Seungwon Shin

Background: Korean Medicine clinical practice guidelines (KM-CPGs) undergo mandatory external peer review of their drafts during development, yet reviewers lack a standardized, validated instrument to guide this task. Widely used appraisal tools assess the quality of completed guidelines rather than support the section-level review of a draft. We aimed to develop an external peer review instrument for KM-CPG drafts (KM-EPRI) and to assess its content validity. Methods: In this two-phase methodological study, a draft instrument was first derived by directed qualitative content analysis of the external review comments produced for previously published KM-CPGs, with each comment coded into one of four predefined review modules: the clinical questions (CQ), the introductory components (CPG-I), the development methods (CPG-M), and the recommendations (CPG-R). The content validity and acceptability of the items were then assessed through a modified Delphi study with a multidisciplinary panel of KM clinicians and evidence-based medicine methodologists. Consensus was defined a priori as an item-level content validity index (I-CVI) ≥ 0.80. The scale-level content validity index (S-CVI/Ave), Kendall’s coefficient of concordance ( W ), and the interquartile range (IQR) were reported as supporting measures. Results: From 3,630 external review comments, 2,073 content-related comments were consolidated and refined into a finalized instrument of 117 review items across 4 modules and 33 subdomains. All 10 invited experts participated (response rate 100%, no attrition), and every item reached the consensus threshold in a single round under a pre-defined early-stopping rule. All 117 items had an I-CVI ≥ 0.80, the S-CVI/Ave was 0.976, and the IQR was ≤ 1 for every item (median 0.75). Kendall’s W was low (0.196), reflecting a ceiling effect from uniformly high ratings rather than disagreement among panelists. Conclusion: KM-EPRI can serve as a consensus-based, structured reference for the external peer review of KM-CPG drafts during development. Its effect on review quality and inter-rater reliability remains to be evaluated in practice.

Objectives: To investigate whether sustained integrative care, combining traditional Korean medicine (TKM) with conventional medical care, is associated with lower mortality and reduced risk of major medical complications among older adults undergoing postfracture rehabilitation in long-term care hospitals (LTCHs). Design: A nationwide, population-based, retrospective propensity score-matched cohort study. Setting: LTCHs in South Korea, using the National Health Insurance Service customised claims database (2014–2023). Participants: Older adults (aged ≥65 years) newly admitted to LTCHs with a fracture diagnosis were included in the cohort. Patients were matched 1:1 using propensity scores to an integrative care group (receiving acupuncture, moxibustion or cupping alongside conventional medical care) and a usual care group (receiving conventional care alone), resulting in a matched cohort of 40 720 participants (20 360 per group) with a mean follow-up of 3.0 years. Primary and secondary outcome measures: The primary outcome was all-cause mortality. Secondary outcomes included the incidence of major immobility-related complications: pneumonia, deep vein thrombosis, pressure ulcers and urinary tract infections. The propensity score-matched groups were compared with multivariable Cox proportional hazards regression models. Results: Compared with the usual care group, the integrative care group exhibited significantly lower risks of all-cause mortality (adjusted HR (aHR) 0.79 (95% CI 0.77 to 0.81)) and major complications, including pneumonia (aHR 0.72 (95% CI 0.69 to 0.76)), deep vein thrombosis (aHR 0.71 (95% CI 0.58 to 0.88)), pressure ulcers (aHR 0.76 (95% CI 0.72 to 0.80)) and urinary tract infections (aHR 0.75 (95% CI 0.70 to 0.80)). Conclusions: Integrative care during postfracture rehabilitation in LTCHs is associated with lower mortality and fewer immobility-related complications in older adults. These findings support integrative rehabilitation as a potential strategy for postfracture care, although confirmation in prospective studies is warranted.

Objectives: This study aimed to investigate the utilization patterns and end-of-life trajectories of older adults in Korean long-term care hospitals (LTCHs) using nationwide population-based data. Methods: This retrospective observational study analyzed National Health Insurance Service claims data (2014–2023). We constructed three analytical groups: an annual inpatient group to examine longitudinal trends in volume and mortality; a newly admitted inpatient group to assess the sociodemographic profile at the time of LTCH entry; and a decedent group to reconstruct the clinical trajectory and cumulative resource use from initial admission to death. Results: While the volume of older inpatients increased, the annual number of deaths involving LTCH use increased from 68,357 in 2014 to 112,157 in 2023 over the decade. Patients were newly admitted to LTCHs in their early 80s (median age 81 years, IQR 75–86) and were predominantly female (62.1%). In addition, Medical Aid beneficiaries (13.7%) and individuals with registered disabilities (28.0%) were overrepresented, indicating high sociodemographic vulnerability. Decedents spent a median of 79 days (IQR 22–299) as LTCH inpatients. While 30.1% stayed for <30 days, 22.2% remained hospitalized for ≥ 360 days, indicating substantial variation in length of stay. Overall, 68.5% of decedents died during LTCH stay. While admissions were driven by chronic geriatric syndromes, the end-of-life phase was dominated by a surge in acute infectious and systemic conditions (e.g., pneumonia, 10.2% to 22.3%; sepsis, 3.3% to 11.9%). Conclusions: LTCHs in Korea have played an increasingly important role as a setting for end-of-life care, managing a distinct trajectory from chronic frailty to acute deterioration. Given that these institutions are functioning as end-of-life care settings, policy reforms should strengthen palliative care integration, advance care planning, workforce training, and end-of-life care capacity within LTCHs.

Real-world evidence studies using health insurance claims data are utilized in clinical research. This review provides operational definitions of the study population, intervention/exposure, comparison, and outcomes (PICO) in integrative medicine research (conventional and Korean medicine approaches), with case-based examples. Illustrative claims-based studies using Korean national health insurance data were selected, and how PICO elements had been operationally defined in the research were reviewed. Key variables were categorized into general information, diagnosis information, and medical service information, and mapped to Health Insurance Review and Assessment Service-National Patient Sample and National Health Insurance Service-National Sample Cohort tables to describe their roles in constructing each PICO component. Population was primarily defined using diagnosis information, with variations depending on the breadth of diagnosis code inclusion, while medical service utilization information enabled more refined patient selection. Intervention was mainly operationalized using treatment and prescription codes, service types, and treatment intensity. Comparison groups were constructed by confirming no exposure and improving clinical comparability using confounding-control strategies. Outcomes were defined using combinations of diagnosis records, healthcare utilization events, and mortality data. This review provides a practical framework for operationally defining PICO elements in claims-based real-world evidence studies and may improve rigor and reproducibility in future research.

Background: This study aims to figure out the changes in traditional Korean medicine (TKM) utilization over the last decade, using the complete dataset of all claims submitted to the National Health Insurance (NHI) system in Korea. Methods: This is a repeated cross-sectional study between 2013 and 2022. To observe TKM healthcare resources, we collected the number of TKM institutions, beds, and doctors. To observe changes in the utilization of TKM services, we collected the number of patients, claims, and medical expenses submitted to NHI. Data was analyzed according to inpatient/outpatient and hospitals/clinics. The compound annual growth rate was calculated. Results: The growth was observed in the number of TKM hospitals, beds, and doctors. The changes in the claim count and the number of patients told us that TKM is going through a structural shift into hospital-centered services, even though the total number of patients utilizing TKM services decreased. The increase in TKM medical expenses was not merely a result of general inflation but reflects an increase in utilization of TKM services. Conclusions: The key findings include a significant increase in inpatient services of TKM hospitals and medical expenses. The diversification of diagnostic and treatment methods highlights the evolving nature of TKM. Future research should focus on a more comprehensive study to examine the sociocultural and clinical factors influencing TKM utilization.

Bee venom acupuncture (BVA) is used in traditional Korean medicine (TKM) for various diseases, but its evaluation within clinical practice guidelines (CPGs) has not been comprehensively reviewed. This study aimed to review TKM-CPGs to characterize the range of conditions for which BVA is recommended, summarize the level of evidence and recommendation grades, and assess the factors influencing the grades. Eighteen TKM-CPGs, including 30 BVA-related recommendations, were identified. Data on targeted diseases/symptoms, treatment protocols, evidence levels, and recommendation grades were extracted. The CPGs recommended BVA for musculoskeletal and neurological disorders in standalone or combined therapy. Most of the evidence for BVA recommendations was evaluated with low to moderate levels based on randomized controlled trials. The grades of recommendations were mostly B or C, indicating that BVA is advisable or potentially beneficial. Although the CPGs offer some guidance on treatment protocols for BVA, there remains a lack of detailed specifications, and we need to conduct additional research to provide evidence. Also, the heterogeneity of recommendations across different CPGs presents a challenge in establishing consistent clinical guidelines. Future research should focus on generating high-quality evidence and standardizing treatment regimens to support more robust recommendations for BVA in TKM clinical practice.

Low fertility is a critical social problem worldwide, and infertility has a prevalence of 15%. This cross-sectional study aimed to understand the factors affecting the usage and satisfaction of Korean medicine (KM) in subfertile women. An online survey was conducted from 3 November to 8 November 2021. The survey collected basic information, KM treatment experience, and satisfaction from women who experienced poor pregnancy. The t-test and chi-square test (χ²-test) were used to determine the overall characteristics of the subjects and factors affecting the utilization and satisfaction of KM treatment. Of the total of 29,465 people, 4922 read the survey email, and 601 responded. After excluding 51 respondents with questionable response patterns, 550 respondents were included in the final analysis. Of these, 43.1% (n = 237) had experience with conventional treatment, and 16.5% (n = 91) had received KM treatment. The group that received both KM treatment and CM treatment (n = 59, 24.9%) was significantly more prevalent than the group that received KM treatment alone (n = 32, 10.2%) (p = 0.00). Women who had given birth more than once or held a master’s degree were significantly more willing to participate in the ‘KM Support Project for Subfertility’ program. Our findings suggest that subfertile patients prefer integrated treatment that combines KM and CM treatments. Further studies are needed to assess the status of integrative medicine treatment, satisfaction with each KM intervention, factors for low satisfaction, and patient requirements.