• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제20권3호
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• pp.7-15
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• 2014

Purpose: This study is to propose direction for healing environment design in hospital architecture considering the characteristics of elderly patients. The primary goal of a public hospital is providing cheap health care and quality service chance to the underprivileged and elderly in the dead zone. Compared to the rapid increase of the aged population and chronic diseases, Ministry of Health & Welfare is currently planning model of health promotion hospital in development plans of local based public hospital. Due to the increased elderly medical expenses, elderly patients' high utilization is considered. Methods: The literature on the design factors of healing environments were investigated. based on this, analyzed drawings of surveyed hospitals ward in architectural characteristics and observe and evaluate directly healing environment design through field surveys. Results: The design of hospital environment affects patient's therapeutic effect. There is no any official formula for hospital design but environment that architect create could be a big part of the healing process. To increase the quality of the environment, apply the characteristic factors and harmonize well as a human-centered healing environment. Implications: Healing environment design for the elderly is first necessary condition due to high proportion of elderly patients.

• 성인간호학회지
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• 제15권3호
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• pp.402-410
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• 2003

Purpose: The purpose of this study was to develop a fundamental reference for the clinical implementation of Complementary and Alternative Therapy(CAT) by surveying and analyzing different perception and attitude between nurses and physicians. Method: A total of 167 nurses and 103 physicians from two C university health science centers participated in this survey, and SPSS program with version 10.0 was used to analyze the result of survey. Result: As results, 72.7% nurses and 57.1% physicians showed positive attitude for the concept of CAT, 60.6% nurses and 36.7% physicians responded positively while 2.6% nurses and 25.9% physicians responded negatively for the application of CAT to the clinical practice. There was a meaningful difference between two groups in the belief of therapeutic effectiveness of CAT. 67.7% nurses believed the therapeutic effectiveness of CAT while 38.8% physicians did. For attitudes of nurses and physicians toward CAT showed meaningful difference according to general characteristics: age, gender, marital status, a level of education, position in the organization, religion, and duration of health care service other than inpatient units. Conclusion: In this study, the attitudes of nurses and physicians about CAT showed meaningful difference that nurses were more positive than physicians in application.

• 간호행정학회지
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• 제23권2호
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• pp.139-150
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• 2017

Purpose: The purpose of this study was to identify nursing service costs associated with all health care costs incurred by the institution. Methods: This study was an empirical case study research in which the nursing cost was separated from total medical cost. The nursing cost index was calculated through a cost allocation method after summarizing costs for personnel, raw materials and administration of each department in one public hospital. The 2014 budget plan, published in 'Public Hospitals Alert', was used as data and the data were analyzed using the Microsoft Office EXCEL 2013 program. Results: When comparing total medical costs and nursing costs, the nursing cost were 27.14% of the total medical cost. The nursing cost per nurse per hour was calculated as \29,128 The nursing cost per inpatient per day was calculated as \157,970, and the administration cost per patient was calculated as \133,710. Conclusion: The results of the research present the process of cost allocation of specific cost elements in the hospital and evidence for administrative costs which in the past have been only vaguely formulated. These are the significant implications of this study.

• 한국병원경영학회지
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• 제23권3호
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• pp.52-62
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• 2018

This study aims to analyze the factors affecting in-hospital complication and length of stay in elderly patients with total knee arthroplasty. A total of 8,224 inpatients over 65 years old were selected from the national old inpatient sample data which was produced by Health Insurance Review and Assessment Service in 2016. STATA 12.0 was performed using frequency, chi-square test, t-test, ANOVA and multiple linear and logistic regression analysis. Analysis results show that ages(over 85), Charlson Comorbidity Index, district(metropolitan) for general hospitals and gender, district, beds(100-199) for hospitals are significantly influenced in-hospital complication. Statistically significant factors affecting the length of stay are gender, insurance type, depression, district, bed(300 over) for general hospitals and gender, type of insurance, Charlson Comorbidity Index, depression, district, beds(200-299) for hospitals. Based on these findings, the factors affecting in-hospital complication and length of stay were different depending on the type of medical institution. Accordingly, policymakers should analyze the differences in care behavior depending on the type of medical institution and expand policy and financial support to resolve them.

• 보건행정학회지
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• 제26권1호
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• pp.71-78
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• 2016

The value of using health insurance claim database is continuously rising in healthcare research. In studies where comorbidities act as a confounder, comorbidity adjustment holds importance. Yet researchers are faced with a myriad of options without sufficient information on how to appropriately adjust comorbidity. The purpose of this study is to assist in selecting an appropriate index, look back period, and data range for comorbidity adjustment. No consensus has been formed regarding the appropriate index, look back period and data range in comorbidity adjustment. This study recommends the Charlson comorbidity index be selected when predicting the outcome such as mortality, and the Elixhauser's comorbidity measures be selected when analyzing the relations between various comorbidities and outcomes. A longer look back period and inclusion of all diagnoses of both inpatient and outpatient data led to increased prevalence of comorbidities, but contributed little to model performance. Limited data range, such as the inclusion of primary diagnoses only, may complement limitations of the health insurance claim database, but could miss important comorbidities. This study suggests that all diagnoses of both inpatients and outpatients data, excluding rule-out diagnosis, be observed for at least 1 year look back period prior to the index date. The comorbidity index, look back period, and data range must be considered for comorbidity adjustment. To provide better guidance to researchers, follow-up studies should be conducted using the three factors based on specific diseases and surgeries.

• Tuberculosis and Respiratory Diseases
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• 제81권3호
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• pp.175-186
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• 2018

Pneumonia is an important cause of morbidity and mortality. Since 2014, the Health Insurance Review and Assessment Service (HIRA) has assessed the overall quality of care among hospitalized adult patients with community-acquired pneumonia (CAP) provided by all medical institutions in Korea. A committee of the Korea Academy of Tuberculosis and Respiratory Diseases developed the hospital inpatient quality measures set for CAP consisting of eight core measures and five monitoring measures. The composite measure score was calculated. The medical records of hospitalized adult patients ages 18 years or more with CAP from October to December 2014 were evaluated. The data of 523 hospitals (42 tertiary hospitals [8.0%], 256 general hospitals [49%], and 225 hospitals [43.0%]) and 15,432 cases (tertiary hospitals, 1,673 cases [10.8%]; general hospitals, 8,803 cases [57.1%]; hospitals, 4,956 cases [32.1%]) were analyzed. We found large variations among institutions in terms of performance of care measures for CAP. For the composite measure score, the mean value was 66.7 (tertiary hospitals, 98.5; general hospitals, 79.2; hospitals, 43.8). Despite significant differences in measure scores between tertiary, general hospitals and hospitals, no significant differences were found in mortality between hospitals. Further studies are needed to determine the care measures appropriate for CAP.

• Perspectives in Nursing Science
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• 제6권1호
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• pp.77-83
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• 2009

The number of nurses per bed at acute-stage hospitals is quite low in Korea compared with other OECD countries. In order to prevent the degradation of the quality of inpatient nursing services due to insufficient nurse staffs, the national health insurance introduced the differentiated nursing care fee system. This did not work as a motive for inducing the employment of nursing staff due to insufficient cost compensation. Because of insufficient nursing staff, family members have to stay with the patient or patients have to hire a personal care attendant. This increases the burden and cost to families. For the activation of hospitals without guardians, there should be policies for raising additional nursing staff such as standardizing jobs among nursing staff, particularly between nurses and nursing assistants, setting adequate standards of staffing in nursing according to medical service, substantiating the cost of nursing under the differentiated nursing care fee system, improving the medical fee system of hospitals without guardians including health insurance payment, supplying nursing staff stably through improving their working conditions such as providing child rearing services and salary increase, clarifying the qualification of personal care attendants working at acute.stage hospitals, developing indexes for assessing the quality of nursing care services, and monitoring for the management of uniform quality.

• 임상간호연구
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• 제23권1호
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• pp.64-72
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• 2017

Purpose: This study aimed to explore the distributions of nurse staffing grades and to report changes in staffing grades in general wards and adult and neonatal intensive care units(ICUs) by hospital type and location. Methods: Data collected from the Health Insurance Review and Assessment Service were analyzed. Nurse staffing was categorized from grades 1 to 6 or 7 for general wards, 1 to 9 for adult ICUs, and 1 to 4 for neonatal ICUs based on the nurse-to-bed ratio. Results: The staffing grade for the general wards improved during 2008-2016 in 69.8% of the tertiary hospitals, 58.5% of the general hospitals, and 31.7% of the non-general hospitals. The adult ICUs at tertiary hospitals exhibited a greater improvement in staffing grades (48.8%) than did those of general hospitals (44.2%) during 2008-2015. Tertiary hospitals in non-capital regions showed a greater improvement than those in the capital region. The majority of neonatal ICUs (67.1%) had no change in the staffing grade during 2008-2015. Conclusion: Improvements in nurse staffing differed by hospital type and location. Government policies to improve nurse staffing in non-tertiary hospitals and those in non-capital regions are required to reduce variations in nurse staffing.

• 한국병원경영학회지
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• 제27권2호
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• pp.44-52
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• 2022

Purposes: This study tried to extract variables affecting patient-experience satisfaction level in hospital situation, using a multiple-regression analysis and ISA(Revised Importance-Satisfaction Analysis), and to explore variables needed to be improved. Methodology: A mobile-based online patient-experience survey was conducted in eleven general hospitals in A city. To test the validity of this test, this data was compared with the data from Health-Insturance Review and Assessment Service. Then, the standardized regression coefficients extracted from a multiple-regression analysis were used as the importance scale to be used in ISA. Finding: Taken together, the areas with the highest contribution for the in-hospital patient-experience satisfaction level were medication and treatment process and hospital environment. In conclusion, the revised ISA which can show satisfaction and importance both with simultaneously and multi-axis way would be useful in hospital improvement activities. Practical Implications: This study tried to develop a mobile-based patient-experience survey, and to extract the major variables affecting patient-satisfaction level and to identify variables need to be improved. Finally, this should help hostipals to prepare the assessment process with various improvement activities.

• The Journal of Asian Finance, Economics and Business
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• 제9권1호
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• pp.93-103
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• 2022

The main purpose of this study was to gauge the patient satisfaction index and subsequently discuss the Importance-Performance (IP) matrix analysis of the inpatient services in the context of the private hospital setting. The Malaysian Customer Satisfaction Index Model was employed as the theoretical framework for the above purposes. This study involving 242 patients in Malaysian's private healthcare sector used a Web-based survey as the main method of data collection. Partial least square structural equation modeling (PLS-SEM) was utilized for data analysis. Using Fornell et al. (1996)'s formula, the resulting patient satisfaction index was slightly lower than the "very satisfied" category, the target level required for positioning as one of the world's premier medical tourism players. The IP matrix showed that medical quality is the main competitive advantage of the private hospitals that can propel their growth in the global healthcare marketplace. The results also indicate that outcome quality, patient rights, and privacy, and service quality are the three quality domains that need to be prioritized for further improvement. On the other hand, the servicescape quality domain needs to be strategized as the unique selling proposition as the performance of the private hospitals in this regard is already extremely good.