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JKM > Volume 37(1); 2016 > Article
Park, Uhm, and Kim: A Study about the Quality of Life and QALYs of Stroke Patients according to the Medical Care Utilization Behavior: Findings from the 2009–2012 Korea Health Panel Data

Abstract

Objectives:

There are no studies which have investigated the health related quality of life(HRQOL) about stroke patients according to the medical care utilization behavior by longitudinal analysis. The purpose of this study is to analyze the quality of life(QOL) and quality adjusted life years(QALYs) of stroke patients of western and combined treatment group by longitudinal analysis.

Methods:

A retrospective cohort study was conducted among 37 new patients who initiated diagnosis with stroke in 2009 from Korea Health Panel Data. We analyzed the HRQOL of stroke patients and calculated the QALYs after medical use initiation for up to 3 years according to the medical care utilization behavior.

Results:

Overall, the quality of life of stroke patients was lowered somewhat from 0.8431 to 0.7864 in 2009∼2012. Western treatment group was appeared slightly declined in from 0.8527 to 0.8231 and combined treatment group was shown to be falling from 0.8173 to 0.6875. The QALYs of total patients were calculated 2.3654 and western treatment group were 2.4436, combined treatment group were 2.1542 during the 4 year period. The difference of QALYs between two groups was 0.2894 QALYs.

Conclusions:

Although there was a small difference in QALYs of the two groups, it is not certain that the difference is come from medical care utilization behavior. Further studies should be needed to confirm the relation of the medical care utilization behavior and quality of life by considering severity of the stroke.

Fig. 1.
QALYs of western and combined treatment group using EQ-5D
jkm-37-1-41f1.tif
Table 1.
General Characteristics of Participants
Variables Combined Western Total

No. % No. % No. %
Gender
Male 3 30.00 13 48.15 16 43.24
Female 7 70.00 14 51.85 21 56.76

Age
50∼59 0 0.00 2 7.41 2 5.41
60∼69 2 20.00 3 11.11 5 13.51
70∼79 4 40.00 10 37.04 14 37.84
80∼89 4 40.00 12 44.44 16 43.24

Marital status
Marriage 8 80.00 19 70.37 27 72.97
Bereavement 2 20.00 7 25.93 9 24.32
Single 0 0.00 1 3.70 1 2.70

Education
Elementary 7 70.00 16 59.26 23 62.16
Middle school 1 10.00 4 14.81 5 13.51
High school 1 10.00 5 18.52 6 16.22
University 1 10.00 2 7.41 3 8.11

Economic activity
Yes 2 20.00 12 44.44 14 37.84
No 8 80.00 15 55.56 23 62.16

Income*
1st 3 30.00 10 37.04 13 35.14
2nd 2 20.00 6 22.22 8 21.62
3th 3 30.00 7 25.93 10 27.03
4th 2 20.00 1 3.70 3 8.11
5th 0 0.00 3 11.11 3 8.11

Chronic diseases
Count none 2 20.00 1 3.70 3 8.11
1∼3 2 20.00 11 40.74 13 35.14
4∼6 5 50.00 12 44.44 17 45.95
7∼9 1 10.00 3 11.11 4 10.81
Type Hypertension 5 50.00 15 55.56 20 54.05
Arthritis 3 30.00 10 37.04 13 35.14
Diabetes mellitus 2 20.00 9 33.33 11 29.73

* 한국의료패널 자료에서 제공하는 가중치가 적용된 총 가구소득 5분위로서, 불균등 추출확률에 대한 보완, 무응답에 대한 보완, 그리고 사후층화를 통해 알려진 모집단 분포와 표본 분포가 일치하도록 조정하는 작업을 거쳐 계산된 것이며, 당해 연도 가구에 속한 가구원의 횡단 가중치를 기저로 가구 횡단 (cross-sectional) 가중치를 부여한 것임.

† 만성질환의 종류는 인별로 중복보유가 가능하므로 빈도와 백분율의 총합이 대상자 전체와 일치하지 않으며, 상기 항목은 다빈도 순서로 상위 3가지 질환만 을 제시하였음.

Table 2.
Medical Use Related Characteristics of Participants
Variables* Combined Western Total

No. % No. % No. %
Emergency utilization
Yes 7 70.00 15 55.56 22 59.46
No 3 30.00 12 44.44 15 40.54

Inpatient days
none 2 20.00 11 40.74 13 35.14
1∼7 7 70.00 12 44.44 19 51.35
8∼14 0 0.00 2 7.41 2 5.41
22+ 1 10.00 2 7.41 3 8.11

Outpatient frequency
none 0 0.00 1 3.70 1 2.70
1∼4 2 20.00 19 70.37 21 56.76
5∼9 3 30.00 6 22.22 9 24.32
10+ 5 50.00 1 3.70 6 16.22

* 의료이용관련 특성 변수 항목들의 빈도와 백분율은 2009∼2012년 기간 내의 평균값을 활용하였음

Table 3.
Medical Care Utilization by Year
Variables Combined (N=10) Western (N=27) Total (N=37)

No. % No. % No. %
2009
Emergency N 5 50.00 13 48.15 18 48.65
frequency 8 15 23
days 11 16 27
Inpatient N 6 60.00 14 51.85 20 54.05
frequency 9 16 25
days 243 476 719
Outpatient N 9 90.00 23 85.19 32 86.49
frequency 165 93 258

2010
Emergency N 2 20.00 1 3.70 3 8.11
frequency 2 1 3
days 2 1 3
Inpatient N 3 30.00 3 11.11 6 16.22
frequency 7 9 16
days 216 462 678
Outpatient N 9 90.00 23 85.19 32 86.49
frequency 293 147 440

2011
Emergency N 1 10.00 0 0.00 1 2.70
frequency 1 0 1
days 1 0 1
Inpatient N 2 20.00 1 3.70 3 8.11
frequency 2 2 4
days 50 46 96
Outpatient N 7 70.00 14 51.85 21 56.76
frequency 102 80 182

2012
Emergency N 0 0.00 1 3.70 1 2.70
frequency 0 1 1
days 0 1 1
Inpatient N 1 10.00 1 3.70 2 5.41
frequency 1 1 2
days 22 36 58
Outpatient N 7 70.00 12 44.44 19 51.35
frequency 107 118 225
Table 4.
Medical Care Utilization of Combined Treatment Group by Year (unit: No.)
2009 2010 2011 2012 Total

ER In Out ER In Out ER In Out ER In Out ER In Out
W* 5 6 1 2 3 3 1 2 4 0 1 5 8 12 13
K 0 0 4 0 0 1 0 0 2 0 0 2 0 0 9
C 0 0 4 0 0 5 0 0 1 0 0 0 0 0 10

* W: Western medicine use,

† K: Korean medicine use,

‡ C: Combined medicine use

Table 5.
QOL Differences according to the Years and QALY Calculation
Quality of life 2009 2010 2011 2012
Overall 0.9420 0.9340 0.9354 0.9303
Stroke 0.8431 0.7731 0.7775 0.7864
Western 0.8527 0.8000 0.8057 0.8231
Combined 0.8173 0.7005 0.7013 0.6875

QALYs

Overall* 2.8055
Stroke 2.3654
Western 2.4436
Combined 2.1542
difference 0.2894

* Overall: Calculate QALYs during 2009∼2012(the study period) of Korea Health Panel Survey participants in 2009 by per protocol(PP) analysis

† Stroke: Calculate QALYs during 2009∼2012(the study period) of stroke patients diagnosed in 2009 by intention to treat(ITT) analysis

‡ difference: QALY differency between Western treatment group and Combined treatment group

참고문헌

1.. Dobkin BH. The clinical science of neurologic rehabilitation. 2nd Edition. New York: Oxford University Press;2003. p. 375–450.


2.. Korea Health Industry Development Institute. The research on the actual use and consumption of Traditional Korean Medicine. 2014; 178


3.. Statistics Korea. KOSIS index 100. 2016. [1screen]. Available at: URL: http://kosis.kr/nsportalStats/nsportalStats_0102Body.jsp?menuId=6&NUM=239. Accessed January 20, 2016.


4.. Ahlsiö B, Britton M, Murray V, Theorell T. Disablement and quality of life after stroke. Stroke. 1984; 15:5. 886–890.
crossref

5.. Kim HM, Shim MK. The Effects of Mental Health on the Quality of Life After Stroke. Journal of Digital Convergence. 2015; 13:2. 237–244.
crossref

6.. Yoon WD. The quality of life of stroke, social support. self-efficacy Research. Gwangju: Kwangju women’s Univ.;2015.


7.. Jang YS, Kim HD, Chung HA. Correlations Among the Sleep, Fatigue and Quality of life in patients with stroke. Journal of the Korea Academia-Industrial cooperation Society. 2013; 14:12. 6302–6308.
crossref

8.. Beatrix A, Bengt F, Alarcos C, Katharina SS, Lennart C. Factors Associated With Health -Related Quality of Life After Stroke: A 1-Year Prospective Cohort Study. Neurorehabilitation and Neural Repair. 2012; 26:3. 266–274.
crossref

9.. Ha HG. Quality of life in relations to the characteristics of the stroke : National Health and Nutrition examination survey 2005. Seoul: Yonsei Univ;2008.


10.. Jo MW, Kim SK, Lee JY, Lee KS. Estimating Quality Adjusted Life Year Loss of Persons Disabled by Stroke Using EQ-5D in Korea. Journal of agricultural medicine & community health. 2011; 36:2. 120–129.
crossref

11.. Kim NK, Lee DH, Jo GW, Seo ES. A study about the Life Expectancy, Quality of Life and QALYs of Stroke patients. Journal of Society of Preventive Korean Medicine. 2012; 16:3. 15–26.


12.. Kim MS, Han SS. Comparison in Quality of Life, Relationship with Patients and Family Support, between Caregiver of Patients with Cerebro-Vascular Accident(CVA) in Western and Oriental Medicine. Journal of East-West nursing research. 2006; 12:1. 33–42.


13.. Korea Health Panel survey. 2016. [1screen]. Available at: URL:https://www.khp.re.kr:444/. Accessed January 12, 2016.


14.. Jung YH, Seo NK, Ko SJ, Han EJ, Park SB, Jung YH, et al. A report on the Korea Health Panel Survey of 2008. Korea Institute for Health and Social Affairs. 2010; 180.


15.. Jung YH, Ko SJ. Effectiveness of Health Outcome in Health Plan 2020. Korea Institute for Health and Social Affairs. 2011; 57.


16.. Nam HS, Kim KY, Kwon SS. Research Report for estimated weight for Quality of Life Survey (EQ-5D). Korea Centers for Disease Control and Prevention. 2007.


17.. Korea Centers for Disease Control and Prevention. The Sixth Korea National Health and Nutrition Examination Survey(KNHANES VI-1,2) user guide. 2015; 32


18.. Han TR, Bang MS. Rehabilitation medicine. 3rd Edition. Seoul: Koonja;2008. p. 509–548.


19.. Niemi ML, Laaksonen R, Kotila M, Waltimo O. Quality of life 4 years after stroke. Stroke. 1988; 19:9. 1101–1107.
crossref

20.. Carod-Artal F, Egido JA. Quality of Life after Stroke: The Importance of a Good Recovery. Cerebrovascular diseases. 2009; 27:1. 204–214.
crossref

21.. Won JI. The Relationship Between Activities of Daily Living and Health-Related Quality of Life in Ambulatory Stroke Patients. Physical Therapy Korea. 2008; 15:1. 12–19.


22.. Suh MH, Choi SM. Structural Equation Modeling on Quality of Life in Stroke Survivors. J Korean Acad Nurs. 2010; 40:4. 533–541.
crossref

23.. Lee DG. A Study on Economic Stress-Related Factors with Stroke Patients. Daejeon: Mokwon Univ;2007.


24.. Lim DO, Whang GS, Kim KS. Measuring and Explaining the Improvement of Life Expectancy at Birth in Korea. Journal of Reproductive Medicine and Population. 2010; 23:95–105.


25.. Hill MD, Hachinski V. Stroke treatment : time is brain. The Lancet. 1998; 352:3. S10–S14.
crossref

26.. Park KH. Acute Cerebral Hemorrhage Patient’s Medical Examination Record According to The Time Transported to General Hospital: On the Basis of Spontaneous Subarachnoid Hemorrhage Patient. Suwon: Ajou Univ;2003.


27.. Han JS, Kim YS, Moon YS, Han SJ, Park IS, Lee SH, et al. Experiences of Stroke Patients With Combined Treatment of Self-selected Oriental and Western Medicine. Journal of digital convergence. 2014; 12:6. 375–384.
crossref

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