• Journal of Digital Convergence
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• v.13 no.12
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• pp.245-257
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• 2015

This study was to develop the predictive model for severity-adjusted mortality of inpatients with multiple chronic conditions and analyse the factors on the variation of hospital standardized mortality ratio(HSMR) to propose the plan to reduce the variation. We collect the data "Korean National Hospital Discharge In-depth Injury Survey" from 2008 to 2010 and select the final 110,700 objects of study who have chronic diseases for principal diagnosis and who are over the age of 30 with more than 2 chronic diseases including principal diagnosis. We designed a severity-adjusted mortality predictive model with using data-mining methods (logistic regression analysis, decision tree and neural network method). In this study, we used the predictive model for severity-adjusted mortality ratio by the decision tree using Elixhauser comorbidity index. As the result of the hospital standardized mortality ratio(HSMR) of inpatients with multiple chronic conditions, there were statistically significant differences in HSMR by the insurance type, bed number of hospital, and the location of hospital. We should find the method based on the result of this study to manage mortality ratio of inpatients with multiple chronic conditions efficiently as the national level. So we should make an effort to increase the quality of medical treatment for inpatients with multiple chronic diseases and to reduce growing medical expenses.

• Health Policy and Management
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• v.11 no.1
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• pp.1-18
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• 2001

The purpose of the present study was to assess the agreement of survival probability estimated by International Classification of Diseases l0th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with professional panel's judgment on preventable death. ICISS has a promise as an alternative to Trauma and Injury Severity Score(TRISS) which have served as a standard measure of trauma severity, but requires more validation studies. Furthermore as original version of ICISS was based ICD-9CM, it is necessary to test its performance employing ICD-10 which has been used in Korea and is expected to replace ICD-9 in many countries sooner or later. Methods : For 1997 and 1998 131 trauma deaths and 1,785 blunt trauma inpatients from 6 emergency medical centers were randomly sampled and reviewed. Trauma deaths were reviewed by professional panels with hospital records and survival probability of trauma inpatients was assessed using ICD-10 based ICISS. For trauma mortality degree of agreement between ICISS survival probability with judgment of professional panel on preventable death was assessed and correlation between W-score and preventable death rate by each emergency medical center was assessed. Results : Overall agreement rate of ICISS survival probability with preventable death judged by professional panel was 66.4%(kappa statistic 0.36). Spearman's correlation coefficient between W-score and preventable death rate by each emergency medical center was -0.77(p=0.07) and Pearson's correlation coefficient between them was -0.90(p=0.01). Conclusions : The agreement rate of ICD-10 based ICISS survival probability with of professional panel's judgment on preventable death was similar to TRISS. The W-scores of emergency medical centers derived from ICD-10 based ICISS were highly correlated with preventable death rates of them with marginal statistical significance.

• Quality Improvement in Health Care
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• v.15 no.2
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• pp.107-120
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• 2009

Background : To estimate fall incidence rate and associated factors in inpatients from a general hospital. Method : The data were collected from 104 fall incident reports developed by the patient safety committee in a general hospital in Seoul from 01 January 2007 to 31 December 2008. Information included general characteristics of patients, factors related to fall, types, places, circumstances and outcomes of fall. Result : The incidence rate of fall, which was 4.4 per 1,000 total discharged patients and 0.5 per 1,000 patient-days, was much lower than that of several hospitals in the United States. The difference may reflect the different incidence reporting system of each hospital. Fall-prone patients were, in general, $$\geq_-$$65 years of age, had an alert mental status, were ambulatory with some assistance, and were dependent on and ambulatory device. High incidence of falls was associated with patients with circulatory disease. The majority of fall events usually occurred in bed or at the bedside in the patient's room, and occurred more often during the night than during the day or evening. Risk factors of fall were use of drugs (antihypertensive or neuropsychiatric drugs) and environmental factors (e.g., overly high bed height, surrounding objects, inadequate fitness shoes and slippery floor). Physical injury occurred in 43.3% of fall events, which typically required diagnosis of injury and treatment such as suturing. Risk factors for repeated falls were use of a neuropsychiatric drug (odds ratio=13.9) and gait disturbance (odds ratio=91.2). Risk factors for fall-related injury were alert mental status (odds ratio=3.3 times more likely to fall than those who were drowsy or in a stupor) and general weakness(odds ratio=3.3 times more likely to fall than those who were not generally weak). Conclusion : Medical and nursing staff should be aware of the fall risk factors of hospitalized patients and should intensively pursue preventative strategies. Development of fall prevention education based on these results is recommended.

• Journal of Korean Clinical Nursing Research
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• v.23 no.3
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• pp.350-360
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• 2017

Purpose: The purpose of this study was to investigate the present status of falls among inpatients in general hospitals and to identify the fall risk factors that reflect the characteristics of domestic hospitals. Methods: Data were collected between December 15, 2016 and January 15, 2017 from 32 Korean hospitals having 500 or more beds. First, 42 risk factors were extracted based on literature review and expert opinions. Then the importance of each factor was evaluated by 223 nurses from medical and surgical adult ward and intensive care units in 40 hospitals. Results: The incidence rate of falls in 18 hospitals was 3.87 per 1,000 total discharged patients and 0.55 per 1,000 patient-days, and the rate of injury-related falls was 40.5%. Major risk factors for falling were identified as the following: being over 65 years of age, history of falls during admission, physical mobility disorders requiring assistance, physical factors (dizziness or vertigo, unstable gait, general weakness, walking aids, visual problems), cognitive factors (delirium, lack of understanding on limitations), neurological disease, CNS medications Conclusion: The findings provide information that can be in the development of a fall risk assessment tool for inpatients in general hospitals in Korea.

• Health Policy and Management
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• v.23 no.3
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• pp.233-243
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• 2013

Background: This study was conducted to evaluate the individual and community level factors which were influencing the severe injury patients' death and transfer at discharge. Methods: Analysis data is based on Korean National Hospital Discharge In-depth Survey Data released by the Korea Center for Disease Control and Prevention from 2006 to 2008. Study subjects was 11,026 inpatients with of severe injury. For multi-level analysis, socio-demographic characteristics, injury related characteristics, hospitalization related characteristics were used as individual level factors, and socio-environmental characteristics and health care resource characteristics were used as community level factors. Results: As to community level factors affecting mortality of severe injury, the possibility of death was also high in cases of less numbers of surgeons per a population of 100,000 and more number of operation beds. As to community level factors affecting transfer of severe injury, vulnerable areas with higher social deprivation index and low population density had higher possibility of transfer. Conclusion: Both individual level factors and community level factors affected clinical outcomes of treatment for severe injury. In particular, since there happened higher death and transfer of severe injury in socioeconomic and medical vulnerable areas, special efforts for establishing preventive policy and care system for injury in national and area level should be directed toward such areas.

• The Korean Journal of Rehabilitation Nursing
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• v.20 no.1
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• pp.33-41
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• 2017

Purpose: This study is a descriptive study to analyze the relationship between the cognitive function, body image and pain, and the influencing factors on the daily life performance of brain injured patients. Methods: The study subjects were 119 inpatients with brain injury who gave informed consent. The activities of daily living (ADLs), cognitive function, pain and body image were measured by Modified Barthel Index (K-MBI), K-MMSE (Mini-Mental State Examination), Visual Analog Scale (VAS), Semantic Differential Method (SDM), respectively. Results: ADLs was significantly associated with body image, cognitive function, and pain. Multiple regression analysis showed that paralysis, consciousness, cognitive function, and pain were significant factors influencing ADLs. Overall, approximately 48% of total variability in the ADLs could be explained by the 4 variables ($R^2=.477$, p<.001). Conclusion: To improve ADLs of brain injury patients, a deeper understanding of paralysis, consciousness, cognitive function, and pain of patients is required and active nursing invention should be conducted.

• Physical Therapy Korea
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• v.12 no.4
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• pp.48-57
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• 2005

The purpose of this study was to evaluate the general characteristics, complications and level of social adaptation of spinal cord injured patients. The subjects were one hundred forty five members who were inpatients or outpatients from October 1, 2004 to April 30, 2005 in general hospitals and municipal welfare centers for the handicapped located in the metropolitan city of Gwangju. The following results were obtained using Modified Barthel Index (MBI). 1) Gender distribution was 77.9% male and 22.1% female. The mean age at the time of injury was 35.4 and the mean age during the study was 44.2. 2) The degree of paralysis among the subjects was as follows: 49.0% had complete paralysis and 51.0% suffered incomplete paralysis. The most frequently injured lesion among the subjects was cervical (49.0%), followed by thoracic (35.9%), and lumbar (15.2%). 3) The mean MBI score was 63.5. There was statistically significant difference in the MBI score in the relation between complete and incomplete paralysis, the relation between cervical, thoracic, and lumbar injury, and the relation between a recovery period of less than three years and more than three years according to the characteristics of injury (p<.05). 4) There was statistically significant difference in the MBI score of subjects who had complications concerning spasticity, deformity, urinary tract infection, and sexual dysfunction (p<.05). 5) The most serious emotional pain after spinal cord injury resulted from economic issues, which affected 35.2% of the subjects. The group having a shorter recovery period after spinal cord injury complained of psychological matters, the group having a longer recovery period complained about the surrounding environment (lack of convenient facilities), suggesting statistically significant difference (p<.05). 6) The most common activities of the group with injuries more than ten years old included meeting schoolmates and working, while most common activities of the group with injuries less than three years old included attending religious functions and miscellaneous others (watching TV, spending time with family), suggesting statistically significant difference (p<.05).

• Physical Therapy Korea
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• v.12 no.1
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• pp.54-62
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• 2005

The purpose of this study was to find the effects of using aid in enhancing walking ability inpatients with spinal cord injury who have received rehabilitative care. The study population consisted of 24 spinal cord injury patients referred to the Department of Rehabilitation Medicine in the National Rehabilitation Center (NRC). All subjects were ambulatory with or without an assistive devices. All of the participants were assessed on SCIM II, WISCI II, FIM, MBI, gait speed (m/s), and walking endurance (120 min/m). The data were analyzed using a paired t-test, a one-way ANOVA, and a Duncan test. The results revealed that TSCIM II and all of the items of SCIM II of the cervical ASIA D group patients were higher than those of the Thoracic ASIA A and C group patients (p<.05). The FIM, MBI, and WISCI II of the cervical ASIA D group patients were higher than those of the Thoracic ASIA C group patients (p>.05). The walking velocities of the lumbar ASIA C group patients were higher than those of Thoracic ASIA A group patients (p<.05). The walking endurance of the lumbar ASIA C group patients was higher than that of the thoracic ASIA C group patients (p<.05). The ASIA D group patients used bilateral standard canes or crutches, but none used AFO. The ASIA A and C group patients used bilateral standard walkers with KAFO for standing and walking. The findings suggest that injury level as well as the functionality of walking aids should be considered when formulating a rehabilitative plan for patients with spinal cord injury.

• The Journal of Internal Korean Medicine
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• v.41 no.3
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• pp.531-541
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• 2020

From January 2014 to December 2016, 38 out of 153 inpatients admitted to the Korean Medicine Hospital for more than one month underwent follow-up blood tests to evaluate their liver function levels, and one drug-induced liver injury (DILI) patient was observed. 1. At the time of admission, six (15.8%) of the 38 patients had abnormal alanine aminotransferase (ALT) levels and five of them recovered after hospitalization. 2. At follow-up, two (5.3%) patients had a Council for International Organizations of Medical Science (CIOMS)-based liver injury. One was identified as a liver injury accompanied by pneumonia, and one was judged as a liver injury caused by the drug. 3. The patient had a suspected DILI and completely recovered after 13 days while discontinuing the herbal medication and by using Sanggangunbi-tang (生肝健脾湯).

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.159-167
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• 2022

Purpose: The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea. Methods: In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study. Results: VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3-5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0-2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3-5) for VTE was 1.891 (95% confidence interval, 1.043-3.430). Conclusions: Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.