Background : To propose effective strategies for successful implementation of QI in health care institutions, by identifying facilitating factors and barriers to conducting QI programs. Methods : In order to examine empirical evidence on the success factors or barriers to QI implementation in hospitals, a literature study was performed on the basis of MEDLINE search. Among the identified literature. 13 provided reliable findings and basis comprehensive discussion on this issue and thus were selected for in-depth analysis. A mailed questionnaire survey was conducted for hospital CEOs and QI directors of hospitals with 400 beds or greater to investigate what attributes of their organizations they perceived as success factors or obstacles to QI implementation. Result : The analysis of selected literature and survey results presented that the primary factors considered to be most important as successful implementation of QI were: strong support from hospital CEOs, setting higher priority for QI activities, continuous and persistent efforts in QI activities, and active participation of clinical staffs. The barriers identified in this study were : the lack of orientation and understanding of QI concepts, low level of interest and participation of physician in QI programs, the lack of evaluation and rewarding system for QI activities. Conclusion : By identifying factors that affect facilitation of QI, the study results will be of great use for either institutions being in the early stage of evolving QI or those looking for better strategies to achieve more active and persistent QI implementation in their institutions.

Background : This study was conducted to compare the level of satisfaction between mothers who were educated on the care of newborns by video-taped method and those by verbal one before discharge. Methods : Fifty-two mother (verbal method group) from a free standing OB & GY hospital in Wonju City and forty-seven mothers (videotaped method group) from the OB & GY section of Wonju Christian Hospital(WCH) were selected for a study sample. The knowledge and understanding of newborn care and the degree of maternal satisfaction were assessed after the education by self-administered questionnaires. The opinions of the 11 nurses of WCH who were involved in the education were also collected by a questionnaire. Results : With respect of the level of understanding and satisfaction with the discharge education on newborn care, there is no significant difference between the videotaped educated group and verbal educated one. The correlation analysis of the video education group revealed a strong correlation between the score of understanding and satisfaction with the discharge preparation(r=0.409, p=0.01), and between the satisfaction scores for discharge preparation and discharge education(r=0.844, p=0.001). As for the verbal education group, the score of understanding also correlated significantly with both the score of satisfaction with the discharge education(r=0.272, p=0.001) and the discharge preparation(r=.680, p=0.001). Conclusions : This study showed that the discharge education to mothers regarding newborn care by a videotaped method does not improve the understanding or satisfaction of the mothers. However, the response to the mode of discharge education varies by the characteristics of the mothers. In conclusion, the characteristics of the mother should be considered in order to improve the understanding and knowledge of newborn care when the mode discharge education is chosen.

Background : This study was carried out to assess the quality improvement(QI)activities in Korean hospitals. Methods : A mailed questionnaire survey was conducted between September 15 and October 30, 2000. The staffs being charge of QI each of the hospitals with 400 beds or more responded to the questionnaire. Of the 108 hospitals eligible for inclusion in our study, 69 participated, yielding a response rate of 63.9%. Results : Based on these survey, 87.3 percent of the responding hospitals were performing QI projects and 54 percent of the hospitals had a separate department for QI activity. About 62 percent of hospitals performing QI activity (QI hospitals) had a QI manager and 58 percent had a separate budget for QI activities. Among the QI hospitals, 85 percent had cross-functional or cross-departmental teams as the major mechanisms for doing QI projects, 94 percent had one or more educational programs on QI. The level of physician's participation level for QI projects was lower than other staff(CEO, nurses and other administrators). Conclusion : The majority of the hospitals have undertaken activities in QI. For the successful implemented QI, the involvement of and education for employees(including physicians and other health professionals)are needed as well as management strategy and leadership. Understanding of other hospitals experience would be helpful for health care managers to plan and initiate QI activities.

Background : This study presented an analysis of healthcare quality indicators using data mining and a development of decision support system for quality improvement. Method : Specifically, important factors influencing the key quality indicators were identified using a decision tree method for data mining based on 8,405 patients who discharged from a medical center during the period between December 1, 2000 and January 31, 2001. In addition, a decision support system was developed to analyze and monitor trends of these quality indicators using a Visual Basic 6.0. Guidelines and tutorial for quality improvement activities were also included in the system. Result : Among 12 selected quality indicators, decision tree analysis was performed for 3 indicators ; unscheduled readmission due to the same or related condition, unscheduled return to intensive care unit, and inpatient mortality which have a volume bigger than 100 cases during the period. The optimum range of target group in healthcare quality indicators were identified from the gain chart. Important influencing factors for these 3 indicators were: diagnosis, attribute of the disease, and age of the patient in unscheduled returns to ICU group ; and length of stay, diagnosis, and belonging department in inpatient mortality group. Conclusion : We developed a decision support system through analysis of healthcare quality indicators and data mining technique which can be effectively implemented for utilization review and quality management in a healthcare organization. In the future, further number of quality indicators should be developed to effectively support a hospital-wide Continuous Quality Improvement activity. Through these endevours, a decision support system can be developed and the newly developed decision support system should be well integrated with the hospital Order Communication System to support concurrent review, utilization review, quality and risk management.

Background : The objective of this study is proving the basic data for developing a management system for the discharges against medical advice(AMA) by identifying the characteristics of the AMA patients of an university hospital for 10 years. Methods : By using discharge abstract data base, we divided the total discharges(435,254) into two groups, discharge against medical advice and discharge with discharge order. We confirmed the characteristics of AMA group by analyzing discharge abstract data of the both groups by SAS software V6.12 and $x^2$ test. Medical records of AMA patients in the year 2000 were reviewed to identify the reasons for AMA which we couldn't extract from discharge abstract DB. Result : The total number of AMA for 10 years were 9,358(2.15%) and the AMA rate has been continuously decreased for 10 years. Male, admission through emergency room, discharges admission via other hospital, patients without operation during hospitalization, discharges in hopeless or not improved condition showed higher AMA rate. The AMA rate was higher as the age of the patients was higher, and the average length of stay was longer in AMA patients than in those with discharge order. The AMA rate in psychiatry was highest(14.3%) and it was higher in surgery departments than those of medical or other sections. The AMA rate varied by attending physicians even in the same department and it was statistically significant. Patients with the principal diagnosis of "medical observation and evaluation for suspected diseases" showed the highest AMA rate(15.5%), and that of schizophrenia or psychosis was the nest. One hundred twenty-one patients(19.5%) out of 622 AMA in 2000 discharged against medical advice for transfer to order health care facilities. Among them 71 patients(58.7%) discharged with their medical care information, such as copies of medical record, medical certificates, summaries, etc. Written oath of the patients discharged AMA was filed in their medical records in 466 cases(74.9%) although some of them were incomplete. Conclusion : Characteristics of AMA discharge could be used as the basic data in developing a system to manage the patients who have risk factors to leave the hospital against medical advice. By reducing number of patients leaving the hospital against medical advice we can increase satisfaction of medical providers and consumers.

Background : The purpose of this study was to investigate the understanding and the attitude of Korean hospital CEOs toward the healthcare quality improvement. Methods : A mailed questionnaire survey to the CEOs of hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for the study, 58 participated, yielding a response rate of 54 percent. Result : The hospital CEOs have expressed that their hospital management was arduous job, and they had been pressured by increasing competitions among healthcare providers. They indicated that the low fees of health insurance made their hospital management difficult. The results also indicated that there was general consensus that the improvement of service quality was important in encouraging their organizations, but the investment of manpower and equipment ranked higher than the improvement of service quality. The majority of the CEOs have good understanding about quality improvement activities. However the facts that in general QI must be focused at the process of services and customer satisfaction, meanwhile quality improvement activities are helpful for the organizational productivity embarrassed them. The hospital CEOs responded that there were successful changes in terms of quality of care, patient satisfaction, and process efficiency after QI activities, but no increase in patient number and profit. Lack of understanding to QI activities and limited budget seem to attribute unsatisfactory outcomes. Conclusion : The majority of Korean hospital CEOs have a good understanding and attitude about QI activities. As mentioned in the result, despite of several limitations, several facts regarding the CEOs of hospital in Korean can be elucidated. (1) The general cognition of the QI project is relatively high, and it is accepted with positive concern, (2) the priority of the QI project, however, is not set higher than other projects and (3) the specific concepts of the actual QI project such as customer (patient)-focused work driving, the recognition of the work accomplishment, and the importance of rewards have not sufficiently understood.

Background : the hospitals in Korea are in a situation of a severe competition than the past. This situation was resulted from the increase in the number of hospitals and also from the government policy controlling the medical insurance fee. Moreover, consumer's desire for the high quality medical service g\has been significantly increased. Many programs to improve the quality of medical services are being performed in hospitals since the middle of 1990's. Studies up to now reported that more than 10 programs are being performed per hospital in Korea. So far studies have been performed to measure only the number of such programs in a hospital. The purposes of this study are to examine a specific area involved in the programs designed to improve the medical service quality and to suggest a future direction of the such programs. In addition, we hope that the results from this study could assist the programs for the medical service quality. Methods : A mailed questionnaire survey of the QI staffs at hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for inclusion in our study, 69 participated, yielding a response rate of 63.9%. Excluding 7 hospital which are not responsed about activities of hospital then 62 hospitals were used for the analysis. Result : The total number of programs was 1,081 from the 62 hospitals participated in the survey. The highest number (24.8 programs) was found in the hospital having more than 800 beds and performing the programs more than 5 years. The 1,081 programs were consisted of 445 from the medical examination area, 343 from the medical examination support area, and 296 from the management area. Conclusion : This study showed the present situation of hospitals in Korea regarding to the quality improvement programs. The results from this study suggest that the pattern of the program for the medical service improvement is being changed to service process and result-centered programs from the structural area.