Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
Objectives To provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea.Design Cross-sectional, retrospective, observational...
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open |
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| author | Yunji Lee Minjeong Jo Taehwa Kim Kyoungsun Yun |
| author_facet | Yunji Lee Minjeong Jo Taehwa Kim Kyoungsun Yun |
| author_sort | Yunji Lee |
| collection | DOAJ |
| description | Objectives To provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea.Design Cross-sectional, retrospective, observational study.Setting Tertiary hospitals in South Korea.Participants We analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors.Primary and secondary outcome measures Usage and cost of high-intensity care.Results The most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs.Conclusion Findings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea’s ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care. |
| format | Article |
| id | doaj-art-ba679a2fc4904ae7bdba2ffdff2c1aae |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-ba679a2fc4904ae7bdba2ffdff2c1aae2025-08-20T02:21:02ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2021-049711Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample databaseYunji Lee0Minjeong Jo1Taehwa Kim2Kyoungsun Yun3College of Nursing, Pusan National University, Yangsan, Republic of South KoreaCollege of Nursing, Catholic University of Korea, Seoul, Republic of South KoreaDivision of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of South KoreaNursing Department, Dongnam Health University, Suwon, Republic of South KoreaObjectives To provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea.Design Cross-sectional, retrospective, observational study.Setting Tertiary hospitals in South Korea.Participants We analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors.Primary and secondary outcome measures Usage and cost of high-intensity care.Results The most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs.Conclusion Findings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea’s ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care.https://bmjopen.bmj.com/content/11/8/e049711.full |
| spellingShingle | Yunji Lee Minjeong Jo Taehwa Kim Kyoungsun Yun Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database BMJ Open |
| title | Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database |
| title_full | Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database |
| title_fullStr | Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database |
| title_full_unstemmed | Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database |
| title_short | Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database |
| title_sort | analysis of high intensity care in intensive care units and its cost at the end of life among older people in south korea between 2016 and 2019 a cross sectional study of the health insurance review and assessment service national patient sample database |
| url | https://bmjopen.bmj.com/content/11/8/e049711.full |
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