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      Preliminary Results of Teleconsultations Temporarily Allowed during the COVID-19 Pandemic

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          Abstract

          Purpose

          During the COVID-19 pandemic, Korea has temporarily expanded coverage of teleconsultation to ensure access to essential health services. As a preliminary study, we investigated service utilization patterns and the characteristics of doctors and patients involved in these temporary teleconsultation services.

          Materials and Methods

          Using national health insurance claims data from February 23, 2020 to June 30, 2020 from the Health Insurance Review and Assessment Service, 228269875 cases were identified. Among them, 567390 cases that received teleconsultation services were included in our study. We performed descriptive analyses according to the types of healthcare institutions.

          Results

          In total, 6193 healthcare institutions provided teleconsultation. Of these, 5466 (88.3%) were clinics. Physicians providing teleconsultations were most likely to be doctors of internal medicine (34.0%) or pediatricians (7.0%) and based in the Seoul Metropolitan area (30.4%). In terms of patients undergoing teleconsultation, the most common major disease categories treated were circulatory system diseases (I00–I99). In a detailed analysis, hypertensive diseases (I10–I15) were the most common diagnoses, with a total of 88726 cases (15.6%), followed by diabetes mellitus at 60298 cases (10.6%). The proportion of Medical Aid recipients receiving teleconsultations was higher (9.5%) than other socioeconomic groups. Among all participants, 356622 cases (84.6%) were from a return visit, and 108838 cases (19.2%) received teleconsultation services without being prescribed drugs.

          Conclusion

          Temporarily allowed teleconsultation services were provided mostly to the following patients: 1) those scheduled for revisitation, 2) those with chronic diseases, and 3) those living in pandemic hotspots.

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          Most cited references15

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          Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

          The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.
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            New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.

            The ICD-9-CM adaptation of the Charlson comorbidity score has been a valuable resource for health services researchers. With the transition into ICD-10 coding worldwide, an ICD-10 version of the Deyo adaptation was developed and validated using population-based hospital data from Victoria, Australia. The algorithm was translated from ICD-9-CM into ICD-10-AM (Australian modification) in a multistep process. After a mapping algorithm was used to develop an initial translation, these codes were manually examined by the coding experts and a general physician for face validity. Because the ICD-10 system is country specific, our goal was to keep many of the translated code at the three-digit level for generalizability of the new index. There appears to be little difference in the distribution of the Charlson Index score between the two versions. A strong association between increasing index scores and mortality exists: the area under the ROC curve is 0.865 for the last year using the ICD-9-CM version and remains high, at 0.855, for the ICD-10 version. This work represents the first rigorous adaptation of the Charlson comorbidity index for use with ICD-10 data. In comparison with a well-established ICD-9-CM coding algorithm, it yields closely similar prevalence and prognosis information by comorbidity category.
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              Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate: Study evaluates the impact of social distancing measures on the growth rate of confirmed COVID-19 cases across the United States.

              State and local governments imposed social distancing measures in March and April 2020 to contain the spread of the novel coronavirus disease (COVID-19). These measures included bans on large social gatherings; school closures; closures of entertainment venues, gyms, bars, and restaurant dining areas; and shelter-in-place orders. We evaluated the impact of these measures on the growth rate of confirmed COVID-19 cases across US counties between March 1, 2020, and April 27, 2020. An event study design allowed each policy's impact on COVID-19 case growth to evolve over time. Adoption of government-imposed social distancing measures reduced the daily growth rate of confirmed COVID-19 cases by 5.4 percentage points after one to five days, 6.8 percentage points after six to ten days, 8.2 percentage points after eleven to fifteen days, and 9.1 percentage points after sixteen to twenty days. Holding the amount of voluntary social distancing constant, these results imply that there would have been ten times greater spread of COVID-19 by April 27 without shelter-in-place orders (ten million cases) and more than thirty-five times greater spread without any of the four measures (thirty-five million cases). Our article illustrates the potential danger of exponential spread in the absence of interventions, providing information relevant to strategies for restarting economic activity.
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                Author and article information

                Journal
                Yonsei Med J
                Yonsei Med J
                YMJ
                Yonsei Medical Journal
                Yonsei University College of Medicine
                0513-5796
                1976-2437
                01 September 2021
                17 August 2021
                : 62
                : 9
                : 850-857
                Affiliations
                [1 ]HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, Korea.
                [2 ]Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
                [3 ]Integrated Health Service Department, World Health Organization, Geneva, Switzerland.
                [4 ]Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
                [5 ]Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
                Author notes
                Co-corresponding author: Jin Yong Lee, MD, PhD, MHA. Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: 82-2-2072-1580, Fax: 82-2-2072-2304, jylee2000@ 123456gmail.com
                Co-corresponding author: Jee-Ae Kim, MPP, PhD. HIRA Research Institute, Health Insurance Review & Assessment Service, 60 Hyeoksin-ro, Wonju 26465, Korea. Tel: 82-44 76 760 6919, kimjeeae@ 123456gmail.com

                *Hansang Kim and Hyejin Lee contributed equally to this work.

                Author information
                https://orcid.org/0000-0001-7347-7342
                https://orcid.org/0000-0001-5279-340X
                https://orcid.org/0000-0001-8298-0150
                https://orcid.org/0000-0001-6433-5633
                https://orcid.org/0000-0002-0772-3039
                https://orcid.org/0000-0003-4080-5543
                https://orcid.org/0000-0002-3195-2552
                https://orcid.org/0000-0002-7752-2697
                Article
                10.3349/ymj.2021.62.9.850
                8382728
                34427072
                46d93059-9bd5-4f30-932b-c8f740187ee7
                © Copyright: Yonsei University College of Medicine 2021

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 April 2021
                : 29 June 2021
                : 06 July 2021
                Categories
                Original Article
                Medical Informatics

                Medicine
                sars-cov-2,covid-19,telemedicine,national health insurance,korea
                Medicine
                sars-cov-2, covid-19, telemedicine, national health insurance, korea

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