• Quality Improvement in Health Care
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• v.7 no.2
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• pp.190-202
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• 2000

Background : The objectives of this study were to examine patients' satisfaction with the DRG based payment method and its association with their awareness of the method, to examine patient reported changes in doctors' caring attitude, level of their out-of-pocket payments, providers' acceptance of patients' request for additional services after the program, and to examine changes in service utilization recorded in medical records. Method : One hundred-four patients who had cesarean sections before and after the demonstration program at two hospitals located in Seoul participated in the study. Patients were surveyed before discharges when their charges were finalized. Their medical records were reviewed as well to collect data for service utilization during hospital stays. The association between patients' satisfaction with the payment method and their awareness of the method was analyzed by ${\chi}^2$-test, and the significance of changes in providers' acceptance of patients' request for additional services and service utilization after the program were examined by ${\chi}^2$-test and t-test, respectively. Results : A large proportion of patients did not know of the DRG based payment method at the time of survey and a significantly larger proportion of patients who came to the hospitals with the knowledge satisfied with the method. About the same proportion of patients reported improvement and deterioration in doctors' caring attitude compare to the previous hospitalizations and a similar result was found concerning out-of-pocket payments. Providers' acceptance of patients' request for medication, PCA and painless delivery decreased significantly after the program whereas the acceptance for additional hospital days and laboratory and radiology tests did not. Length of stay, the numbers of days on antibiotics and antianemic medication, and the number of blood tests decreased significantly after the program, however, decreases in the rate of antianemic medication and the number of urine analyses were not statistically significant. Re-operation, in-hospital death, and complications were not observed before and after the program. Conclusion : The study findings indicated a need for better patient education and publicity about the newly introduced payment method to improve their satisfaction with the system. Other study findings concerning service utilization and quality of care indicators were consistent with the government funded evaluation studies.

• Quality Improvement in Health Care
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• v.15 no.1
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• pp.73-78
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• 2009

문제: 오늘날 간호사는 과거와 달리 현대적 보건의료 요구를 해결할 수 있는 체계적인 이론과 기술을 습득하도록 훈련된 고급 전문 인력이고, 간호행위를 생산하기 위해서는 서비스의 생산원가 뿐만 아니라 전문 인력으로서의 훈련 및 유지비용 등도 투입되어야만 가능하게 함으로서 2008년 7월부터 시행한 중환자실 간호등급에 따른 간호수가 책정으로 인해 중환자실 내에서 이루어지고 있는 많은 간호행위 중 수가를 받을 수 있는 부분이 생기게 되었고 간호행위의 중요성과 더불어 간호를 시행 후 받을 수 있는 수가에 대한 간호사들의 입력에 대한 의무도 늘어나게 되었다. 이에 빈번히 누락되고 있는 간호수가 관리를 통한 경제적 손실을 방지해야 할 필요성을 느껴 개선활동을 하고자 한다. 목적: 2008년 7월부터 시행한 중환자실 간호등급에 따른 간호수가 책정으로 인해 중환자실내에서 이루어지고 있는 간호 행위의 중요성을 인식하고 구체적인 문제 분석과 간호 현장에서의 개선안을 도출함으로써 경제적 손실을 방지할 수 있는 간호수가 누락률을 감소시키고자 함이다. 의료기관: 대구파티마병원 내과 중환자실. 질 향상 활동: 업무개선의 방법으로 환자 개인별 간호수가 입력 누락 방지 체크 리스트 사용 및 처방 전달 시스템의 간호수가 재입력 화면을 이용하여 입력의 용이성 도모하였고 입력된 간호수가를 처방 전달 시스템 간호수가 조회 프로그램을 이용해 익일 누락여부를 매일 모니터링 하였다. 교육 및 홍보활동으로는 간호수가 입력누락 방지를 위한 간호수가 입력 지침을 제작하여 전체간호사는 년 2회, 신규간호사는 개별 교육을 실시하였으며, 월별 간호수가 누락통계를 실명 공고 하여 간호수가 다 빈도 누락 간호사는 추가 개별교육을 실시하였다. 개선효과: 간호수가 입력 프로세스 개선을 통해 간호수가 평균 누락률이 개선 전 6.5%, 개선 후 1.2%로 5.3%의 누락 감소율을 보였으며 역치 5%를 달성하였고 간호수가 누락금액은 개선 전 2,992,752원, 개선 후 590,787원으로 2,401,965원의 누락 효과 비용을 구할 수 있었다. 본 QA활동으로 중환자실 간호수가 전산입력에 대한 체계적인 교육부재와 신규간호사들의 잦은 전산누락이 있어왔으나 표준화 된 체크리스트 지침과 입력확인 작업으로 전산입력 누락률이 감소하는 효과를 가져왔다. 추후 심평원 청구 작업을 하는 부서와 연계되어 실제 청구 누락률에 대한 비교와 간호사 근무연수와 간호수가 입력 누락률에 대한 상관관계 조사를 제언 해 본다.

• Korean Journal of Clinical Pharmacy
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• v.26 no.4
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• pp.318-323
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• 2016

Background: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. Methods: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product ($cCa{\times}P$), and the prescription rate of non-calcium based P-binders. Results: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target $cCa{\times}P$ level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher $cCa{\times}P$ levels than $55mg^2/dL^2$ (P <0.001). Conclusion: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.

• Journal of the Korea Convergence Society
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• v.6 no.6
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• pp.9-15
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• 2015

The study aims to examine the knowledge and awareness of care workers on oral health knowledge at the geriatric care facilities in order to improve and develop oral health services. For the research method, the study carried out a questionnaire survey to 163 care workers working at the geriatric care facilities (10) in D Metropolitan City from May 1~31, 2015 and then the collected data were statistically analyzed. As a result, the oral health knowledge of care workers was 20.09 points out of total 26 points (77.2%). The highest knowledge was 'proper toothbrushing method' with 93.0% and the lowest one was 'knowledge on the use of oral supplementary goods' with 58.1%. Those with experience of oral health education had higher demand on oral health education (P<0.001), and those with higher experience of oral health education had significantly higher oral health knowledge (P<0.001), demand (P<0.01) and awareness (P<0.05). As for factors influencing care workers' oral health awareness, if they had higher oral health knowledge points (P<0.01), oral health education demand (P<0.01), they had higher oral health awareness level. Accordingly, it is required to provide efficient, sustainable and practical oral health education of care workers considering oral characteristics of the long-term hospitalized patients at the care hospital. And, the role of dental hygienist as the person in charge of oral health education is necessary. Therefore, institutional support from the government is required to assign professional personnel.

• The Korean Journal of Rehabilitation Nursing
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• v.4 no.2
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• pp.207-218
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• 2001

This study was carried out to find out the basic data required to plan and develop Rehabilitation Day Care Program for the stroke survivor's family in Korea. The subjects comprised of 92 stroke survivor's family who discharged from 4 hospitals in Seoul during the past 2 years. The data were collected from August 3, 1998 to September 18, 1998, through interviews with questionnaires about general characteristics, activities of daily living, depression and service need of rehabilitation day care program at the outpatient clinics by trained nursing graduates. Data were analyzed with descriptive analysis, Pearson's correlation analysis, and Stepwise multiple linear regression analysis using SPSS/WIN 10.0 program. The results obtained are as follows; 1. The mean score of the general need of rehabilitation day care program of stroke survivor's family was 3.10(range 1-4). The highest need among the service categories of the rehabilitation day card program was self-care and restorative activities category(3.30), and health services referral category, recreation category, psychosocial activities category in order. The needs of each category are as follows. In the health services referral category, the need for dental examination and medical examination were highest, followed by the need for physical therapy and occupational therapy. In the psychosocial activities category, the need for family counselling was highest. In the self-care and restorative activities category, the need for ROM exercise training was highest, followed by bowel training, and ambulation training. 2. The need of family for rehabilitation day care program service displayed a correlation with the level of education, ADL, and the level of depression, and a reverse correlation with age, illness intrusiveness, depression, knowledge, subject and object burden and relationship with stroke survivors. 3. The stepwise multiple linear regression analysis revealed following results. For the need for rehabilitation day care program service, 22.6% of the variance was initially explained by level of family's knowledge about caring method for stroke survivors, 8.8% was the level of subjective burden and 5.4% was relationship with stroke survivors. In conclusion, above characteristics should be considered to develop stroke survivors' rehabilitation day care program.

• Journal of Convergence for Information Technology
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• v.10 no.5
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• pp.75-82
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• 2020

This study is a descriptive research study to identify Unmet Dementia Information Needs (UDIN) for caregivers of dementia patients at Dementia Relief Center and to understand the effectiveness of the program for workers. The subjects were 114 caregivers and 217 practitioners from dementia relief centers in 25 autonomous districts of S city from November 1, 2019 to January 31, 2020. The UDIN questionnaire is a 7-point Likert scale. The Crisis Management Questionnaire is a Likert 5-point scale consisting of 10 questions from 6 categories. As a result of the study, the proportion of depressed caregivers experiencing UDIN was 12.3times higher than those who did not (p<.001). The program effectiveness was 8.98times better than those who perceived the lack of risk management as good (p=.004), and social workers were 2.81times better than nurses (p=.091). It is necessary to conduct interactive operations to meet the needs of the community residents by listening to their diverse opinions rather than simply implementing a one-sided policy to raise the service of a dementia relief center to the highest level in a short period of time.

• Journal of Hospice and Palliative Care
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• v.14 no.1
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• pp.34-41
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• 2011

Purpose: The purpose of this study was to analyze the reason to select complementary and alternative therapy for terminally ill cancer patients. Methods: The data were collected from 21 terminal cancer patients and families through the in-depth interview. Data analysis were performed by the Colaizzi's phenomenological method (1976). Results: The reason to select complementary and alternative therapy for terminal cancer patients and families was then categorized with 4 elements; Awareness of limitations in contemporary medical treatments, Belief in effectiveness of the CAM, Satisfaction with emotional needs of family members, and Disbelief due to negative attitudes of physicians. The result indicated the following 9 themes expectation for a complete cure, uncertainty in hospital treatments, complementary method for management of side effect of chemotherapy, alleviation of symptoms and life-sustaining, fear for side effects of cancer treatments, belief in earned information, referrals by other, responsibility of family, and dissatisfaction with negatine attitudes of physicians. Conclusion: Physicians should provide a sufficient explanation and try to effectively communicate with clients about hospice and palliative service and the CAM. We strongly realized that concerns about patients' best care and satisfactions with family's needs should be understood.

• Journal of the Korean Data and Information Science Society
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• v.24 no.3
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• pp.515-521
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• 2013

Healthcare approach in Western medicine and Korean Traditional Medicine (KTM) varies from its nature of human understanding and cultural differences. This fundamental difference in their approach of the human pathology has dualised and hindered common medical communication between the two fields of medicines. Within this current difficulty, the integrative medical service is said to become a novel method to provide the patients with the best medical care as their intent is to adapt and combine the advantages stated from the two different fields. This research paper shows the integrative approach of treating jaundice, where the symptoms of dampness and heat on Korean traditional standards are analyzed using statistical methods based on monitoring the blood test results. Therefore, we can explore an approach to diagnose and treat with comprehensive and integrative medicine algorithm.

• Journal of Korea Multimedia Society
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• v.1 no.1
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• pp.45-55
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• 1998

In the tele-medical system, the broadband network for multimedia telecommunication and the multimedia terminal equipment for the remote access of the tele-medical information are essential. Especially, the tele-medical terminal equipment should provide the multimedia GUI environment in order to support the similar medical process by the tele-medical system. In this paper, we present a multimedia GUI (Graphic User Interface) for a Multimedia Tele-Medical System (TeleMedi_GUI) based on ATM/B-ISDN. In the tele-medical system, one workstation is used for the multimedia data server that is supporting multiple client terminals that are connected by the ATM network. The client terminals are based on Multimedia Personal Computers, and provide the remote access environment of the tele-medical database. We also developed the remote access protocols among the clients and the server to access multimedia medical information of the multimedia server. With using the TeleMedi_GUI, the doctors can examine and treat patients efficiently, using image data like X-ray/CT and voice data such as the S-ray diagnosis. The result of this paper can be applied to the following areas: 1) the implementation of the advanced medical service system interconnecting the small-scale health center and general hospitals, 2) the development of a fully computerized medical information system within the hospital.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.3
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• pp.353-359
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• 2020

This study investigated the effects of emotional labor and resilience on burnout of long-term care hospital nurses. The study was conducted in D, B, and G cities, from May 23 2019 to June 5, 2019, enrolling 195 long-term care hospital nurses who had been on duty since 6 months. Means, standard deviations, Pearson correlation coefficients, t-tests, ANOVA, and multiple regression analysis of the SPSS 21.0 statistical program were applied for analyzing the data. Emotional labor (r= 0.476, p<0.005) and resilience (r= -0.416, p<0.005) showed significant differences associated with burnout in the long-term care hospital nurses, with all variables showing significant correlation. Regression analysis revealed that emotional labor (β= 0.37, p<0.001) and resilience (β= 0.17, p<0.048) were significant variables affecting the burnout of long-term care hospital nurses, and these variables explained 25.5% of adaptation to their burnout (F=23.51, p<0.001). Based on the results of this study, we propose the necessity to develop and utilize a program to manage emotional labor and resilience as a way to improve adaption for long-term care hospital nurses.