• Journal of Korean Critical Care Nursing
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• v.14 no.3
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• pp.26-36
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• 2021

Purpose : This study aimed to present the incidence of pressure ulcers and identify different associated factors according to the time of occurrence of pressure ulcers in intensive care unit (ICU) patients. Methods : The participants were 313 patients who reported pressure ulcers among 2,908 patients in ICUs at a large tertiary hospital in Gyeonggi-do. Among them, 220 patients (70.3%) had a pressure ulcer before admission, and 93 patients (29.7%) reported newly developed pressure ulcers after admission to the ICU. Data were collected between August 2018 and April 2019. Along with the time of occurrence and characteristics of pressure ulcers, diverse associated factors were gathered through electronic medical records. Data were analyzed using descriptive statistics, independent t-tests, and 𝑥²-tests. Results : Different risk factors associated with pressure ulcers in ICU patients according to the time of occurrence were main diagnosis, score of acute physiology and chronic health evaluation, score of Richmond agitation sedation scale, level of consciousness, administered sedatives, use of a ventilator, insertion of a feeding tube, and the duration of fasting period. Conclusion : Based on the results of this study, healthcare providers, especially ICU nurses, should try to detect early signs and symptoms of pressure ulcers, taking into account the derived factors associated with pressure ulcers in ICU patients. Practical intervention programs and strategies considering the factors associated with pressure ulcers must be developed to prevent and alleviate such ulcers in ICU patients in the future.

• Health Policy and Management
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• v.24 no.4
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• pp.357-366
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• 2014

Background: The objective of this study was to evaluate the efficiency of an emergency ambulance system and to investigate socio-economic and clinical characteristics associated with emergency ambulance service. Methods: Based on 2011 Korea health panel, unmet need and inappropriate use of emergency ambulance service were measured by Gibson in 1977. Furthermore, the factors associated with unmet need and inappropriate use of emergency ambulance service were identified by Fisher's exact tests and multiple logistic regression models. Results: Unmet need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 59.8%. Inappropriate use, defined as the proportion of emergency patient receiving ambulance care who did not clinically need it, was found to be 37.2%. There were statistically significant differences between appropriate and inappropriate groups in overall variables of socio-economic and clinical characteristics. Specifically, gender, age, relationship to household, and reasons of visiting emergency department (accident/disease) were statistically significant factors associated with appropriate use of emergency ambulance service. Conclusion: Unmet ambulance need is a useful measure for patients needs assessment, and inappropriate ambulance use is a valid criteria in judging the efficiency of emergency ambulance system. To improve and understand emergency ambulance system, unmet need and inappropriate use of emergency ambulance service should be more concerned.

• The Korean Journal of Emergency Medical Services
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• v.12 no.3
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• pp.129-135
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• 2008

Purpose : This study was to analyze the demand for emergency ambulance service and to characterize the factors associated with the demand. Method : The basis for the model was from the actual demand for public emergency ambulance and socioeconomic and geographic characteristics. Multiple regression analyses were done for the related characteristics of public ambulance service. Result : The model explained total demand with a high degree of accuracy : the coefficient of determination($R^2=0.96$). For the regression, the set of variables indicative of low socioeconomic status were all significant. It showed the inappropriate use of public ambulance system. Public ambulance demand increased in higher housing density, low income, male unemployment and female labor force. Conclusion : The demand for public ambulances appeared to be highly predictable, using a simple linear model employing socioeconomic variables, quality of service variables, and land use variables. Low-income families tended, to use the public ambulance system more often than higher income. Area having elderly people or children also made many calls. Estimated demand calls were stable and had a tendency to be similar incident types.

• Korean System Dynamics Review
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• v.6 no.2
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• pp.53-71
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• 2005

In the short view, the medical fee regulation has contributed for patients by reducing their hospital expenses and helping them to visit hospital more easily. But, some medical parts have gone into red ink because the medical fee has been different with each item. So, that medical parts have been experienced the medical specialist shortage. And some hospitals have been interested in high-priced medical services to cover their deficit. Moreover, most medical doctors don't need to use low-priced medicine undergo these circumstance, domestic small and medium pharmaceutical company has been going into bankruptcy and the dependence on foreign drug company has been rising. If these abnormal medical service keep to patience, people will get more burden of medical fee cause 9 casual loop work very complicated. In other words, present medical fee regulation were made by some politicians who had plain thinking. Those who govern the people, therefore, stand for not present medical service user but the welfare and health promotion of people and give attention to desirable medical fee with systems thinking.

• The Korean Journal of Emergency Medical Services
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• v.20 no.2
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• pp.21-35
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• 2016

Purpose: This study aims to investigate awareness and performance of infection control during ambulance attendant training, and to provide basic data for infection control. Methods: The subjects were 235 paramedic students who completed ambulance attendant training. There were 51 questions. The infection control dimension was divided into hand washing, personal protective equipment use, and environmental management, for each sub-dimension, awareness and performance were measured by a 4-point scale. The collected data were analyzed using SPSS statistics ver. 22.0. Results: A total of 95.3%, of the subjects completed an orientation for ambulance attendant training and 71.7% received education on infection. In all three sub-dimensions, hand- washing (p<.001), personal protective equipment use (p<.001), and environmental management (p<.001), awareness scored higher than performance. The awareness of infection control showed a significantly positive correlation (r=.394) with performance. Conclusion: In order to improve performance of infection control, education to improve awareness should be provided, and paramedics with higher performance levels in hand washing, and use of gloves and masks wearing should be assigned as training advisors.

• Radiation Oncology Journal
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• v.37 no.4
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• pp.249-253
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• 2019

Purpose: We aimed to analyze the trend in intensity-modulated radiation therapy (IMRT) use in Korea from 2011 to 2018. Materials and Methods: We collected data from the Health and Insurance Review and Assessment Service (HIRA) big data based on the National Health Insurance Service claims and reimbursements records using primary treatment planning codes (HD 041) for IMRT from 2011 to 2018. We analyzed the changing patterns in clinical application to specific tumor sites and regional differences in IMRT utilization. Results: The use of IMRT has exhibited an 18-fold steep rise from 1,921 patients in 2011 to 34,759 in 2018. With regard to IMRT in 2018, 70% of patients (24,248/34,759) were treated in metropolitan areas (Seoul, Incheon, and Gyeonggi Province). IMRT was most commonly used to treat breast, lung, and prostate cancers in 2018. Among these, the use of IMRT for breast cancer shows the most remarkable increase from 2016 when the National Health Insurance began to cover IMRT for all solid tumors. Conclusion: The use of IMRT is steadily increasing to treat cancer and is concentrated in metropolitan areas.

• Health Policy and Management
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• v.30 no.1
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• pp.72-81
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• 2020

Background: The out-of-pocket maximum is one of the distinctive healthcare systems which sets a ceiling on co-payment in order to reduce the burden of households from the unpredictable medical expenditure. However, this leads to an increase in the demand for healthcare services especially in long-term care hospitals (LTCHs) in Korea. Methods: This study analyzed the influence factor of medical service overuse of 165,592 inpatients in LTCHs which out-of-pocket maximum is applied, by utilizing data from the National Health Insurance Service (2016). Based on Anderson Model, the medical service overuse, as a dependent variable, was defined as long-stay admission more than 180 days at the LTCHs. Independent variable was comprised of predisposing factors (gender, age), enabling factors (income level, types of out-of-pocket maximum) and need factors (illness level, patient use of tertiary hospital). Results: The most powerful factor of medical service overuse in LTCHs was availability of pre-payment for the out-of-maximum (odds ratio [OR], 191.66; p<0.001). This tendency was found in high income level status (p<0.001). Furthermore, mild inpatients (OR, 1.50; p<0.001) which had no experience with the tertiary hospitals (OR, 2.06; p<0.001) were more relevant to the medical service overuse in LTCHs, compared to the severe inpatients. Conclusion: It is suggested that a separate standard of out-of pocket maximum with regards to LTCHs is required to secure the beneficial functions of long-term hospitals and prevent unnecessary financial leakage to achieve sustainable and financially sound National Health Insurance.

• Journal of radiological science and technology
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• v.26 no.4
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• pp.53-61
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• 2003

This system Will allow primary and secondary treatment institutions poorly equipped with medical equipment to use Internet and book their patients' medical checkups with tertiary hospitals equipped with remote medical information system. This research aims to make theoretical studies on the remote medical service information sharing system and discuss its utility and factors to be considered for spreading the system. To efficiently push ahead with the remote medical service information sharing system, we need to be open-minded in sharing medical service information, establish comprehensive pursuit system, introduce incentive aimed at activating the information system, have close coordination with the central government, flexibly respond to changing technologies, and offer publicity and education.

• Health Policy and Management
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• v.22 no.1
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• pp.65-84
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• 2012

Because of the rising healthcare costs, there is a growing need for developing efficiency indicators for medical resources use and measuring efficiency of healthcare providers and healthcare systems using them. In this study, we aimed to develop efficiency indicators for medical resources use by means of Delphi technique. We systematically reviewed the existing measures of medical resource use. Thirty nine indicators were selected as a candidates across the six domains: medical personnel, medical equipment, medical facilities, ethical management, resource efficiency, and drug use. To develop efficiency indicators with professional consensus, a 2-round Delphi survey was conducted among 29 professional experts. The following indicators were selected based on the Delphi survey results: adjusted number of the patient per day and level of the nurse number medical personnel in medical personnel domain; the number of the scan a professional physician and the quality of the scan in medical equipment domain; bed utilization rate in medical facility domain; drug price reported pharmaceutical price by medical institutions, medical fee billing transparency, and medical care appropriateness in ethical management domain; costliness index in resource efficiency domain; and utilization of high cost drug and items per prescription in drug use domain. The efficiency indicators could provide valid information about efficiency of healthcare providers and healthcare systems with respect to their resources use and facilitate policies to improve their efficiency.

• Korea Journal of Hospital Management
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• v.4 no.2
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• pp.21-40
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• 1999

One Diagnosis Related Group(DRG) pilot study participating hospital was measured and analyzed to see if there were any changes after the DRG program. It was implemented in consideration of medical service utilization, hospital charges, and non-covered medical service charges by insurance in all Cesarean section cases by reviewing medical records for 3 years, including 1 year before pilot study as well as 1 and 2 years after, respectively. The results were as follows: First, the use of intramuscular antibiotics decreased statistically significantly, whereas intravenous use did not. Second, the administration period and charges of antianemic medication decreased significantly, where the prescription was appropriate. Third, the length of hospital stay decreased statistically significantly. Fourth, there were significant statistical differences in cost sharing between the insured and the insurer: cost sharing of the insured was reduced, whereas the share of the insurer increased. However, there was no change in the quality of care. Fifth, there were no statistically significant changes in the Cesarean section rate. As a result, if the fee schedule is reasonably high, hospitals can provide quality care. This DRG pilot study resulted expected outcomes: by paying a higher fee schedule than fee-for-service, then hospitals can provide quality care to their patients and increase hospital profits.