• 대한임상검사과학회지
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• 제50권4호
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• pp.477-483
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• 2018

뇌혈류 초음파 검사는 비침습적인 방법으로 대뇌 혈관 혈류 속도와 방향을 도플러 원리로 측정하는 검사이다. 뇌혈류 초음파 검사의 박동지수는 원위부 혈관 저항을 반영하는 측정 지표이며 대뇌 소혈관 질환 발생과 확산지표로 사용되고 있다. 본연구의 목적은 허혈성 뇌졸중 환자에서 기저 동맥의 박동지수에 영향을 미치는 위험 인자를 평가하는데 있다. 2014년 1월부터 2015년 5월까지 내원 환자를 대상으로 뇌혈류 초음파 검사 박동지수를 측정하여 기저동맥 박동지수 대상자 422명을 선정하였다. 기저동맥 박동지수를 종속변수로 하여 단변량 분석을 실시하였고, 박동지수에 영향을 미치는 인자를 변수에 특징을 고려하여 다중회귀 분석을 실시하였다. 단변량 분석 결과 박동지수에 영향을 미치는 인자는 연령, 고혈압 유무, 당뇨 유무, 고지혈증 유무, 적혈구용적으로 나타났다(P<0.1) 다중회귀분석을 실시한 결과 연령(P<0.001), 당뇨 유무(P=0.004), 고지혈증 유무(P=0.041)가 통계적으로 유의한 결과를 보였다. 뇌혈류 초음파 검사의 박동지수에 영향을 미치는 위험인자는 고령, 당뇨, 고지혈증이다. 이후 추가적인 연구를 통하여 두 개 내 박동지수 증가는 고령, 당뇨, 고지혈증을 반영하는 지표로 활용 될 수 있을 것으로 생각된다.

• 대한방사선기술학회지:방사선기술과학
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• 제31권4호
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• pp.347-353
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• 2008

본 연구는 의료기관 PACS 운영 및 영상정보관리 과정에서의 개인정보보호와 보안 관리에 대한 보안평가 기준 및 보안평가에 따른 등급기준을 마련하고자 하였다. 보안평가기준과 보안평가 등급기준의 지표를 도출하기 위해 ISO17799(BS 7799), HIPPA(Health Insurance and Portability and Accountability Act of 1996), 국내 의료법 등을 참조하여 정책적 보안, 기술적 보안, 데이터관리 보안, 물리적 보안 등 4가지 항목을 대분류로 선정 후 10개의 세부 평가항목을 선정하여 점수화 하였다. 도출된 보안평가기준과 보안등급의 지표를 가지고 30곳의 의료기관에서 조사를 시행하였다. 대분류의 평가 요소 중 물리적 보안 항목의 전체 의료기관평균 점수는 20점 만점기준 18.5점(93%)으로 가장 우수한 점수를 나타내었으며, 정책보안항목 30점 기준18.5점(62%), 데이터관리 보안항목 20점 기준 12점(60%), 기술적 보안항목 30점 기준 17.5점(58%) 순임을 알 수 있었다. 30개 종합병원의 보안평가 점수는 평균 67점으로 4등급 수준을 나타내었다. PACS환경에서 취약한 개인정보보호 및 보안의식에 대한 관리기준 수립이 필요하다.

• 보건행정학회지
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• 제18권4호
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• pp.66-84
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• 2008

Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.

• 대한한의학회지
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• 제37권3호
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• pp.112-122
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• 2016

Objectives: This study aimed to assess the validity of 'Korean Diagnosis Related Groups-Korean Medicine (KDRG-KM)' which was developed by Health Insurance Review & Assessment Service (HIRA) in 2013 Methods: Among inpatient EDI claim data issued by hospitals and clinics in 2012, the data which included Korean medicine procedures were selected and analyzed. We selected control targets in the Korean medicine hospitals which had longer Episodes-Costliness index (ECI) and Lengthiness index (LI) than average of total Korean medicine hospitals, and compared the results of selection between the major diagnosis-based patient classification system and the KDRG-KM system. Finally, the explanation power (R2) and coefficient of variation (CV) of the KDRG-KM system using practice expenses were calculated. Results: The numbers of control target in Korean medicine hospitals changed from 36 to 32 when patient grouping adjustment method was changed from major diagnosis to KDRG-KM. For expenses of all outpatient claim data on Korean medicine, explanation power of KDRG-KM system was 66.48% after excluding outliers. CVs of expenses of patient groups in Korean medicine hospitals were gathered from under 70% to under 90%, and those in long-term care hospitals mostly belonged under 70%. Conclusions: The validity of KDRG-KM system was assured in terms of explanation power. By adapting KDRG-KM system, fairness of control targets selection for costliness management in Korean medicine hospitals can be enhanced.

• 대한치과의사협회지
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• 제54권12호
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• pp.971-984
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• 2016

The increase rate of dentists' competition is very fast at metropolitan areas in South Korea. We compare metropolitan and rural parameters to investigate the relation between competition and revenue variation. The competition and revenue variables of 73 metropolitan and 75 rural areas were calculated from 2010 Census of Service Industry microdata which include non-insurance revenues of dental clinics. Independent sample t-test results showed that the level of competition among dental clinics in metropolitan areas is higher. The lowest and the low ranked revenues are higher in rural areas. The highest and the average revenues are higher in metropolitan areas. But, 25 percentile and median revenues has no significant difference between two areas. Simple log linear regression results showed that the number of clinics could explain the distribution of revenues in both areas better than the density of active dentists and Herfindahl-Hirschman index. In the areas with many clinics have high maximum and average revenues and low minimum revenues. The increasing rate of maximum revenues is higher in metropolitan areas though the decreasing rate of minimum revenues is higher in rural areas. Metropolitan areas have higher Gini coefficients than rural areas, but the increasing rate of Gini coefficients is lower than rural areas. Findings from this study are useful reference when the dentists select the opening areas. One is that the median revenues between metropolitan and rural areas have no significant difference. The other is that the rural areas ensure the more stable and uniform revenues. The results would help to relieve the consumptive competition among dentists and to achieve the distributional efficiency of dental human resources.

• 대한치과의사협회지
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• 제55권5호
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• pp.339-350
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• 2017

The aim of the study was to analyze the distribution of dental filling materials for carious permanent teeth of school children in a city. The study was designed as time-serial study, using the data of the dental survey for children aged 8-, 10- and 12-year children living in Gimhae city. The samples were selected by stratified clusters sampling. The number of surveyed samples in depth-analysis for types of dental filling materials were 567 in 2009 and 331 in 2013, respectively. They had dental restorations on one or more teeth. The changing pattern of used dental filling materials was analyzed between 2009 and 2013. Statistical analysis was conducted according to variables related to dental filling material type; DMFT and DMFS index, number of fissure sealed teeth and surface and surveyed year. Amalgam filling rate decreased from 27.9% in 2009 to 18.8% in 2013, while filling rate of tooth-colored materials increased from 56.1% in 2009 and 68.9% in 2013. Amalgam filling rate was a negative correlation with filling rate of tooth-colored materials or gold and number of fissure sealed teeth and a positive correlation with DMFT index. Filling rate of tooth-colored materials was a negative correlation with filling rate of amalgam or gold and DMFT index and a positive correlation with number of fissure sealed teeth. The light-curing composite resin should be included in the reimbursement range of National Health Insurance to solve an inequity of dental health care services.

• Journal of Preventive Medicine and Public Health
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• 제37권3호
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• pp.267-273
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• 2004

Objectives : This study was aimed at investigating the medical service utilization pattern of patients who use public medical aid compared to those who have health insurance. Methods : We selected every patient between the age of 18 and 69 who used public medical aid from January 1, 1999, to December 31, 2001, in Gwangju metropolitan city, South Korea. For comparison, a list of patients with health insurance was gathered for same period. Then the medical records of those who had been hospitalized for acute appendicitis were selected among both groups. Of those records, we compared the number of cases of ruptured appendicitis to cases of whole acute appendicitis in both groups. Regarding coding for ruptured appendicitis, International Classification of Diseases - 10 (ICD-10) was used. Multiple logistic regression was used as a statistical tool to determine the effectiveness of risk factors. Results : Even after adjusting for risk factors, such as age and sex, the proportion of perforation of acute appendicitis among public medical aid patients was found to be significantly higher than among insured patients. Conclusions : This comparative study on ruptured appendicitis among public medical aid patients and insured patients, indicates that the proportion of perforation of acute appendicitis could be an index showing that these types of patients utilize medical services differently than insured patients. We know that when abdominal pain is not properly treated at the outset, it easily develops into ruptured appendicitis complicated with peritonitis. Considering this data analysis, we guess the public medical aid system to have significant problem with medical accessibility. So additional and systematic research on the pattern of utilization of medical services of public medical aid patients is needed.

• 보건의료산업학회지
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• 제10권2호
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• pp.71-82
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• 2016

Objectives : This study purposed to analyze the productivity trends of regional health care resource uses in South Korea. Methods : Data was provided from the regional health care statistics by the National Health Insurance Service(NHIS) and collected from 2011 to 2014 at the 226 administrative regions such as Si(city in Korean), Gun(county in Korean), Gu(district in Korean). Productivity trend was analyzed with Malmquist Productivity Index(MPI). Input variables were the number of medical personnels, facilities, and major medical equipments. Output variables were the number of inpatient and outpatients in model A, and the amount of inpatient and outpatient reimbursements in model B. Results : In model A, the productivity of 62 regions were increased but it was decreased in 164 regions. In model B, the productivity of 123 regions were increased but it was decreased in 123 regions. Conclusions : If these trends were continued, there will be problems with the efficiency of national regional healthcare resource utilization. Health policy makers will require to focus in solving this phenomenon.

• 보건교육건강증진학회지
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• 제31권4호
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• pp.51-62
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• 2014

Objectives: The objective of study was to calculate the municipal level environmental burden of disease (EBD) due to heat wave. Methods: The data used were Korea National Health Insurance 2011 claim data and 2011 death registry. Heatwave related diseases included hypertensive heart diseases, ischemic heart diseases, cerebrovascular disease, and heat related illness. According to the method that WHO proposed, the study computed population-attributable fraction with relative risk which come from previous study and proportion of exposure which the study calculated with historical meteorology data. Results: The Average of 251 municipal EBD was 2.11 per thousand persons. The value of years lost due to disability was 11 times higher than that of years of life lost. On average EBD of county and southern geographical areas tended to be higher than those of District or city areas. The relationship between municipal deprivation index (composite deprivation index) and EBD showed the positive association, which means that the worse deprived municipal is, the higher EBD takes. Conclusions: Climate change is getting one of the major risk factors of cardio-cerebrovascular disease, which is the second leading cause of death. The study results suggested the urgent policy planning and reaction of climate change adaptation.

• The Journal of Korean Physical Therapy
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• 제21권1호
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• pp.27-34
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• 2009

Purpose: The purpose of this study was to evaluate the effects of 8weeks of exercise station training with elastic band and swissball on body compositions and balance ability for elderly women. Methods: This study was designed as a experimental pre-post exercise station training evaluation. The experimental group performed exercises with band and ball for 8 weeks. The effects of the program were assessed using instruments measuring the body compositions and balance ability before and after participating in the training program. Results: There were no significant differences in body compositions and index of falling down risk, however, there were significant differences with balance index, functional reach test and one leg stand test. Conclusion: These findings suggest that exercise station training with elastic band and swissball can serve as an effective means of improving balance ability in elderly women.