• 보건행정학회지
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• 제32권4호
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• pp.389-399
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• 2022

Background: This study aimed to analyze changes in medical utilization and cost before and after long-term care (LTC) implementation. Methods: We used the National Health Information Database from National Health Insurance Service. The participants were selected who had a new LTC grade (grade 1-5) for 2015. Medical utilization was analyzed before and after LTC implementation. Segmented regression analysis of interrupted time series was conducted to evaluate the overall effect of the LTC implementation on medical costs. Results: The total number of participants was 41,726. A major reason for hospitalization in grade 1 was cerebrovascular diseases, and dementia was the top priority in grade 5. The proportion of hospitalization in grade 1 increased sharply before LTC implementation and then decreased. In grade 5, it increased before LTC implementation, but there was no significant difference after LTC implementation. As for medical cost, in grades 1 to 4, the total cost increased sharply before the LTC implementation, but thereafter, changes in level and trend tended to decrease statistically, and for grade 5, immediately after LTC implementation, the level change was decreasing, but thereafter, the trend change was increasing. Conclusion: Long-term care grades showed different medical utilization and cost changes. Long-term care beneficiaries would improve their quality of life by adequately resolving their medical needs by their grades.

• 보건행정학회지
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• 제28권2호
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• pp.186-193
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• 2018

Background: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. Methods: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. Results: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (-1.40%, p<0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, -0.33%; non-target organizations of same region, -0.19%; non-target organizations of other regions, -0.17%). Conclusion: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.

• 정보화정책
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• 제28권4호
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• pp.19-35
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• 2021

본 연구의 목적은 온라인 공간의 속성을 규명하고, 이러한 속성이 민주주의 운영에 미칠 영향을 경험적으로 분석하는 데 있다. 본 연구는 2021년 4월 7일 치러진 서울시장 및 부산시장 보궐선거에 관한 언론 기사와 댓글을 수집하여 온라인 공간의 속성과 정치 양극화를 경험적으로 분석하고 있다. 구체적으로 본 연구는 토픽모델링을 활용하여 보궐선거에 나타난 언론 보도의 다양성을 측정하였으며, 감성분석을 활용하여 기사 댓글에 비친 온라인 여론을 측정하였다. 이후 언론이 가장 주목한 보도가 온라인 여론에 영향을 미치는 여부를 단절적 시계열 분석을 통하여 분석하였다. 이러한 시도는 온라인 여론의 견고성을 검증하는 시도로써 정치 양극화의 수준을 측정하는 지표로 사용된다. 분석 결과를 보면, 첫째 언론은 보궐선거 지역과 후보에 따라 선거 관심도와 주제가 달랐다. 둘째, 언론 보도의 다양성에도 불구하고, 기사 댓글에 나타난 온라인 여론은 높은 부정 여론, 낮은 긍정 여론이 지속적으로 나타났다. 특히 선거일에 즈음할수록 양극화의 수준은 더욱 분명했다. 셋째, 단절적 시계열 분석 결과를 보면, 선거 관심도에 따라 정치 양극화의 변화 가능성이 차별적인 것으로 나타났다. 향후 온라인 공간을 통한 정치참여가 거부할 수 없는 흐름이란 점을 고려할 때, 본 연구는 온라인 공간에서 재현되는 정치 양극화 해소를 위한 방안 마련이 시급하다고 제언하고 있다.

• 한국의료질향상학회지
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• 제30권1호
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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.

• 한국간호교육학회지
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• 제21권3호
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• pp.350-360
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• 2015

Purpose: The purpose of this study was to evaluate the effectiveness and retention period of immediate remediation for infant cardiopulmonary resuscitation (CPR) in child care teachers. Methods: This study used a nonequivalent comparison pre- and post-test design to measure knowledge about and confidence in infant CPR and an interrupted time-series design to determine skill performance. The experimental group (n=25) received both immediate remediation and video learning for infant CPR, and the comparison group (n=28) received video learning only. Knowledge and confidence were measured before and after 4 weeks. Their skill performance was tested immediately, and 4 weeks, 8 weeks, 12 weeks, and 24 weeks after intervention. Data analysis consisted of ${\chi}^2$ tests, t-tests, paired t-tests, and a generalized linear mixed model. Results: There were significant increases in knowledge and confidence within the experimental group. Skill performance showed a significant difference according to the group factor (F=10.81, p=.002) and measurement time (F=146.80, p<.001). The experimental group maintained significantly higher skill performance than did the comparison group. Conclusion: These findings support the necessity of immediate remediation education for infant CPR to maintain skill performance. In addition, appropriate renewal time and the improvement of training programs for child care teachers are necessary.

• 한국병원경영학회지
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• 제27권1호
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• pp.20-30
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• 2022

Purposes: This study purposed to evaluate the effect of a value incentive program(VIP) on the in-hospital mortality of acute stroke. Methodology: Study period was from January 2010 to December 2018. This study included 63 hospitals for acute hemorrhagic stroke that the mortality rate per month was more than one during study period. Independent variables were time variables and hospital characteristics such as hospital type, district and bed number. Interrupted time series analysis was applied to analyze the data. Findings: In case of general hospitals, the in-hospital mortality rate per month for acute hemorrhagic stroke tends to be increased by 0.03% in overall study periods but decreased by 0.32% after the implementation of the policy. On the other hand, tertiary hospital changes are not statistically meaningful. Conclusion: This study provides evidences how the VIP was effective in improving quality of acute hemorrhagic stroke care. General hospitals showed higher policy effect compare to that of tertiary hospitals.

• Journal of Preventive Medicine and Public Health
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• 제43권6호
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• pp.496-504
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• 2010

Objectives: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. Methods: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. Results: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. Conclusions: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

• 대한교통학회지
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• 제21권1호
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• pp.91-102
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• 2003

본 연구는 $\circled1$Cellular Automata(이하 CA)모형을 기반으로 대규모 네트워크에 적용 가능한 보다 현실적인 CA차량모형 구축. $\circled2$구축된 CA차량모형을 이용한 차량 모의실험기의 개발과 개발된 차량 모의실험기를 이용한 단기링크통행시간 예측으로 구성된다. 구축된 CA차량추종모형은 기존의 CA차량추종모형 보다 현실적으로 감속을 통한 정지과정을 설명하면서 거시적 지표인 교통량-밀도-속도관계를 설명하였다. 또한 링크의 유출교통량(Outflow)을 제어하기 위한 차량의 링크전이모형은 기존의 차량 링크전이모형에 비하여 보다 안정된 대기차량을 형성하였다. 단기링크통행시간 예측을 위한 차량모의실험기는 대규모 가로망에 적용이 가능하도록 차량묶음(Packet, 이하차량묶음)방식과 링크기반 모의실험방식으로 컴퓨터의 연산 수행속도 및 메모리를 효율적으로 처리할 수 있었으며, 기존의 시계열자료 예측기법에서 고려할 수 없었던 차량의 행태 및 링크 상에서 발생하는 이동류 과포화, 뒷막힘현상 등의 메커니즘을 고려함으로서 기존 시계열자료 예측기법에 비하여 우수한 예측력을 보였다.

• 한국의료질향상학회지
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• 제17권1호
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• pp.69-78
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• 2011

Objectives : The purpose of this study was to determine whether the published AMI report card could reduce in-patient mortality, 7-day after discharge mortality, and length of stay (LOS). Methods : Interrupted time-series intervention analysis was used to evaluate the impact of the report card for AMI care quality in November 2005 in terms of risk-adjusted in-patient mortality, risk-adjusted 7-day after discharge mortality, and DRGs case-mix LOS using the claim data of Health Insurance Review and Assessment Service. Results : Public disclosure of AMI care quality decreased risk-adjusted in-patient mortality and DRGs case-mix LOS by 0.00050% per month and 0.042 days per month respectively, however there was no effect on risk-adjusted 7-day after discharge mortality. Patterns of effect of public disclosure on AMI outcomes were a fluctuating pattern on risk-adjusted mortalities and a pulse impact for 1 month on DRGs case-mix LOS. Conclusions : We found the public disclosure of AMI care quality had decreasing effects on risk-adjusted in-patient mortality and DRGs case-mix LOS, but the size of the effect was marginal.

• 한국의료질향상학회지
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• 제24권2호
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• pp.62-75
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• 2018

Purpose: The objective of this study was to publicly report the hospital-level surgical volume for 7 types of surgery including gastrectomy. Also, to investigate the changes in patient behaviors after the public reporting among patients with gastrectomy. Methods: This study used data from the National Health Insurance Service Cohort. The data comprised of 2,214 patients who were diagnosed with gastric cancer and underwent gastrectomy during 2004-2012. An interrupted time series analysis was performed to investigate the association between patients' choice and public reporting. Results: 79.27% of the patients visited a hospital with high surgical volume. The time trend after introduction of public reporting was positively associated with visiting a high volume hospital (per 1 month, RR: 1.004, p=0.0329). However, after adjusting the health policies by reducing copayment, public reporting on surgical volume was not associated with visiting a high volume hospital. Sub-group analyses had also similar results. Conclusion: Patients were more affected by policies on economic support than on public reporting, and the changes in treatment options may have been affected by the increasing preference for large size hospitals. Thus, public reporting did not significantly improve the options available for patients and their decision making on health care utilization.