• 디지털융복합연구
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• 제11권10호
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• pp.459-467
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• 2013

이 연구의 목적은 질병관리본부의 퇴원손상환자조사 자료를 이용하여 지역의 소득수준에 따른 의료이용의 차이를 규명하는 것이었다. 지역의 경제적 수준은 234개 시 군 구의 재정자립도를 지표로 하여 5분위로 구분하였다. 주요 결과로는 첫째, 소득수준이 낮을수록 연령표준화입원률과 표준화사망률이 증가하였다. 둘째, 16개 주요 질환 중 뇌혈관질환, 심장질환, 폐암, 위암이 소득수준에 따른 표준화사망률의 변화가 큰 것으로 나타났다. 셋째, 소득수준이 낮을수록 응급 경유 입원이 증가하였다. 넷째, 대부분의 주요 질환에서 소득수준이 낮을수록 평균재원일수가 증가하는 것으로 나타났다. 따라서, 지역별 건강 불평등의 격차를 줄이기 위해서는, 지역 및 소득수준별 특성에 맞는 지역보건의료정책이 수립되어야 할 것이다.

• 대한화상학회지
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• 제23권1호
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• pp.1-6
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• 2020

Purpose: PL, creatinine and urine output are biomarkers of the suitability and prognosis of fluid therapy in severe burn patients. The purpose of this study is to evaluate the usefulness of predicting mortality by biomarkers and its change during initial fluid therapy for severe burn patients. Methods: A retrograde review was performed on 733 patients from January 2014 to December 2018 who were admitted as severe burn patients to our burn intensive care unit (BICU). Plasma lactate, serum creatinine and urine output were measured at the time of admission to the BICU and after 48 hours. ABSI score, Hangang score, APACHEII, revised Baux index and TBSA were collected after admission. Results: 733 patients were enrolled. PL was the most useful indicators for predicting mortality in burn patients at the time of admission (AUC: 0.813) and after 48 hours (AUC: 0.698). On the other hand, mortality prediction from initial fluid therapy for 48 hours showed different results. Only creatinine showed statistical differences (P<0.05) in mortality prediction. But there were no statistical differences in mortality prediction with PL and UO (P>0.05). Conclusion: In this study, PL was most useful predictor among biomarkers for predicting mortality. Improvement in creatinine levels during the first 48 hours is associated with improved mortality. Therefore, efforts are needed to improve creatinine levels.

• Journal of Preventive Medicine and Public Health
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• 제53권5호
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• pp.381-386
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• 2020

Objectives: Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes. Methods: This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence. Results: A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis. Conclusions: In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient's motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.

• Tuberculosis and Respiratory Diseases
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• 제78권2호
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• pp.85-91
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• 2015

Background: In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. Methods: This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. Results: Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. Conclusion: In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality.

• 한국병원경영학회지
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• 제26권3호
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• pp.1-12
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• 2021

Purpose: This study aims to examine the effect of the copayment reduction policy on the health care utilization of patients under age 15 after the policy started in 2017. (이하는 아래 methodoloty로 이동) Methodology: Data on the ALOS, the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age from 2015 to 2019 were obtained from the National Health Insurance database. Policy effects were measured by analyzing three dependent variables before and after policy: the average length of stay (ALOS), the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age. The collected data were analyzed using the SAS package, and the analysis methods used in this study were the mean difference test and linear regression analysis. Findings: The study results reveal that, after the copayment reduction policy in the year 2017, the ALOS and the out-of-pocket expenditure were significantly decreased, but the average admission cost was significantly increased. Practical Implications: These results imply that the policy of copayment reduction for the patients under the age of 15 has contributed to mitigating the patients' financial burden with little concern about growing medical utilization.

• 한국의료질향상학회지
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• 제2권1호
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• pp.58-67
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• 1995

이 연구는 3차 진료기관 응급실의 기능을 정상화하기 위한 기초 자료를 수집하기 위하여, 한 3차 진료기관 응급실을 방문한 환자를 대상으로, 입원 결정서 발부와 환자의 입원 결정 양상 및 이에 영향을 미치는 요인을 파악하였다. 또한 적절성 평가 지침을 이용하여 응급실을 통한 입원의 적절성을 평가하였고 입원의 적절성과 응급실 입원 대기시간의 적절성에 영향을 미치는 요인을 분석하였다. 입원 결정서 발부에 영향을 미치는 요인은 환자의 내 외과계 구분, 진료과수, 환자 상태, 방문 경로, 방문 시간과 방문 요일이었다. 입원 결정서 발부 후 환자의 입원 여부는 환자의 성, 환자 상태, 방문 경로, 방문 요일에 따라 달리 나타났다. 환자의 연령, 내 외과계 구분과 방문 요일에 따라 입원의 적절성에 차이를 보였다. 입원 대기시간은 환자의 연령이 증가할수록 적절성이 낮았다. 이 연구를 통하여 응급실을 통한 입원 중 반수 이상의 입원이 부적절한 입원으로 평가되었고, 이 중 일부는 입원을 빨리 하기 위한 방법의 하나로 응급실을 편법으로 이용하고 있기 때문인 것으로 판단되었다. 또한 입원 결정서가 발부된 환자 중 상당수의 환자가 병상을 구할 수 없어 입원하지 못하고 있는 것으로 보아, 3차 진료기관의 환자 집중 현상과 응급실 과밀화 요인 해소를 위한 의료정책의 수립이 필요함을 확인할 수 있었다.

• Korean Journal of Radiology
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• 제23권9호
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• pp.878-888
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• 2022

Objective: To investigate the clinical impact of a quality improvement program including dedicated emergency radiology personnel (QIP-DERP) on the management of emergency surgical patients in the emergency department (ED). Materials and Methods: This retrospective study identified all adult patients (n = 3667) who underwent preoperative body CT, for which written radiology reports were generated, and who subsequently underwent non-elective surgery between 2007 and 2018 in the ED of a single urban academic tertiary medical institution. The study cohort was divided into periods before and after the initiation of QIP-DERP. We matched the control group patients (i.e., before QIP-DERP) to the QIP-DERP group patients using propensity score (PS), with a 1:2 matching ratio for the main analysis and a 1:1 ratio for sub-analyses separately for daytime (8:00 AM to 5:00 PM on weekdays) and after-hours. The primary outcome was timing of emergency surgery (TES), which was defined as the time from ED arrival to surgical intervention. The secondary outcomes included ED length of stay (LOS) and intensive care unit (ICU) admission rate. Results: According to the PS-matched analysis, compared with the control group, QIP-DERP significantly decreased the median TES from 16.7 hours (interquartile range, 9.4-27.5 hours) to 11.6 hours (6.6-21.9 hours) (p < 0.001) and the ICU admission rate from 33.3% (205/616) to 23.9% (295/1232) (p < 0.001). During after-hours, the QIP-DERP significantly reduced median TES from 19.9 hours (12.5-30.1 hours) to 9.6 hours (5.7-19.1 hours) (p < 0.001), median ED LOS from 9.1 hours (5.6-16.5 hours) to 6.7 hours (4.9-11.3 hours) (p < 0.001), and ICU admission rate from 35.5% (108/304) to 22.0% (67/304) (p < 0.001). Conclusion: QIP-DERP implementation improved the quality of emergency surgical management in the ED by reducing TES, ED LOS, and ICU admission rate, particularly during after-hours.

• 보건행정학회지
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• 제34권2호
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• pp.120-128
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• 2024

2024년 2월부터 현재까지 의과대학 입학정원 확대를 두고 논란이 계속되고 있다. 이런 논란은 현재와 미래의 시점의 문제가 혼합되어 논란을 더 가중하고 있다. 현시점에서 의사의 인력부족 여부에 대한 논란은 다양하다. 동일한 근거가 의사 부족 또는 부족하지 않은 근거로 제시되기도 한다. 부족하다는 근거로 제시하는 것에 대해서도 이견이 많으며 그 반대의 근거도 이견이 많다. 현시점에서 의사 부족 여부를 둘러싼 이런 논란은 합의될 가능성이 그리 크지 않다. 10년 후에는 노인인구의 급격한 증가로 인해 의사가 더 필요하게 될 것이므로 의과대학 입학인원을 늘려야 할 것이다. 그러나 그 숫자는 의학교육의 질이 저하되지 않을 수준이어야 한다. 이를 위해 의학교육의 질이 높은 의과대학에 더 많은 입학인원을 배정해야 하며, 그 대안으로 대규모 의과대학은 입학인원을 20%-30% 늘리고, 소규모 의과대학은 입학인원을 40%-50% 늘리면 전체 증가인원은 760-1,066명이 되는 것이다. 2,000명 증원이 강행된다면 의학교육의 질을 면밀히 평가해 그 결과를 의과대학 정원 조정에 반영해야 할 것이다. 20년 후에는 의과대학 입학정원을 줄여야 한다. 이는 의사공급이 1차함수로 증가할 것인데 반해 의사수요(의료수요)가 꼭지점이 있는 2차함수로 변화하고 있기 때문이다. 현재의 인원을 유지하더라도 2048년부터는 의사가 과잉되기 때문에 의과대학 입학인원을 줄여야 하며, 규모는 현재보다 1,000명이 적은 2,000명 정도로 축소해야 할 것이다. 정원 축소 시 모든 의과대학에 일률적으로 축소한다면 소규모 의과대학이 많아지기에 M&A (mergers and acquisitions) 전략을 적용해야 할 것이며, 그 대상은 40개의 의과대학과 12개의 한의과대학이어야 할 것이다. 우리나라의 경우 의사수요 추정에 가장 큰 영향을 미치는 요인은 인구 변화이다. 합계출산율의 급격한 감소로 인해 향후 인구 전망은 불확실성이 상당 수준 있으며, 최근 의료이용률의 급격한 증가가 반영된 수급추계는 재검토되어야 한다. 의사 수급추계의 불확실성으로 인해 의사 수급추계는 최소한 5년 단위로 지속적으로 실시되어야 하며, 이를 위해 보건의료인력검토위원회를 설치 운영해야 한다.

• 여성건강간호학회지
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• 제14권4호
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• pp.278-289
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• 2008

Purpose: This study was a survey to provide basic data about nursing interventions for improving the quality of life among family caregivers for the elderly by examining their care burden, burnout, and quality of life, and by confirming the correlation between each of them. Method: The subjects were 215 people in Seoul and Gyeonggi Province who understood the purpose of this study and participated voluntarily from April 1 to June 4, 2007. Data was analyzed by the SAS program. Result: 1. Concerning primary caregivers of the elderly, it was found that their care burden was slightly high, burnout was high and quality of life was good on the whole. 2. When it comes to the correlation among care burden, burnout, and quality of life among family caregivers, it was found that burnout increases in proportion to care burden, quality of life decreases as care burden increases, and bigger burnout leads to a lower quality of life. Conclusion: The quality of life among primary caregivers should be improved by reducing their care burden and burnout. Thereby, a priority might be considered for admission to nearby, comfortable nursing homes or failing that, home visiting services, rather than family support in the home.

• 한국의료질향상학회지
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• 제19권2호
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• pp.68-80
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• 2013

Background: This study investigates improvements in non-value-added nursing activities in clinical work, in order to improve the efficiency and quality of nursing activities. Methods: The study was performed as a quality improvement project at a tertiary general hospital. The nursing activities that needed improvements were categories into admission care, discharge care, supply management, diagnostic work-up related activities, and others. The nursing time and frequency of non-value-added activities were compared across nine nursing units before and after implementation of the quality improvement program. Post-implementation patient and nurse satisfaction were subsequently analyzed. Result: Post-implementation, the time spent on non-value-added nursing activities was reduced and patients and nurses were satisfied with the improvements. Discussion: Reducing non-value-added activities in nursing can increase the work efficiency and ensure time for patient care, thus improving the quality of nursing care. For further study, accurate surveys on nursing activities based on nursing time are required.