• Title/Summary/Keyword: medicare

Search Result 85, Processing Time 0.025 seconds

Current Status and Future Perspective of PET (PET 이용 현황 및 전망)

  • Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
    • /
    • v.36 no.1
    • /
    • pp.1-7
    • /
    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.

Does Process Quality of Inpatient Care Serve as a Guide to Reduce Potentially Preventable Readmission (PPR)? (의료서비스의 과정적 질과 잠재적으로 예방 가능한 재입원율과의 관계)

  • Choi, Jae-Young
    • Korea Journal of Hospital Management
    • /
    • v.23 no.1
    • /
    • pp.87-106
    • /
    • 2018
  • Objective: The objective of this study is to examine the association between process quality of inpatient care and risk-adjusted, thirty-day potentially preventable hospital readmission (PPR) rates. Data Sources/Study Setting: This was an observational cross-sectional study of nonfederal acute-care hospitals located in two states California and Florida, discharging Medicare patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia January through December 31, 2007. Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services Hospital Compare database, and the American Hospital Association Annual Survey of Hospitals. Study Design: The dependent variable of this study is condition-specific, risk-adjusted, thirty-day potentially preventable hospital readmission (PPR). 3M's PPR software was utilized to determine whether a readmission was potentially preventable. The independent variable of this study is hospital performance for process quality of inpatient care, measured by hospital adherence to recommended processes of care. We used multivariate hierarchical logistic models, clustered by hospitals, to examine the relationship between condition-specific, risk-adjusted, thirty-day PPR rates and process quality of inpatient care, after taking clinical and socio-demographic characteristics of patients and structural and operational characteristics of hospitals into account. Findings: Better performance on the process quality metrics was associated with better patient outcome (i.e., low thirty-day PPR rates) in pneumonia, but not generally in two cardiovascular conditions (i.e., heart failure and acute myocardial infarction). Practical Implication: Adherence to the process quality metrics currently in use by CMS is associated with risk-adjusted, thirty-day PPR rates for patients with pneumonia, but not with cardiovascular conditions. More evidence-based process quality metrics closely linked to 30-day PPR rates, particularly for cardiovascular conditions, need to be developed to serve as a guideline to reduce potentially preventable readmissions.

An introductory study on the urban functions using CHAID technique (CHAID 技法에 의한 都市機能의 試論的 硏究)

  • ;Yang, Soon-Jeong
    • Journal of the Korean Geographical Society
    • /
    • v.29 no.3
    • /
    • pp.360-368
    • /
    • 1994
  • To this day, a number of quantitative analytical methods have been employed in clarifying regional characteristics in the discipline of geography. This paper attempted, as a part of application of those quantitative analyses, to make clear the urban functions and consequently the urban characteristics statistically by adopting newly-introduced CHAID, a sort of discriminant analyis technique. The processing of data was sonducted in two phases. To begin with, the urban functions were classified after designating twenty cities - the population of each city counting 250, 000 or more - as predictor variable, and at the same time four major urban functions like administration, marketing, finance and production as response variable. And then, preeminent functions of individual region were discriminated and concurrently classified by treating the remaining traffic, education, medicare, culture and transportation functions as predictor variable, and the following five regions as response variable: Metropolitan Seoul Area. Pusan region, Taegu region, Kwangju region and Chungcheong region. According to the result of this analysis, marketing and administration are emereed as meaningful functions in Seoul and Taegu respectively. As for the finance function only Pusan and Pucheon can be discriminated. Seoul, Pusan and Seongnam reveal their dominancy in production function. To take a look at the result of the latter analysis, the Metropolitan Seoul area shows, among other functions, strong traffic and finance functions. When it comes fo Pusan region, adminstration, education and finance functions are recorded as a leading ones, and Taegu region is preferable in education, medicare and transportation functions. In case of Kwangju region adminstration, production and education functions are discriminated from any other functions. Chungcheong region shows similar aspect with only traffic function replacing the production function of Kwangju region. Based on aforementioned anlysis, it can be said that the CHAID technique, which is capable of processing large amount of categorical data and, by presenting its outcome in the form of dendrogram, facilitates the interpretation work, is an effective, meaningful means to classify and discriminate certain geographical regions and their characteristics.

  • PDF

Refinement and Evaluation of Korean Diagnosis Related Groups (한국형진단명기준환자군의 개선과 평가)

  • 강길원;박하영;신영수
    • Health Policy and Management
    • /
    • v.14 no.1
    • /
    • pp.121-147
    • /
    • 2004
  • Since the pilot program for a DRG-based prospective payment system was introduced in 1997, the performance of KDRGs has been one of hotly debated issues. The objectives of this study are to refine the classification algorithm of the KDRGs and to assess the improvement achieved by the refinement. The U.S. Medicare DRGs version 17.0 and the Australian Refined DRGs version 4.1 were reviewed to identify areas of possible impro-vement. Refined changes in the classification and result of date analyses were submitted to a panel of 48 physicians for their reviews and suggestions. The refinement was evaluated by the variance reduction in resource utilization achieved by the KDRG The database of 2,182,168 claims submitted to the Health Insurance Review Agency during 2002 was used for evaluation. As the result of the refinement, three new MDCs were introduced and the number of ADEGs increased from 332 to 674. Various age splits and two to four levels of severity classification for secondary diagnoses were introduced as well. A total of 1,817 groups were defined in the refined KDRGs. The variance reduction for charges of all patients increased from 48.2% to 53.6% by the refinement, and from 65.6% to 73.1% for non-outlier patients. The r-square for length of stays of all patients was increased from 28.3% to 32.6%, and from 40.4% to 44.9% for non-outlier patients. These results indicated a significant improvement in the classification accuracy of the KDRG system.

A Study on the Spatial Composition of Health Facilities for the Elderly in Japan (일본 노인보건시설의 공간구성에 관한 연구)

  • Soh Jun-Young
    • Korean Institute of Interior Design Journal
    • /
    • v.14 no.2 s.49
    • /
    • pp.142-152
    • /
    • 2005
  • It is estimated that the need to build health facilities for the elderly will grow in the near future as the Korean society is aging. Thus the study on the spatial composition of 22 facilities as well as on the cases of health facilities for the elderly in Japan, where public health and medicare for aged people are well taken care of, was conducted and the following are the results: 1. As of 2000, there was one facility for every 8,000 and 1,100 aged citizen under long-term care, and these facilities secured beds enough for $8\%$ of those who need long-term care. 2. The spatial composition was categorized into general living space, long-term care, management, provision, and home assistance, and housing was provided. Moreover, the space was divided according to their nature of use, the arrangement, the form of entrance into the building, moving line inside, the relationship with the health facilities and their characteristics are analyzed based on different users, managers, moving line including that of provision of food, the relationship between different spaces with different functions as well as on the relationship between locations of each space. 3. The total capacity, building area and actual area of the welfare facilities for the elderly are analyzed, and area per person, detailed area for each space, percentage of each living space for long-term care patients and characteristics of recuperation room are suggested.

The Experience of Transition in Pregnancy and Childbirth among the Married Immigrant Women in Korea (결혼이주 여성의 임신.출산을 통한 삶의 전환 체험)

  • Lim, Hyun-Suk
    • Women's Health Nursing
    • /
    • v.17 no.3
    • /
    • pp.243-255
    • /
    • 2011
  • Purpose: This study was to provide understanding of the meaning of the transition experiences in pregnancy and childbirth among the married immigrant women. Methods: Data was collected through a face-to-face interview from 11 married immigrant women. Their conjugal lives were followed using the hermeneutics phenomenological method developed by van Manen: focusing on the meaning of lived experience. Results: The essential themes that were associated with the transition experiences of the participants' lives during pregnancy and childbirth were as follows: "entering a strange world filled with chaos and tension where they feel like outsiders", "being pregnant and giving birth in increasingly difficult times", "giving birth to a child, which strengthens them to persevere through painful life experiences", "receiving greater support from their families". Conclusion: It contributes a deeper understanding of the essence of the transition experiences of married immigrant women who undergo pregnancy and childbirth after immigration. On the basis of this understanding, this study would be likely to highlight the importance of establishing an appropriate health and medicare systems and the expert network of nursing care for immigrant wom.

Clinical Application of $^{18}F-FDG$ PET in Epilepsy (간질에서의 $^{18}F-FDG$ PET의 임상 이용)

  • Kim, Yu-Kyeong
    • Nuclear Medicine and Molecular Imaging
    • /
    • v.42 no.sup1
    • /
    • pp.172-176
    • /
    • 2008
  • FDG PET has been used as a diagnostic tool for localization of seizure focus for last 2-3 decades. In this article, the clinical usefulness of FDG PET in the management of patients with epilepsy has been reviewed, which provided the evidences to justify the medicare reimbursement for FDG PET in management of patients with epilepsy. Literature review demonstrated that FDG PET provides an important information in localization of seizure focus and determination whether a patients is a surgical candidate or not. FDG PET has been reported to have high diagnostic performance in localization of seizure focus in neocortical epilepsy as well as temporal lobe epilepsy regardless of the presence of structural lesion on MRI. Particularly, FDG PET can provide the additional information when the results from standard diagnositic modality such as interictal or video-monitored EEG, and MRI are inconclusive or discordant, and make to avoid invasive study. Furthermore, the presence of hypometabolism and extent of metabolic extent has been reported as an important predictor for seizure free outcome. However, studies suggested that more accurate localization and better surgical outcome could be expected with multimodal approach by combination of EEG, MRI, and functional studies using FDG PET or perfusion SPECT rather than using a single diagnostic modality in management of patients with epilepsy. Complementary use of FDG PET in management of epilepsy is worth for good surgical outcome in epilepsy patients.

Establishing research priorities of FDG PET in oncology indications using Delphi technique (델파이법을 활용한 종양분야 FDG PET의 경제성 평가 연구 우선순위 선정)

  • Do Young Kyung;Lee Jin Yong;Kim Young-Ik;Kwon Young Hoon;Lee Sang-Il;Kim Chang-Yup
    • Health Policy and Management
    • /
    • v.14 no.3
    • /
    • pp.45-65
    • /
    • 2004
  • The rapid increase in PET devices and its utilization in Korea necessitates relevant health insurance policies based on scientific evidence, including economic evaluation of PET in clinical conditions. However, there is very little amount of evidence regarding PET, and the first step would be to establish research priorities to give a momentum for research and assure efficient use of research capacities. To this end, we conducted a two-round Delphi study, which produced stable consensus on about top 10 oncology indications for research, which included lymphoma staging, colorectal cancer recurrence/restaging, lung cancer staging, and other conditions. The results were largely consistent with current U.S. Medicare reimbursement indications and are expected to lead to relevant researches and evidence-based health policies on PET reimbursement and regulation.

Assessment of the Forecasting Studies on 12 Traditional Korean Medicine Policy Realization (12개 미래 예측 한의약 정책 과제의 실현 평가 연구)

  • Park, Ju-Young;Shin, Hyeun-Kyoo
    • Journal of Society of Preventive Korean Medicine
    • /
    • v.17 no.1
    • /
    • pp.65-76
    • /
    • 2013
  • Objectives : Aim of this study is to contribute to establishment of the Traditional Korean Medicine (TKM) policies in the future. Final assessment for 12 of the forecasting projects was carried out on the TKM policies that deduced by professionals in 1996 whether or not to realize in 2013. Methods : We investigated governmental and private research projects, reports and papers, and laws and systems on the forecasting projects. We reviewed them through the Traditional Korean Medicine Information Portal OASIS (http://oasis.kiom.re.kr), Korean studies Information Service System (KISS) (http://kiss.kstudy.com/) and DBpia (http://www.dbpia.co.kr/), Akomnews(http://www.akomnews.com/), THE MINJOK MEDICINE NEWS(http://www.mjmedi.com/), Ministry of Government Legislation(http://www.law.go.kr/). Results : Of the 12 forecasting projects, five were judged as 'realization', four were as 'partial realization' and three were as 'un-realization', The realization rate was 75.0%. Three un-realized projects included the TKM insurance coverage for various herbal medicines, leadership secure on medical technicians and commercialization of the TKM managing system on senior medicare policy. Realization of the future forecasting TKM policy projects was decided depending on conditions such as the importance, domestic capability levels, principal agents, methods and restrains. Conclusions : Continuous studies and new developed forecasting projects for the TKM policies will be required to realize the projects in the future.

The Effect of Their Sense of Depression and Suicidal Thinking for Managerial Characteristics in Hypertense and Diabetic Patients (고혈압과 당뇨병 환자의 관리적 특성이 우울과 자살생각에 미치는 영향)

  • Park, So-Hee;Hwang, Byung-Deog
    • The Korean Journal of Health Service Management
    • /
    • v.7 no.4
    • /
    • pp.221-232
    • /
    • 2013
  • This study aims to analyze the effect of hypertense, diabetic patients, managerial characteristics on their depression and suicidal thinking. Thus, this study selected 6,217 adults over the age of 19 from the 5th first-year data of Korean National Health and Nutrition Examination Survey conducted by KCDC(Korea Centers for Disease Control and Prevention) in 2010. As factors having effect on their suicidal thinking, unmarried patients(p=.000), middle school(p=.045), high school(p=.015), college and higher(p=.018), medicare(p=.045), hypertense(p=.042), exercise walking irregularly(p=.021), sense of depression(p=.035) showed a higher rate of suicidal thinking which were found to be statistically significant variables. Hypertense show a higher rate of suicidal thinking than normal people. Accordingly, it is necessary not only to pay attention to establishing plans to provide Hypertense and Diabetic patients with medical treatments, but to have more concern about their mental health so that they may be provided with a political support future.