• Quality Improvement in Health Care
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• v.6 no.1_2
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• pp.38-46
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• 1999

Background : To evaluate the frequency and cause of return to the emergency department within 48 hours and to identify the nature of the problem. Methods : We reviewed the medical records of 76 patients who returned to the emregency department within 48 hours from September 1998 to February 1999. Results : Overall revisit rate within 48hours was 2.6%. Of 76 patients, 5(6.6%) had planned return, 64(84.2%) had unplanned return and 7(9.2%) had incomplete documentation. The causes of unplanned return were inadequate medical management (11.8%), discharge against medical advice (27.6%), return after scheduled ambulatory care (22.4%), and unavoidable revisit due to symptom aggrevation or development of new symptom (22.4%). Conclusion : The study provided a basic information for us to improve the quality of emergency care by reducing unnecessary return to the emergency department. It is necessary to monitor continuously the quality of emergency care and to develop the standard of emergency return rate.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.2
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• pp.313-323
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• 1998

This study was a descriptive research on the level of self-care available to continous ambulatory peritoneal dialysis patients (hereinafter referred to as 'CAPD patient') related to the specific area of infection management. The method employed for the collection of data was a modified instrument of the self-care survey essentially based on Young Sook Choi's instrument. The relevant data was collected from september 1, 1996 to september 30, 1996. The subjects were provided with an open-ended question regarding the reasons behind why they did not seek self-care. The answers provided about self-care compliance were analyzed by SPSS for frequency, percentage, mean, t-test, ANOVA. Reasons for non-compliance were analyzed by content analysis. The results of the study were as follows : 1. The percentage of patients engaging in self-care were according to the following self performed tasks : preparation of dialysis : 30.58 points Dialysate exchange procedures : 49.40 points - Two bag type : 50.50 points - Spike type : 48.80 points - Neo type : 48.90 points Catheter exit site care : 25.13 points More specifically, in relation to the preparation of dialysis as referred to above, those patients engaging in self care was relatively high with respect to the cleaning of the dialysis before use and for the preservation of peritosol. However, in dialysate exchange procedures, data revealed that those patients engaging in self-care are relatively low with respect to putting on a mask during the performance of peritosol exchange. Similary in peritosol exchange procedure and catheter exit care, low levels of self-care performance were found in the area of putting on a mask during the peritosol exchange procedures and catheter line testing procedures, respectively. 2. In general characteristics, there appeared to be no distinction in self-care compliance among CAPD patients. 3. The main reasons for non-compliance were based in the following factor : intellectual, attitude, enviromental surrounding and physical. As a result of the foregoing finding, nurses should provide adequate assistance to promote self-care compliance by CAPD patients by checking the preparation of dialysis, dialysate exchange procedure, and catheter exit site care which recieved low point in this research.

• Journal of Preventive Medicine and Public Health
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• v.39 no.5
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• pp.411-418
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• 2006

Objectives: The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. Methods: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. Results: The numbers of physician visits per 100 patients were $0.78{\sim}0.97$ times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were $1.16{\sim}1.77$ times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: $0.44{\sim}0.70$), and the ORs of hospitalization for the disabled were significantly higher (OR: $1.16{\sim}1.89$). The lower physician visit group (number of physician visits ${\leq}$1) was more likely to be hospitalized than the higher physician visit group (number of physician visits ${\geq}$2) (OR: $1.69{\sim}19.77$). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. Conclusions: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.

• Tuberculosis and Respiratory Diseases
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• v.80 no.3
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• pp.241-246
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• 2017

Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and effective treatment of outpatients can prevent worsening of the illness and hospitalization. Current COPD guidelines provide appropriate guidance for the diagnosis and treatment of patients with COPD. In fact, it has been shown that when appropriate guidance and treatment are performed, the morbidity and mortality rates of COPD patients are reduced. However, there is a gap between the clinical guidelines and the actual clinical treatment. Therefore, the Health Insurance Review and Assessment Service (HIRA) conducted an evaluation of the adequacy of COPD diagnosis and treatment using the Claims Database of HIRA. This review provides a summary of the COPD adequacy assessment results reported by the HIRA and some brief comments on the results.

• Journal of Preventive Medicine and Public Health
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• v.20 no.2 s.22
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• pp.287-300
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• 1987

Island regions suffer from a shortage of health care in part because they are less developed, they cover a widespread area relative to the population, and due to transportation barriers. The purpose of this study was to assess the level of illness and the magnitude of medical care utilization, and to investigate the determinants of utilization in these area. The data were collected by means of a household survey conducted from February 16 to 25, 1987 on S islands which were selected in consideration of the size of the population, the distance from the main land, and the distribution of health care facilities. The household response rate was 89.1% (491 of 551 households), and 1971 persons were surveyed. The major findings of this study are as follows: 1) The morbidity rate of the island inhabitants was 27.7% during the two weeks, and 25.5 chronic illnesses and 9.1 acute illnesses per 100 persons, were noted. Differences in the magnitude of illness were statistically significant by sex, age, education, and family size. 2) The magnitude of total ambulatory carl utilization was 16.8 visits per 100 persons during the two weeks, which was less than that of other regions; and differences in the magnitude of total ambulatory care were statistically significant by sex, age, education, occupation, and family size. 3) Unmet needs were classified as 56.0% in chronic illnesses and 19.6% in acute illnesses; and differences in unmet needs were statistically significant by sex, age, education, occupation, income, and family size. 4) Statistically significant determinants in medical care utilization included the frequency of acute illness and chronic illness, and income in total utilization; the frequency of chronic illness and acute illness, and medical care insurance in physician visits. 5) According to the results of the path analysis, need factors had the greatest effect on utilization, and predisposing factors had more indirect effects through enabling or need factors than direct effects.

• Journal of Korean Biological Nursing Science
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• v.18 no.4
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• pp.193-202
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• 2016

Purpose: The study was to analyze clinical outcomes and risk factors of for complications associated with the hip fracture surgery in the elderly before and after interdisciplinary treatment. Methods: A retrospective method was used to investigate the general and therapeutic characteristics, frequency of complications and clinical outcomes. The subjects of the study were 553 patients who underwent hip fracture surgery from January, 2009 to December, 2014. Results: The interdisciplinary group was older and less likely to walk independently even before the fracture than a usual care group. The incidence of complications was higher in the interdisciplinary group than the usual care group. The prevalence of complications in both groups was 66.5%. Multivariate logistic regression analysis showsed that the risk factors for complications of hip fracture surgery were as follows: advanced age, stroke, Parkinson disease, time interval from emergency room to operation, pre & post ambulatory status, American Society of Anesthesiologists (ASA) classification quality of postop intensive care unit (ICU) care and foley indwelling. Conclusion: This study has implications in that it recognized the necessity for interdisciplinary treatment and provided the basic base data for nursing intervention of the elderly patients who underwent hip fracture surgery.

• Asian Oncology Nursing
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• v.9 no.2
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• pp.136-144
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• 2009

Purpose: This study was to compare the differences in self-care behaviors between the group with fighting spirit and the group with helplessness. Methods: This study utilized a cross-sectional descriptive design. A total of 97 ambulatory cancer patients completed the Mental Adjustment to Cancer (MAC) scale by Watson et al. (1988) and Self Care Behaviors Scale by Oh et al. (1997). The data was analysed using frequency, percentage, t-test, ANOVA, Pearson's correlation and stepwise multiple regression. Results: Fighting spirit group were found to conduct self-care behaviors more compared to the helplessness group (t=3.346, p<.0001). The score of the self-care behaviors in fighting spirit group was 4.42 out of a total score of 7 and that of helplessness group was 3.85. There was a significant difference (p<.0001) in self-care behaviors according to the level of faith and performance status. Fighting spirit ($R^2$=0.120, p<.0001), performance status ($R^2$=0.078, p=.001) were predictive of self-care behaviors. Conclusion: Cancer patients' mental adjustment is correlated with the degree of self-care behaviors. Having fighting spirit is one of the most adaptive techniques that cancer patients could use in adjustment to the life with cancer.

• Korea Journal of Hospital Management
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• v.22 no.1
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• pp.1-9
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• 2017

Purpose : Many studies showed that having a usual source of care improved the efficient access of healthcare service. However in Korea there have been few studies on the usual source of care. So this study aims to find whether having a usual source of care affect the medical utilization and expense. Methodology/Approach : We used the Korean Health Panel data in 2012, 2013 to examine the change of utilization and expenses in ambulatory care affected by having a usual source of care. We selected 1,215 hypertension patients without usual source of care in 2012 and performed linear regression analysis to identify the difference between treatment group(with usual source of care in 2013) and control group(without usual source of care in 2013). Then we performed analysis again separated by the age group. Findings : Among study population, 711(58.5%) reported that they have a usual source of care in 2013. Treatment group reported 1.85 less increase in outpatient visits and 69,234 won less increase in expense than control group with weak significance(visit ${\beta}$ -1.85 p-value 0.0807, expense ${\beta}$ -69,234 p-value 0.0541). People under the age of 65 showed significant change in outpatient visits for tertiary hospital (visit ${\beta}$ -0.78 p-value 0.0154, expense ${\beta}$ -91,462 p-value 0.0168). The analysis which focused outpatient for mild disease showed similar trend. Practical Implications : This study supports the positive effect of having usual source of care which decrease inefficient outpatient utilization. Promoting physician-patient relationships is important for efficiency of healthcare service.

• Journal of Preventive Medicine and Public Health
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• v.19 no.1 s.19
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• pp.137-145
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• 1986

A Nationwide health care utilization survey was conducted from March 11 to September 19, 1985 to assess the level of illness and the magnitude of medical care utilization. A probability sample of 15,427 persons was taken from 180 Enumerated Districts designated by the Economic Planning Board. Of those 4,500 housewives were proxy respondents. A interview was conducted with pre-tested questionnaire schedule which was recorded by well trained interviewers. Age and sex compositions of the study population were similar to those of general population structure in 1985. The major findings of this survey are as follows : 1) A total of 64.5% of the study population lived in city area and 35.5% lived in county area. 2) While no difference was observed in interview rate between city and county area, it showed statistically significant difference in the medical security program coverage rate between the two areas(44.7% and 37.1%, respectively) 3) Morbidity rate was 79 per 1,000 persons during the two week periods. There was difference in age and sex adjusted morbidity rates between city and county area. Furthermore morbidity rates by the status of the program were significantly difference between the two areas. 4) Average ambulatory care utilization rate was 7.2 visits per person per year and average admission rate was 1.8 per 100 persons per year. There was significant difference in average ambulatory care utilization rate by the program. but no significant difference in medical utilization rate between city and country area. 5) The major symptoms of the perceived illness was the respiratory system(44.1%). 6) A total of 50.4% of the perceived illness among the covered group by the program were treated at the hospital and clinics, but those who are not covered used primarily drug stores(61.3%).

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.2
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• pp.120-125
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• 2007

Background: Propofol has been used extensively for short-acting intravenous sedative agent during monitored anesthesia care (MAC). This study was designed to evaluate the safety and availability of MAC using propofol in implant surgery of the one-day admission patients. Methods: In this study, subjects were divided into two groups according to ASA physical status. The heart rate, blood pressure, peripheral oxygen saturation and ECG of a patient were estimated under MAC by an anesthesiologist and the vital signs were recorded in recovery room periodically afterwards. The subjective satisfaction with regard to outpatient ambulatory surgery under MAC procedure was evaluated the next day. Results: Systolic and diastolic blood pressure were significantly decreased during MAC in ASA I group, but other remarkable changes in vital sign were not observed. There was no significant difference in pain and anxiety level between ASA I and ASA II, III group. Satisfaction rate was high in both groups. Conclusion: Monitored-Anesthesia Care using propofol during implant surgery of the one-day admission patients might be safe and available procedure because heart rate, blood pressure and oxygen saturation are stable before and during surgery, and adequate control of pain and anxiety is supported.