• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• Restorative Dentistry and Endodontics
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• v.27 no.4
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• pp.370-381
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• 2002

This study was performed to evaluate the temperature rise on various position of the Buchanan plugger, the peak temperature of plugger's type and the temperature change by its touching time of heat control spling. The heat carrier system 'System B' (Model 1005, Analytic Technologies, USA) and the Buchanan's plug-gers of F, FM, M and ML sizes are used for this study. The temperature was set to 20$0^{\circ}C$ which Dr. Buchanan's "continuous wave of condensation" technique recommended on digital display and the power level on it was set to 10. In order to apply heat on the Buchanan's pluggers, the heat control spring was touched for 1, 2, 3, 4 and 5 seconds respectively. The temperature rise on the surface of the pluggers were measured at 0.5 mm intervals from tip to 20 mm length of shank using the infrared thermography (Radiation Thermometer-IR Temper, NEC San-ei Instruments, Ltd, Japan) and TH31-702 Data capture software program (NEC San-ei Instruments, Ltd, Japan). Data were analyzed using a one way ANOVA followed by Duncan's multiple range test and linear regression test. The results as follows. 1. The position at which temperature peaked was approximately at 0.5 mm to 1.5 mm far from the tip of Buchanan's pluggers (p<0.001). The temperature was constantly decreased toward the shank from the tip of it (p<0.001). 2. When the pluggerss were heated over 5 seconds, the peak temperature by time of measurement revealed from 253.3$\pm$10.5$^{\circ}C$ to 192.1$\pm$3.3$^{\circ}C$ in a touch for 1 sec, from 218.6$\pm$5.$0^{\circ}C$ to 179.5$\pm$4.2$^{\circ}C$ in a touch for 2 sec, from 197.5$\pm$3.$0^{\circ}C$ to 167.5$\pm$3.7$^{\circ}C$ in a touch for 3 sec, from 183.7$\pm$2.5$^{\circ}C$ to 159.8$\pm$3.6$^{\circ}C$ in a touch for 4 sec and from 164.9$\pm$2.$0^{\circ}C$ to 158.4$\pm$1.8$^{\circ}C$ in a touch for 5 sec. A touch for 1 sec showed the highest peak temperature, followed by, in descending order, 2 sec, 3 sec, 4 sec. A touch for 5 sec showed the lowest peak temperature (p<0.001). 3. A each type of pluggers showed different peak temperatures. The peak temperature was the highest in F type and followed by, in descending order, M type, ML type. FM type revealed the lowest peak temperature (p<0.001). The results of this study indicated that pluggers are designed to concentrate heat at around its tip, its actual temperature does not correlate well with the temperature which Buchanan's "continuous wave of condensation" technique recommend, and finally a quick touch of heat control spring for 1sec reveals the highest temperature rise.

• Korean Security Journal
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• no.22
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• pp.91-111
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• 2010

Around the middle of the ninth century the strict bone-rank system of Silla frustrated many people who had political ambition but lacked nobility. They had to seek other ways, including maritime trade. Such an undertaking reflected and also increased their economic and military power. Trade prospered with T'ang China and with Japan as well. The threat of piracy to Silla's thriving maritime trade caused to create a succession of garrisons at important coastal points. Chonghae Jin (Chonghae garrison) was regarded as the most important of these. It was established in 828 by Chang Pogo. Chonghae Jin was on Wando, an island just east of the southwestern tip of Korea and a key place at this time in the trade between China, Korea, and Japan. From this vantage point Chang Pogo became a merchant-prince with extensive holdings and commercial interests in China and with trade contacts with Japan. Although piracy was rampant in East Asia at that time, either the Chinese or Silla government was not able to control it due to inner political strife and lack of policing resources. Infuriated by the piracy and the government's inability to control it, Chang Pogo came back to Silla to fight against the pirates and to protect maritime trade. He persuaded the king of Silla and was permitted to control the private armed forces to sweep away the pirates. In 829 he was appointed Commissioner of Chonghae-Jin with the mission of curbing piracy in that region. Chang's forces were created to protect people from pirates, but also developed into traders among Silla Korea, T'ang China, and Japan in the 9th century. This was geographically possible because the Chonghae Garrison was situated at the midpoint of Korea, China, and Japan, and also because Chang's naval forces actually dominated the East Asia Sea while patrolling sea-lanes. Based on these advantages, Chang Pogo made a great fortune, which might be collected from a charge for protecting people from pirates and the trades with China and Japan. Chang's forces could be termed the first private security company in the Korean history, at least in terms of historical documents. Based on historical documents, the numbers of private soldiers might be estimated to exceed tens of thousands at least, since Chang's forces alone were recorded to be more than ten thousand. Because local powers and aristocratic elites were said to have thousands of armed forces respectively, the extent of private forces was assumed to be vast, although they were available only to the privileged class. In short, the domination of Chang's forces was attributable to the decline of central government and its losing control over local powers. In addition it was not possible without advanced technologies in shipbuilding and navigation.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.12
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• pp.126-134
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• 2017

There have been numerous studies on extracting the R-peak from electrocardiogram (ECG) signals. However, most of the detection methods are complicated to implement in a real-time portable electrocardiograph device and have the disadvantage of requiring a large amount of calculations. R-peak detection requires pre-processing and post-processing related to baseline drift and the removal of noise from the commercial power supply for ECG data. An adaptive filter technique is widely used for R-peak detection, but the R-peak value cannot be detected when the input is lower than a threshold value. Moreover, there is a problem in detecting the P-peak and T-peak values due to the derivation of an erroneous threshold value as a result of noise. We propose a robust R-peak detection algorithm with low complexity and simple computation to solve these problems. The proposed scheme removes the baseline drift in ECG signals using an adaptive filter to solve the problems involved in threshold extraction. We also propose a technique to extract the appropriate threshold value automatically using the minimum and maximum values of the filtered ECG signal. To detect the R-peak from the ECG signal, we propose a threshold neighborhood search technique. Through experiments, we confirmed the improvement of the R-peak detection accuracy of the proposed method and achieved a detection speed that is suitable for a mobile system by reducing the amount of calculation. The experimental results show that the heart rate detection accuracy and sensitivity were very high (about 100%).

• Korean Security Journal
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• no.36
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• pp.139-176
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• 2013

It is believed that the Koryo dynasty era is the period which has very special meaning with regard to the history of the VIP guard system. The guard system in the early Koryo dynasty time focused on the official protection for kings and their families with absolute royal authority. On the contrary, the guard system in the late Koryo dynasty time, especially military regime period, conducted providing private protection for military rulers and increasing their power. The official guard troops named 2Gun6Wii became just perfunctory organizations at that time. That is the reason why this study develops the discussion only about the guard system of the early Koryo time. The official VIP guard organizations under the government structure of the early Koryo period were Naegoonbu, Byeongbu and Joongchoowon. This study particularly reviewed the Joongchoowon with thorough research. In the meantime, the guard organizations under the military chart of the early Koryo period were 2Gun6Wii, Gonghakgoon, Geonryonggun and so on. 2Gun consisted of ungyanggun and yonghogun. They were the royal bodyguards. This study especially tried to review the substance of the Gonghakgoon, Geonryonggun with different point of view from other theories. The Gumowwii, one of 6 Wii, conducted many official duties such as royal palace protection, capital city Gaesung defence, area patrols, criminal apprehension and disturbance prevention. It also accomplished crowd control and convoy mission at the streets to respond emergency cases while carrying out VIP protection roles for kings and Chinese diplomats. Many bibliographies verified that the Chunwoowii was the royal bodyguards which helped kings during state ceremonies and grand meetings held by kings. Consequentially, it is true that this study discovered, analyzed and evaluated various references and research materials related with the guard system. It is meaningful that this study newly reviewed the organizations and functions of the guard system as one structure.

• Journal of Environmental Policy
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• v.6 no.2
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• pp.97-122
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• 2007

In 2006, the Ministry of Environment of the Republic of Korea, completed the construction on national environmental geographic informations including National Environmental Assessment Map, Ecological Map, Land Cover Map and so on. At this point of time, it is necessary to establish the advance strategy on national environmental geographic information, considering the complicated characteristics. Therefore, this study suggests the advance strategy on national environmental geographic information, reflecting results of analyzing the given condition and the trend of informatization. National environmental geographic information has spacial quality to be managed dispersedly in a department unit or an operations unit. According to this quality, requirements for users who need the policy based on national environmental geographic information and complex information are not satisfactory. And, the information system centering the process of administrative affairs should be converted to one putting decision supporting first in importance. Therefore, this study sets up "the realization of the sustainable land management system by advancing national environmental geographic information" as the vision of the advancing strategy. In order to accomplish the vision, this study established the purpose as follow; constructing strategic and geographic information based on knowledge, arranging the foundation to open information to the public transparently, building expanded and integrated national environmental geographic information, embodying the environmental administration based on national environmental geographic information, enhancing the efficiency of national environmental geographic information, and supporting efficiently the process of administrative affairs. And this study suggests executive plans to achieve the vision and the purpose as next; developing the quality control program to verify the information confidence, building the system to integrate and to provide environmental information, collecting information, readjusting laws and regimes in parts of the construction, the application and the management of the system, and operating the task process, human power, organization and information technology. This study puts the emphasis on providing the turning opportunity politically which is possible to make sure of the information confidence in quality, advancing from the expansion of one in quantity. However, this improvement strategy doesn't reflect all national environmental geographic information and current status of environmental administrations. Therefore, for applying the result of this study to the actual environmental administration, it is necessary to discuss regularly the systematic categorization of national environmental geographic information, to interview with the contracting parties and so on hereafter.

• The Korean Journal of Archival Studies
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• no.34
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• pp.221-250
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• 2012

This paper introduces the characteristics of the records and archives management of Korea from Joseon dynasty to now. This paper also explains historical background of making the records and archives management in Joseon dynasty. This paper introduces the process of establishment of modern records management system by adopting records management system and public administration of USA after liberation in 1945. The Joseon bureaucrats established systematic methodologies for managing and arranging the records. Jeseon dynasty managed its records systematically since it was a bureaucratic regime. It is also noticeable that the famous Joseonwangjosilrok(Annals of Joseon dynasty) came out of the power struggles for the control of the national affairs between the king and the nobility during the time of establishment of the dynasty. Another noticeable feature of the records tradition in Joseon dynasty was that the nobility recorded their experience and allowed future generations use and refer their experiences and examples when they performed similar business. The records of Joseon period are the historical records which recorded contemporary incidents and the compilers expected the future historians evaluate the incidents they recorded. In 1894, the reformation policy of Gaboh governments changed society into modernity. The policy of Gaboh governments prescribed archive management process through 'Regulation(命令頒布式)'. They revised the form of official documents entirely. They changed a name of an era from Chinese to unique style of Korean, and changed original Chinese into Korean or Korean-Chinese together. Also, instead of a blank sheet of paper they used printed paper to print the name of each office. Korea was liberated from Japanese Imperialism in 1945 and the government of Republic of Korea was established in 1948. In 1950s Republic of Korea used the records management system of the Government-General of Joseon without any alteration. In the late of 1950's Republic of Korea constructed the new records management system by adopting records management system and public administration of USA. However, understanding of records management was scarce, so records and archives management was not accomplished. Consequently, many important records like presidential archives were deserted or destroyed. A period that made the biggest difference on National Records Management System was from 1999 when was enacted. Especially, it was the period of President Roh's five-year tenure called Participation Government (2003-2008). The first distinctive characteristic of Participation Government's records management is that it implemented governance actively. Another remarkable feature is a nomination of records management specialists at public institutions. The Participation Government also legislated (completely revised) . It led to a beginning of developing records management in Republic of Korea.

• Sleep Medicine and Psychophysiology
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• v.26 no.1
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• pp.44-48
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• 2019

Objectives: Insomnia is one of the most prevalent sleep disorders. Recent studies suggest that cognitive and physical arousal play an important role in the generation of primary insomnia. Studies have also shown that information processing disorders due to cortical hyperactivity might interfere with normal sleep onset and sleep continuity. Therefore, focusing on central nervous system arousal and normalizing the information process have become current topics of interest. It has been well known that neurofeedback can reduce the brain hyperarousal by modulating patients' brain waves during a sequence of behavior therapy. The purpose of this study was to investigate effects of neurofeedback therapy on electroencephalography (EEG) characteristics in patients with primary insomnia. Methods: Thirteen subjects who met the criteria for an insomnia diagnosis and 14 control subjects who were matched on sex and age were included. Neurofeedback and sham treatments were performed in a random order for 30 minutes, respectively. EEG spectral power analyses were performed to quantify effects of the neurofeedback therapy on brain wave forms. Results: In patients with primary insomnia, relative spectral theta and sigma power during a therapeutic neurofeedback session were significantly lower than during a sham session ($13.9{\pm}2.6$ vs. $12.2{\pm}3.8$ and $3.6{\pm}0.9$ vs. $3.2{\pm}1.0$ in %, respectively; p < 0.05). There were no statistically significant changes in other EEG spectral bands. Conclusion: For the first time in Korea, EEG spectral power in the theta band was found to increase when a neurofeedback session was applied to patients with insomnia. This outcome might provide some insight into new interventions for improving sleep onset. However, the treatment response of insomniacs was not precisely evaluated due to limitations of the current pilot study, which requires follow-up studies with larger samples in the future.

• Journal of Intelligence and Information Systems
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• v.22 no.1
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• pp.107-118
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• 2016

The advent of 5G mobile communications, which is expected in 2020, will provide many services such as Internet of Things (IoT) and vehicle-to-infra/vehicle/nomadic (V2X) communication. There are many requirements to realizing these services: reduced latency, high data rate and reliability, and real-time service. In particular, a high level of reliability and delay sensitivity with an increased data rate are very important for M2M, IoT, and Factory 4.0. Around the world, 5G standardization organizations have considered these services and grouped them to finally derive the technical requirements and service scenarios. The first scenario is broadcast services that use a high data rate for multiple cases of sporting events or emergencies. The second scenario is as support for e-Health, car reliability, etc.; the third scenario is related to VR games with delay sensitivity and real-time techniques. Recently, these groups have been forming agreements on the requirements for such scenarios and the target level. Various techniques are being studied to satisfy such requirements and are being discussed in the context of software-defined networking (SDN) as the next-generation network architecture. SDN is being used to standardize ONF and basically refers to a structure that separates signals for the control plane from the packets for the data plane. One of the best examples for low latency and high reliability is an intelligent traffic system (ITS) using V2X. Because a car passes a small cell of the 5G network very rapidly, the messages to be delivered in the event of an emergency have to be transported in a very short time. This is a typical example requiring high delay sensitivity. 5G has to support a high reliability and delay sensitivity requirements for V2X in the field of traffic control. For these reasons, V2X is a major application of critical delay. V2X (vehicle-to-infra/vehicle/nomadic) represents all types of communication methods applicable to road and vehicles. It refers to a connected or networked vehicle. V2X can be divided into three kinds of communications. First is the communication between a vehicle and infrastructure (vehicle-to-infrastructure; V2I). Second is the communication between a vehicle and another vehicle (vehicle-to-vehicle; V2V). Third is the communication between a vehicle and mobile equipment (vehicle-to-nomadic devices; V2N). This will be added in the future in various fields. Because the SDN structure is under consideration as the next-generation network architecture, the SDN architecture is significant. However, the centralized architecture of SDN can be considered as an unfavorable structure for delay-sensitive services because a centralized architecture is needed to communicate with many nodes and provide processing power. Therefore, in the case of emergency V2X communications, delay-related control functions require a tree supporting structure. For such a scenario, the architecture of the network processing the vehicle information is a major variable affecting delay. Because it is difficult to meet the desired level of delay sensitivity with a typical fully centralized SDN structure, research on the optimal size of an SDN for processing information is needed. This study examined the SDN architecture considering the V2X emergency delay requirements of a 5G network in the worst-case scenario and performed a system-level simulation on the speed of the car, radius, and cell tier to derive a range of cells for information transfer in SDN network. In the simulation, because 5G provides a sufficiently high data rate, the information for neighboring vehicle support to the car was assumed to be without errors. Furthermore, the 5G small cell was assumed to have a cell radius of 50-100 m, and the maximum speed of the vehicle was considered to be 30-200 km/h in order to examine the network architecture to minimize the delay.

• Journal of Korean Academy of Nursing
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• v.20 no.2
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• pp.227-248
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• 1990

The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.