• Journal of The Korea Institute of Healthcare Architecture
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• v.27 no.4
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• pp.61-70
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• 2021

Purpose: The study aims at identifying patient-related and environmental factors associated with an increased risk of falling and, therefore, both caregivers and designers can be aware of fall risk factors and can contribute to prevent inpatient falls in their own areas of expertise. Methods: A case-control study has been conducted, utilizing patient data and physical environmental data in the unit of General Medicine in the United States. The case-control study investigated data about patients who had suffered falls as well as patients with similar characteristics (e.g., age, gender, and diagnosis) who did not suffer falls. Results: The study identified both patient-related and physical environmental factors associated with inpatient falls. Morse fall risk score, patient visibility, and patient accessibilityB were identified as significant predictors to inpatient falls, when controlling for other significant variables. Implications: The findings of the study can provide implications to both caregivers and healthcare and hospital environment designers. Caregivers should give special attention to patients with high Morse Fall Risk Scores to prevent inpatient falls. Designers also need to examine and to fine-tune the unit layout of inpatient care units to maximize each patient room's patient visibility from the rest of the unit and patient accessibilityB from working areas of nurses.

• Journal of The Korea Institute of Healthcare Architecture
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• v.24 no.1
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• pp.33-40
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• 2018

Purpose: The main objective of this paper is, to assess environment, care process, and patient-related factors associated with patient falls. The study also aims at identifying various factors that would affect inpatient falls and, therefore, helping both caregivers and designers contribute to better prevent inpatient falls in their own areas of expertise. Methods: A retrospective analysis of inpatient falls that occurred in the unit of General Medicine in the United States has been conducted and environment, care process, patient-related factors associated with those falls have been analyzed at the same time. Results: The study identified several factors associated with inpatient falls. They range from environmental factors to care process- and patient-related factors. Patient visibility and patient accessibility can matter to patient falls and where those falls occur, along with patient days per room, the percentage of patient days with high fall risk patients per room, the percentage of high fall risk patients per room. Implications: The findings of the study can provide design implications that can be incorporated into design process and design decisions to promote fall prevention in inpatient care units. Inpatient falls can be effectively reduced when caregivers and designers work together to understand the complex nature of inpatient falls and the importance of multidisplinary efforts among various experts in the areas of healthcare.

• Journal of Hospice and Palliative Care
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• v.2 no.2
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• pp.91-100
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• 1999

Purpose : This study was performed to investigate the satisfaction in the hospice services provided for inpatient families and bereaved families whose members had been admitted to the hospice unit at Kangnam St. Mary's Hospital to improve the quality of care for the terminally ill patients and their families. Methods : This sample consisted of 33 families of hospice patients during the period of April to lune, 1998 and 30 bereaved families whose patients had died from March, 1993 to March, 1998. The data were collected through a self-report questionnaire and analyzed using t-test and ANOVA. Results : 1) The satisfaction level of inpatient families and bereaved families showed the mean value of 3.5 where the highest value is 5.0. 2) According to age, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family, medical management and nursing management(P=0.0001). The level of satisfaction of bereaved families showed significant differences in the field of support for the family, medical management, nursing management, and facilities of the hospice unit(P=0.0001). 3) By family relationship, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family, medical management and nursing management (P=0.0001). 4) According to religion, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family and nursing management (P=0.0001), but there was no significant difference for the bereaved families. Conclusions : The findings of this study showed that hospice services had positive influence on families with terminal disease such as cancer. To improve the level of satisfaction in the hospice services for families with hospice patients, we need to provide care by an interdisciplinary hospice team approach, and to assess needs of the families according to their socio-psychological characteristics. Further studies need to be conducted with large samples.

• Health Policy and Management
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• v.32 no.2
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Health Policy and Management
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• v.32 no.2
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• pp.125-136
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• 2022

The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• The Korean Journal of Health Service Management
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• v.8 no.2
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• pp.11-22
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• 2014

This study purposed to analyze the regional variation of the local-out rates of inpatient services. Multiple data sources collected from National Health Insurance Corporation and statistics Korea were merged to produce the analysis data set. The unit of analysis in this study was city, Gun, Gu, and all of them were included in analysis. The dependent variable measured the local-out rate of inpatient cost in study regions. Local environments were measured by variables in three dimensions: provider factors, socio-demographic factors, and health status. Along with the traditional ordinary least square (OLS) based regression model, geographically weighted regression (GWR) model were applied to test their effects. SPSS v21 and ArcMap v10.2 were applied for the statistical analysis. Results from OLS regression showed that most variables had significant relationships with the local-out rate of inpatient services. However, some variables had shown diverse directions in regression coefficients depending on regions in GWR. This implied that the study variables might not have consistent effects and they may varied depending the locations.

• Child Health Nursing Research
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• v.15 no.1
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• pp.53-60
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• 2009

Purpose: The purpose of this study was to analyze metacommunicative episodes comprised of nurses' metacommunicative behavior and children's responses occurring in the dyads of nurse-child within the context of an inpatient pediatric unit. Methods: Twelve dyads of nurses and children were videotaped for four hours each day over a two-day period as they interacted with each other on the inpatient unit. The metacommunicative episodes were recorded from the videotapes. The metacommunicative behavior was categorized within Shin's metacommunicative behaviors. Results: The total number of episodes between the nurses and children included in this study was 242. The most frequently used metacommunicative behavior was 'reflection', followed by tagging, baby talk, approaching, mediating eye level, friendly demand, encouraging, description of acts, symbolization, turnabouts, touching, and mimic voice, respectively. The most common response to the nurses' metacommunicative behavior was agreeing, followed by tension release. Conclusion: Young children responded positively to metacommunicative behavior by the nurses. Understanding metacommunicative behavior may help nurses approach their young patients more easily and with confidence.

• Health Policy and Management
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• v.8 no.1
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• pp.1-14
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• 1998

Analysis of practice variations has been one of important issues in trying to contain costs as well as to manage quality in health care. This study was conducted to provide statistical model for analysing variations in inpatient costs by type of hospitals. Four K-DRGs including Cesarean section, appendectomy, cataract extraction, and pediatric pneumonia with CC class 0 were selected, and means and dispersions of inpatient procedure and operation costs were simultaneously compared between type of hospitals. The results indicated that joint modelling of means and dispersions by gamma distribution was a very useful analytic tool for identifying factors which might have relationship with variations in inpatient costs. This model can be expanded to test the significance of several independent variables in analysing cost variations. In surgical conditions, means and unit variations of procedure and operation costs showed consistent pattern which was tertiarty hospital, general hospital, and hospital in descending order. Different findings were identified in pediatric pneumonia, from which mean and unit variation of procedure and operation cost was the highest in general hospital. The practical implication of this difference could not be drawn from this study. It will be done by further sophisticated researches. In order to develop health policy for cost containment and quality management in Korea, it is essential to find out manageable factors affecting variations in practice patterns which include characteristics of population, providers, regions, and so on. The statistical model presented in this study will give health services researchers useful insights for future investigations in analysing cost variations.

• Journal of Hospice and Palliative Care
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• v.25 no.2
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• pp.76-84
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• 2022

Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

• Korean Journal of School Psychology
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• v.8 no.3
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• pp.263-285
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• 2011

The present study was designed to evaluate the effects of staff training in PBS on the behaviors of staff and children with developmental disabilities in an inpatient unit. The perceived significance of children's problem behavior and staff's caring stress significantly decreased with the intervention. A satisfaction survey reported staff's high satisfaction with the process and results of staff training. This study suggests that PBS is a socially valid and positive intervention with problem behavior of children with developmental disabilities. The implications and limitations of this study, with directions for future research, are also discussed.