• Journal of Preventive Medicine and Public Health
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• 제53권2호
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• pp.82-88
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• 2020

Objectives: The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.

• 보건행정학회지
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• 제15권3호
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• pp.94-113
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• 2005

The purpose of this study was to determine the level of appropriateness in hospital stays and factors influencing inappropriate hospital stays. The study was conducted at fifteen general care units in a tertiary university hospital. Appropriateness of hospital stay was assessed using Appropriateness Evaluation Protocol by trained head nurses. The total of 447 patient records were reviewed. Among them, 352 patient data were included in the final data set. A unit of observation was patient day. A rate of appropriate hospital stay was calculated per patient as a unit of analysis. Multiple regression analysis was performed to determine the factors affecting inappropriate hospital stay. The eighty-three percent (2030/2651) of hospital stays were evaluated as appropriate. There were significant differences in appropriateness of hospital stay according to patient's age, type of health insurance, medical specialty, and length of stay(p<0.05). In the multiple regression analysis, medical speciality was the most significant factor to predict the inappropriate hospital stay. The study showed a substantial proportion of hospital stay was found to inappropriate. Level of appropriateness was significantly different from medical specialty. Interdepartmental approach should be required to coordinate and improve appropriate resource utilization.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.413-428
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• 1992

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For cesarean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals and between hospital groups by size. The most freqeunt indication of C/S was repeated operation, followed by cephalopelvic disproportion (CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons fur admission were 'failure to initial treatment', 'suspected bacterial pneumonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activiteis would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studios with plentiful subjects and more representative diseases or procedures should be tried.

• 한국환경과학회지
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• 제13권10호
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• pp.855-861
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• 2004

This study analysed the influencing factors involved in deciding the policy through the analysis of procedure in the policy on the natural resources in local governments. To evaluate the political consensus of decision making in policy determination as political rationality in natural resources policy, we analyzed the degree of the satisfaction from the residents. Among the analysis factors of the satisfaction of natural resources policy, the most significant independent factors were the goal and the method of the policy, the institutional conditions and interested groups, the appropriateness of the content of decision making, supervising and controlling, cooperating relations, the effect of policy, and the consistency. From the analysis of the effect and the goal of policy, we found $70.5\%$ of residents was against the policy and only $27.8\%$ consented. Considering the appropriateness of supervising and controlling in accordance with the process of the policy decision and its execution, the influence of local governments and institutions concerned enjoying comparatively more economic benefits was strong, however, the involvement of the residents and supervising and monitoring institutions were found negligible.

• 한국병원경영학회지
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• 제22권2호
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• pp.17-27
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• 2017

Objective: This study was performed to find out the characteristics of nurse administrators and the relationships among their personality types, administrative work appropriateness and job satisfaction. Methods: Participants were 112 nurse administrators who had worked for more than 1 year in a hospital administrative position in Seoul and Gyeonggi area. Data were collected form April 14 to Jun 17, 2016, using questionnaires. For the analysis, SPSS WIN 20.0 program was used. Results: Personality types are related to job satisfaction and administrative work appropriateness. Among big-5 personality types, the neurotic level is negatively related to job satisfaction. However, extroversion is positively related. For the appropriateness of administrative work, the way of transfer and working department show no significant relations but age shows significant relation. The influence of age needs further study. Conclusion: The personalty types are related to nurse administratorsʼ job satisfaction and administrative work appropriateness.

• 디지털융복합연구
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• 제13권8호
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• pp.91-99
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• 2015

최근에 소프트웨어(SW) 융복합 시대를 맞아 SW품질관리의 중요성에 대한 관심이 높아지고 있다. 이에 본 연구에서는 품질관리전담기관의 SW품질활동관리 적정성을 객관적으로 평가 할 수 있는 방안에 대하여 기존의 품질 활동관리 적정성 사례를 기반으로 새로운 적정성 평가 방안을 제안하고자 한다. 이를 위하여 다음과 같이 연구 목적을 세 가지로 설정한다. 첫째, 기존의 국가 SW R&D 프로젝트의 SW품질활동관리 적정성 평가의 문제점을 도출하고 분석한다. 둘째, 기존의 SW품질활동관리 적정성 평가에 대한 문제점을 극복할 수 있는 새로운 적정성 평가 방법을 제안한다. 셋째, 새로운 적정성 평가 방법을 WBS(World Best Software) 프로젝트를 대상으로 적용해서 그 가능성과 효과성에 대하여 살펴본다. 본 연구에서 새롭게 제시한 국가 SW R&D 품질활동관리 적정성 평가 프레임워크를 대형 SW R&D 프로젝트인 WBS 프로젝트의 2개 과제에 실질적으로 적용해봄으로써 새로운 품질활동관리 적정성 평가 프레임워크의 효과성과 실무 적용 가능성을 입증하였다.

• 한국의료질향상학회지
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• 제1권1호
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• pp.96-108
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• 1994

Background: An appropriate use of hospital beds can improve productivity of hospital significantly. The authors' previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropriately used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Overall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. These instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.

• 보건행정학회지
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• 제7권2호
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• pp.19-45
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• 1997

This study was performed to evaluate the appropriateness of resource allocation based on the ranking of health center function. Through the Delphi processes, health center functions were ranked in order of importance as follows; planning and research, followed by health education, health promotion, management of chronic diseases, health screening tests, welfare activities, mental health services, medical personnel management, medical services, prevention of communicable diseases, maternal and infant health services, housekeeping, management of oral hygiene, nutrition services, surveillance for community health services, family planning, and administration of the health center. In relation to the above priorities, the allocation of manpower was not appropriate. Even though the expert groups emphasized on functions such as planning and research, health education, and health promotion, they inputted more personnel for administration of a health center, maternal and infant health services, and medical services which were evaluated with lower importance. The budget allocation showed the same trends as the above. Although the functions such as planning and research, health education, and health promotion, and management of chronic diseases were evaluated highly, the budget was allocated accordingo to the the results of the former fiscal year rather than on the importance of function. However the budget for nutrition services, surveillance for the community health services, family planning, and administration of a health center was allocated according to priority. Based upon the above findings, community health center should be given the opportunity to make their own ranking of health center function and to allocate their resources including personnel and budget in order to improve the responsibilities and roles of the community health center.

• 한국문헌정보학회지
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• 제48권4호
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• pp.135-171
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• 2014

본 연구에서는 정책정보서비스를 제공하기에 적합한 분류체계를 제안하고자 하였다. 이를 위해 BRM분류체계분석, 문헌분석, 정책정보제공사이트 분류체계분석, 분류전문가논의과정, 정책정보수요자대상 설문조사 및 면담조사, 정책정보자료의 실제적 구축을 통한 경험적 검증과정을 거쳤다. 최종적으로 BRM 분류체계를 수정 보완하여, 정책정보관련 정보자원을 제공하기에 적합한 분류체계를 제안하였다. 전문가 논의 과정을 거쳐 정책정보서비스에 적절한 BRM 분류 단계를 3단계로 확정하였다. 국내외 정책정보제공사이트를 제공하고 있는 기관의 분류체계와 서비스 조사를 통해 BRM 분류체계가 정책정보자료 제공을 위해 적합하다는 것을 확인하였다. 실무자 면담 조사를 통해 BRM의 적절성 확인과 개선점을 도출하였다. 설문조사를 통해 정책정보서비스를 위한 BRM 분류체계 사용의 적절성과 BRM 주제분야별 보완요구사항을 분석하였다. 마지막으로 경험적 검증을 통해 정책정보서비스를 위한 BRM 분류 체제의 주제 내용을 확정하였다.

• 한국의료질향상학회지
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• 제4권2호
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• pp.184-195
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• 1997

Background : The purpose of this research was to evaluate the appropriateness of preoperative hospital days in a tertiary care hospital and to examine the reasons of the inappropriateness, so as to provide basic information and policy for enhancing appropriateness of preoperative hospitalization and benefit of patients and hospital. Methods : The subjects of the research were the 344 patients who received operation among discharged patients during January, 1996 in surgical departments including general surgery, neurosurgery, orthopedic surgery, plastic surgery and ophthalmology. Their medical records were reviewed and appropriateness of hospital days was evaluated by the Appropriateness Evaluation Protocol. Result : The results of evaluating the appropriateness of preoperative hospitalization showed that inappropriate hospital days were 80.8%. The reasons of inappropriate hospital stays were the tests or preparation which could be done in outpatient basis' followed by 'possible tests or preparation on the operation day' and 'cancelation of operation'. Conclusion : In order to shorten the inappropriate preoperative length of stay, it is recommended that lengthening of laboratory running time and doing most of tests necessary for operations on the outpatient basis prior to admission should be considered. In addition, the operation at the same day of hospitalization and usage of day surgery should be encouraged. Finally there should be changes in the inpatient management system and attitudes and behaviors of surgeons to shorten unnecessary preoperative and maximize the benefit for patients and hospital.