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Development of Nutrition Screening Index for Hospitalized Patients (입원 환자 영양검색 지표 개발)

  • Kim, Su-An;Kim, So-Yeon;Sohn, Cheong-Min
    • Korean Journal of Community Nutrition
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    • v.11 no.6
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    • pp.779-784
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    • 2006
  • Several studies about hospital malnutrition have been reported that about more than 40% of hospitalized patients are having nutritional risk factors and hospital malnutrition presents a high prevalence. People in a more severe nutritional status ended up with a longer length of hospital stay and higher hospital cost. Nutrition screening tools identify individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutritional support. For the early detection and treatment of malnourished hospital patients , few valid screening instruments fur Koreans exist. Therefore, the aim of this study was to develop a simple, reliable and valid malnutrition screening tool that could be used at hospital admission to identify adult patients at risk of malnutrition using medical electrical record data. Two hundred and one patients of the university affiliated medical center were assessed on nutritional status and classified as well nourished, moderately or severely malnourished by a Patient-Generated subjective global assessment (PG-SGA) being chosen as the 'gold standard' for defining malnutrition. The combination of nutrition screening questions with the highest sensitivity and specificity at prediction PG-SGA was termed the nutrition screening index (NSI). Odd ratio, and binary logistic regression were used to predict the best nutritional status predictors. Based on regression coefficient score, albumin less than 3.5 g/dl, body mass index (BMI) less than $18.5kg/m^2$, total lymphocyte count less than 900 and age over 65 were determined as the best set of NSI. By using best nutritional predictors receiver operating characteristic curve with the area under the curve, sensitivity and 1-specificity were analyzed to determine the best optimal cut-off point to decide normal or abnormal in nutritional status. Therefore simple and beneficial NSI was developed for identifying patients with severe malnutrition. Using NSI, nutritional information of the severe malnutrition patient should be shared with physicians and they should be cared for by clinical dietitians to improve their nutritional status.

Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea

  • Song, Jung-Kook;Kim, Chang-Yup
    • Journal of Preventive Medicine and Public Health
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    • v.43 no.2
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    • pp.117-124
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    • 2010
  • Objectives: The Diagnosis Related Group (DRG) payment system, which has been mplemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. Methods: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. Results: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. Conclusions: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Performance of Administrative Personnel in Hospitals (병원행정부서인력의 업무수행수준분석)

  • 김진순;손태용
    • Health Policy and Management
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    • v.8 no.2
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    • pp.58-75
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    • 1998
  • The hospital is characterized by it's remarkable labor industry and human resources input by unit. Recently, the administrative personnel are recognized as important staff to provide a hospital guidance to consumer and also easiness for consumer's visit to hospital. The objectives of this study is to find the performance of the administrative personnel in hospitals. The unit of analysis is the hospitals and data was collected form 144 staffs in 5 hospitals. Self administered questionnaire was given to analyze the general characteristics of staft such as age, sex, education, experience, and performance level in terms of frequency, ability, necessity of tasks. The major findings are as follows: 1. The 5 major tasks such as general affairs, insurance related affairs, hospital statistics, admission/discharge, and analysis of treatment cost were analyzed. Performance level of these tasks were not showed consistent level. It means that the same task was showed both high level performance and low level one. 2. The higher rates of performance level, ability and necessity were found, below 29 years of age, junior college graduates and university hospital than that of general one. 3. Factors mostly affected to performances were found as characteristics of hospital, age and education. 4. Concerning the various manpower management, On the job training, incentive mechanism and colose relationship among units were somewhat lack. In conclusion, most responded administrative personnel have performed actively in dealing with their tasks. however, the performance level and ability of the same task were showed differently, it means that such routine works were not standardized. Therefore, standardization and specification of tasks should be developed to strength the performance. Finally, this study is the first attempt to find out the performance of the administrative staffs and the study results imply that further study could be neeed to promote the performance of administrative personnel efficiently and effectively.

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Adaptive Differentiated Integrated Routing Scheme for GMPLS-based Optical Internet

  • Wei, Wei;Zeng, Qingji;Ye, Tong;Lomone, David
    • Journal of Communications and Networks
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    • v.6 no.3
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    • pp.269-279
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    • 2004
  • A new online multi-layer integrated routing (MLIR) scheme that combines IP (electrical) layer routing with WDM (optical) layer routing is investigated. It is a highly efficient and cost-effective routing scheme viable for the next generation integrated optical Internet. A new simplified weighted graph model for the integrated optical Internet consisted of optical routers with multi-granularity optical-electrical hybrid switching capability is firstly proposed. Then, based on the proposed graph model, we develop an online integrated routing scheme called differentiated weighted fair algorithm (DWFA) employing adaptive admission control (routing) strategies with the motivation of service/bandwidth differentiation, which can jointly solve multi-layer routing problem by simply applying the minimal weighted path computation algorithm. The major objective of DWFA is fourfold: 1) Quality of service (QoS) routing for traffic requests with various priorities; 2) blocking fairness for traffic requests with various bandwidth granularities; 3) adaptive routing according to the policy parameters from service provider; 4) lower computational complexity. Simulation results show that DWFA performs better than traditional overlay routing schemes such as optical-first-routing (OFR) and electrical-first-routing (EFR), in terms of traffic blocking ratio, traffic blocking fairness, average traffic logical hop counts, and global network resource utilization. It has been proved that the DWFA is a simple, comprehensive, and practical scheme of integrated routing in optical Internet for service providers.

Determinants of Patient Satisfaction and Intent to Revisit at National University Hospitals in Korea (국립대학교병원의 환자만족도 및 재이용 의사 결정요인)

  • Jung, Seung-Won;Seo, Young-Joon;Lee, Hae-Jong;Lee, Kyun-Jik
    • Korea Journal of Hospital Management
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    • v.10 no.2
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    • pp.1-25
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    • 2005
  • This study purports to investigate the determinants of patient satisfaction and intent to revisit at national university hospitals in Korea. A total of 8 independent variables for outpatients, 9 independent variables for inpatients, and an intervening variable of overall patient satisfaction were selected through literature review. The independent variables for outpatients contain the level of satisfaction with physicians, nurses, ancillary staff, administrative procedure, medical cost, physical environment, facility convenience. and health recovery. With regard to the independent variables for inpatients, the quality of ward services was added to those of outpatients. Each variable contains 3 to 8 items measuring the level of satisfaction with various aspects of the variable. The sample used in this study consisted of 879 outpatients and 821 inpatients. Data were collected with interview survey and analyzed using path analysis. The major findings of the study are as follows: 1) The following variables have significantly positive effect on the intent to revisit of outpatients: health recovery, overall satisfaction, satisfaction with physicians, and ancillary staff. 2) The following variables have significantly positive effect on the intent to revisit of inpatients: health recovery, satisfaction with nurses and physicians, overall satisfaction, and administrative procedure. 3) The following variables of admission procedure, satisfaction with ancillary staff, facility convenience, quality of ward services were found to have significantly positive effect only on the level of overall satisfaction, even though they do not have significant total effect on the intent to revisit. The results of the study indicate that national university hospitals in Korea should make an effort to improve the satisfactory level of patients with clinical outcome, services provided by physicians, nurses, and ancillary staff, and the quality of administrative procedure for enhancing the intent to revisit of patients.

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A Dynamical Hybrid CAC Scheme and Its Performance Analysis for Mobile Cellular Network with Multi-Service

  • Li, Jiping;Wu, Shixun;Liu, Shouyin
    • KSII Transactions on Internet and Information Systems (TIIS)
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    • v.6 no.6
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    • pp.1522-1545
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    • 2012
  • Call admission control (CAC) plays an important role in mobile cellular network to guarantee the quality of service (QoS). In this paper, a dynamic hybrid CAC scheme with integrated cutoff priority and handoff queue for mobile cellular network is proposed and some performance metrics are derived. The unique characteristic of the proposed CAC scheme is that it can support any number of service types and that the cutoff thresholds for handoff calls are dynamically adjusted according to the number of service types and service priority index. Moreover, timeouts of handoff calls in queues are also considered in our scheme. By modeling the proposed CAC scheme with a one-dimensional Markov chain (1DMC), some performance metrics are derived, which include new call blocking probability ($P_{nb}$), forced termination probability (PF), average queue length, average waiting time in queue, offered traffic utilization, wireless channel utilization and system performance which is defined as the ratio of channel utilization to Grade of Service (GoS) cost function. In order to validate the correctness of the derived analytical performance metrics, simulation is performed. It is shown that simulation results match closely with the derived analytic results in terms of $P_{nb}$ and PF. And then, to show the advantage of 1DMC modeling for the performance analysis of our proposed CAC scheme, the computing complexity of multi-dimensional Markov chain (MDMC) modeling in performance analysis is analyzed in detail. It is indicated that state-space cardinality, which reflects the computing complexity of MDMC, increases exponentially with the number of service types and total channels in a cell. However, the state-space cardinality of our 1DMC model for performance analysis is unrelated to the number of service types and is determined by total number of channels and queue capacity of the highest priority service in a cell. At last, the performance comparison between our CAC scheme and Mahmoud ASH's scheme is carried out. The results show that our CAC scheme performs well to some extend.

Perioperative Comprehensive Supportive Care Interventions for Chinese Patients with Esophageal Carcinoma: a Prospective Study

  • Zhang, Xiao-Dan;Zhao, Qing-Yu;Fang, Yi;Chen, Guan-Xuan;Zhang, Hui-Fang;Zhang, Wen-Xiao;Yang, Xiao-Ping
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7359-7366
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    • 2013
  • Objective: To assess the effects of perioperative comprehensive supportive care interventions on outcome of Chinese esophageal cancer patients in a prospective study. Methods: 60 patients with primary esophageal carcinoma were randomized into an intervention group (IG, n=31) and a control group (CG, n=29). The Chinese version of symptom checklist-90 (SCL-90) was adopted to assess their psychological status. The interventions, including health education, psychological support, stress management, coping strategies and behavior training, were carried out in 3 phases (preoperative, postoperative I and postoperative II), and psychological effects were thereafter evaluated accordingly before surgery, and 1 week, 4 weeks and 24 weeks post-surgery. Medical costs were estimated at discharge. Survival of patients was estimated each year post-surgery. General health status and satisfaction-with-hospital were surveyed by a follow-up questionnaire 4 years post-surgery. Results: All the subjects demonstrated higher scores in the preoperative phase than the normal range of Chinese population concerning 7 psychological domains including somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety and paranoid ideation. Although no significant difference was observed between the two groups at admission, the scores of IG, which tended to decrease at a faster rate, were generally lower than those of CG at weeks 1, 4 and 24 post-surgery. The length of hospital stay and medical costs of IG were significantly less than those of CG and satisfaction-with-hospital was better. However, there was no significant difference in 4-year survival or health status between two groups. Conclusions: Appropriate perioperative comprehensive supportive care interventions help to improve the psychological state of Chinese patients with esophageal carcinoma, to reduce health care costs and to promote satisfaction of patients and their families with hospital.

Hospital Visits, Admissions and Hospital Costs among Patients with Respiratory and Cardiovascular Diseases according to Particulate Matter in Seoul (서울지역 미세먼지 농도가 호흡기계 및 심혈관계의 외래 방문 및 입원과 진료비에 미치는 영향)

  • Lee, Hyeong Suk
    • Journal of Environmental Health Sciences
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    • v.42 no.5
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    • pp.324-332
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    • 2016
  • Objectives: The annual average of PM10 in Seoul was $45{\mu}/m^3$, which surpasses the WHO annual guidelines ($20{\mu}/m^3$). Most previous analyses of the effects of PM exposure have been retrospective studies using single hospital data, and fewer studies have attempted to address the relationship of PM10 and hospital costs. This study was conducted to investigate the effects of the concentration of PM10 on hospital visits, admissions and hospital costs in patients with respiratory and cardiovascular diseases. Methods: Medical data from the National Health Insurance Service and the monthly average of PM10 from National Institute of Environmental Research were used to identify the effects of PM10 on hospital visits, admissions and hospital costs. We applied Poisson regression and linear regression to perform the analysis. Results: The relative risks for admissions per $10{\mu}/m^3$ increase in PM10 were 23.11%, 10.2% and 6.9% increases for acute bronchiolitis, asthma and bronchitis, respectively. The relative risk for hospital visits per $10{\mu}/m^3$ increase in PM10 were 10.4%, 6.7% and 5.9% for chronic obstructive pulmonary disease, asthma and chronic sinusitis, respectively. For cardiovascular disease, the relative risk for admissions per $10{\mu}/m^3$ increase in PM10 were 2.2% and 2.1% increases in angina and acute myocardial infarction, respectively. A $10{\mu}/m^3$ increase in the monthly average of PM10 corresponded to 170,723,000 won (95% CI: 125,587,000-215,860,000 won), 123,636,000 won (95% CI: 47,784,000-199,487,000 won) and 78,571,000 won (95% CI: 29,062,000-128,081,000 won) increases in hospital costs for asthma, acute tonsillitis and chronic sinusitis, respectively. Conclusion: Hospital admissions for respiratory and cardiovascular disease were associated with PM10 levels. PM10 exposure is also associated with increased costs for respiratory diseases.

Single-Stage Reconstruction with Titanium Mesh for Compound Comminuted Depressed Skull Fracture

  • Eom, Ki Seong
    • Journal of Korean Neurosurgical Society
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    • v.63 no.5
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    • pp.631-639
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    • 2020
  • Objective : Traditionally, staged surgery has been preferred in the treatment of compound comminuted depressed fracture (FCCD) after traumatic brain injury (TBI) and involves the removal of primarily damaged bone and subsequent cranioplasty. The main reason for delayed cranioplasty was to reduce the risk of infection-related complications. Here, the author performed immediate reconstruction using a titanium mesh in consecutive patients with FCCD after TBI, reported the surgical results, and reviewed previous studies. Methods : Nineteen consecutive patients who underwent single-stage reconstruction with titanium mesh for FCCD of the skull from April 2014 to June 2018 were retrospectively analyzed. The demographic and radiological characteristics of the patients with FCCD were investigated. The characteristics associated with surgery and outcome were also evaluated. Results : The frequency of TBI in men (94.7%) was significantly higher than that in women. Most FCCDs (73.7%) occurred during work, the rest were caused by traffic accidents. The mean interval between TBI and surgery was 7.0±3.9 hours. The median Glasgow coma scale score was 15 (range, 8-15) at admission and 15 (range, 10-15) at discharge. FCCD was frequently located in the frontal (57.9%) and parietal (31.6%) bones than in other regions. Of the patients with FCCDs in the frontal bone, 62.5% had paranasal sinus injury. There were five patients with fractures of orbital bone, and they were easily reconstructed using titanium mesh. These patients were cosmetically satisfied. Postoperatively, antibiotics were used for an average of 12.6 days. The mean hospital stay was 17.6±7.5 days (range, 8-33). There was no postoperative seizure or complications, such as infection. Conclusion : Immediate bony fragments replacement and reconstruction with reconstruction titanium mesh for FCCD did not increase infectious sequelae, even though FCCD involved sinus. This suggests that immediate single-stage reconstruction with titanium mesh for FCCD is a suitable surgical option with potential benefits in terms of cost-effectiveness, safety, and cosmetic and psychological outcomes.

Comparison of Moxifloxacin Monotherapy versus Cephalosporin-Azithromycin Combination Therapies for the Treatment of Community Acquired Pneumonia (원외획득폐렴 환자 치료에서 Moxifloxacin 단독요법과 Cephalosporin-Azithromycin 병용요법의 비교)

  • Cheong, Eun-Jin;Lee, Suk-Hyang
    • Korean Journal of Clinical Pharmacy
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    • v.15 no.2
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    • pp.75-81
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    • 2005
  • Community acquired pneumonia (CAP) remains a prevalent and potentially life threatening illness. American Thoracic Society and Infectious Disease Society America recommend combination therapies with ${\beta}-lactam$ plus a macrolide or a fluoroquinolone monotherapy for the empirical treatment of CAP. The aim of this study was to compare moxifloxacin monotherapy with cephalosporin plus azithromycin combination therapies. From January 2004 to March 2005, 18 patients in the moxifloxacin group(MG) and 21 patients in the cefuroxime or ceftriaxone plus azithromycin group(CAG) with CAP were retrospectively reviewed with regard to clinical, laboratory and microbiological data. Each patient was stratified into mild (risk class I-II), moderate (risk class III) and severe (risk class VI, V) group according to and PSI (Pneumonia Severity Index) score. Each group was compared for microbiological eradication, clinical assessment, the length of hospital stay. As results, Total 39 patients with CAP were reviewed. The appropriateness of admission was 83.3% in MC vs. 76.2% in CAC. The mean length of the hospital day was for 8.31 days vs. 7.39 days, days switching parenteral to oral antibiotics in 5.19 days vs. 5.28 days, clinical improvement in 2.43 days vs. 2.61 days in MG vs. CAC. Radiological improvement required 3.75 days vs 3.63 days in MG vs. CAG and bacteriological eradication rate at discharge was the same in the both groups. Mortality rate was 11.1% (2 of 18) vs 14.3% (3 of 21) in MG vs. CAG (p=0.77). Drug cost of the mean 5 hospital days requiring parenteral antibiotics was the most inexpensive in moxifloxacin group for the 147,045 won, and ceftriaxone 1g-azithromycin group for the 170,285 won, cefuroxime bid-azithromycin group for the 207,800 won, ceftriaxone 2g-azithromycin group far the 220,570 won, cefuroxime tid-azithromycin group for the 251,700 won. There was no significant statistical difference in clinical, bacterial, radiological cure and hospital days, and switch to oral days. In conclusion, that i.v. moxifloxacin monotherapy was as effective as azithromycin plus cefuroxime or ceftriaxone combination therapies fur the treatment of CAP. In drug cost analysis, moxifloxacin is less expensive than CAG.

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