• 보건행정학회지
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• 제11권2호
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• 농촌의학ㆍ지역보건
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• 제30권3호
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• pp.263-277
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• 2005

본 연구는 지역사회 노인들의 구강보건행동과 구강건강상태를 알아보고 그에 대한 관련성을 검토하고자 하였다. 조사대상은 충청남도 공주시 6개면에 거주하고 있는 65세 이상 노인들 중 2005년 1월 1일부터 2월 28일까지 2개월 동안 보건소 및 보건지소에서 치과검진을 받은 206명(남자 100명, 여자 106명)으로 하였다. 조사는 구강보건행동과 잇몸출혈 자각증상에 대해 설문조사를 실시하였고, 치과의사에 의해 구강검사를 실시하였으며, 구강보건행동에 따른 구강건강상태에 대한 지표(우식치, 처치치, 상실치, DMFT 및 CPITN)를 검토하였다. 주요 결과는 다음과 같다. 1. 전체 조사대상자들의 구강보건행동을 보면 "년 1회 이상 치과진료를 받는다"는 군이 24.3%, "주 1회 이상 구강 내 관찰을 한다"는 군이 20.4%, "1일 3회 이상 잇솔질을 한다"는 군이 15.5%, "3분 이상 잇솔질을 한다"는 군이 24.3%, "주당 2~3회 이상 보조용품을 사용한다"는 군이 7.8%, 비흡연군이 68.9%, 감미음료 및 감미식품을 "섭취하지 않는다"는 군이 23.3% 이었다. 2. 전체 조사대상자들의 구강건강상태를 보면 잇몸출혈의 경우 "항상 있다" 8.7%, "가끔 있다" 28.2%, "거의 없다" 32.0%, "없다" 31.1%의 비율이었다. 우식치는 평균 1.2개 이었으며, 처치치는 9.9개, 상실치는 7.4개, DMFT는 18.4개, CPITN은 2.4이었다. 3. 구강보건행동별 구강건강상태를 보면, 년 1회 이상의 치과진료를 받지 않은 군은 받은 군보다 상실치(p=0.002), DMFT(p=0.002) 및 CPITN(p=0.018)이 유의하게 많았고, 주 1회 이상 구강 내 관찰을 하지 않는 군은 하는 군에 비해 처치치는 유의하게 적은 반면(p=0.002), 상실치(p=0.000)와 CPITN(p=0.000)은 유의하게 많았다. 잇솔질 횟수별로는 "1일 3회 미만 군"이 "1일 3회 이상 군" 보다 우식치(p=0.000), 상실치(p=0.000), DMFT(p=0.000) 및 CPITN(p=0.000)이 유의하게 많았고, 잇솔질 시간별로는 "3분 미만군"이 "3분 이상 군" 보다 상실치(p=0.002)와 DMFT(p=0.041)가 유의하게 많은 반면, 처치치는 유의하게 적었다(p=0.036). 보조용품 사용여부별로는 "사용하는 군"보다 "사용하지 않는 군"에서 DMFT(p=0.041) 및 CPITN(p=0.018)이 유의하게 많았고, 흡연습관 별로는 흡연군이 비흡연군보다 우식치(p=0.035) 와 CPITN (p=0.001)이 유의하게 많았다. 4. 다변량 회귀분석 결과 우식치수에 영향을 미치는 요인으로는 잇솔질 횟수, 성별 및 구강 내 관찰이 유의한 변수로 선정되었고(설명력 14.2%), 처치치수에는 성별, 구강 내 관찰, 보조용품사용, 잇솔질 횟수, 주관적 건강상태 및 감미음료섭취 여부(설명력 18.2%)가, 상실치수에는 잇솔질 횟수와 연령(설명력 13.9%)이, DMFT에는 잇솔질횟수, 성별, 치과진료여부, 연령(설명력 13.5%)이, CPITN에는 흡연여부, 치과진료여부, 보조용품사용여부(설명력 10.8%)가 유의한 변수로 선정되었다. 이상의 결과를 볼 때 노인들의 구강보건행동은 매우 저조한 상태로 보이며, 따라서 구강건강상태도 양호하지 못한 것임을 시사한다. 또한 구강건강상태는 여러 구강보건행동 요인에 따라 영향을 받게 됨으로 구강보건행동에 대한 홍보 및 교육이 필요하다고 본다.

• 대한영양사협회학술지
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• 제14권1호
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• pp.23-35
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• 2008

Improved nutritional intake contributes to maintaining health and quality of life in elderly population and also reducing individual and social medical costs. Most of nutrition assistance programs for elderly, such as congregate or home-delivered meal programs, are not currently serviced in rural communities mainly due to low cost efficiency of program operation. However, the needs and necessity of such programs are presumed to be higher in rural area where the population density of elderly at nutritional risk is relatively high. Therefore, the purpose of this study was to develop a community-based meal program for the rural elderly. In 2007, four rural communities located in Jeon-Nam province were selected and the pilot meal program was applied for three months. Following are key features of the meal program model developed in this study: 1) meal production and service are operated by elderly participants to overcome the voluntary personnel shortage 2) utilization of locally-produced foods is maximized to reduce the meal cost, 3) traditional cooking methods are applied to adjust the food preference of elderly, and 4) foods are serviced on site to minimize the food safety problem possibly caused by delivery process. The pilot programs resulted in high satisfaction with the programs of participating elderly. The community-based meal program model developed in this study is expected to be used as an effective nutrition and health intervention model for the rural elderly.

• 한국산학기술학회논문지
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• 제16권10호
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• pp.7126-7137
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• 2015

본 연구는 종합병원에 근무하고 있는 간호사의 사회심리적 요인(A형 행동유형, 자기존중감, 통제신념, 불안), 직무스트레스 및 피로수준이 간호서비스의 질에 미치는 영향을 규명하고자 시도하였다. 연구대상은 대전광역시의 6개 종합병원에 근무하고 있는 간호사 503명으로 하였으며, 자료 수집은 2014년 4월 1일부터 6월 30일까지의 기간 동안에 구조화된 무기명 자기기입식 설문조사에 의하였다. 공분산 구조분석에 의한 연구결과, 사회심리적 요인은 직무스트레스나 피로보다 간호서비스의 질에 더 큰 영향을 미쳤으며, 사회심리적 요인에서 자기존중감이 높고, 불안감이 낮으며, 직무스트레스와 피로도가 낮을 수록 간호서비스의 질을 높이는 효과가 있는 것으로 나타났다. 이 같은 연구결과는 종합병원 간호사들의 간호서비스의 질은 사회심리적 요인(자기존중감, 불안), 직무스트레스 및 피로와 유의한 관련성이 있음을 시사한다.

• 한국산학기술학회논문지
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• 제11권1호
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• pp.361-367
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• 2010

이 연구는 2007년 1월 1일부터 동년 12월 31일까지 1년간 대전 소재 일개대학병원에서 수술 취소된 총 146명의 환자를 대상으로 하였으며, 계획된 수술의 취소율을 극소화하여 병원 경영의 합리적 개선과 진료 만족도를 증가시키고자하는 목적에서 이루어졌다. 조사대상자의 성별 분포를 보면, 남자 56.8%, 여자 43.2%로 여자보다 남자가 높은 분포를 보였다. 수술 취소 원인을 살펴보면 수술취소까지 이르지 않을 수 있었던 사항과 불가항력적으로 수술을 취소해야 할 사항으로 나눌 수 있는데, 이런 분류를 통해 전체 수술 취소 사유 중 60.0%는 예방이 가능했던 사항이라고 했다. 본 연구결과를 기초로 타 연구자와 병원관리자에게 수술 취소율 감소 개선을 위한 정책방향의 수립을 제언한다.

• 한국산업보건학회지
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• 제26권4호
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• pp.436-444
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• 2016

Objectives: Despite recent efforts to prevent suffocation disasters, a number of confined space accidents still happen and each year deaths continue to occur. There have been insufficient studies on the dangers of various potential disaster sites, such as manholes, septic tanks, reactors, and other tanks according to type, characteristics, task-specific disasters, equipment specific disasters, etc. The purpose of this study was to analyze recent suffocation disasters based on place and properties. Methods: In this study, we analyzed confined space accident cases from 2005 to 2015 in Korea and grouped them by type, size, monthly occurrence, continuous service period, accident location, person-specific group, age, employment, structural work and subcontracting work. We studied examples of accidents developed in other countries. Results: (1) We reviewed confined-space accident statistics, compared legal standards and analyzed cases of suffocation accidents in the United States and Japan. (2) Using a case study report from the Korea Occupational Safety & Health Agency, we specified confined-space accident statistics based on place, person-specific group, age, employment, structural work and subcontracting work. As a result we generated some precautions about confined-space accidents for the prevention of such accidents. Conclusions: Conclusions: Statistical analysis of recent suffocation disaster cases was performed to establish improvement measures, compare practices from developed countries, and develop precautionary measures accordingly. In this study, we presented the causes of disaster that occur in a confined space and proposed related preventive measures.

• 보건행정학회지
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• 제17권4호
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• pp.82-98
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• 2007

This study aimed to analyze the factors that influence the job satisfaction of nurses involved in medical insurance reviews. The study involved a self-administered questionnaire survey which was conducted with to 297 nurses who were in charge of medical insurance reviews between April 10 and April 28, 2000. The average job satisfaction of the subjects was 3.04. The sub-items of job satisfaction were noted to be high for 'professional status'(3.79) and low for wage (2.46). The job satisfaction of subjects showed statistically significant differences with regard to education, career, and volume of service(p<0.05). The average job stress of subjects was 2.57. The sub-items of job stress included problems pertaining to human relationships problem(2.84), conflicts with doctors at work (2.79), and the burden of excessive workloads(2.79), in that order. Multiple regression analysis demonstrated that job satisfaction was significantly low when the job stress was higher. It also showed that the job satisfaction was significantly high as there was more frequency of judgements and higher education. These results suggest that the job stress of nurses involved in medical insurance reviews has a profound impact on their job satisfaction. Therefore, the efforts should be made to reduce their job stress. It may also be beneficial to reinforce the training with the doctors and nurses in order to improve their communication skills. Disseminating more information about insurance standards may also be considered.

• 디지털융복합연구
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• 제15권2호
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• pp.519-525
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• 2017

본 연구는 고령친화 요양산업을 대상으로 정책의 활성화시킬 수 있는 요인과 전략방안들을 도출하는 것이 연구의 목적이다. 분석방법은 DEMATEL기법을 통해 주요 요인들 간의 인과성을 분석하였다. 이는 고령친화 요양산업을 구성하는 활성화 요인 및 그 요인 간의 관련이 복잡 불명확한 것을 정책강화의 우선순위 도출을 통해 보다 명확하게 확인하고자 하였다. 분석결과 종합강도가 가장 높게 나타난 활성화 요인으로는 식사서비스(22.095)가 가장 종합강도가 높은 것으로 분석되었다. 그리고 다음으로 건강증진시설(19.97), 건강관리(17.726) 등의 순으로 높게 나타났다. 가장 낮은 요인은 스포츠(15.896)이다. 따라서, 이러한 요인의 개선 및 증진을 위해서 시설요양서비스, 재가요양서비스, 예방지원서비스와 밀접한 연관성을 가지고 지속적인 정책방안을 모색하여야 할 것이다.

• 대한장애인치과학회지
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• 제11권2호
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• pp.58-61
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• 2015

The people with disabilities living in residential facilities have more difficulty in caring oral hygiene than those living at home. The purpose of this study is to evaluate the recent 2014 dental treatment records of free mobile dental clinic service for disabled people in Korea. 203 disabled living in residential facilities participated in mobile dental clinic. Patients classified according to types of disability. Mental retardation were 75.3%, mental disorder were 6.0%, crippled disorder were 7.4%, brain disorder were 6.5%, visual disorder were1.4%, auditory and speech disorder were 2.3% and autism disorder were 0.9%. Performed treatments were 99 scaling and curettage, 88 fluoride varnish and TBI, 4 extraction, 1 endodontic treatment, 16 caries control (resin filling, GI filling), 1 denture repair and 8 refuse the treatment. Free mobile dental clinic can not provide complex dental treatment. So, the organization should systemize advanced dental treatment and regular preventive programs. Furthermore, we need to have a more concerns about the people with disabilities living in residential facilities and constantly participate on a dental voluntary work.

• 대한간호학회지
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• 제50권6호
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• pp.837-847
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• 2020

Purpose: The purpose of this study was to investigate the effects of hospital characteristics on employment rate, working period, and retirement of ward nurses in Korea through a retrospective cohort study based on HIRAS data. Methods: Data were obtained from a report on medical care institutions of Health Insurance Review & Assessment Service (HIRAS). Data from 259,941 nurses who were working for a day or more from January 1, 2012, to December 31, 2016, at 2,942 medical care institutions were analyzed. Life table method analysis, Kaplan-Meier analysis, and Cox proportional hazard regression analysis were conducted. Results: The employment rates of 5 yeas and 10 years for the total sample were 38% and 28%, respectively. The estimated mean value of the working period was 3,642.7 days (SE: 17.4 days). Cox proportional hazard regression analyses revealed that nurses who were working at the general hospital/hospital, clinic, and nursing hospital were more likely to leave the hospital compared to those who were working at the 3rd general hospital. Nurses who were working at the medical institutions which were located in cities and countries, established by the private foundation, rated lower levels of nursing, and owned an insufficient number of beds, nurses and doctors were more likely to leave their workplace compared to those of the counterparts. Conclusion: This study indicates that hospital characteristics may play a significant role in retirement and working period of ward nurses in Korea. The improvement of hospital conditions to reduce ward nurses' retirement are needed.