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Biomedical subjects

Herng-Ching Lin

Publications and source records attributed to Herng-Ching Lin.

At least 19 recordsLinked to original sources
PubMed2007

A population-based study on the specific locations of cancer deaths in Taiwan, 1997-2003.

INTRODUCTION: In traditional Taiwanese culture, home death is generally regarded as implying a good death, as it is believed that the spirit will not be left to wander. The purpose of this study was to determine the place of death and identify the predictors of home deaths for all cancer patients in Taiwan. MATERIALS AND METHODS: We undertook a population-based study using death registration data on all cancer deaths which occurred in Taiwan between 1997 and 2003. In total, 173,187 eligible cancer deaths occurring during the period were examined. RESULTS: Results revealed that around 60% of all cancer deaths in Taiwan between 1997 and 2003 occurred at home. Female cancer patients and those aged between 55 and 64 years, who were either married or widowed, living in less-urbanized areas of Taiwan, and areas with a low density of hospital beds, were found to be more likely to have died at home. Results from the logistic regression revealed that predictors for a home death included being female, aged more than 55 years, having been married, being employed, having respiratory cancer, living in central Taiwan, and living in less-urbanized areas. DISCUSSION: There is increased awareness on a global scale of the desire among terminally ill patients to be able to die at home, and indeed, we are seeing greater efforts towards promoting home deaths; however, greater palliative home care services will be necessary if home deaths are to become a feasible option in Taiwan.

Adult↗
PubMed2006

Impact of hospital and physician characteristics on medical expenditures for acute myocardial infarction hospitalization.

This study aims to examine the impact of length of stay, hospital characteristics, physician characteristics and other factors on the expenditures of hospitalization for acute myocardial infarction (AMI) under Taiwan's National Health Insurance program. This study uses data collected from the Taiwan's National Health Research Institute's 2001-2003 National Health Insurance Research Database. We estimated contributors to increased expenditures of hospitalization using three-stage least square regression model. The hospital expenditures for the treatment of AMI averaged NT$126,366 (US$3829, US$1=NT$33) per discharge, with the largest proportion (27%) spent on room expenditures. They were strongly impacted by length of stay, increasing around 4.8% per day. We conclude that hospital expenditures for the treatment of AMI patients may vary widely depending on the characteristics of the hospital and physicians that provide them care.

Adult↗
PubMed2006

Increased risk of developing stroke among patients with bipolar disorder after an acute mood episode: a six-year follow-up study.

BACKGROUND: Despite cerebrovascular diseases having been reported as one of the major causes of death among patients with bipolar disorder, there is scant information on the risk of stroke among this patient population. This study estimated the relative risk of developing stroke among patients with bipolar disorder in 6 years following hospitalization for an acute mood episode compared with patients undergoing appendectomy. METHODS: Two study cohorts were identified from the Taiwan National Health Insurance Research Database for the year 1998: patients hospitalized with bipolar disorder, and patients undergoing an appendectomy. Follow-up was undertaken to determine whether sampled patients had utilized emergency medical services for the management of any type of stroke in the period 1998-2003. RESULTS: Stroke occurred among 2.97% of patients with bipolar disorder and 1.50% of patients undergoing appendectomy between 1998 and 2003. The adjusted odds ratio of developing stroke, by cohort, shows that after adjusting for demographic characteristics, comorbid medical disorder, and substance or alcohol dependence, patients with bipolar disorder were more likely to develop stroke (OR=2.05; 95% CI=1.73-3.54). LIMITATIONS: The validity of diagnoses, lacking of information on smoking, body mass index, and socioeconomic status, and possible selection bias might compromise the findings. CONCLUSIONS: During the six-year follow-up period, the likelihood of developing stroke was twice as great amongst patients with bipolar disorder as patients undergoing an appendectomy. A requirement exists for the initiation of research providing an understanding of the pathophysiological mechanisms of the association between stroke and bipolar disorder.

Acute Disease↗
PubMed2006

Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study.

BACKGROUND: Over the past decade, about one-third of all births nationwide in Taiwan were delivered by cesarean section (CS). Previous studies in the US and Europe have documented the need for risk adjustment for fairer comparisons among providers. In this study, we set out to determine the impact that adjustment for patient-specific risk factors has on CS among different physicians in Taiwan. METHODS: There were 172,511 live births which occurred in either hospitals or obstetrics/gynecology clinics between 1 January and 31 December 2003, and for whom birth certificate data could be linked with National Health Insurance (NHI) claims data, available as the sample for this study. Physicians were divided into four equivalent groups based upon the quartile distribution of their crude (actual) CS rates. Stepwise logistic regressions were conducted to develop a predictive model and to determine the expected (risk-adjusted) CS rate and 95% confidence interval (CI) for each physician. The actual rates were then compared with the expected CS rates to see the proportion of physicians whose actual rates were below, within, or above the predicted CI in each quartile. RESULTS: The proportion of physicians whose CS rates were above the predicted CI increased as the quartile moved to the higher level. However, more than half of the physicians whose actual rates were higher than the predicted CI were not in the highest quartile. Conversely, there were some physicians (40 of 258 physicians) in the highest quartile who were actually providing obstetric care that was appropriate to the risk. When a stricter standard was applied to the assessment of physician performance by excluding physicians in quartile 4 for predicting CS rates, as many as 60% of physicians were found to have higher CS rates than the predicted CI, and indeed, the CS rates of no physicians in either quartile 3 or quartile 4 were below the predicted CI. CONCLUSION: Overall, our study found that the comparison of unadjusted CS rates might not provide a valid reflection of the quality of obstetric care delivered by physicians, and may ultimately lead to biased judgments by purchasers. Our study has also shown that when we changed the standard of quality assessment, the evaluation results also changed.

Adolescent↗
PubMed2006

Seasonal variations in bipolar disorder admissions and the association with climate: a population-based study.

OBJECTIVE: Although seasonal influences on bipolar disorder admissions have long been observed, the issues of seasonality on different subtypes of mood episodes and the effects of associated climatic parameters remain controversial. This study sets out to examine seasonal variations in bipolar disorder admissions and the association with climate in Taiwan, a subtropical area with fairly constant weather conditions. METHODS: This retrospective population-based study uses the Taiwan National Health Insurance Research Database for 1999-2003, identifying 15,060 admissions for bipolar disorder, comprising of 8631 manic, 2078 depressive and 4351 mixed/unspecified episodes. The auto-regressive integrated moving average model was applied to examine the presence of seasonality and the association with climate in each subtype of mood episodes. RESULTS: Admission peaks were noted during spring/summer, early winter and early spring, for manic, depressive and mixed/unspecified episodes, respectively, while the associations with climatic parameters varied between the subtypes of mood episodes. CONCLUSIONS: Seasonality in bipolar disorder does exist for all subtypes of mood episodes. The distinct seasonal patterns and various associations with the climatic parameters imply different underlying mechanisms for the onset of each subtype of mood episodes. The association between admission rates and certain climatic variables found in this study is informative and could pave the way for future studies aimed at exploring the influence of climate on the psychopathology of bipolar patients as well as the underlying mechanisms.

Adult↗
PubMed2006

Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country.

BACKGROUND: Using 4-year nationwide population-based data for Taiwan, this study compared in-hospital surgical mortality rates with hospital volume for five cancer-related gastrointestinal resections. METHODS: The study sample was drawn from the Taiwan National Health Insurance Research Database. A total of 34,715 patients, each of whom had undergone a cancer-related colectomy, gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between 2000 and 2003, were selected as the study sample. The outcome measure was in-hospital mortality. The study sample was categorized into five patient groups for each procedure, and logistic regression analyses were performed for each procedure after adjustment for hospital and patient characteristics to assess the independent association between hospital volume and in-hospital mortality. RESULTS: The adjusted odds ratios showed a steady decline in mortality rates for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing hospital volume. The adjusted mortality odds for these four procedures in very-high-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to .05. As regards pancreatic resection, after adjustment for patient, clinical, and hospital factors, no statistically significant association was discernible between hospital volume and the likelihood of mortality. CONCLUSIONS: After adjustment for hospital and physician characteristics, in four of the five procedures, patients treated at higher-volume hospitals had lower in-hospital mortality rates than those treated at lower-volume hospitals. Our findings confirm, for the most part, the hypothesis that better outcomes are associated with higher-volume hospitals.

Aged↗
PubMed2006

Maternal request CS--role of hospital teaching status and for-profit ownership.

OBJECTIVE: To examine whether hospitals' for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively. METHOD: Retrospective, cross-sectional, population-based study of Taiwan's National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997-2000, using multiple logistic regression analyses. RESULTS: Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5-2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively). CONCLUSIONS: Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals' preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure.

Adult↗
PubMed2006

The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use.

OBJECTIVE: To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care services. DATA SOURCES: Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN: We constructed a simultaneous recursive model to obtain efficient estimates by treating preventive care (neonatal care and well-baby care) and inpatient care (hospitalization admissions) as dependent variables. PRINCIPAL FINDINGS: Utilization of neonatal care had strongly negative significant coefficients for the likelihood of being admitted to the hospital. The impact of the NHI was found to be significant. CONCLUSIONS: The hypothesis that the NHI interferes with the effectiveness of preventive care at reducing inpatient care use was not reinforced. Since support from the NHI depends on a balance of push and pull between access to inpatient care and the benefits of preventive care, it can further improve infant health by promoting the benefits of preventive care while making both types of care more accessible.

Child Health Services↗
PubMed2006

Taiwan's perspective on electronic medical records' security and privacy protection: lessons learned from HIPAA.

The protection of patients' health information is a very important concern in the information age. The purpose of this study is to ascertain what constitutes an effective legal framework in protecting both the security and privacy of health information, especially electronic medical records. All sorts of bills regarding electronic medical data protection have been proposed around the world including Health Insurance Portability and Accountability Act (HIPAA) of the U.S. The trend of a centralized bill that focuses on managing computerized health information is the part that needs our further attention. Under the sponsor of Taiwan's Department of Health (DOH), our expert panel drafted the "Medical Information Security and Privacy Protection Guidelines", which identifies nine principles and entails 12 articles, in the hope that medical organizations will have an effective reference in how to manage their medical information in a confidential and secured fashion especially in electronic transactions.

Computer Security↗
PubMed2006

Seasonality in pediatric asthma admissions: the role of climate and environmental factors.

BACKGROUND: Population-based data from Taiwan are used to examine seasonality in pediatric asthma admissions (proxy for asthma exacerbations) and associations with air pollutants and climatic factors. Monthly admission rates per 100,000 population, classified into three age groups, 0 approximately 2, 2 approximately 5, and 6 approximately 14 years (calculated from a total of 27,275 hospitalizations during 1998-2001) were subjected to autoregressive integrated moving average (ARIMA) modeling to examine seasonality. Spearman rank correlations were used to examine associations with criterion air pollutants (PM(10), SO(2), CO, O(3), NO(2)) and meteorological factors (ambient temperature, relative humidity, atmospheric pressure, rainfall, and sunshine hours). RESULTS: Both seasonality and associations with air pollutants and climate factors vary by age group. Among under-twos, the rates are lowest in January-February and highest in November, with a trough in June-July. Among preschoolers, the rates are lowest in June-July and highest in November, with two upsurges in August and March. Among school-goers, admission rates are lowest during June-August, with upsurges in March and September. The number of weather and pollutant predictors increases with age. Among under-twos, only two factors, PM(10) and rainfall, significantly predict admissions. For preschoolers, five factors (PM(10), CO, O(3), temperature, and pressure), and for school-goers, all air pollutants except NO(2,) and all climatic factors except rainfall are significant. CONCLUSION: Seasonality in pediatric asthma admissions vary by age in a subtropical island setting.

Adolescent↗
PubMed2006

Suicide rates and the association with climate: a population-based study.

BACKGROUND: Seasonality of suicide has been noted in several studies. A spring peak of suicide was observed, and associations between various climatic parameters and suicide have been suggested. This study sets out to verify seasonal patterns of suicide rates and to explore the association with climate in Taiwan. METHOD: The study used a nationwide mortality database in Taiwan from January 1997 to December 2003. An autoregressive integrated moving average model was applied to examine the presence of seasonality and the association of climate with suicidal death. RESULTS: Seasonality with a spring peak was evident in suicidal death regardless of gender or age. Ambient temperature was positively associated with suicide after adjustment for trend and seasonality. LIMITATIONS: Misclassification and underreporting of suicidal death in the registry system might confound the results. Ecological fallacies might exist. CONCLUSIONS: The seasonal effect on suicide is significant in Taiwan. Suicide rates may be influenced by ambient temperatures. The findings are of research interest for future studies regarding mechanisms of suicidal behavior, and also of practical interest for better timing of suicide interventions and effective preventive strategies.

Adolescent↗
PubMed2006

Differences in practice income between solo and group practice physicians.

An examination of the distribution of physician incomes between different types of practices could help policymakers and researchers alike to gain an understanding of the effects of different organizational characteristics of practices on the practice of medicine as a whole. This study uses a national database to explore the relationships that exist between practice incomes and practice types vis-à-vis the overall size of practices. The primary data source for this study, which includes 7757 office-based physicians, was provided by the Taiwan Department of Health (DOH), with the dependent variable of interest to this study being the annual gross income of physician practices, while the independent variables are physician practice types and the number of physicians within a clinic. Multiple regression analyses were used to model the logarithm of annual physician practice incomes as a linear function of a set of independent variables. Kruskal-Wallis test results revealed the existence of significant relationships between practice incomes and practice types (p<0.001) and the number of physicians within a clinic (p<0.001). Multiple regression analysis also showed that after adjusting for socio-demographic and professional characteristics, the annual incomes of physicians in both single-specialty or multi-specialty group practices (p<0.001) were higher than those of their solo practice counterparts. This study concludes that after adjusting for other factors, higher practice incomes are enjoyed by physicians in single-specialty or multi-specialty group practices as compared to their solo practice counterparts. The finding of higher incomes for those physicians organized into groups supports the policy call from the DOH in Taiwan for the widespread formation of group practices.

Adult↗
PubMed2006

The association between readmission rates and length of stay for schizophrenia: a 3-year population-based study.

OBJECTIVE: A nationwide population-based dataset was used to explore the association between length of stay (LOS) and 30-day readmission rates for hospitalized patients with schizophrenia in Taiwan. METHODS: The National Health Insurance Research Database was used for the years 2001-2003 and included a total of 29,373 patients with schizophrenia divided equally into four groups according to LOS of index hospitalization. After adjusting for hospital, physician and patient characteristics, a multivariate regression analysis was used to determine the relationship between LOS and 30-day readmission rates. RESULTS: After discharge from their index hospitalization, 12,468 (42.5%) patients with schizophrenia were readmitted within 30 days. The adjusted odds ratio for 30-day readmission rates was increased for shorter LOS. CONCLUSIONS: Healthcare providers should exert caution while trying to reduce LOS within the current cost-conscious environment and balance it with creating a minimal status necessary for discharge.

Adult↗
PubMed2006

The effects of weather on the incidence of sudden sensorineural hearing loss: a 5-year population-based study.

OBJECTIVE: This study utilizes 5-year population data to examine the association between weather conditions and the incidence of sudden sensorineural hearing loss (SSNHL) in Taiwan with a specific focus on ambient temperature, relative humidity, atmospheric pressure, rainfall and total hours of sunshine. METHOD: The data, covering the period from 1998 to 2002, is sourced from the Taiwan National Health Insurance Research Database (NHIRD), with a total of 8712 first-time admissions being identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). After controlling for time trend effects, this study adopted the autoregressive integrated moving average regression method as a means of evaluating the effects of climatic and monthly factors on SSNHL incidence rates. RESULTS: Although significant associations were found between ambient temperature, relative humidity and the SSNHL incidence rates for the total population, after adjusting for seasonality, months and trends, the significant relationship between SSNHL incidence rates and the climatic parameters disappeared. CONCLUSIONS: This study has demonstrated that after adjusting for seasonality, months and trends, there is no significant relationship between monthly SSNHL incidence rates and weather conditions. Therefore, the theory that weather is a triggering factor in SSNHL pathogenesis is not supported by this study.

Adult↗
PubMed2006

Sudden sensorineural hearing loss: evidence from Taiwan.

OBJECTIVE: This study uses 5-year population data to determine the incidence rate of sudden sensorineural hearing loss (SSNHL) in Taiwan, taking into consideration the age and gender of patients, as well as seasonal variations. STUDY DESIGN: A retrospective cross-sectional study. METHOD: The data used is from the Taiwan National Health Insurance Research Database covering the period from 1998 to 2002. A total of 9,267 sample patients were identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). The autoregressive integrated moving average (ARIMA) method was also carried out in order to identify any variations in the monthly incidence rates of SSNHL. RESULTS: We find that for the period under examination, gender-specific incidence rates per 100,000 of the population were 8.85 for males, and 7.79 for females, and that there was an increase in age-specific SSNHL incidence with age. The ARIMA test for seasonality was found to be significant for the whole sample. Of all the seasons in Taiwan, the highest SSNHL incidence rates were found in autumn. CONCLUSIONS: Our finding of significant variations in the monthly incidence of SSNHL provides valuable information for otolaryngologists and public health officials, creating an awareness of periods of a potential increased risk of SSNHL.

Adolescent↗
PubMed2006

Association between surgeon and hospital volume in coronary artery bypass graft surgery outcomes: a population-based study.

BACKGROUND: We have found no study conducted outside of the United States on the association between physician volume and patient outcomes after coronary artery bypass graft surgery. The aim of this study is to examine the association between surgeon-hospital coronary artery bypass graft volume and patient outcomes using three-year population-based data on Taiwan. METHODS: This study uses the Taiwan National Health Insurance Research Database covering the period 2000 to 2002, with the study sample comprising 9,895 first-time coronary artery bypass graft admissions, treated by 316 surgeons in 46 hospitals. RESULTS: Of the sampled patients, 356 (3.6%) were discharged after death. Those patients treated by low-volume (1-50 cases) surgeons had significantly higher mortality rates than those treated by medium-volume (51-100 cases) surgeons (7.0% vs 3.8%), high-volume (101-150 cases) surgeons (7.0% vs 2.7%), or very-high-volume (> or = 151 cases) surgeons (7.0% vs 3.2%). However, hospital coronary artery bypass graft volume alone is an insufficient predictor of hospital in-patient deaths (p = 0.078). The adjusted odds ratio of hospital in-patient deaths declined with increasing surgeon volume, with the odds of in-patient death for those patients treated by low-volume surgeons being 1.52 times those of medium-volume surgeons, 1.89 times those of high-volume surgeons, and 2.04 times those of very-high-volume surgeons. CONCLUSIONS: We conclude that for all coronary artery bypass graft surgeries taking place in Taiwan, the skill and experience of individual surgeons is a more critical factor for patient outcome than either hospital equipment or surgical teams.

Aged↗