• Journal of Preventive Medicine and Public Health
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• 제38권2호
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• pp.132-140
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• 2005

Objectives: To propose a risk-adjustment model from insurance claims data, and analyze the changes in cesarean section rates of healthcare organizations after adjusting for risk distribution. Methods: The study sample included delivery claims data from January to September, 2003. A risk-adjustment model was built using the 1st quarter data, and the 2nd and 3rd quarter data were used for a validation test. Patients' risk factors were adjusted using a logistic regression analysis. The c-statistic and Hosmer-Lemeshow test were used to evaluate the performance of the risk-adjustment model. Crude, predicted and risk-adjusted rates were calculated, and compared to analyze the effects of the adjustment. Results: Nine risk factors (malpresentation, eclampsia, malignancy, multiple pregnancies, problems in the placenta, previous Cesarean section, older mothers, bleeding and diabetes) were included in the final risk-adjustment model, and were found to have statistically significant effects on the mode of delivery. The c-statistic (0.78) and Hosmer-Lemeshow test ($x^2$=0.60, p=0.439) indicated a good model performance. After applying the 2nd and 3rd quarter data to the model, there were no differences in the c-statistic and Hosmer-Lemeshow $x^2$. Also, risk factor adjustment led to changes in the ranking of hospital Cesarean section rates, especially in tertiary and general hospitals. Conclusion: This study showed a model performance, using medical record abstracted data, was comparable to the results of previous studies. Insurance claims data can be used for identifying areas where risk factors should be adjusted. The changes in the ranking of hospital Cesarean section rates implied that crude rates can mislead people and therefore, the risk should be adjusted before the rates are released to the public. The proposed risk-adjustment model can be applied for the fair comparisons of the rates between hospitals.

• 한국보육지원학회지
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• 제12권6호
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• pp.79-102
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• 2016

The purpose of this study was to identify school adjustment groups by applying a Latent Profile Analysis(LPA) and to investigate the effects of children's emotional problems and study habits on determining the membership of these groups. LPA and multiple logistic regression were conducted using the data of 2,200 third-graders from the Korean Children and Youth Panel Study. The results are listed as follows. First, four school adjustment groups were identified: adjustment, approach to adjustment, maladjustment risk, and maladjustment group. Second, accomplishment value and mastery goal orientation were relatively strong predictors of membership of the school adjustment groups. Time management was also a significant variable that predicted the membership of maladjustment or the maladjustment-risk group. Third, attention problems and depression were the most consistent predictors of membership of maladjustment or the maladjustment-risk group. Physical symptoms and social withdrawal were also significant. Based on the results, implications for intervention to promote early school adjustment were discussed.

• 한국학교보건학회지
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• 제23권1호
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• pp.41-52
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• 2010

Purpose: The objective of this study is to investigate the relationship between middle and high school students' internet addiction, social support, self-efficacy and school life adjustment. Data were collected by self-administered questionnaires at middle and high school students located in Seoul and the metropolitan areas. Methods: The response rate is 94.8% (474 cases). The internet addition was measured by K Scale. The various methods of analysis were used, for example, frequency analysis, t-test, analysis of variance, and multiple regression analysis. Results: First, the mean score of internet addiction level is 2.07 in 5 Likert scale. the internet addiction level of the male students are higher than female students (p<.05). Second, as a result of classification of internet addiction groups by K Scale, 11 students (2.3%) are included in high risk group, 27 students (5.7%) are in potential risk group, 436 students (92.0%) are in general group. Third, the level of social support and self-efficacy of middle and high school students are very high. The difference of social support by internet addiction groups was not statistically significant. But, the difference of self-efficacy by internet addiction groups was statistically significant. The level of self-efficacy of the students in general groups are more higher than in high risk group and in potential risk group (p<.01). Fourth, the difference of school adjustment by internet addiction groups was very statistically significant. The level of school life adjustment of the students in general groups are more higher than in high risk group and in potential risk group (p<.01). Fifth, the internet addiction have a negative correlation with school life adjustment. And the social support and self-efficacy have a positive correlation with school life adjustment (p<.01). Finally, in stepwise multiple regression analysis, the internet addiction affects negatively on the school adjustment. And the support of teacher among three types of them affects positively on the school life adjustment. And the social self-efficacy among two types of them affects positively on the school adjustment (p<.01). Conclusion: to adjust desirably the school environment of the middle and high school students, optimal and efficient management of internet addiction was needed in the future and the improvement and promotion of social support and social self-efficacy of the students was also demanded.

• Journal of Preventive Medicine and Public Health
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• 제39권1호
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• pp.13-20
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• 2006

Objectives: To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. Methods: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. Results: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test ($x^2=6.92$, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971 patients) and 4 high-volume hospitals (1,087 patients) were identified. Significant differences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. Conclusions: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship.

• 디지털융복합연구
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• 제15권12호
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• pp.59-70
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• 2017

본 연구는 중도입국 청소년의 학교적응에 영향을 미치는데 있어 위험요인에 대한 보호요인의 조절효과가 있는지를 알아보고자 하였다. 이를 위해 2015년 전국다문화가족실태조사 대상 중 만 9~24세 청소년 자녀 6,079명 데이터에 가중치를 적용한 69,720명을 분석하였다. 분석결과 첫째, 중도입국 청소년의 위험요인인 차별경험, 학교폭력, 우울은 학교적응에 모두 부적인 영향을 미쳤다. 보호요인인 부모관계, 자아존중감, 한국어 능력, 국적취득은 학교적응에 모두 정적인 영향을 보였다. 둘째, 중도입국 청소년의 학교적응에 있어 3개의 위험요인 가운데 우울을 조절하는 보호요인 중에는 자아존중감과 국적취득 변인, 학교폭력을 조절하는 보호요인은 부모관계, 자아존중감, 한국어 능력, 국적취득 변인으로 분석되었다. 본 연구의 분석결과를 토대로 중도입국 청소년에 대한 우울감소, 학력폭력 대처, 다양한 역량강화 프로그램 개발과 지원을 주요 사회복지적 실천방안으로 제시하였다.

• Journal of Preventive Medicine and Public Health
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• 제34권4호
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• pp.337-346
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• 2001

Objective : To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. Methods Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. Results : The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. Conclusions : Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.

• 보건행정학회지
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• 제26권4호
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• pp.359-372
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• 2016

Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, $R^2$ values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.

• 인간행동과 음악연구
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• 제9권1호
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• pp.55-71
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• 2012

본 연구는 군 생활 적응에 어려움을 호소하는 관심병사들을 대상으로 집단음악심리치료를 시행하여 군 생활 스트레스와 적응 정도에 미치는 영향을 알아보는 것을 목적으로 한다. 본 연구는 ${\bigcirc}{\bigcirc}$ 사단에 소속된 병사들 중 국군병원 정신과 진료 및 군 전문상담관의 개별상담을 통해 관심병사로 분류된 7명을 대상으로 총 12시간에 걸쳐 집단음악치료 프로그램으로 진행되었다. 선행연구에서 계발 및 사용되었던 군 생활 스트레스 척도와 군 생활 적응척도를 사용하여 사전, 사후 검사를 실시하였고, 검사결과는 비모수에 의한 Wilcoxon 검정을 실시하였다. 집단음악치료 프로그램 중재 후 대상자들의 군 생활 스트레스 전체의 사전사후 검사결과는 통계적으로 유의미한 결과를 보였다(p < .05). 이를 하위 요인별로 보면 역할스트레스와 외부스트레스는 유의미한 차이가 있었고, 관계스트레스 및 직무스트레스는 통계적으로 유의미하지 않았다. 군 생활 적응척도의 전체 결과는 통계적으로 유의미하지 않았다(p < .05). 하지만 하위요인에서 심신의 상태와 직책과 직무만족은 통계적으로 유의미한 차이가 있었고, 임무수행의 의지와 군 환경에 대한 태도는 통계적으로 유의미하지 않았다. 이러한 결과들은 심리 정서적 지지 차원의 집단음악치료 활동이 군 부적응 관심병사의 스트레스와 군 생활 적응도에 긍정적 영향을 미칠 수 있음을 시사한다.

• 대한가정학회지
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• 제38권6호
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• pp.149-169
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• 2000

The purpose of this study was to examine the environmental characteristics of adolescents in low-income families, identify the high-risk & protective factors among environmental contexts surrounding adolescents, and investigate the relative importance of high-risk & protective factors to adolescents'psychological and behavioral adjustment separately. The present study was the primary research of developing prevention program for adolescents'deviant behaviors in low-income families. Subjects of this study consisted of 176 adolescents drawn from 8 social-welfare institutions in Chungbuk province. The pilot study was done to examine the applicability of survey instrument. Data were analyzed by the frequency, percentage, Pearson correlation, stepwise regression using SPSS/WIN program. The results were as followings: 1. There was statistically correlated with each other in environmental high-risk and protective factors except an housing environment. The results implies that environmental contexts itself surrounding adolescents in low-income families can be either high-risk factors or protective factors. 2. The adolescents in low-income families perceived that stresses from consumer and school environments were high-risk factors among other environmental contexts. 3. The adolescents in low-income families perceived that resources from friend and school were protective factors among other environmental contexts. 4. The stresses from friend and eating behaviors were significant factors predicting adolescents'relative psychological adjustment. However, the behavioral adjustment was not predicted by environmental contexts. 5. The resources from school, consumer, and eating behaviors were significant factors predicting adolescents'relative psychological adjustment. Also, the resources from school, eating behavior, and family were predictors of behavioral adjustment. This research implies that the findings can be based on the development of prevention program for adolescents deviant behaviors in low-income families.

• 한국경제지리학회지
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• 제12권4호
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• pp.665-680
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• 2009

본 연구의 목적은 위험조정모형을 활용하여 미국 REITs의 부동산 유형별 성과 특성을 분석하는 것이다. 특히, REITs의 성과가 성장기, 정체기, 금융위기기에 각각 어떻게 차별적인 지를 살펴본다. 분석결과를 요약하면 다음과 같다. 첫째로, 초과 종합수익률의 관점에서 REITs 부동산 유형별 성과를 보면, 1기와 2기에는 정(+)의 초과 성과가 발생한 반면, 3기에는 부(-)의 초과 성과가 나타난다. 금융위기 시기인 3기의 경우, 부(-)의 수익률이 발생한 뿐만 아니라 수익률의 변동성도 큰 것으로 나타난다. 둘째로, 자본자산가격결정모형에 의해 추정한 베타값을 보면, <분석모형 (1)>의 결과에서 평균적인 REITs에 비해 호텔, 지역몰, 상업모기지는 고위험-고수익 특성을, 자유입지, 아파트, 조립식주택, 특수목적 부동산은 저위험-저수익 특성을 가진 것으로 나타난다. <분석모형 (2)>의 결과를 보면, 금융위기 하에서 투자상품으로서의 REITs의 성격이 저위험-저수익에서 고위험-고수익으로 변화하고 있다. 마지막으로, 위험조정모형 추정결과를 보면, <분석모형 (1)>과 <분석모형 (2)> 모두 체계적 위험은 요구수익률에 정(+)의 영향을 미치는 반면, 비체계적위험은 요구수익률에 부(-)의 영향을 미치는 것으로 나타난다. 위험조정모형을 통해 도출된 요구수익률을 실제수익률과 비교한 결과, 헬쓰케어 부문이 가장 높은 정(+)의 성과를 보이고 있다.