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Analyses of the Efficiency in Hospital Management (병원 단위비용 결정요인에 관한 연구)

  • Ro, Kong-Kyun;Lee, Seon
    • Korea Journal of Hospital Management
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    • v.9 no.1
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    • pp.66-94
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    • 2004
  • The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

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The Factors Related to Musculoskeletal Symptoms of Family Care-Givers who Have a Patient with Brain Damage (뇌손상 가족 간병인의 근골격계 자각증상과 관련요인)

  • Jeon, Eun-Mi;Lee, Seong-A;Gu, Jung-Whan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.1
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    • pp.336-344
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    • 2017
  • This study was conducted to identify factors related to the musculoskeletal symptoms of 340 family caregivers who have a patient with brain damage based on self-administered questionnaires. The questionnaires included general characteristics, characteristics of care activities and caregivers' musculoskeletal symptoms. Data were collected from many long-term care hospitals and rehabilitation centers during March 17 to March 21, 2014. The results indicated that complaint rates of work-related musculoskeletal systems of the body sites differed. Factor analysis revealed that neck complaints were related to education (under mid), while shoulder complaints were related to sex (female), age (50-59), education (mid) and duration of care (< 2 years). Arm/elbow complaints were related to age (40-49), education (high) and duration of care (12-24). Complaints regarding the hand/wrist/finger were related to age (50-59) and duration of care (12-24), while those associated with the legs/feet were related to age (50-59) and duration of care (< 6[ED highlight - years? Please specify.]). Back problems were related to education (under mid, mid stage, high) and gait. The complaint rate regarding musculoskeletal symptoms during daily life was not statistically significant. Logistic regression analysis of significant factors related to subjective musculoskeletal symptoms identified ambulation and gait as having the greatest influence and complaint factor among family caregivers. The complaint rate of family caregivers differed among body parts. Being a caregiver for less than one year was found to have a significant impact on pain. Overall, long term family caregivers could be faced with risk factors for musculoskeletal problems, but there are many different factors that affect musculoskeletal symptoms with regards to their activities. Accordingly, comprehensive and systematic prevention plans for family caregivers who have patients with brain damage should be developed.

$H_2$ Receptor Antagonists and Gastric Cancer in the Elderly: A Nested Case-Control Study (노인 인구에서 $H_2$ Receptor Antagonist와 위암과의 관련성: 코호트 내 환자-대조군 연구)

  • Kim, Yoon-I;Heo, Dae-Seog;Lee, Seung-Mi;Youn, Kyoung-Eun;Koo, Hye-Won;Bae, Jong-Myon;Park, Byoung-Joo
    • Journal of Preventive Medicine and Public Health
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    • v.35 no.3
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    • pp.245-254
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    • 2002
  • Objective : To test if the intake of $H_2$ receptor antagonists ($H_2$-RAs) increases the risk of gastric cancer in the elderly. Methods : The source population for this study was drawn from the responders to a questionnaire survey administered to the Korea Elderly Pharmacoepidemiological Cohort (KEPEC), who were beneficiaries of the Korean Medical Insurance Corporation, were at least 65 years old, and residing in Busan in 1999. The information on $H_2$-RAs exposure was obtained from a drug prescription database compiled between inn. 1993 and Dec. 1994. The cases consisted of 76 gastric cancer patients, as confirmed from the KMIC claims data, the National Cancer Registry and the Busan Cancer Registry. The follow-up period was from Jan. 1993 to Dec. 1998. Cancer free controls were randomly selected by 1:4 individual matching, which took in to consideration the year of birth and gender. Information on confounders was collected by a mail questionnaire survey. The odds ratios, and their 95% confidence intervals, were calculated using a conditional logistic regression model. Results : After adjusting for a history of gastric ulcer symptoms, medication history, and body mass index, the adjusted OR (aOR) was 4.6 (95% CI=1.72-12.49). The odds ratio of long term use (more than 7 days) was 2.3 (95% CI=1.07-4.82). The odds ratio of short term use was 4.6 (95% CI=1.26-16.50). The odds ratio of parenteral use was 4.4 195% CI=1.16-17.05) and combination use between the oral and parenteral routes (aOR, 16.8; 95% CI=1.21-233.24) had the high risk of gastric cancer. The aOR of cimetidine was 1.7 (95% CI=1.04-2.95). The aOR of ranitidine was 2.0 (95% CI=1.21-3.40). The aOR of famotidine was 1.7 (95% CI=0.98-2.80). Conclusion : The intake of $H_2$-RAs might increase the risk of gastric cancer through achlorhydria in the elderly.

A Study on the Quality Control of Transvaginal Ultrasound Transducer using ATS-539 Ultrasound Phantom (ATS-539 초음파 팬텀을 이용한 경질 초음파 검사용 탐촉자의 정도관리에 대한 연구)

  • Park, Ji Hye;Heo, Yeong Cheol;Kim, Yon min;Han, Dong Kyoon
    • Journal of the Korean Society of Radiology
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    • v.15 no.4
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    • pp.463-472
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    • 2021
  • Demand for examinations using transvaginal transducer with high frequencies is increasing to observe pelvic organs in gynecological ultrasound tests. However, the quality control of the replacement probe in clinical trials is not properly implemented and the evaluation criteria have not been established. Therefore, 58 transvaginal transducers and 20 convex transducers were applied to the ATS-539 ultrasound phantom for 20 ultrasound devices currently in clinical use to obtain their respective images and measure them quantitatively and qualitatively. For quantitative measurements, vertical measurement, horizontal measurement, and focal zone and qualitative measurements, dead zone, axial·lateral resolution, sensitivity, functional resolution, gray scale·dynamic range were performed. Quantitative statistical analysis showed significant differences between the two transducers in the lateral measurement and local area (p<0.05). qualitative comparative analysis showed differences in sensitivity and functional resolution. This occurs due to the difference in frequency between transducers and the transducer's injection geometry. Based on the above experiments, the tolerance for horizontal measurement is raised to 10% (±8 mm), the tolerance for sensitivity is observed up to 6 cm deep, which is 12 cm deep,which is the level of the third quartile (75%). The permissible range of functional resolution is up to 6 (12 cm), 6 (12 cm), 11 (11 cm), 9 (9 cm), 6 (6 cm) target, which is the level of the third quartile (75%). It is considered reasonable to adjust the depth of targets in gray scale·dynamic range to measure at a depth of 2 cm, which is 50% of the depth of 4 cm. As above, the criteria for evaluating the quality of transvaginal transducer for use in the past have been proposed and it is expected that this study will be used as a basic data for the production of phantom exclusively for transvaginal transducer in the future.

Optimum Design of Soil Nailing Excavation Wall System Using Genetic Algorithm and Neural Network Theory (유전자 알고리즘 및 인공신경망 이론을 이용한 쏘일네일링 굴착벽체 시스템의 최적설계)

  • 김홍택;황정순;박성원;유한규
    • Journal of the Korean Geotechnical Society
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    • v.15 no.4
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    • pp.113-132
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    • 1999
  • Recently in Korea, application of the soil nailing is gradually extended to the sites of excavations and slopes having various ground conditions and field characteristics. Design of the soil nailing is generally carried out in two steps, The First step is to examine the minimum safety factor against a sliding of the reinforced nailed-soil mass based on the limit equilibrium approach, and the second step is to check the maximum displacement expected to occur at facing using the numerical analysis technique. However, design parameters related to the soil nailing system are so various that a reliable design method considering interrelationships between these design parameters is continuously necessary. Additionally, taking into account the anisotropic characteristics of in-situ grounds, disturbances in collecting the soil samples and errors in measurements, a systematic analysis of the field measurement data as well as a rational technique of the optimum design is required to improve with respect to economical efficiency. As a part of these purposes, in the present study, a procedure for the optimum design of a soil nailing excavation wall system is proposed. Focusing on a minimization of the expenses in construction, the optimum design procedure is formulated based on the genetic algorithm. Neural network theory is further adopted in predicting the maximum horizontal displacement at a shotcrete facing. Using the proposed procedure, various effects of relevant design parameters are also analyzed. Finally, an optimized design section is compared with the existing design section at the excavation site being constructed, in order to verify a validity of the proposed procedure.

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Correlation between Sleep Disorders and Sleepy Drivers (수면장애와 졸음운전의 상관성)

  • Kim, Ki-Bong;Sung, Hyun-Ho;Park, Sang-Nam;Kim, Bok-Jo;Park, Chang-Eun
    • Korean Journal of Clinical Laboratory Science
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    • v.47 no.4
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    • pp.216-224
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    • 2015
  • This study aims to identify the prevalence of sleep related disease in those who experienced car accidents caused by drowsy driving. To this end, a survey of usual sleep habits, polysomnography, and multiple sleep latency tests were conducted in 34 persons who experienced an accident after normal sleep (Group 1), 22 persons who experienced an accident after abnormal sleep (Group 2), and 17 persons who was proven to be normal as a result of polysomnography and had no accident (Group 3). In all, 192 persons responded to the preliminary survey and the results were compared and analyzed. Crossover analysis was conducted to test the homogeneity of statistical characteristics, and the physical characteristics by age were analyzed. In the survey of sleeping habits, there was a significance between groups in how often they woke up while asleep (p<0.01), how difficult it was to go back to sleep again after waking up from sleep (p<0.05), how early they woke up in the morning (p<0.05), how difficult it was to get up in the morning (p<0.05), how sleepy they felt in the daytime (p<0.01), and how tired they felt in the daytime (p<0.01). Furthermore, among 56 subjects who had an accident during drowsy driving, 94.6% (53 persons) were found to have sleep related diseases. This suggests that car accidents during drowsy driving is not simply caused by temporary lack of sleep but by sleep related diseases even when sleep is adequate, leading to car accidents. Therefore, this study is significant identifying the association between car accidents during drowsy driving and sleep related disorders. Furthermore, the data would be considered basic to prepare social measures against drowsy driving related to such sleep related disorders.

The effect of cavity wall property on the shear bond strength test using iris method (Iris 법을 이용한 전단접착강도 측정에서 와동벽의 영향)

  • Kim, Dong-Hwan;Bae, Ji-Hyun;Cho, Byeong-Hoon;Lee, In-Bog;Baek, Seung-Ho;Ryu, Hyun-Mi;Son, Ho-Hyun;Um, Chung-Moon;Kwon, Hyuck-Choon
    • Restorative Dentistry and Endodontics
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    • v.29 no.2
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    • pp.170-176
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    • 2004
  • Objectives : In the unique metal iris method. the developing interfacial gap at the cavity floor resulting from the cavity wall property during polymerizing composite resin might affect the nominal shear bond strength values. The aim of this study is to evaluate that the iris method reduces the cohesive failure in the substrates and the cavity wall property effects on the shear bond strength tests using iris method. Materials and Methods : The occlusal dentin of 64 extracted human molars were randomly divided into 4 groups to simulate two different levels of cavity wall property (metal and dentin iris) and two different materials ($ONE-STEP^{\circledR}$ and $ALL-BOND^{\circledR}$ 2) for each wall property. After positioning the iris on the dentin surface. composite resin was packed and light-cured. After 24 hours the shear bond strength was measured at a crosshead speed of 0.5 mm/min. Fracture analysis was performed using a microscope and SEM. The data was analyzed statistically by a two-way ANOV A and t-test. Results : The shear bond strength with metal iris was significant higher than those with dentin iris (p=0.034). Using $ONE-STEP^{\circledR}$, the shear bond strength with metal iris was significant higher than those with dentin iris (p=0.005), but not in $ALL-BOND^{\circledR}$ 2 (p=0.774). The incidence of cohesive failure was very lower than other shear bond strength tests that did not use iris method. Conclusions:The iris method may significantly reduce the cohesive failures in the substrates. According to the bonding agent systems. the shear bond strength was affected by the cavity wall property.

Pain Reduction Effects of Lidocaine Gel for Urethral Catheterization : A Systematic Review and Meta-Analysis (요도 카테터 삽입술에서 리도카인 윤활제의 통증 감소 효과 : 체계적 문헌고찰과 메타분석)

  • Hong, Hyun-Jung;Kim, Ga-Eun;Lee, Ha-Nee;Lee, A-Reum
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.6
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    • pp.438-448
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    • 2017
  • This study was a systematic review and meta-analysis that evaluated the results of research on the pain reduction effects of lidocaine gel for urethral catheterization in adults. A literature search was conducted using seven electronic databases, gray literature and other resources based on the guidelines of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). A Risk of Bias (RoB) tool was applied to assess the quality of selected studies. Data were analyzed using the RevMan 5.3.-program. Sixteen randomized controlled trials involving 1904 adults were included. RoB was not observed in the funnel plot. Overall, lidocaine gel was effective for pain reduction during urethral catheterization (Standard Mean Difference[SMD] -0.96;95% CI: -1.43, -0.49). To explore the cause of heterogeneity (I2=95%, p<.001), subgroup analysis was conducted according to three catheter types (urinary catheter, flexible cystoscopy, and rigid cystoscopy) and the SMDs were -0.88 (95% CI:-1.51, -0.26), -0.31 (95% CI:-0.63, 0.01), and -1.93 (95% CI:-2.88, -0.97), respectively. A significant pain reduction effect was observed regardless of gender in urinary catheterization. However, in rigid cystoscopy, a significant pain reduction effect was observed only in male subjects. Pain reduction effects were observed when 10~11ml lidocaine gel was used during rigid cystoscopy and when lubrication was used during urinary catheterization, irrespective of application time. These findings suggest that lidocaine gel is a useful anesthetic lubricant for urinary catheterization and rigid cystoscopy in male adults.

Effect of working time on the film thickness of dental resin cements (레진 시멘트의 혼합 후 시간에 따른 피막도의 변화)

  • Yi, Yu-Seung;Kim, Sung-Hun;Lee, Jai-Bong;Han, Jung-Suk;Yeo, In-Sung;Ha, Seung-Ryong;Kim, Hee-Kyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.53 no.4
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    • pp.325-329
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    • 2015
  • Purpose: The aim of this study was to compare the film thicknesses of several resin cements as a function of time after mixing and to examine the effect of working time on the film thicknesses. Materials and methods: The film thickness (${\mu}m$) of 4 resin cements (n=10), 1 composite resin (Panavia F 2.0), 3 self-adhesive resin (Clearfil SA luting, Zirconite, RelyX U200) cements was measured at 20-second intervals after mixing of the cements up to 200 seconds under a load of 50 N. Linear regression was fitted to verify the effect of working time on the film thickness of each cement. Data were compared to the working time recommended by manufacturers using Wilcoxon test ($\alpha$=.05). Results: All of the materials showed a positive linear correlation between the film thickness and working time. There was no statistically significant difference between the working time based on our results and the values recommended by the manufacturers even though there was a discrepancy between those two values. Conclusion: The film thickness of resin cements could increase with the increase of working time. Working time to meet the ISO standard of $50-{\mu}m$ maximum film thickness could be different from the manufacturer's recommended value.

Evaluation of Patient Radiation Doses Using DAP Meter in Interventional Radiology Procedures (인터벤션 시술 시 면적선량계를 이용한 환자 방사선 선량 평가)

  • Kang, Byung-Sam;Yoon, Yong-Su
    • Journal of radiological science and technology
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    • v.40 no.1
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    • pp.27-34
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    • 2017
  • The author investigated interventional radiology patient doses in several other countries, assessed accuracy of DAP meters embedded in intervention equipments in domestic country, conducted measurement of patient doses for 13 major interventional procedures with use of Dose Area Product(DAP) meters from 23 hospitals in Korea, and referred to 8,415 cases of domestic data related to interventional procedures by radiation exposure after evaluation the actual effectives of dose reduction variables through phantom test. Finally, dose reference level for major interventional procedures was suggested. In this study, guidelines for patient doses were $237.7Gy{\cdot}cm^2$ in TACE, $17.3Gy{\cdot}cm^2$ in AVF, $114.1Gy{\cdot}cm^2$ in LE PTA & STENT, $188.5Gy{\cdot}cm^2$ in TFCA, $383.5Gy{\cdot}cm^2$ in Aneurysm Coil, $64.6Gy{\cdot}cm^2$ in PTBD, $64.6Gy{\cdot}cm^2$ in Biliary Stent, $22.4Gy{\cdot}cm^2$ in PCN, $4.3Gy{\cdot}cm^2$ in Hickman, $2.8Gy{\cdot}cm^2$ in Chemo-port, $4.4Gy{\cdot}cm^2$ in Perm-Cather, $17.1Gy{\cdot}cm^2$ in PCD, and $357.9Gy{\cdot}cm^2$ in Vis, EMB. Dose referenece level acquired in this study is considered to be able to use as minimal guidelines for reducing patient dose in the interventional radiology procedures. For the changes and advances of materials and development of equipments and procedures in the interventional radiology procedures, further studies and monitorings are needed on dose reference level Korean DAP dose conversion factor for the domestic procedures.