHP, MEOHP, and MECPP) had the main effect of the overall mixture. Discussion: Urinary concentrations of prevalent phthalates exhibited significant associations with slow walking speed in adults ages 60-98 y. https://doi.org/10.1289/EHP10549.This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Korea Ministry of Education and the Korea Ministry of Science and Information and Communication Technology (grant numbers 2013R1A6A3A04059556; 2020R1A2C110170311). Also, this study was supported by the Susceptible Population Research Program (2008–2010) from the Korea Ministry of Environment (grant numbers 0411-20080013, 0411-20090007, 0411-20100016). E.G.-E. was supported by the Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) (ESP21PI04/2021). The funders had no role in this study design, data collection, and analysis and prepared all results. All authors participated in literature search and data interpretation. Y.C. supervised the study; Y.C. and Y.H. participated in designing the study; H.K., S.K., and K.K. acquired the data; J.Y., J. Kim, and J. Kwak analyzed data; J.Y. wrote the manuscript; E.G.-E., J. Kim, J. Kwak, H.K., Y.H., and Y.C. critically revised the manuscript. Patient consent was obtained. This study was approved by the institutional review board (IRB) of Seoul National University Hospital/College of Medicine (IRB No. H-1209-004-424).S

Strain sensitive flexible magnetoelectric ceramic nanocomposites

Advanced flexible electronics and soft robotics require the development and implementation of flexible functional materials. Magnetoelectric (ME) oxide materials can convert magnetic input into electric output and vice versa, making them excellent candidates for advanced sensing, actuating, data storage, and communication. However, their application has been limited to rigid devices due to their brittle nature. Here, we report flexible ME oxide composite (BaTiO3/CoFe2O4) thin film nanostructures that can be transferred onto a stretchable substrate such as polydimethylsiloxane (PDMS). In contrast to rigid bulk counterparts, these ceramic nanostructures display a flexible behavior and exhibit reversibly tunable ME coupling via mechanical stretching. We believe our study can open up new avenues for integrating ceramic ME composites into flexible electronics and soft robotic devices

Evaluation of a technology-enhanced, integrated community health and wellness program for seniors (HWePS): protocol of a non-randomized comparison trial

Background Healthy aging for all in the community is a shared public health agenda for countries with aging populations, but there is a lack of empirical evidence on community-wide preventive models that promote the health of older people residing in socially-disadvantaged communities. The Health and Wellness Program for Seniors (HWePS) is a technology-enhanced, multi-level, integrated health equity intervention model. This study evaluates the effect of the HWePS on the health and well-being of older adults residing in urban, low-income communities.  Methods/design HWePS is a prospective, non-randomized comparison trial conducted in an intervention and a control neighborhood (dong) in Seoul, South Korea, over 12 months. Older people who reside in the small areas and meet the inclusion/exclusion criteria are eligible to participate. The multi-level, multi-faceted HWePS intervention is a preventive community care model for older residents guided by the expanded chronic care model, the comprehensive health literacy intervention model, and the Systems for Person-centered Elder Care model along with health equity frameworks. HWePS consists of four components: a health literacy intervention based on individual and community needs assessments, personalized (self-)care management featuring nurse coaching and peer support, a healthy-living and healthy-aging community initiative, and information and communication technology (ICT) systems. The primary outcomes are self-reported health and health-related quality of life. Outcome assessors and data analysts are blinded to group assignment. Process evaluation will be also conducted. Discussion As a multi-level health equity project, HWePS has adopted a novel study design that simultaneously targets individual- and community-level factors known to contribute to health inequality in later life in the community. The study will provide insights into the effectiveness and implementation process of an integrated, multi-level, preventive community care model, which in turn can help improve the health outcomes of older residents and reduce disparities in underserved urban communities. Trial registration ISRCTN29103760. Registered 2 September 2021, https://www.isrctn.com/ISRCTN29103760This work was based on the Project to Empower Communities to Reduce Health Disparities, supported by the Korea Disease Control and Prevention Agency and the Seoul Metropolitan Government; the project was executed in Jungnang-gu (district) in Seoul. The funding sources had no role in the study design; data collection and management; writing the manuscript; or the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the ofcial views of the funding sources

Depressive symptoms, chronic medical illness, and health care utilization: findings from the Korean Longitudinal Study of Ageing (KLoSA)

Background: This population-based study examined the relative and combined relationships of chronic medical illness (CMI) and depressive symptoms with health care utilization among older adults in South Korea.Methods: A nationally representative sample of 3224 older adults participating in the Korean Longitudinal Study of Ageing (KLoSA) were categorized into four groups based on clinical characteristics: CMI only; depressive symptoms only; CMI and depressive symptoms; and neither CMI nor depressive symptoms. We estimated the use of various health care services by the groups while adjusting for clinical and sociodemographic characteristics.Results: Depressive symptoms, as measured by the short-form Center for Epidemiological Studies-Depression scale (CES-D10), were prevalent, often occurring together with CMI in community-dwelling older adults in South Korea. Having depressive symptoms was positively associated with the use of inpatient services, outpatient physician services, and public health centers. The odds of using health care services were larger among older people with both depressive symptoms and CMI than depressive symptoms only.Conclusions: Self-reported depressive symptoms and self-reported CMI are prevalent among older adults in South Korea, often occurring together and possibly increasing health care utilization. These findings imply a need for chronic disease management targeting older people with complex mental and medical conditions and evaluation of its effects on health outcomes and service use.OAIID:oai:osos.snu.ac.kr:snu2011-01/102/0000052039/1SEQ:1PERF_CD:SNU2011-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:2.24FILENAME:40_Depressive symptoms, chronic medical illness, and health care utilization_KLoSA.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM:

Steering Algorithm for a Flexible Microrobot to Enhance Guidewire Control in a Coronary Angioplasty Application

Magnetically driven microrobots have been widely studied for various biomedical applications in the past decade. An important application of these biomedical microrobots is heart disease treatment. In intravascular treatments, a particular challenge is the submillimeter-sized guidewire steering; this requires a new microrobotic approach. In this study, a flexible microrobot was fabricated by the replica molding method, which consists of three parts: (1) a flexible polydimethylsiloxane (PDMS) body, (2) two permanent magnets, and (3) a micro-spring connector. A mathematical model was developed to describe the relationship between the magnetic field and the deformation. A system identification approach and an algorithm were proposed for steering. The microrobot was fabricated, and the models for steering were experimentally validated under a magnetic field intensity of 15 mT. Limitations to control were identified, and the microrobot was steered in an arbitrary path using the proposed model. Furthermore, the flexible microrobot was steered using the guidewire within a three-dimensional (3D) transparent phantom of the right coronary artery filled with water, to show the potential application in a realistic environment. The flexible microrobot presented here showed promising results for enhancing guidewire steering in percutaneous coronary intervention (PCI)

Predictors and outcomes of unplanned readmission to a different hospital

Objectives: To examine patient, hospital and market factors and outcomes associated with readmission to a different hospital compared with the same hospital. Design: A population-based, secondary analysis using multilevel causal modeling. Setting: Acute care hospitals in California in the USA. Participants: In total, 509 775 patients aged 50 or older who were discharged alive from acute care hospitals (index hospitalizations), and 59 566 who had a rehospitalization within 30 days following their index discharge. Intervention: No intervention. Main Outcome Measures(s): Thirty-day unplanned readmissions to a different hospital compared with the same hospital and also the costs and health outcomes of the readmissions. Results: Twenty-one percent of patients with a rehospitalization had a different-hospital readmission. Compared with the same-hospital readmission group, the different-hospital readmission group was more likely to be younger, male and have a lower income. The index hospitals of the different-hospital readmission group were more likely to be smaller, for-profit hospitals, which were also more likely to be located in counties with higher competition. The different-hospital readmission group had higher odds for in-hospital death (8.1 vs. 6.7%; P &lt; 0.0001) and greater readmission hospital costs ($15 671.8 vs.$14 286.4; P &lt; 0.001) than the same-hospital readmission group. Conclusions: Patient, hospital and market characteristics predicted different-hospital readmissions compared with same-hospital readmissions. Mortality and cost outcomes were worse among patients with different-hospital readmissions. Strategies for better care coordination targeting people at risk for different-hospital readmissions are necessary