• 대한기관윤리심의기구협의회지
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• 제5권1호
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• pp.21-32
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• 2023

Purspose: The purpose of this study is to examine the meaning and definition of vulnerable subjects in clinical trials in light of domestic and international regulations and guidelines, to analyze the contents of standard operation procedures (SOPs) among advanced general hospitals in Korea that conduct clinical trials, and to examine deliberation procedures for operation plans. Methods: The study examined how vulnerable research subjects were defined and described in related regulations and the classification of vulnerable research subjects presented in the IRB/HRPP SOPs of 18 clinical trial institutions, including 11 AAHRPP-accreditated general hospitals in Korea, as well as the operation of the IRB deliberation. Results: Among all domestic and international regulations and guidelines, only the The Council for International Organization of Medical Sciences (CIOMS) guidelines explain why vulnerability is related to judgments on the severity of physical, psychological, and social harm, why individuals are vulnerable, and for what reasons. However, the classification of vulnerable subjects by institutions differed from the classification by the International Conference on Harmonization-Good Clinical Practice (ICH-GCP). A total of the 16 institutions classified children and minors as vulnerable research subjects. 14 institutions classified subjects who cannot consent freely were classified as vulnerable subjects. 15 institutions classified sujects who can be affected by the organizational hierarchy were classified as vulnerable subjects. Subjects in emergency situations were regarded as vulnerable research subjects in 8 of institutions, while people in wards, patients with incurable diseases, and the economically poor including the unemployed were categorized as vulnerable research subjects in 7, 4, and 4 of institutions, respectively. Additionally, some research subjects were not classified as vulnerable by ICH-GCP but were classified as vulnerable by domestic institutions 15 of the institutions classified pregnant women and fetuses as vulnerable, 11 classified the elderly as vulnerable, and 6 classified foreigners as vulnerable. Conclution: The regulations and institutional SOPs classify subjects differently, which may affect subject protection. There is a need to improve IRBs' classifications of vulnerable research subjects. It is also necessary to establish the standards according to the differences in deliberation processes. Further, it is recommended to maintain a consistent review of validity, assessment of risk/benefit, and a review using checklists and spokeperson. The review of IRB is to be carried out in a manner that respects human dignity by taking into account the physical, psychological, and social conditions of the subjects.

• 한국병원경영학회지
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• 제9권3호
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• pp.71-97
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• 2004

This study conducted a comparative analysis of awareness level of review standards, continuing education, and awareness about the need for speciality and educational courses in order to improve quality of Korean health insurance review work and to present directions for policies of personnel development and continuing education to smoothly perform hospital's insurance claim work and Agency's review work. The analysis unit of the study is individuals, and survey was conducted among hospital's claim officers and Agency' review officers by distributing questionnaires. The major results of the study are as follows: First, it is found that hospital's claim officers and Agency's review officers have conflicting awareness about review standards; more Agency's review officers think that current review standards are universal and reasonable, while more hospital's claim officers believe that they need to be revised. Especially, hospital's claim officers replied that it is possible that review results can differ according to government's policies. Second, there is no significant difference between the two groups in the opinion that there are individual differences in awareness level of review standard. In particular, both groups share the opinion that review results can differ according to officer's interpretation of review standards. Third, Both review officer groups feel the need for further training and continuing education. Fourth, there is no difference between the two groups in the opinion that both groups members should be educated in review related educational institutions. However, while 81.5% of Agency's review officers the education should be offered at the Agency, only 45.2% of hospital's claim officers agreed to it. Fifth, both review personnel do not show any difference in awareness of needed experience to successfully perform review work; both groups replied that three to four years experience is necessary to smoothly perform claim work and review work. This study was tried in order to search for directions to improve Korean insurance review work in quality rather than to explore characteristics themselves of individual factors. In this sense, this study presupposed an intention that the educational subjects for further training and continuing education for the two groups should be the same in order to narrow the awareness gap between hospital's claim officers and Agency's review officers. Thus, this study suggests that it is desirable to offer beginner courses at junior colleges or in undergraduate courses and advanced courses in professional graduate school for six to twelve months. In that a comparison of awareness level of hospital's claim officers and Agency's review officers who are actually in practice should precede appropriate presentation of directions for the qualitative improvement of insurance review work in Korea, the significance of this study lies in comparatively analyzing the awareness level of hospital's claim officers and Agency's review officers and in presenting the establishment of future further training and continuing education.

• 척추신경추나의학회지
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• 제16권1호
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• pp.67-72
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• 2021

Objectives The purpose of this study was to analyze the current status of utilization of Korean medical institutions. Methods This study analyzed the Health Insurance Review and Assessment Service data (2016-2020). We included patients with one of the five most frequent diseases in Korea and examined the variation in healthcare utilization. Results This study analyzed the Health Insurance Review and Assessment Service data (2016-2020). We included patients with one of the five most frequent diseases in Korea and examined the variation in healthcare utilization. Conclusions As a result of this study, It was possible to understand the impact of Chuna treatment and COVID-19 on the use of Korean medical institutions. Further studies are needed to establish a definite conclusion regarding the relevance of COVID-19.

• 의료법학
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• 제12권2호
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• pp.189-217
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• 2011

According to the current law of national health insurance, the Minister of Health and Welfare can impose a suspension of business or license, and a fine with medical institutions who violate the law. In case that medical institutions raise an action for ity with each penalty, they ask for replacing the suspension of business with a fine during the pendency of the action. But there is a long gap of time between an offense and administrative measures. One violation cause several types of administrative measures (suspension of business or fine, suspension of license etc.) and different government departments impose these penalties. It takes a lot of time to organize their opinions and they are liable to impose penalties after considerable space of time because of overwhelming tasks. Then the medical institutions can sustain a loss by getting unexpected administrative measures after their offense against the law. Thus, this article review whether extinctive prescription apply to the right of imposing fine on the law of national health insurance or not. Meanwhile, we have no regulations imposing a same fine to co-representatives of medical institution who infringe the law of national health insurance. On this point, this study review whether they have equal duty on that or not.

• 의학교육논단
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• 제25권1호
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• pp.55-67
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• 2023

This study was conducted to examine trends in research about nurse educators in Korean hospitals. The methodological framework consisted of previous work by Arksey and O'Malley. A literature search was performed of electronic databases (RISS, KISS, CINAHL, and PubMed) from January 2000 to June 2022. Each study was collated and analyzed, and the studies' data were abstracted into the following categories: publication year, study design, study participants, and education program details. Eight studies were reviewed. Most of the studies were published after 2020 (87.5%). The most frequently used design was quasi-experimental (50.0%). There were three studies whose subjects were nursing educators and five studies were conducted on programs in which nurse educators participated. In Korean medical institutions, clinical nurse educators have various roles, including the development and operation of programs and serving as facilitators and evaluators. In most studies, knowledge and skills were measured as outcome variables of educational programs led by nurse educators. The roles of nurse educators were diverse in Korean medical institutions. Therefore, a program to enhance the competency of nurse educators is needed. Judging from the effects of nurse educators in Korean medical institutions, it is necessary to expand the nurse educator system, and additional research on nurse educators should be conducted.

• 한국전문물리치료학회지
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• 제30권1호
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• pp.1-7
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• 2023

Background: Like many other countries, falls and related injuries in older adults are great concerns in South Korea. In particular, falls are common in medical institutions, often causing the increase of the length of hospitalization. Objects: The purpose of this review was to help understand and address falls in hospitalized individuals in South Korea. Methods: The review was conducted on literature published in Korean from 2010 to 2022, searched in the Korea Citation Index and PubMed. Keywords used for the search were as follows: falls, fall risk, fall risk assessment, hospital, inpatient, intervention, Korea, and prevention. Results: A total of 54 articles were found and reviewed. The most common place of fall accidents was the inpatient room, where there were many cases of falls while walking. Loss of balance was the most common cause of falls, and many falls occurred in patients admitted to the internal medicine. Furthermore, a risk of falling increased with the type of medications taken. In terms of tools to assess patients' fall risk, the Morse Fall Scale (MFS) was commonly used. Patient-specific fall prevention activities were common to address falls, and they decreased the frequency of falls and the fear of falling. Factors influencing the effectiveness of the fall prevention activities included attitudes toward falls, education, environmental factors, patient safety culture, and self-efficacy in preventing falls. Conclusion: Our results should help understand and address falls and injuries in medical institutions.

• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.148-155
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• 2012

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poorquality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

• 한국의료질향상학회지
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• 제25권2호
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• pp.16-25
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• 2019

Purpose:The healthcare system of South Korea is at the extreme of the dispersed system. Few regulations limit patients from directly visiting higher-level medical institutions for primary care sensitive conditions. As a result, similar to local clinics, general and tertiary teaching hospitals also provide diverse primary care services. Our study aimed to examine the general public's perceptions of their primary care performance. Methods: Face-to-face surveys were conducted with 1000 adults who were living in South Korea with the aid of a questionnaire that included the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of five domains, which are the main indicators of primary care performance: first contact, comprehensiveness, coordination, personalized care, and family/community orientation. One-way analysis of variance and post hoc tests were used to compare the KPCAT scores across the three types of medical institutions. Results: Domain-wise analyses revealed two different patterns. With regard to first contact and its subdomains, the highest and lowest scores emerged for local clinics and tertiary teaching hospitals, respectively. However, the other four domain scores were significantly lower for local clinics than for the other two types of medical institutions. Conclusions: Local clinics were perceived to be medical institutions that are responsible for providing primary care. However, the general public perceived only one domain of their primary care to be superior to that of the other two types of medical institutions: first contact. National efforts should be taken to strengthen their other four domains of primary care by training their workforce and providing appropriate incentives.

• 디지털융복합연구
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• 제16권12호
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• pp.533-540
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• 2018

이 연구는 건강보험 심사평가원 자료를 이용하여 동일 환자의 동일 질환에 대하여 서로 다른 의료기관이 부여하는 질병 코딩의 불일치성을 분석하여 국가 보건 통계 질 향상을 위한 기초 자료로 활용하고자 시행하였다. 건강보험심사평가원 2014년 전체 환자 데이터셋(HIRA-NPS)에서 9,976,826건의 진료비 명세서를 연구 대상으로 하였다. 연구결과 의료기관의 이동 경로에 따라서 질병 코딩 불일치의 차이가 존재 하였고 불일치율은 보건기관 이외의 타 의료기관에서 보건기관으로 이동하였을 때 높아지는 경향이 발견되었고, 상급종합병원 간 이동하였을 때는 불일치율이 현저하게 낮았다. 본 연구의 의료기관 간 질병 코딩 불일치 현황 분석은 국내 의료기관에서 일관성 있는 질병 코딩이 이루어지기 위한 제도적 보완의 필요성을 시사하고 있다.

• 지식경영연구
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• 제24권3호
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• pp.35-52
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• 2023

본 연구는 혁신에 관한 이론적 논의를 검토하고, 위탁집행형 준정부기관의 특징을 바탕으로 혁신을 위한 방향을 탐색하는데 목적이 있다. 또한 지식창출을 위한 혁신의 주요 내용과 방향성을 탐색함으로서, 위탁집행형 준정부기관 혁신을 위한 방향을 도출하는데 목적이 있다. 혁신과제란 하나의 사업이자 공적 서비스이므로, 서비스의 혁신의 논의를 활용해 혁신과제 유형화를 위한 이론적 검토를 실시하고자 한다. 이론적 틀에 따르면 공공부문 혁신의 시작은 환경 및 사회적 가치의 변화를 탐색하는데서 시작한다. 이 과정을 통해 혁신의 목표와 방향은 물론이고 기관별 핵심역량과 연계된 혁신 과제를 설정하게 된다. 이때 주의할 점은 제도적 조건과 해당 위탁집행형 준정부기관의 특성을 고려해야 한다는 점이다. 결론적으로 이러한 특성을 고려하여, 위탁집행형 준정부기관들은 자신들의 혁신과제 달성을 위한 노력을 확인하고, 자신이 어느 유형에 속하는지 혁신의 추진여건을 진단할 필요가 있다.