• Quality Improvement in Health Care
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• v.28 no.2
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• pp.50-60
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• 2022

Purpose: To examine the degree of recognition regarding the concept of patient safety, as perceived by the patient, using a focus group discussion. Methods: A focus group discussion was conducted with a patient group comprising seven patients. Results: When the participants heard the term "patient safety" they seemed to understand it to be related to the hospital environment or satisfaction with the overall hospitalization experience. The participants emphasized communication between the medical staff and the patients in relation to the explanation of treatments, as well as the provision of information regarding prevention, experience, and the treatment of incidents with patient safety. They agreed on the need for indicators reported by patients. However, they emphasized that additional items and a questionnaire method that considers the patients' point of view are needed. Conclusion: It is necessary to establish and implement various strategies that can raise the awareness of patient safety using patient safety indicators and increase participation in patient safety activities.

• Journal of Preventive Medicine and Public Health
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• v.47 no.4
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• pp.206-215
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• 2014

Objectives: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. Methods: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. Results: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. Conclusions: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

• Women's Health Nursing
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• v.6 no.2
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• pp.234-257
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• 2000

At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

• Korea Journal of Hospital Management
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• v.10 no.1
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• pp.48-70
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• 2005

The purpose of this study was to make an analysis of the impact of the DRG payment system on medical care pattern and cost of cataract surgery in a general hospital. The subjects were 173 patients whose DRG severity grade was zero, selected from among the hospitalized who underwent cataract surgery before and after the joining to the demonstrational operation of the third year DRG payment system. Their medical records and the details of their medical bills were examined to find out the length of hospital stay, medical care pattern provided to them, the cost of medical care, and the quality of medical care. The length of stay and the amount of medical care supplied during being in hospital dropped significantly for both single-eye and double-eyes cataract surgery groups. The amount of antibiotic use went down during the hospitalization and upon discharge from the hospital, but decreased after discharge. The total medical bills and the rate of basic examination implementation increased in the OPD before hospitalization but after discharge dropped. For double-eyes cataract patients, the rate of double-eyes cataract surgery went down. The total medical bills of DRG payment system converted into the fee-for-service system was greater by 113.3% for the single-eye cataract surgery group and by 102.9% for the doble-eyes cataract surgery group, compared to that by the fee-for-service. The contribution shared by the insurance corporation increased for both single-eye and double-eyes cataract surgery groups, but the copayment by the insured went down. Regarding the treatment outcome, no difference was found in complication rate, resurgery rate and mortality rate before and after the joining to the DRG payment system was implemented. The use of special lens lessened significantly. The amount of medical care supplied during hospitalization decreased but the complication rate didn't increase. But the increased use of low-price artificial cataract and the avoidance of double-eyes cataract surgery was observed. The phenomenon decreased number of OPD visit and the decreased total medical bills of OPD care after discharge in this hospital required further evaluation.

• Journal of Acupuncture Research
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• v.40 no.3
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• pp.238-244
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• 2023

Background: Occipital neuralgia (ON) is an established risk factor for headaches in the posterior cervical region. Several conservative treatments by nerve decompression and pain relief are available for ON, but these treatments have limitations. Acupuncture treatment, which is known to demonstrate analgesic effects, involves various stimulation methods, and several studies have reported their clinical benefit. No recent systematic review (SR) has compared each acupuncture type for ON treatment. Thus, this SR aims to investigate the clinical effectiveness of each acupuncture type for treating ON. Methods: We will identify relevant studies using electronic databases, including EMBASE, MEDLINE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Korean Studies Information Service System (KISS), Korean Medical Database, KoreaMed, and National Digital Science Library (NDSL) from the inception until August 2023. The primary outcome will include the numerical change of pain symptoms (visual analog scale and numerical rating scale) and effective rate. Safety and secondary outcomes will include adverse events and quality of life. We will compare the conservative treatment with the acupuncture treatment using network meta-analysis. The Cochrane Collaboration "risk of bias" tools will be used to assess the quality of included trials. The Grades of Recommendation, Assessment, Development, and Evaluation will be used to examine the evidence level. Conclusion: This study will provide clinical evidence of several acupuncture types for ON and help clinicians decide on the best.

• Physical Therapy Korea
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• v.30 no.2
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• pp.120-127
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• 2023

Background: In general, measurement qualities of cross-culturally adapted quality of life (QOL) measures are altered in many aspects, although versions of them are well-validated measures. The latent trait and measurement qualities of the QOL measures for cancer-related samples should be considered when developing cross-culturally adapted measures. Objects: To investigate the latent trait of the translated into Korean World Health Organization Quality of Life-BREF (WHOQOL-BREF) administered to different cancer survivors who had palliative rehabilitation care service (PRCS). Methods: A cross-sectional study with 139 cancer survivors who had an experience of cancer survivorship with PRCS were conducted with a two-step analytic procedure including exploratory factor analysis (EFA) to confirm the latent trait and Rasch rating scale modeling to investigate the measurement qualities of the cross-culturally adapted WHOQOL-BREF measure. Results: While the original WHOQOL-BREF measure constitutes a 4-latent trait, the EFA reveals that 24 items constitute six substantial factors. The item loadings are predominantly spread over factors 1 through 4 in a mixed manner of the latent traits, while the loadings of 'physical health' and 'environmental health' latent traits show similarity to what the original measure intended to assess. The latent trait of the cross-culturally adapted WHOQOL-BREF measure administered to different cancer survivors is likely to reveal more dimensions than the original WHOQOL-BREF measure. Person reliability (i.e., analogous to Cronbach's alpha) and separation are measured with 0.92 and 3.48, respectively. All items except the one item (medical treatment item) fit the Rasch rating model. Conclusion: Findings suggest that the latent trait and the measurement qualities of the cross-culturally adapted WHOQOL-BREF measure should be taken into consideration when applying versions of it to various populations.

• The Journal of Internal Korean Medicine
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• v.44 no.6
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• pp.1176-1185
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• 2023

Introduction: Non-erosive reflux disease (NERD) is the most common subtype of gastroesophageal reflux disease (GERD). This study aims to synthesize evidence on the efficacy and safety of various herbal medicines for the treatment of NERD. Methods and analysis: Ten electronic databases will be examined: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, Embase, Allied and Complementary Medicine Database, China National Knowledge Infrastructure Database, Citation Information by Nii, Korean Medical Database, Korean Studies Information Service System, National Digital Science Library, and Oriental Medicine Advanced Searching Integrated System. All randomized controlled trials published from inception to May 2023 that meet the eligibility criteria will be selected. Two independent researchers will extract data, such as publication year, study design, intervention details, outcome measures, main results, and adverse events. The risk of bias and quality of evidence will be assessed, and subgroup analyses will be performed according to the type of control intervention and herbal medicine. The analysis process will be conducted using Review Manager 5.4 software. Discussion: This review will present a summary and rationale for herbal medicine's effectiveness in treating NERD. The findings of this review can help those who want to apply herbal medicine to the treatment of NERD.

• Journal of Korean Clinical Nursing Research
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• v.21 no.3
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• pp.335-346
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• 2015

Purpose: The purpose of this study was to identify patient satisfaction about nursing care provided by Advanced Practice Nurses (APN) using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). Methods: The investigation was conducted including 263 patients who experienced care provided by 41 APNs at a tertiary hospital in Korea. Patient satisfaction with nursing care was measured using 41-item LOPSS. We analyzed the data using descriptive statistics, independent t-test and one-way ANOVA. Results: Overall patient satisfaction with APN care was high. The LOPSS scores for APNs were 52.26 for good impression, 61.75 for interpersonal support, 81.32 for dissatisfaction and 195.93 for total score. "APNs talk down to me" was a reverse coding item which demonstrated the highest score for patient satisfaction. Among patients' characteristics, age and type of main caregiver were independent factors related to patients's satisfaction. Among APN's characteristics, work experience was significantly related to patients' satisfaction. Conclusion: This study identified patient satisfaction regarding nursing care provided by APNs. High patient satisfaction in APN services demonstrated APNs' contribution to quality improvement in health care services. It is recommended that various outcome research about APN service needs to be performed.

• Journal of the Korea Convergence Society
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• v.10 no.6
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• pp.365-379
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• 2019

This review aimed to analyze characteristics and performances of patient and family-centered care interventions and evaluate the convergence effectiveness. Randomized controlled trials were searched, selected, data extracted and quality-assessed using the Risk of Bias in 15 databases. Characteristics suggested from 21 studies were provision of information, education, communication and family and friend participation. There were 89 measurement variables of performances. Patient outcome was measured by mortality, length of hospitalization, etc., indicated as significantly improved in 18 studies. This review has provided evidence that patient and family-centered care improved experience and performance of diverse patients, families and health-care providers. There is need to convergence adopt patient and family-centered care and conduct evidence-based studies for improvement of quality of healthcare and patient safety in the future.

• Journal of Society of Preventive Korean Medicine
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• v.8 no.2
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• pp.99-113
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• 2004

Problems and current situation of public health globally and domestically were analyzed in this study and based on these findings, ways to improve from western medicine and Oriental medicine can be deduced as follows: 1. Current problems of public health in Korea and the world 1) Increase of diseases resulted from daily habits and infectious diseases, many are at the brink of being ill. Quality of life from extended life span and unbalanced health care must be solved. 2) Natural and societal factors including host factors, public health service, and other external and internal factors play an important role in deciding healthy and being ill. 3) Some of the limits and problems of modem medicine include insufficient academic knowledge and incomplete theory, as well as misled approach to the treatment. Human itself isn't perfect organism and other realistic problems hinder one's well-being. 4) Regardless of western medicine or Oriental medicine, patients were approached as someone with diseases and disorders, and wholistic approach was disregarded. Lack of clinical training, absence of clear educational philosophy and goal are some of the reasons why the education isn't under concrete system 2. Important factors for the medical education and proper direction for the education of Oriental medicine 1) Important factors for medical education - Education should not be limited on the human health and illness, but also cover qualities such as well-being, social welfare, service, and happiness. Every aspects of human life must be considered and attended for more productive outcome. - Basic understanding of humanity must be included in the educational curriculum - Foundation of human diseases and pain are associated with inner life and surrounding causes including family, society, nature, race, culture, religion, politics, and etc., thus the education must be approached to recognize aforementioned criteria. 2) Proper direction for the education of Oriental medicine - Values of Oriental medicine for medical principles and importance of lifehood must be educated. - Educational goal, limits, and levels must be established for the school of Oriental medicine - Respect for life must be the top priorities of educational direction which should lead to solution based education for the human health. Latest medical theory and technology should be accommodated as well as prevention, treatment, and balancing of basic courses and clinical training for optimal education.