In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.
No previous investigations of coronavirus disease 2019 (COVID-19) have estimated medical expenses, length of stay, or factors influencing them using administrative datasets. This study aims to fill this research gap for the Republic of Korea, which has over 10,000 confirmed COVID-19 cases. Patients and Methods: Using the nationwide health insurance claims data of 7590 confirmed COVID-19 patients, we estimated average medical expenses and inpatient days per patient, and performed multivariate negative binomial, and gamma regressions to determine influencing factors for higher outcomes. Results: According to the results, COVID-19 patients with history of ICU admission, chest CT imaging, lopinavir/ritonavir and hydroxychloroquine use stayed longer in the hospital and spent more on medical expenses, and anti-hypertensive drugs were insignificantly associated with the outcomes. Female patients stayed longer in the hospital in the over 65 age group but spent less in medical expenses that the 20-39 group. In the 40-69 age group, patients with health insurance stayed longer in the hospital and spent more on medical expenses than those aged over 65 years. Comorbidities did not affect outcomes in most age groups. Conclusion:In summary, contrary to popular beliefs, medical expenses and length of hospitalization were mostly influenced by age, and not by comorbidities, anti-viral, or antihypertensive drugs. Thus, responses should focus on infection prevention and control rather than clinical countermeasures.
This cross-sectional study investigated the status of life-sustaining treatment (LST) practices and identified characteristics and factors influencing decision-making practices. Materials and Methods The National Agency for Management of Life-sustaining Treatment retains records provided by doctors regarding patients subject to LST implementation. A total of 71,327 patients receiving LST were identified. We analyzed all nationally reported data between February 2018 and October 2019. Indicators such as the proportion of deaths, records for decision to terminate LST, implementation of LST records, and registration of Advance Statements on LST were analyzed. Results A total of 67,252 (94.3%) end-of life decisions were implemented in South Korea. The proportion of deaths preceded by a LST plan, non-self-determination LST decision, and any advance statements was 33.5% (23,891/71,327), 66.5% (47,436/71,327), and 1.2% (890/71,327), respectively. The logistic regression model revealed that self-determination to terminate LST was more frequent for men than for women and higher for those aged 30-69. Disability (OR: 0.59, 95% CI: 0.56-0.61), living in non-metropolitan areas (OR: 0.84, 95% CI: 0.81-0.86), and disease comorbidity was independently associated with a low level of selfdetermination. Conclusion After the implementation of the new LST Act, about a third of patients in end-of-life process made decisions regarding their medical LST. However, family members still play a major role in LST decisions where the patient's intention cannot be verified. Decisions related to LST are CANCER RESEARCH AND TREATMENT (CRT) 3 Korean Cancer Association This article is protected by copyright. All rights reserved. predominantly made when death is imminent. Thus, it is necessary to increase awareness of end-of-life LST decision making among medical staff and the public.
Aims: Patients with mental illness are vulnerable to SARS-CoV-2 infection because of behavioral changes associated with cognitive deterioration, especially without their caregivers. While studies have reported that SARS-CoV-2 infection risk and severe clinical outcomes are high among patients with mental illness, there is a lack of quantitative research supporting this claim. This study investigates if SARS-CoV-2 infection and Coronavirus Disease 2019 (COVID-19)-related death is higher in patients with mental illness than among those without a mental disorder. Methods: A cohort study was conducted using the COVID-19 database of National Health Insurance Service in South Korea. A total of 123,480 patients aged ≥20 years who visited a hospital between January 1, 2020, and May 30, 2020 were analyzed. Mental disorder diagnoses and types were determined based on 2019 medical records, and a multivariate logistic regression model was used to calculate the odds ratios (ORs) for SARS-CoV-2 infection and deaths. Results:The ORs for SARS-CoV-2 infection (OR: 1.58; 95% CI: 1.45-1.71) and COVID-19related death (OR: 2.18; 95% CI: 1.57-3.04) were high among patients with mental illness. The OR of SARS-CoV-2 infection was higher among patients with severe mental illness (OR: 2.60; 95% CI: 2.21-3.06), dementia (OR: 1.90; 95% CI: 1.62-2.22), and substance use disorder (OR: 4.98, 95% CI: 3.60-6.88). The OR for COVID-19-related death was high among patients with severe mental illness (OR: 3.53; 95% CI: 1.82-6.83) and dementia (OR: 2.12; 95% CI: 1.39-3.22). Conclusions: Patients with mental illness are at high risk for SARS-CoV-2 infection and COVID-19-related death. Behavioral changes associated with cognitive deterioration and long-term care facility residence increase SARS-CoV-2 infection risk, and severe medical conditions and delayed treatment increase the COVID-19-related mortality risk in patients with mental illness. Patients with mental illness are a priority target population for COVID-19 prevention and treatment, and it is important to plan prevention measures that address their needs.
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