• Health Policy and Management
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• v.26 no.4
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• pp.289-304
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• 2016

Background: Rehabilitations in subacute phase are different from acute treatments regarding the characteristics and required resource consumption of the treatments. Lack of accuracy and validity of the Korean Diagnosis Related Group and Korean Out-Patient Group for the acute patients as the case-mix and payment tool for rehabilitation inpatients have been problematic issues. The objective of the study was to develop the Korean Rehabilitation Patient Group (KRPG) reflecting the characteristics of rehabilitation inpatients. Methods: As a retrospective medical record survey regarding rehabilitation inpatients, 4,207 episodes were collected through 42 hospitals. Considering the opinions of clinical experts and the decision-tree analysis, the variables for the KRPG system demonstrating the characteristics of rehabilitation inpatients were derived, and the splitting standards of the relevant variables were also set. Using the derived variables, we have drawn the rehabilitation inpatient classification model reflecting the clinical situation of Korea. The performance evaluation was conducted on the KRPG system. Results: The KRPG was targeted at the inpatients with brain or spinal cord injury. The etiologic disease, functional status (cognitive function, activity of daily living, muscle strength, spasticity, level and grade of spinal cord injury), and the patient's age were the variables in the rehabilitation patients. The algorithm of KRPG system after applying the derived variables and total 204 rehabilitation patient groups were developed. The KRPG explained 11.8% of variance in charge for rehabilitation inpatients. It also explained 13.8% of variance in length of stay for them. Conclusion: The KRPG version 1.0 reflecting the clinical characteristics of rehabilitation inpatients was classified as 204 groups.

• Journal of Korean Medical classics
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• v.30 no.1
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• pp.185-209
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• 2017

Objectives : The objective of this paper is to review the healing processes employed in the traditional age and discover the unique features found in the Korean Medicine through categorizing and analyzing the distribution of patients, and the aspects and results of treatments as recorded in Gyeongbosinpyeon, a historical text thought to have been authored by a regional doctor active in Joseon during the mid- to late-19th century. Methods : A table is created to view all of the total of 141 medical records introduced in the Gyeongbosinpyeon, and 7 categories were created to each contain 2 to 3 medical records that have special images. The paper provides their translation texts along with the original texts, and analyzed their medical and social significances by comparing each medical record. Results : The clinical competence displayed by the doctor who had worked in Joseon during the 19th century was surprisingly high, and it seems its values are worthy of dissemination when compared with Yeogsimanpil that has been introduced to the world. There is a great significance in how the principle of holistic treatments, the fundamental aspect of Joseon's medical study, was adhered. Additionally, the parts that show the historical text's author's medical activities and their unique characteristics are also worthy of attention. Conclusions : Korean medicine possesses a remarkable text called Donguibogam, but clinical behaviors' successes are not guaranteed solely with textual knowledge. It can be witnessed that such texts of authority and such medical records that have recorded actual activities complement each other in order to improve the quality of Joseon's study of medicine.

• Clinical and Experimental Emergency Medicine
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• v.5 no.4
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• pp.264-271
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• 2018

Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.

• Korea Journal of Hospital Management
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• v.15 no.4
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• pp.125-142
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• 2010

Objective : To determine demographic, clinical, health care utilization factors predicting unplanned readmission(within 28 days) to the hospital. Methods : A case-control study was conducted from January to December 2009. Multiple logistic regression was used to examine risk factors for readmission. 180 patients who had been readmitted within 28 days and 1,784 controls were recruited from an university hospital in Seoul. Results : Six risk factors associated with readmission risk were identified and include mail sex, medical service rather than surgical service, number of comorbid diseases, type of patient's room, lenth of stay, number of admissions in the prior 12 months. Conclusions : One of the association with readmission risk identified was the number of hospital admissions in the previous year. This factor may be the only risk factor necessary for assessing prior risk and has the additional advantage of being easily accessible from computerized medical records without requiring other medical record review. This risk factor may be useful in identifying a group at high readmission risk, which could be targeted in intervention studies. Multiple risk factors intervention approach should be considered in designing future prevention strategies.

• Journal of Korean Clinical Nursing Research
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• v.19 no.3
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• pp.357-368
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• 2013

Purpose: The purpose of this study was to investigate risk factors related to delirium and to develop screening model on delirium occurrence in MICU (Medical Intensive Care Unit) patients. Methods: For developing a preliminary tool for delirium, the data of 166 patients were collected and analyzed. In order to estimate the accuracy and discriminating power for the developed screening model, 98 patients were enrolled. The data used in this study were collected by EMR (Electronic Medical Record) review from January to September in 2012. The collected data were analyzed using SPSS/PC Win 18.0 program. Results: Screening model on delirium in MICU patients was developed using the results of logistic regression. The total score of screening model was 24 point and measuring point was 10 point. When the measuring point is over 10 point, it means that the risk of delirium occurrence is high. The discriminating power and the validity of screening model showed AUC .908 (p <.001) and .935 (p <.001) respectively. This result showed that the screening model on delirium which developed in this study was an appropriate model for screening the delirium risk group in MICU. The sensitivity of the screening model was 83%, specificity 89% and accuracy 84%. Conclusion: The developed screening model on delirium occurrence in MICU should be combined with EMR for screening and preventing delirium in a high risk group.

• Journal of Physiology & Pathology in Korean Medicine
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• v.35 no.5
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• pp.132-138
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• 2021

Artificial intelligence technology sheds light on new ways of innovating acupuncture research. As acupoint selection is specific to target diseases, each acupoint is generally believed to have a specific indication. However, the specificity of acupoint selection may be not always same with the specificity of acupoint indication. In this review, we propose that the specificity of acupoint indication can be inferred from clinical data using reverse inference. Using forward inference, the prescribed acupoints for each disease can be quantified for the specificity of acupoint selection. Using reverse inference, targeted diseases for each acupoint can be quantified for the specificity of acupoint indication. It is noteworthy that the selection of an acupoint for a particular disease does not imply the acupoint has specific indications for that disease. Electronic medical record includes various symptoms and chosen acupoint combinations. Data mining approach can be useful to reveal the complex relationships between diseases and acupoints from clinical data. Combining the clinical information and the bodily sensation map, the spatial patterns of acupoint indication can be further estimated. Interoperable medical data should be collected for medical knowledge discovery and clinical decision support system. In the era of artificial intelligence, machine learning can reveal the associations between diseases and prescribed acupoints from large scale clinical data warehouse.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.82-103
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• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• Information Systems Review
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• v.25 no.1
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• pp.165-187
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• 2023

The continuous increase in life expectancy and high interest in health has brought about significant changes in the use of health information by the public according to the development of information technology represented by the Internet and smartphones. As the medical market expands to the mobile health environment, many health-related apps have been created and distributed, but the acceptance rate is slow as it has become challenging to provide services due to various regulations. In this study, perceived value, perceived risk factors (psychological risk, risk of time-loss, legal risk), and perceived benefits (usefulness, interaction, autonomy) were derived and verified as factors that affect the acceptance resistance of personal health record apps based on the privacy calculation model. In addition, by analyzing the moderating effect of trust in the manufacturer, how the perceived risk and perceived benefit affect the perceived value was verified. A survey was conducted on Korean college students who recognized the personal health record apps but did not use them, and 127 samples were analyzed using structural equations. As a result of hypothesis verification, perceived value has a negative effect on acceptance resistance, perceived risk (risk of time-loss) has a negative effect on perceived value, and perceived benefits (usefulness, interaction, autonomy) were found to have a positive effect on perceived value. Trust in manufacturers has weakened the impact of perceived risks (legal risk) on perceived values. This study is expected to play an important role in maintaining a competitive advantage in the personal health record app market environment by identifying and proposing detailed criteria for reducing the acceptance resistance of personal health record apps.

• Journal of Korean Clinical Nursing Research
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• v.21 no.3
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• pp.377-388
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• 2015

Purpose: To identify user requirements for electronic nursing record (ENR) systems so as to ensure system usability. Methods: A mixed methods approach were applied in three steps : (i) task and workflow analysis with literature review of nursing documentation, (ii) literature reviews of system usability, and (iii) Use Case idenfication and consensus-based validation. We analyzed the nursing activity logs collected from a time-motion investigation of six hospitals. The Use Cases were validated by eight clinical experts from different hospitals and two experts from academia in a sequential Delphi survey. Consensus was achieved for the significance score and agreement among the panel. Results: Eight task groups and patterns of task flow were observed, which were translated into nine Use Cases. The specification of Use Cases was derived from principles, guidelines, and recommendations on nursing documentation and electronic health record systems, which was organized into three requirements of each Use Case: functionality, information, and design characteristics. Each Use Case achieved an agreement of 50~70%, and significance scores of 4 or 5 on a 5-point Likert scale. Conclusion: The nine Use Case identified were considered to be important and adequate in terms of both clinical and informatics contexts.

• The Journal of Korean Medical History
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• v.30 no.1
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• pp.51-59
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• 2017

Shihosamul-tang (柴胡四物湯, Bupleurum Four Substances Decoction) is a very effective and widely utilized prescription in Korean medicine. However, there has not been a clinical example written in the classical literature of Korean medicine that deals with Shihosamul-tang and the delicate and changeable clinical use of Shihosamul-tang remains unknown. This study tries, for the first time, to show the clinical practice of Shihosamul-tang through review of KyungBoSinPyun (輕寶新篇). KyungBoSinPyun is a medical book containing 143 case records in the tradition of the East Asian practice of describing clinical encounters and the therapies employed. This study examines eight examples of case records within KyungBoSinPyun highlighting use of Shihosamul-tang. The purpose is to understand how Shihosamul-tang is applied in clinical practice compared to the description of Shihosamul-tang in Donguibogam (東醫寶鑑). Different descriptions about the symptoms and transformation methods of the prescription have been found in the eight examples of Shihosamul-tang case records contained in KyungBoSinPyun. This paper concludes that the difference between clinical practice and a typical description in medical books should be overcome by medical virtuosity and the potential for change for each clinical case, which is gained when seeing beyond the text of medical books.