• Title/Summary/Keyword: Value-based health care

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Stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions

  • Seigo Nakatani;Kosuke Okuwaki;Masafumi Watanabe;Hiroshi Imaizumi;Tomohisa Iwai;Takaaki Matsumoto;Rikiya Hasegawa;Hironori Masutani;Takahiro Kurosu;Akihiro Tamaki;Junro Ishizaki;Ayana Ishizaki;Mitsuhiro Kida;Chika Kusano
    • Clinical Endoscopy
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    • v.57 no.1
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    • pp.89-95
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    • 2024
  • Background/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). Methods: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA's diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. Results: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. Conclusions: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

A Study on Smart Fitness Models for Active Senior (액티브시니어를 위한 스마트 피트니스 모델에 관한 연구)

  • Seungae Kang
    • Convergence Security Journal
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    • v.22 no.1
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    • pp.135-140
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    • 2022
  • This study aims to analyze exercise cases and issues using smart devices and technologies, and to present the development direction of a smart exercise environment suitable for the wellness life of active seniors with high activity and economic power unlike the existing silver generation. In the fitness industry, the subscription economy that regularly receives or uses necessary exercise tools, services, and digital content is expanding, and business models based on hardware sales and content subscription continue to emerge. In order to have value competitiveness as a platform that provides active seniors with integrated exercise services for health care, not only fitness centers, but also home training exercise equipment, fitness-related applications, and smart wearable device markets should be organically connected to form an expanded total platform. In order to have value competitiveness as a platform that provides active seniors with integrated exercise services for health care, not only fitness centers, but also home training exercise equipment, fitness-related applications, and smart wearable device markets should be organically connected to form an expanded total platform. The linkage of the digital healthcare function, which provides real-time changes to exercise programs based on continuous monitoring and feed back through wearable devices before, after, and during exercise by receiving and selecting exercise programs suitable for individual health status, is the differentiating factor in the smart fitness model.

Effectiveness of a Clinical Pathway for Breast Cancer Patients Undergoing Surgical Operation on Clinical Outcomes and Costs

  • Jeong Hyun Park;Danbee Kang;Seok Jin Nam;Jeong Eon Lee;Seok Won Kim;Jonghan Yu;Byung Joo Chae;Se Kyung Lee;Jai Min Ryu;Yeon Hee Park;Mangyeong Lee;Juhee Cho
    • Quality Improvement in Health Care
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    • v.30 no.1
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    • pp.120-131
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    • 2024
  • Purpose: This study aimed to evaluate the impact of implementing a clinical pathways (CPs) on the clinical outcomes and costs of patients undergoing breast cancer surgery. Methods: This retrospective cohort study included patients who were newly diagnosed with primary breast cancer at the Samsung Medical Center between 2014 and 2019 (N=8482; 2931 patients in the pre-path and 5551 patients in the post-path). Clinical outcomes included reoperation during hospitalization, readmission, and emergency room visits within 30 days of discharge. The cost data for each unit were obtained from an activity-based management accounting system. We performed an interrupted time series analysis. Results: The post-path period showed a significantly shorter hospital length of stay (LOS) than the pre-path period (6.3 days in pre-path vs. 5.0 days in post-path; -1.3 days' difference; p=.001), and fewer reoperations during hospitalization and within 30 days after discharge than the pre-path period. After adjusting for inflation rates and relative value scores, the model demonstrated savings of $146 per patient in the post-path for total costs, and $537 per patient for patient out-of-pocket costs (p=.001). Conclusion: CPs can help reduce costs without compromising the quality of care by reducing the number of reoperations, readmissions, and complications.

Cost Analysis of Home Care with Activity-Based Costing(ABC) (활동기준원가계산[ABC]을 적용한 가정 간호 원가 분석)

  • Lee Su-Jeong
    • Journal of Korean Academy of Nursing
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    • v.34 no.6
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    • pp.1117-1128
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    • 2004
  • Purpose: This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. Method: The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. Result: The HHC activities were classified into 70 activities. In resource, the labor cost was 245₩per minute, operating cost was 9,570₩ per visit and traffic expense was an average of 12,750₩. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741₩ and the cost ranged from 55,560₩ to 74,016₩. Conclusion: The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

The Study on the Effect of Health Care Service Quality upon Customer Loyalty : Based upon SERVPERF (의료서비스 품질요인이 환자충성도에 미치는 영향에 관한 연구: SERVPERF 척도를 중심으로)

  • Han, Sang-Sook;Son, In-Sun;Gu, Ja-Chul;Lee, Sang-Chul
    • Journal of Korean Society for Quality Management
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    • v.35 no.1
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    • pp.61-72
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    • 2007
  • The purpose of this research is to identify causalities among service quality, service value, customer satisfaction and customer loyalty. A Structural Equation Model is used to test the hypothesis of conceptual model. To test the model, we collect data by conducting a survey with 508 patients. Empirical result indicates that three factors such as tangibles, assurance, and empathy have direct impact on service value and customer satisfaction. Especially, customer loyalty is positively related not with service value but with customer satisfaction.

Nurses' Perceptions of Person-Centered Care in Long-term Care Hospitals: Focus Group Study (인간중심돌봄에 대한 요양병원 간호사의 인식: 포커스 그룹 연구)

  • Chang, Hee-kyung;Gil, Cho-rong;Kim, Hye-jin;Bea, Han-ju;Yang, Eun-ok;Yoon, Mi-lim;Ha, Ja-hyeon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.11
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    • pp.441-453
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    • 2018
  • This study was conducted to understand and describe Korean nurses' perception of person-centered care for elderly patients in long-term care hospitals. Qualitative data were collected through four focus group interviews consisting of 21 nurses working in four long-term care hospitals in Jeolla and Gyeongsang provinces. Participants completed interviews from July 19 to 30, 2018. All interviews were recorded, transcribed, and analyzed by employing the thematic analysis method. Six main themes for the attributes of person-centered care for elderly patients in the long-term care hospitals were conceptualized: respecting individual needs, walking to the end, supporting hidden dreams, becoming a family partner, helping patients live like they are at home, and changing culture. Person-centered care perceived by nurses was conducted to provide individualized nursing according to elderly's preferences and help them discover the value and meaning of life through various activity programs. Nurses also recognized person-centered care to maintain cooperative relationships with their family members and share their decision-making process, as well as to form a physical environment and organizational culture that respects the rights and autonomy of the elderly. Based on the results of this study, it is necessary to identify the diverse needs of the elderly and develop nursing intervention programs based on person-centered care.

A Development of Healthcare Monitoring System Based on Internet of Things Effective

  • KIM, Song-Eun;MUN, Ji-Hui;KIM, Kyoung-Sook;KANG, Min-Soo
    • Korean Journal of Artificial Intelligence
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    • v.8 no.1
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    • pp.1-6
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    • 2020
  • The Recently there has been a growing interest in health care due to the COVID-19 situation. In this paper, we intend to develop a healthcare monitoring system to provide users with smart healthcare systems in line with the healthcare 3.0 era. The system consists of a wireless network between various sensors, Android smartphones, and OLEDs using Bluetooth, and through this, a health care monitoring system capable of collecting user's biometric information and managing health by receiving data values of sensors connected to Arduino. In conclusion, the user's BPM value was calculated using the heart rate sensor, and the exercise intensity can be adjusted through this. In addition, a step derivation algorithm is implemented using an acceleration sensor, and calorie consumption can be measured using the step and weight values. As such, the heart rate, step count, calorie consumption data can be transmitted to a smartphone application through a Bluetooth module and output, and can be output to an OLED for users who are not easy to access the smartphone. This healthcare monitoring system can be applied to various groups and technologies.

Are the nurses overpaid or underpaid\ulcorner (간호사 임금수준의 상대적 적정성 연구)

  • 김철환;송미숙
    • Health Policy and Management
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    • v.6 no.1
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    • pp.59-84
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    • 1996
  • It is generally believed that the medical profession in Korea is an well-paid field along with legal profession. In this vein, the nursing is regarded one of well-paid profession. The actual data, however, reveals that nurses belong to low income bracket. We carefully compare the nurse's earnings with those of other professions. We selected 58 professions, which are similar in vocational characteristics and education background to nurses and conduct a regression analysis to estimate earning functions. Using the estimated coefficients, we project an optimum salary level for nurse, and compare it with the actual salary level. The estimated results show that the nurses are underpaid : their actual salary is less than the optimum level. We provide several explanations for this phenomenon : a tradition based on Confucian value, wage discrimination for women, and wage inequality among hospitals. Undercompensation will result either ratard professional development, or block the motivation for high quality of nursing care. If the current underpaying situation is not improved, a shortage of nurses along with an noticeable decline in the quality of medical services are expected. Therefore an adequate compensation for nurses must be properly assessed and addresed not only be health care authorities but also by legislators. Further research is needed to explain why there is such as wide salary inequality among nurses, and to find what cause it.

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The Development of Classification System of Dental Services for Temporomandibular Joint Disorders (측두하악장애 의료행위분류에 관한 연구)

  • Song, Yun-Heon;Kim, Mee-Eun;Kim, Ki-Suk
    • Journal of Oral Medicine and Pain
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    • v.30 no.2
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    • pp.257-268
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    • 2005
  • It is recently suggested in Korea that Resource-Based Relative Value Scale (RBRVS) is an alternative plan of Korean Dental Fee Schedule which has been operated on a fee-for-service basis since the introduction of the national health insurance program in 1977. RBRVS applicable to diagnosis and treatment for temporomandibular disorders (TMD), a common cause of orofacial pain, is needed to be estimated in Korea and the establishment of the standard terminology of dental procedures for TMD should be preceded. The purposes of this study were to develop a new classification system of health care service items for TMD and to investigate time needed for each item, which enables RBRVS to be estimated prior to establishment the payment system of health care services for TMD. The dental service items for TMD in this study were categorized through Delphi process which 10 TMD specialists were participated in and the time needed for each service item was investigated by work sampling and time study method with a stopwatch. The results of this study demonstrated the new classification system of dental services for TMD comprising 151 service items and exhibited the average time for each items ranging from 7.22 min for cold laser therapy to 171.71 min for direct fabrication of anterior repositioning splint. Conclusively, it is suggested that the classification system for TMD developed in this study, considering specific characteristics on basis of resources for health care service of dental procedures, should be helpful to estimate payment level for each service item.

The Seosan County Family Planning/Maternal & Child Health Service Research Project, Korea -Project Design and Findings of the Baseline Survey- (가족계획(家族計劃) 및 모자보건사업(母子保健事業)의 효율적 통합방안(統合方案)에 관한 연구(硏究)(서산군(瑞山郡)) -기초조사보고(基礎調査報告)-)

  • Bang, S.;Cho, T.H.;Lee, S.J.;Han, S.H.;Lim, K.J.;Ahn, M.Y.
    • Journal of Preventive Medicine and Public Health
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    • v.16 no.1
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    • pp.163-192
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    • 1983
  • In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has under-taken a service research project. The project has employed a quasi-experimental study design introducing interventions tat provide crucial factors lacking in the ongoing government programs such as midwives and qualified referral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selelcted townships of Seosan County. In this sample survey of bath the study and control areas, 2,484 eligible women (97% reponse rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows.: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning (45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 3. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm or withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women), Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure of 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE: In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity, and they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregancies. In the Korean rural setting. the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.

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