• 한국의료질향상학회지
• /
• 제27권2호
• /
• pp.45-56
• /
• 2021

Purpose: Repeated hospitalization could be a proxy of unnecessary or preventive admission in South Korea where barriers to hospitalization are relatively low. This study aimed to estimate the current status of repeated hospitalization due to ambulatory care sensitive conditions (ACSC) in South Korea. Methods: Using the National Health Information Database, repeated hospitalization databases were constructed in units of episodes for patients who had been admitted more than twice between January 2017 and December 2018. The number of hospitalizations, total in-hospital days, and total medical expenditure were calculated and compared by patient characteristics in both of the entire patient group and the ACSC patient group. Results: Of total hospitalization episodes, 26.6% reported repeated admission, and 6.7% of repeated hospitalization was due to ACSC. A total of 183,110 patients with ACSC had been admitted an average of 2.9 times and spent an average of KRW5,630,118. In other words, KRW1,309 billion had been spent for repeated hospitalization due to ACSC. The scale of medical expenditure was relatively large in the highest and lowest socioeconomic status. Conclusion: Repeated hospitalization for ACSC can be considered a simple and intuitive indicator when assessing unnecessary hospitalizations or evaluating healthcare policy.

• 한국시스템다이내믹스연구
• /
• 제12권4호
• /
• pp.5-34
• /
• 2011

The purpose of this paper is to evaluate the policies for reducing private tutoring expenditure in Roh Mu Hyun and Lee Myeong Bak Government using Causal Loop analysis based on the Systems Thinking perspective. The results are as follows. First, high educational achievers receive more private tutoring than lowers and children who have rich parents have better chance to take private tutoring than the others. It reflects the social characteristics which emphasize the academic ability and educational background. Second, two governments implemented educational policies to control the private tutoring expenditure as balancing loops ; strengthening public education, providing after school programs and EBS KSAT teaching and improving the entrance exam of university. Third, they overlooked the unintended feedback loops coming from 1) incongruity between causes and countermeasures of shadow education 2) wrong perception of substitutional relationship between public education and shadow education 3) side effect of the policy increasing the weight of student record 4) problems of diversifying high schools 5) dilemma of easing the burden of testing through admission officer system. The conclusion is that policies of reducing the private education expenses have failed because two governments don't consider unintended Feedback Loops in the process of making education policies. So we have to make policies based on Systems Thinking and reducing private education expenses should not be the purpose of strengthening the public education.

• 한국통신학회논문지
• /
• 제32권7B호
• /
• pp.438-447
• /
• 2007

인터넷 환경에서 유통되는 사용자 정보는 실소유자가 원하는 데로 제어되어야만 한다. 이를 위해서는 사용자가 요구하는 정보 유통 방식을 표현할 수 있는 프라이버시 정책이 필요하고, 사용자가 편리하게 정책을 설정할 수 있는 인터페이스가 요구된다. 또한 정보 유통이 발생할 때 사용자의 정책에 위배되는지 판단할 수 있는 시스템이 필요하다. 본 논문에서는 인터넷 Identity 관리 시스템 환경에서 운영되는 프라이버시 컨트롤러 시스템 모델을 제안하고 시스템의 인터페이스 및 정책 설정 과정을 제안한다. 정책 구현을 위한 언어로는 OASIS의 XACML을 수정하여 적용하였고, 사용자 정책 외에 도메인 정책, 기본 정보 제공 정책, 정책 충돌 해결 정책을 제안한다.

• 한국경영과학회지
• /
• 제35권1호
• /
• pp.83-95
• /
• 2010

This paper considers a firm that operates make-to-stock and make-to-order facilities in successive stages. The make-to-stock facility produces components which are consumed by the external market demand as well as the internal make-to-order operation. The make-to-order facility processes customer orders with the option of acceptance or rejection. In this paper, we address the problem of coordinating how to allocate the capacity of the make-to-stock facility to internal and external demands and how to control incoming customer orders at the make-to-order facility so as to maximize the firm's profit subject to the system costs. To deal with this issue, we formulate the problem as a Markov decision process and characterize the structure of the optimal inventory allocation and customer order control. In a numerical experiment, we compare the performance of the optimal policy to the heuristic with static inventory allocation and admission control under different operating conditions of the system.

• 한국정보과학회논문지:시스템및이론
• /
• 제33권8호
• /
• pp.505-513
• /
• 2006

클라이언트와 서비스 제공자간의 서비스 수준 계약인 SLA(Service Level Agreement)를 만족시키기 위해서는 클라이언트 요청을 우선순위 계층으로 구분하여, 낮은 수준의 서비스를 요청하는 클라이언트 보다는 고수준의 서비스를 요구하는 클라이언트에게 우선적으로 서비스를 제공할 수 있는 기술이 필요하다. 본 논문에서는 서비스 제공자의 웹 서버 노드를 우선 순위에 따라 정적. 동적으로 분할하는 방법 및 다중계층 (Multiclass) 에서의 승인 제어 (Admission Control) 기법을 연구하였으며, 시뮬레이션을 통해 SLA를 고려한 웹 서버 처리율 및 응답시간 성능을 분석하였다.

• 한국의료질향상학회지
• /
• 제1권1호
• /
• pp.96-108
• /
• 1994

Background: An appropriate use of hospital beds can improve productivity of hospital significantly. The authors' previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropriately used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Overall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. These instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.

• Journal of Preventive Medicine and Public Health
• /
• 제42권6호
• /
• pp.416-423
• /
• 2009

Objectives : This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. Methods : Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. Results : The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. Conclusions : The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

• Journal of Preventive Medicine and Public Health
• /
• 제43권1호
• /
• pp.42-49
• /
• 2010

Objectives: To compare the performance of three International Statistical Classification of Diseases, 10th Revision translations of the Charlson comorbidities when predicting in-hospital among patients with myocardial infarction (MI). Methods: MI patients ${\geq}20$ years of age with the first admission during 2006 were identified(n=20,280). Charlson comorbidities were drawn from Heath Insurance Claims Data managed by Health Insurance Review and Assessment Service in Korea. Comparisions for various conditions included (a) three algorithms (Halfon, Sundararajan, and Quan algorithms), (b) lookback periods (1-, 3- and 5-years), (c) data range (admission data, admission and ambulatory data), and (d) diagnosis range (primary diagnosis and first secondary diagnoses, all diagnoses). The performance of each procedure was measured with the c-statistic derived from multiple logistic regression adjusted for age, sex, admission type and Charlson comorbidity index. A bootstrapping procedure was done to determine the approximate 95% confidence interval. Results: Among the 20,280 patients, the mean age was 63.3 years, 67.8% were men and 7.1% died while hospitalized. The Quan and Sundararajan algorithms produced higher prevalences than the Halfon algorithm. The c-statistic of the Quan algorithm was slightly higher, but not significantly different, than that of other two algorithms under all conditions. There was no evidence that on longer lookback periods, additional data, and diagnoses improved the predictive ability. Conclusions: In health services study of MI patients using Health Insurance Claims Data, the present results suggest that the Quan Algorithm using a 1-year lookback involving primary diagnosis and the first secondary diagnosis is adequate in predicting in-hospital mortality.

• 실천공학교육논문지
• /
• 제16권2호
• /
• pp.227-239
• /
• 2024

본 연구는 학위연계형 일학습병행제를 통해 직업능력향상을 위한 교육훈련을 받고 있는 학습근로자의 학습성과에 미치는 영향을 분석하기 위해 대학 학위과정 입학과 선발 단계에서 고려할 수 있는 다양한 요인들과 입학 이후 대학의 평점평균점수와의 인과관계를 찾아보는데 그 목적이 있다. 이를 위하여 국내 K대학교의 학위연계형 일학습병행제의 모델인 일학습병행대학의 3개 학부과정생 976명의 역사적 입학자료와 평점평균자료를 통해 회귀분석과 분산분석을 진행했다. 분석의 질을 확보하기 위하여 추가로 공개된 기업정보 데이터베이스에서 학습근로자의 학점에 영향을 미칠 것으로 추정되는 기업정보를 포함했다. 분석 결과 출신고등학교의 분류, 성별, 가정환경요소, 고등학교 교과목별 등급, 회사의 재직기간, 입학당시의 연령 등 다양한 요소에서 유의미한 인과관계를 찾을 수 있었으며 이를 바탕으로 동일한 학위과정을 운용하는 대학에서는 학습근로자 선발절차의 업그레이드를 할 수 있으리라 기대한다. 추가로 본 연구결과는 향후 학위연계형 일학습병행제의 정책적 제언을 위한 기초자료로 활용될 수 있을 것이다.

• 보건행정학회지
• /
• 제25권1호
• /
• pp.3-10
• /
• 2015

Background: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). Methods: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. Results: Tertiary hospitals didn't show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. Conclusion: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.