• 한국의료질향상학회지
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• 제26권2호
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• pp.95-103
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• 2020

Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

• 대한지역사회영양학회지
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• 제20권3호
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• pp.220-235
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• 2015

Objectives: The purpose of this study was to investigate how clinical nutrition services is provided at a long term care hospital in Korea and to investigate job satisfaction levels of the clinical dietitians. Methods: Survey questionnaire was sent to dietitians working at a long term care hospital in Korea. The participating hospitals (n=240) were randomly selected from 1,180 long- term care hospitals using a stratified sampling method. A total of 134 long term care hospital s and 223 dietitians completed the survey of clinical nutrition service s and job satisfaction questionnaires The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas. Results: The average nutritional screening rate was 17.9% and the rate of computerized nutritional screening system was 9.7% in the participating hospitals. Nutritional intervention rate was only 3.2% of all patients. KOIHA (Korea Institute for Healthcare Accreditation) accreditated hospitals showed only 50% performance rate of nutrition service evaluation area. This shows that after achieving KOIHA accredition, many hospitals do not emphasize the performance of nutritional services. The job satisfaction scores in all four areas ranged from 2/5 to 3/5, implying generally low job satisfaction level in hospital dietitians. Linear regression analysis results showed that the "hospital adequacy grade" type was a significant predictor of job satisfaction level for two areas (working conditions & relationship). Conclusions: There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service s in long term care hospitals. Therefore, government and local hospitals have to work on implementing nutritional programs and policies for improved service and care.

• 한국응급구조학회지
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• 제17권1호
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• pp.63-78
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• 2013

Purpose : This study aimed to improve quality of prehospital emergency care for the insect bite patients by figuring out its current situations and problems. Methods : This study was conducted to 219 insect bite patients who were transferred to the hospital by 119 ambulance in D-City from July 1, 2009 to June 30, 2011. This study was a descriptive study by 119 run sheets. A total of 171 emergency medical technicians(EMTs) working in D-city and C-province completed the questionnaire. All of data were analyzed by SPSS 18.0. Results : Among the 219 patients, bee sting accounted for 62.6% and wasp sting accounted for 20.1%. Some patients complained of dizziness, headache, dyspnea, and disturbance of consciousness. The 119 EMTs initially treated the patients with oxygen supply to 57 patients (31.1%). Knowledge toward insect bite was statistically significant (p=.000) between advanced EMTs and basic EMTs. The obstacle to the prehospital care, many EMTs answered that the obstacle was due to the lack of 119 EMTs. Conclusion : It is necessary to differentiate the patients' symptoms and provide the better prehospital emergency care to verify the exact symptoms and signs.

• 간호행정학회지
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• 제17권4호
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• pp.432-442
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• 2011

Purpose: The purpose of this study was to identify the factors influencing the intention of the reuse in patients admitted in university hospital emergency medical center. Method: The participants were 253 patients admitted to a niversity hospital emergency medical center. Data were collected with self-administrated questionnaires and analyzed by hierarchical multiple regression. Results: Patient satisfaction with nursing care service and switching cost were positively correlated with reuse by patients while the perceived risk was negatively correlated. As levels of satisfaction with nursing care services and switching cost increase, intention of reuse increases. Satisfaction with nursing care service, switching cost and perceived risk in emergency medical center influence intention to reuse and explain 68.8% of total variation of intention to reuse. Conclusion: Findings provide strong empirical evidence for importance of atient satisfaction with nursing care service, the switching costs and the perceived risk in explaining the intention of reuse an emergency medical center.

• 보건행정학회지
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• 제33권3호
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• pp.370-375
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• 2023

The responsibility to ensure the health rights of detainees, particularly their medical rights, fundamentally lies with the state in all nations. However, in the correctional facilities of the Republic of Korea, these rights are currently not adequately safeguarded. Numerous detainees express dissatisfaction with the medical services provided and show a preference for voluntary external treatment. However, barriers such as prolonged application processes for external treatment and the requirement for detainees to cover their medical expenses present significant challenges. Therefore, the National Human Rights Commission of Korea has advocated for an increased medical budget in correctional facilities and a bolstered professional medical workforce to improve the medical care of detainees. Recommendations for improvements include: (1) establishing dedicated correctional hospitals for detainees, (2) setting up specialized correctional wards, (3) collaborating with military hospitals, (4) launching mobile medical buses for diverse specialties, (5) enhancing collaboration with public and private medical institutions, (6) increasing compensation for partnering external medical institutions, (7) improving the working conditions of medical officers, (8) safeguarding the defense rights of medical staff, (9) improving the working conditions of public health doctors from the Ministry of Justice in correctional facilities, and (10) pre-assigning public health specialists and military doctors to correctional facilities. By implementing these measures, it is anticipated that the quality of medical services in the Republic of Korea's correctional facilities will improve, reducing the demand for external treatments among detainees and ensuring their health and medical rights are realistically upheld.

• 한국응급구조학회지
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• 제24권1호
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• pp.67-76
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• 2020

Purpose: Effective time management, as well as life-saving care, are important in maximizing the prognosis of patients who have sustained major traumas. This study evaluated the appropriateness of emergency medical system (EMS) provider's essential care and how this care impacted on-scene time in patients with major traumas. Methods: This retrospective observational study analyzed the EMS major trauma documents, classified according to the physiological criteria (Glasgow coma scale <14, systolic blood pressure <90mmHg, Respiration rate <10 or >29) in Daejeon, from January, 2015 to December, 2018. Results: Of the 707 major trauma cases, the mean on-scene time was 7.75±4.64 minutes. According to EMS guidelines, essential care accuracy was 67.5% for basic airway, 36.4% for advanced airway, 91.2% for cervical collar, 81.5% for supplemental oxygen, 47.0% for positive pressure ventilation, 19.9% for intravenous access and fluid administration, and 96.0% for external hemorrhage control. Factors affecting on-scene time were positive pressure ventilation (p<.004), and intravenous access and fluid administration (p<.002). Conclusion: Adherence to guidelines was low during advanced airway procedures, positive pressure ventilation, intravenous access, and fluid administration. In addition, the on-scene time was prolonged when the practitioner provided positive pressure ventilation, intravenous access, and fluid administration; however, these durations did not exceed the recommended 10 minutes.

• 한국병원경영학회지
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• 제28권2호
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• pp.21-31
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• 2023

Purposes: Patient experience is a tool to evaluate the process and results of medical services provided by medical institutions from the patient's point of view. Patient satisfaction surveys are a meaningful and essential source of information for improving quality in healthcare organizations. This study aims to provide basic data for improving the quality of medical service that patients can feel by analyzing the recommendation intention and satisfaction of inpatients in specialty hospitals. Methodology: The subjects of this study were 879 inpatients in 28 specialty hospitals in 14 designated fields. We conducted a telephone survey with a structured questionnaire on the satisfaction and recommendation intention for specialty hospitals. Findings: In inpatients, hospital satisfaction was higher in nursing care services and hospital satisfaction was low in physicians care services. The overall patient satisfaction score was 91.4(SD=11.9) out of 100, and the intention of recommendation was 92.0(SD=14.1) out of 100. The factors affecting patient experience were designated fields, sex, age, residential area, monthly household income, and perceived health status. Practical Implications: This study confirmed the high level of patient satisfaction and recommendation intention among inpatients of specialty hospitals. Patient satisfaction can be of great value to healthcare providers in recognizing and improving the quality of care, as well as predicting patients' willingness to revisit medical institutions. This study can be used to improve the quality of hospital care services in specialty hospitals rather than general and tertiary general hospitals.

• 한국응급구조학회지
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• 제17권3호
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• pp.115-137
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• 2013

Purpose: The purpose of this study was to investigate the extended job of paramedic after the 1st job description in 2000 by the National Health Personnel Licensing Examination Board. Methods: This study was carried out from May 2012 to July 2013 on the Developing A Curriculum (DACUM) method to analysts 330 responses among 400 questionnaires (response rate 82.5%) after analysing 30 pilot questionnaires. In order to enhance validity and reliability of this job description, 2 job analysts in universities and 10 EMT-Paramedics in hospitals and fire stations were recruited. Results: There were differences between 166 (year 2000) and 240 (2012) in task element. There were higher answering at triaging patient(2.64 frequency, 4.15 importance), calling for help(2.68 frequency, 4.07 importance) in disaster emergency care. There were higher answering at measuring vital sign (3.95 frequency, 4.22 importance), measuring ECG(3.84 frequency, 4.14 importance), wound care(3.48 frequency, 3.86 importance), bleeding control & wound care(3.46 frequency, 3.86 importance), applying $O_2$(3.40 frequency, 3.94 importance) in physician assistant. Conclusion: Scope of extended practice as a physician assistant in hospital setting recommended us to replace the present curriculum and national exam with new curriculum and national written & skill test.

• 보건행정학회지
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• 제32권1호
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• pp.3-13
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• 2022

Health centers provided intensive health care services for local residents according to changes in the times and environment. Public health centers were given various roles such as medical treatment, administration, and service, and the demand for functional reorganization has emerged. We analyzed the literature on the functional restructuring of public health care institutions. In addition, the current status of medical services, which is the main function of institutions, will be analyzed through health insurance statistical data, and detailed contents will be analyzed according to regional types and income levels. As a result of the analysis of medical services at institutions, the total number of patients was 2,238,000, and the number of visits was 11,806 times. Total medical expenses were 169.6 billion won, of which 132 billion won was found to be benefit. When analyzing the number of patients per institution, public health centers had the largest number of 4,326, and the share of benefit was also the highest at public health centers. It should focus on the function of providing local health and medical services related to health promotion and disease prevention in the community. This functional reorganization of public health centers can contribute to forming cooperative relationships with private medical institutions in the local community. For this, first, to establish the role, essential functions for public health centers for preventive health management are established. Secondly, regular manpower expansion and flexible manpower management are required in the human resources sector. Finally, in the organizational sector, it is necessary to establish a step-by-step organizational system according to environmental changes.

• 가정∙방문간호학회지
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• 제7권1호
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• pp.58-72
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• 2000

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.