• Journal of Preventive Medicine and Public Health
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• 제14권1호
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• pp.3-12
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• 1981

To identify the changes in professional care patterns after the introduction of medical insurance in Korea, professional care in hospitals and clinics of two succeeding years were compared. The hospitals and clinics selected for this study were those which located in Seoul city. Hospitals were classified into 3 categories: university hospital, general hospital and hospital. The diseases selected for this study were acute appendicitis and normal delivery. They were selected because their disease courses are considered to be fairly stable. The variables used for this study were length of stay, total hospital costs, costs of each components of cares. The information used for this study was obtained from the official forms requested by the medical facilities to the Korea Medical Insurance Corporation. The two periods studied were 3 months of each year from March 1st to May 31st in 1979 and 1980, The total number of normal delivery studied was 289 in 1979, 301 in 1980 respectively and the acute appendicitis was 92 and 111 respectively. In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used. The result of the study were briefly summarized in below. 1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals. 2. No significant difference was observed in the average total hospital costs of both diseases in all types of hospital, but in the private clinic the average clinic costs was rather decreased significantly in 1980. 3. More cost decrease were seen than cost increase in 1980 in all types of facilities, More cost changes by items were seen in acute appendicitis than in normal delivery between two study periods. The total hospital costs can be devided into 2 portions: charges for drug and material and for physician. In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the university hospitals, however, the costs for drug and material were increased significantly in 1980. The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy. The increase in the costs for the drug and material in the university hospitals was mainly due to the increase in the cost for drugs for oral administration and injection. 4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal delivery was characteristically increased in 1980 in all hospitals studied. In general the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980. The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection. The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy. Above mentioned changes in hospital and clinic care patterns are considered to be mostly influenced by the review criteria set by the K.I.C. for the assessment of the fee request made by clinics and hospitals.

• 보건행정학회지
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• 제29권2호
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• pp.220-227
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• 2019

Background: Potentially avoidable hospitalizations (PAH) contribute to an increased post-discharge mortality. Methods: To investigate the between-hospital variation and the relationship between all predictors and mortality after discharge among older adults with PAH, we studied 15,186 older patients with PAH in 2,200 hospitals included in the National Health Insurance Service-Senior claims database from 2002 to 2013. Multivariable multilevel logistic regression analyses were performed to analyze the variance at between-hospital for mortality after accounting for differences in patient characteristics. Results: The between-hospital variation in mortality that could be attributed to hospital practice variations were 37.6% at 1-week to 13.9% at 12-month post-discharge, after adjustment for individual patient characteristics and hospital-level factors. Hospital-level factors significantly explained mortality at 3 weeks after discharge. Clinics, compared with general hospitals, demonstrated a 2.75 times higher likelihood of deaths at 3-week post-discharge (p<0.001). Compared with private hospitals, public hospitals exhibited 1.61 times higher odds of 3-week mortality (p=0.01). Conclusion: This study demonstrates considerable between-hospital variations in PAH-related mortality that could be attributed to hospital practices. Monitoring of hospitals to identify practice variations would be warranted to improve the survival of older patients with PAH.

• Tuberculosis and Respiratory Diseases
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• 제49권3호
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• pp.343-352
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• 2000

연구배경 : 대부분의 국내 중환자실에서는 간호사들에 의해 호흡 치료가 이루어지고 있으나 그 실태는 잘 알려지지 않았다. 본 연구는 국내 중환자실에서 시행되는 호흡요법의 종류 및 호흡치료사들의 필요성을 알아보고자 하였다. 방법 : 중환자실이 설치된 117개 병원의 수간호사들을 대상으로 설문조사를 실시하였다. 결과 : 117개 병원 중 100개 병원에서 회신하여 회신율은 85%(대학병원 97%, 산하병원 81%, 종합병원 77%) 였다. 대학병원 66단위 중 18단위, 종합병원 58단위 중 35단위에서 통합 중환자실로 운영되고 있었으며 중환자실 전담의사가 있는 병원은 47.1% 였다. 호흡요법 전문치료사가 있는 병원은 없었으며 응답자의 92.8%가 전문치료사의 필요성을 인정하였다. 중환자실에서 제공되는 호흡요법 중 기관지흡인, 자세 변경, 타진법, 기침유발 등은 대부분 시행되고 있었으며 진동마사지, 간헐적 양압환기법 등은 종합병원에서의 시행률이 낮았다. 이러한 호흡요법은 주로 간호사들에 의해 시행되어졌으며 평균 8시간 근무 중 이러한 호흡요법 시행에 소모되는 시간은 1시간 미만에서 4시간까지 다양하였다. 산소공급을 위해 사용하는 장치 중 venturi mask, T-piece 등은 종합병원에서의 사용률이 낮았으며 종합병원은 전통적인 인공환기법에 대한 의존도가 상대적으로 높았다. Swan-Ganz catheter monitoring등의 혈역학적 감시 장비도 병원간의 차이를 보였다. 의료장비의 관리 및 보관에서도 담당 의공학과가 갖추어진 곳이 종합병원은 드물었다. 결론 : 국내 중환자실의 호흡치료는 간호사들에 의해 제공되고 있으며 병원 수준에 따라 제공되는 호흡요법 수준의 차이가 커 전문적 호흡요법의 수행을 위해서는 호흡치료사 제도의 도입이 필요할 것으로 사료된다.

• Investigative Magnetic Resonance Imaging
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• 제25권1호
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• pp.35-42
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• 2021

Purpose: To evaluate and analyze the adequacy of breast magnetic resonance imaging (MRI)s taken before publication of the 2018 recommendation in South Korea. Materials and Methods: We enrolled 87 cases of breast MRIs, from January 2010 to November 2013, taken at external hospitals in the study. Breast MRI protocol elements are divided into three categories based on the recommendation by the Breast Imaging Study Group of the Korean Society of Magnetic Resonance: (1) Essential elements for breast MRI protocol; (2) Element to consider when evaluating imaging quality; and (3) Optional element for breast MRI protocol. Also, we divided enrolled cases into three groups based on their conducting locations -- (1) Primary hospitals, (2) Secondary hospitals, and (3) Tertiary hospitals-and analyzed them for the adequacy of imaging protocols based on the 2018 recommendation. We used a Chi-square test and Fisher's exact test to identify differences between categorical variables. Results: Over 98% of the criteria for 'essential elements for breast MRI protocol' were satisfied when compared with the 2018 Recommendation. Over 96% of the criteria for 'elements to consider when evaluating imaging quality' were also satisfied, except for the slice thickness (83.9%). Optional elements for breast MRI protocol were satisfied with various percentages. There were no statistically significant differences between groups of tertiary, secondary, and primary hospitals; however, 3 tesla of MRI (P = 0.04), subtraction image protocol (P = 0.032), and DWI protocol (P = 0.03) were used more frequently in the tertiary hospitals than in the others. Conclusion: We found that the categories of 'essential elements' and 'elements to consider when evaluating imaging quality' were satisfied at 98% and 96%, respectively, when compared with the 2018 Recommendation by the Breast Imaging Study Group of the Korean Society of Magnetic Resonance.

• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.9-20
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• 2001

Objectives : To explore the relationship between Percutaneous Transluminal Coronary Angioplasty(PTCA) volume and the associated immediate outcome. Methods : A total of 1,379 PTCAs were peformed in 25 hospitals in Korea between October 8 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. Results : Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals ($\geq200$ cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. Conclusions : After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

• 간호행정학회지
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• 제17권2호
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• pp.209-215
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• 2011

Purpose: This study was done to examine the level of use of essential oriental nursing terms and related characteristics among nurses in oriental medicine (OM) hospitals. Method: A cross-sectional survey design with convenience sampling was employed. Questionnaires were used to collect data from 315 nurses in seven university-affiliated OM hospitals. The questionnaire included 174 oriental nursing terms about actions, tests, drugs, and theories. Multiple regression analysis was performed to determine factors associated with the level of use. Results: The response rate was 98.1% (n=309). Overall mean score for use of essential oriental nursing terms was 2.7(${\pm}\;0.7$) on a five-point Likert scale. Significant factors associated with the level of use were workplace and knowledge of oriental nursing theory terms. Nurses who worked in nursing care wards and those who had a higher level of knowledge of oriental nursing theories had a higher level of use. Conclusions: These findings indicate that level of use of essential oriental nursing terms were below average. Educational programs to enhance knowledge of oriental nursing theories need to be implemented for nurses in OM hospitals, considering their workplace, in order to facilitate nursing data sharing and communication among healthcare providers.

• The Korean Journal of Medicine
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• 제93권6호
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• pp.497-500
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• 2018

• Journal of Chest Surgery
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• 제53권6호
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• pp.400-402
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• 2020

Primary tracheobronchial lipoma is an extremely rare entity, the diagnosis of which is often missed initially. Cases are generally diagnosed late after initial treatment for asthma and bronchitis. We report a case of a 42-year-old man with a left main bronchus lipoma that caused near-total obstruction. The lipoma was treated by bronchoscopic resection with an electrosurgical snare and cryoablation.

• 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.

• 한국실내디자인학회논문집
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• 제19권2호
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• pp.216-224
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• 2010

This study aims to examine a special type of hospital known as Western Oriental medicine treatment designed to provide the best treatment by combining the advantages of Western and Oriental medicine, The actual conditions of the organizations and operations of O.P.D and how the cooperative treatment between Western and Oriental medicine is conducted at general hospitals that operate the cooperative treatment by applying a drawing analysis and an area analysis, and provide materials that help design hospitals that offers the cooperative treatment based on the information. According to the results of this study, the forms of the cooperative treatment between Western and Oriental medicine included several methods; to operate the cooperative center separately between an Oriental hospital and a general hospital, to operate the cooperative hospital, using several floors for an Oriental hospital inside a general hospital, and to operate the cooperative center in specialized centers inside a general hospital and the type of cluster that offers the cooperative treatment in specialized centers is known as the best appropriate treatment.