| Trends in Life-Sustaining Treatment Decisions and Their Implementation: An Interrupted Time Series Analysis |
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Kyupin Ha1, Wangi Park1, Claire Junga Kim2, Do-Kyong Kim2, Hye Ryeon Kim3, Minkook Son4,5 |
1Department of Medicines, Dong-A University College of Medicine, Busan, Korea
2Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea
3Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
4Department of Physiology, Dong-A University College of Medicine, Busan, Korea
5Department of Data Sciences Convergence, Dong-A University College of Interdisciplinary Studies, Busan, Korea |
| 연명의료 중단 등 결정 및 이행 추이: 단절적 시계열 분석 연구 |
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하규빈1, 박완기1, 김정아2, 김도경2, 김혜련3, 손민국4,5 |
1동아대학교 의과대학 의학과
2동아대학교 의과대학 의료인문학교실
3동아대학교 의과대학 내과학교실
4동아대학교 의과대학 생리학교실
5동아대학교 학과간협동과정 데이터사이언스융합학과 |
Correspondence:
Minkook Son, Tel: +82-51-240-2620, Email: physionet@dau.ac.kr
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Received: 10 March 2025 • Revised: 9 October 2025 • Accepted: 21 January 2026 |
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| Abstract |
Background/Aims
Since enforcement of the Life-Sustaining Treatment (LST) Decisions Act, a pilot project for medical insurance reimbursement related to LST decisions and their implementation began in February 2018. This pilot project transitioned into a full-scale project in January 2022 that continues to this day.
Methods
We observed trend changes in LST decisions and their implementation by performing an interrupted time series analysis of data from the Health Insurance Review and Assessment Service from February 2018 to September 2023. We focused on two events: coronavirus disease 2019 (COVID-19) and the transition to a full-scale project.
Results
Our interrupted time-series analysis used the onset of COVID-19 (January 2020) as its reference point. The slopes of most codes for LST decisions and their implementation decreased following the onset of COVID-19. When divided by hospital class, all codes in hospitals, nursing hospitals, and oriental medicine hospitals showed immediate increases before and after the COVID-19 outbreak. A separate interrupted time series analysis was conducted using the transition to a full-scale project (January 2022) as the reference point. While no immediate effects were observed before or after transitioning to full-scale projects, in the institution-specific data, the slopes of all codes in general, nursing, and oriental medicine hospitals increased.
Conclusions
Our results reveal that COVID-19 and the transition to a full-scale project have significantly impacted LST decisions and their implementation. These findings can be used to evaluate and improve reimbursement programs. |
| Key Words:
Life-sustaining treatment decisions; COVID-19; Full-scale project; Reimbursement |
| 주제어:
연명의료 중단 등 결정; COVID-19; 본사업 전환; 수가 |
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