• Journal of The Korea Institute of Healthcare Architecture
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• v.1 no.1
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• pp.61-67
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• 1995

The purpose of this study is to define the problems associated with ambulatory care facilities, to classify the types of ambulatory care facilities, to examine significant architectural case studies, and to point the way toward enhanced architectural solutions for healthier ambulatory health care service environments for the patients. The case study will provide a brief introduction to the selected cases and examine planning concepts and design factors.

• Journal of The Korea Institute of Healthcare Architecture
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• v.6 no.11
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• pp.37-45
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• 2000

The purpose of this study was to analyze the ambulatory care facilities according to the change of medical circumstance and to find the proper ones in Korea. A logical model was used with the data which were obtained from the National Statistical Office, the Ministry of Health and Welfare in Korea and OECD Health Data. A proper ambulatory care facility in Korea is suggested as like as MOB (Medical Office Building). It should be considered for outpatient in distance within 1km long. It's proper size may be designed for 10,000persons to 50,000persons by regions.

• Journal of The Korea Institute of Healthcare Architecture
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• v.25 no.2
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• pp.51-62
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• 2019

Purpose: This study aims to examine spatial characteristics of ambulatory care department Chronologically through case studies; and to consider the social implication of these spatial changes. Methods: In this study, a total of eight ambulatory care departments, one or two for each period, were selected in order to analyze the spatial characteristics. Results: First, since the 1990s, the outpatient department of the US has been changed into a patient-centered space by providing high quality outpatient medical services through individual exam room planning. Second, the exam room has been changed from open/semi-open/group exam room to individual exam room since 1990, and the trend is shifting from the cluster type to the modular type consisting of universal exam rooms in order to achieve the flexibility of exam room. Third, the diagnostic/testing area has been deployed to the ambulatory clinic to enable 'one-stop shopping' for patients-centered care since 1990s, however, it has been disappearing since 2000 due to Reduce medical expenses. Fourth, the Central Nursing Station type first appeared in the outpatient department In the 2000s, followed by the type of decentralized nursing station type since 2010s. And fifth, the area of medical support has been placing to be concentrated on one place due to the Lean Design strategy since 2010. Implications: In the future, it is expected that Korea will be more focused on efficiency, visual control, and flexibility in the planning of the ambulatory care department as in the case of the United States.

• Quality Improvement in Health Care
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• v.5 no.2
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• pp.176-189
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• 1998

This study was conducted to evaluate the subjective ideas about the determinants of quality in ambulatory care unit among outpatients and medical staff of a university hospital, and to compare the differences of the ideas, between patients themselves and hospital staff. A self-administered questionnaire survey was conducted covering 799 outpatients and 190 hospital staff in March, 1998. The questionnaire included general characteristics and 26 determinants of ambulatory care quality. The following are summaries of the findings: 1. Both of outpatients and hospital staff perceived, "Physician's knowledge" as the most important determinant of medical care quality. 2. In respect of 7 determinants related to physician's knowledge and skill, both outpatients and hospital staff perceived "physician's knowledge and skill" as important determinants. The scores of determinants such as, "Not doing unnecessary examinations", and "Assignment of adequate number of patients and duty schedule for the physician" were significantly different between outpatients and hospital staff. 3. In respect of 4 determinants related to doctor-patient relationship, both outpatients and hospital staff perceived "attention to patient's complaints" as the most important determinant. The scores related to the determinants such as "kindness of physician" and "explanation of treatment outcome" were significantly different between outpatients and hospital staff. 4. Among the amenities related determinants, "Modern facilities and equipments" were perceived as the most important determinant in both group. 5. In respect of 8 determinants related to non-financial accommodation, outpatients perceived, "Waiting hours for treatment" as the most important determinant, and hospital staff perceived, "Kindness of hospital staff". 6. In respect of 4 determinants related to financial accommodation, outpatients perceived, "Fare account of medical cost" as the most important determinant, and hospital staff perceived, "Increasing reimbursements". Further comprehensive research should be made on the evaluation of perceptions of medical care quality, both of outpatient and inpatient care, among patients and hospital staff. So good quality in medical care will be achieved based on clients' needs.

• 모자간호학회지
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• v.4 no.1
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• pp.24-32
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• 1994

Using data from the Korean National Health Survey conducted in the years 1989 and 1992, child and maternal ambulatory care utilization patterns were compared. Data from 3,002 families from the 1989 survey and 1,523 families from the 1992 survey which have a child 0-4 years old and mother in the same family were selected and used for the analysis. The results indicate that child medical utilization is closely accociated with maternal medical utilization, as measured by the number of visits to medical facilities. Maternal use appears to be a more powerful predictor of child use than any other family and maternal variables. These results confirm the result of the previous localized studies and suggest that intervention directed at the mother may be effective in ensuring equitable and efficient use of ambulatory services by childeren.

• Health Policy and Management
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• v.10 no.4
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• pp.20-56
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• 2000

The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Journal of Korean Public Health Nursing
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• v.9 no.1
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• pp.83-102
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• 1995

As the society is being industrialized, the fast-paced economic development that has caused substantial increase in cerebrovascular and coronary artery diseases and the industrial development and increased use of means of transportation have resulted in the rapid rise of incidents in external injuries as well. So the pubic has become acutely aware of the need for fast and effective emergency care delivery system. The goal of emergency care delivery system is to meet the emergency care needs of patients. The emergency care delivery system is seeking to efficiently satisfy the care needs of people. Therefore the purpose of this study is designed to develop an effective programs for emergency care delivery system in Korea. The following specific objectives were investigated. This emergency care delivery system must have the necessary man power, for transfering the patients, communication net work, and emergency care facilities. 1) Man power Emergency care requires n0t only specialized traning in the emergency treatment but also knowledge and experience i11 other related area, so emergency care personnel traning program should be designed in order to adapt to the specific need of emergency patients. It will be necessary to ensure professional personnel who aquires the sufficient traning and experience for emergency care and to look for legal basis. We have to develop re-educational programs for emergency nurse specialist. They should be received speciality of emergency nursing care so that they will work actively and positively in emergency part. Emergency medical doctor and nurse specialist should be given an education which is related in emergency and critical care. Emergency care personnel will continue to provide both acute and continuing care as partner with other medical team. 2) Transfering the patients. Successful management of pre-hospital care requires adequate traning for the emergency medical technician. Traning program should be required to participate in a actual first aids activites in order to have apportunities to acquire practical skills as well as theoretical knowledge. The system of emergency medical technician should be remarkablly successful with first responder firefighters. Establishing this system must add necessary ambulances operating at any given time. It will be necessary to standardize the ambulance size and equipment. Ambulance should be arranged with each and every fire station. 3) Communication net work. The head office of emergency commumication network should be arranged with the head office of fire station in community. It is proposed that Hot-line system for emergency care should be introduce. High controlled ambulance and thirtial emergency center should simultaneously equip critical-line in order to communication with each other. Ordinary ambulance and secondary emergency facility should also simultaneously equip emergency-line in order to communication with each other. 4) Emergency care facilities. Primary emergency care facilities should be covered with the ambulatory emergency patients-minor illness and injuires. Secondary emergency care facilities should be covered with the emergency admission patients. Third emergency care center should be covered with the critical patients who need special treatments and operation. Secondary and third emergency care facilities should employ emergency medical doctor and emergency nurse specialist to treat in-patients with severe and acute illness and multiple injuires. It should be fashioned for a system of emergency facilities that meets emergency patients needs. Provide incentives for increased number of emergency care facilities with traning in personal/clinical emergency care. 5) Finance It is recommended to put the finance of a emergency care on a firm basis. The emergency care delivery system should be managed by the government or accreditted organizations. In order to facilitate this relevant program the fund is needed for more efficient and effective emergency researchs, service, programs, and policy. 6) Gaining understanding and co-operation of pubic It is also important to undertake pubic education to improve understanding of first aids and C. P. R of individuals, communities and business. It is proposed that teachers and health officers be certified in C. P. R. The C. P. R education can be powerful influence save lives. Lastly appropriate emergency care information must be provided to the pubic for assisting them in choosing emergency care.

• 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 Foot and Ankle Society
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• v.26 no.4
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• pp.187-191
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• 2022

The author experienced a case of autologous platelet-rich plasma (PRP) affecting the recovery of a chronic neuropathic diabetic foot ulcer combined with infection. A 65-year-aged male with uncontrolled diabetes presented with a Wagner grade 2 diabetic foot ulcer on his left forefoot of more than 2 weeks duration. Osteomyelitis, gangrene, and ischemia requiring acute intervention were absent. Although infection was controlled to a moderate degree, wound healing was unsatisfactory following surgical debridement and simple dressing. Therefore, intralesional autologous PRP injection was performed 5 times as an adjuvant regeneration therapy, and the recalcitrant ulcer healed in 3 months. Intralesional PRP injections are worthwhile as they promote wound regeneration, are evidence-based, safe, and can be easily performed in ambulatory care facilities.