• Health Policy and Management
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• v.17 no.3
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• pp.87-105
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• 2007

The purpose of this study was to analyze whether nonemergency, isolated coronary artery bypass graft (CABG) surgery for high- or low-risk patients biases the assessment of the risk-adjusted mortality rates of hospitals. This study used 2002 National Health Insurance claims data for tertiary hospitals in Korea. The study sample consisted of 1,959 patients from 23 tertiary hospitals. The risk-adjustment model used the patients' biological, admission, and comorbidity data identified in the claims. The subjects were classified into high- and low-risk groups based on predicted surgical risk. The crude mortality rates and risk-adjusted mortality rates for low-risk, high-risk, and all patients in a hospital were compared based on the rank and the four intervals defined by quartile. Also, the crude mortality rates of the three groups were compared with their 95% confidence intervals of predicted mortality rates. The C-statistic (0.83) and Hosmer-Lemeshow test ($X^2$=11.47, p=0.18) indicated that the risk-adjustment model performed well. Presenting crude mortality rates with their 95% confidence intervals of predicted rates showed higher agreements among the three groups than using the rank or intervals of mortality rates defined by quartile in the hospital performance assessment. The crude mortality rates for the low-risk patients in 21 of the 23 hospitals were located on the same side of their 95% confidence intervals compared to that for all patients. High-risk patients and all patients differed at only one hospital. In conclusion, the impact of risk selection by hospital on the assessment results was the smallest when comparing the crude inpatient mortality rates of CABG patients with the 95% confidence intervals of predicted mortality rates. Given the increasing importance of quality improvements in Korean health policy, it will be necessary to use the appropriate method of releasing the hospital performance data to the public to minimize any unwanted impact such as risk-based hospital selection.

• Journal of Digital Convergence
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• v.17 no.4
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• pp.159-166
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• 2019

This paper investigated convergent factors to turnover intention among some Administrative Staff in Medical Institutions(ASMI). The survey used self-administered questionnaires for 320 administrative staffs of 27 medical institutions in the J region, selected arbitrarily from July 2, 2018 to July 27, 2018. The hierarchical multiple regression analysis shows the following results. The turnover intention of respondents turned out to be significantly higher in following groups: a group in which organizational commitment is lower, a group in which organizational loyalty is higher, a group in which exhaustion, cynicism, reduced professional efficacy, sub-areas of job burnout are higher. The results show explanatory power of 50.9%. The results of the study indicate that the efforts, to increase organizational commitment and organizational loyalty, and to decrease exhaustion, cynicism, reduced professional efficacy, sub-areas of job burnout, are required to improve the turnover intention among ASMI. These results could be used in hospital organization personnel management and industrial health education to lower the level of turnover intention in ASMI, vocational aptitude education of health care college students. In following studies, it is necessary to present and analyze the structural model affecting the turnover intention of ASMI.

• Health Policy and Management
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• v.31 no.1
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• pp.74-90
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• 2021

Background: It is getting important to improve the oral health status of the elderly because oral health status may affect their health status of the whole body. In this respect, we aimed to explore the association of oral health status and behavior factors with self-rated health status by sex. Methods: Using the data from the 7th Korea National Health and Nutrition Examination Survey for health surveys and oral examinations (2016-2018), we analyzed a total of 3,070 people aged 65 or older (men: 1,329; women: 1,741). Our dependent variable, self-rated health status, was divided into two groups: not good (bad and very bad) and good (very good, good, and fair), whereas our independent variables of interest were oral health status and behavior factors. In addition to descriptive analysis and the Rao-Scott chi-square test, reflecting survey characteristics, we conducted hierarchical multivariable logistic regression analyses adjusted for socio-demographics and health status and behavior factors. All analyses were stratified by sex. Results: The proportion of people having 'not good' self-rated health was 36.5% in women but 24.5% in men. In a model adjusted for all covariates, the self-rated health status showed significant association with the self-rated oral health status. For example, in men, the risk of having 'not good' self-rated health was high in people having 'poor' (odds ratio [OR], 5.31; 95% confidence interval [CI], 2.34-12.03) self-rated oral health status and in those having 'fair' (OR, 4.03; 95% CI, 1.68-9.70) in comparison with those having 'good' self-rated oral health status. Dental status regarding speaking difficulty seemed to be very important in influencing self-rated health status. For instance, in women, compared to people having 'no discomfort' speaking difficulty, the risk of having 'not good' self-rated health was high in people having 'not bad' (OR, 1.60; 95% CI, 1.14-2.24) and 'discomfort' (OR, 1.79; 95% CI, 1.30-2.47) speaking difficulty. The covariates significantly associated with the risk of having 'not good' self-rated health were: physical activity, chronic disease, stress, and body mass index in both sexes; health insurance type and drinking only in men; and economic activity only in women. Conclusion: Oral health status and behavioral factors were associated with self-rated health status among the elderly, differently by sex. This suggests that public health policies toward better health in the elderly should take their oral health status and oral health behaviors into account in a sex-specific way.

• Health Policy and Management
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• v.32 no.4
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• pp.368-379
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• 2022

Background: This study aimed to establish a strategy to improve the poor working environment and working conditions among long-term healthcare workers in Korea. Methods: A total of 600 questionnaires with which long-term health care workers participated in the targeted base areas of each city and province nationwide were distributed directly and 525 responses were collected and 506 responses were analyzed. Surveys, on-site field visits, and in-depth interviews were also conducted to understand the working environment as well as conditions and establish a strategy for improving the working environment among long-term healthcare workers to understand the demands of working conditions and working conditions. Results: Korean long-term care workers firstly and mostly enumerated their risk factors for ill-health when lifting or moving elderly recipients directly by hand (69.9%), followed by increased physical workload with old beds, tools, and facilities (42.3%) in the workplaces, shortage of manpower (32%), and source of infection (30%). To improve the working environment as well as conditions, Korean long-term care workers considered improving low-wage structures, ergonomic improvements to solve excessive physical loads, and increasing various bonus payments as well as implementing the salary system, positive social awareness, and increasing resting time. Of 506 responses, 92.3% replied that the long-term care insurance system for the elderly should be developed to expand publicization at the national level. Conclusion: This study proposes to improve the low-wage structure of Korean long-term care workers, automation and improvement of facilities, equipment, and tools to eliminate excessive physical loads (beneficiary elderly lifting), and reduction of night labor.

• Health Policy and Management
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• v.32 no.4
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• pp.347-355
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• 2022

Background: Since November 2019, long-term care hospitals have been able to provide patients with discharging programs to support the elderly in the community. This study aimed to identify both patient- and hospital-level factors that affect successful community discharge from long-term care hospitals. Methods: A multilevel logistic regression model was performed using hospitals as a clustering unit. The dependent variable was whether a patient stayed in the community for at least 30 days after discharge from a long-term care hospital. As for the patient-level independent variables, an agreement between a patient and the family about discharge, length of hospital stay, patient category, and residence at discharge were included. The number of beds and the ratio of long-stay patients were selected for the hospital-level factors. The sample size was 1,428 patients enrolled in the discharging program from November 2019 to December 2020. Results: The number of patients who were discharged to the community and stayed at least for 30 days was 532 (37.3%). The intraclass correlation coefficient was 22.9%, indicating that hospital-level factors had a significant impact on successful community discharge. The odds ratio (OR) of successful community discharge increased by 1.842 times when the patients and their families agreed on discharge. The ORs also increased by 3.020 or 2.681 times, respectively when the patients planned to discharge to their own house or their child's house compared to those who didn't have a plan for residence at discharge. The ORs increased by 1.922 or 2.250 times when the hospitals were owned by corporate or private property compared to publicly owned hospitals. The ORs decreased by 0.602 or 0.520 times when the hospital was sized over 400 beds or located in small and medium-sized cities compared to less than 200 bedded hospitals or located in metropolitan cities. Conclusion: The results of the study showed that the patients' and their family's willingness for discharge had a great impact on successful community discharge and the hospital-level factors played a significant role in it. Therefore, it is important to acknowledge and support long-term care hospitals to involve active in the patient discharge planning process.

• Journal of Service Research and Studies
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• v.11 no.2
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• pp.106-117
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• 2021

This study is a descriptive survey study using a self-reported survey method to find out the job value and intention of career choice of college students in the medical management field. This study was conducted on university students in medical management at three four-year universities located in Busan Metropolitan City. A total of 139 effective questionnaires were used as statistical analysis data. As a result of the analysis, social dedication and stability were significantly displayed in the selection of jobs for hospital administration and administrative positions, and social dedication and stability were significantly displayed in the selection of jobs as medical recorders. In choosing a career as an international medical tourism coordinator, the focus on human relations, maintaining face, and pursuing stability have been significant. Only social commitment was significantly shown in the choice of occupation as a health educator. A comparison of job values according to general characteristics showed that there was a difference in the pursuit of knowledge and social commitment. In the case of grades, there was a difference in social dedication and stability. There was no significant difference in the case of religious or non-religious matters. In the case of economic level, only economic priorities differed. Through this study, we would like to present basic data so that college students in medical management who prepare to take the first step into a professional medical management society can recognize the need for recognition of job value and move in a better direction in choosing a job.

• Journal of Preventive Medicine and Public Health
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• v.19 no.2 s.20
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• pp.193-202
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• 1986

The activities of general physicians (GPs) in health subcenters and their competency for clinical skills were assessed to develop a scheme to improve the training program. One hundred-twenty GPs in southern four provinces (Kyungpook, Kyungnam, Chunpook, Chunnam) were randomly selected and 97 were interviewed between January 9 and February 10, 1984. Of the 97 GPs, 86 provided all the information we requested. Average number of patient visits per health subcenter in a day was 30-40 in the demonstration project area for the class II medical insurance whereas it was 3-4 visits in other area. The interviewees were asked to rate their competency in 63 clinical skills. The skills in which over 50% of the interviewees rated themselves competent were only 12 items including IM injection, IV injection, wound dressing, etc. Less than 10% of the interviewees rated themselves competent in such skills as maternal health care, emergency medical care, preventive and promotive health services. Most part of the training program of the NIH for the GPs were not applicable to their field work as the training contents were unrealistic. Clinical training at a local general hospital was of great help in 38.8% and the rest of training was not much helpful as the training was inadequate due to lack of trainer or indifference of the trainer. For more effective training of the GPs, the training program of the NIH should be modified to be more realistic and utilize competent field workers as the instructors. It may be more effective if the training is carried out at several local centers. Ideal length of the clinical training for the GPs is 4 months. A pocketbook should be developed that includes specific skills to master during the clinical training and require the trainer to confirm the achievement. The Ministry of Health and Social Affairs should provide the training hospitals with a training guideline and evaluate the training activities and make sure that the training hospital has specialist for each of the 4 major clinical departments. The Ministry of Health and Social Affairs should provide the GPs with a continuing education to assist the problem solving in the field and motivate them to actively carry out the health program. A province may be divided into several regions and a supervisory committee may be organized with specialists in each region. The committee may hold a meeting for the GPs periodically and respond to the specific questions of the GPs by mail.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.9
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• pp.3336-3340
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• 2010

This study has been carried out against hospitals with less than 100 beds, which were excluded from the previous study on the discharged patients from January 1 to December 31, 2007. To analyze the discharged patients, the general characteristics of discharged patients, means of payment for medical costs, type of disease and surgery and current status of the use of medical services have been investigated based on the medical records. During the year of 2007, the number of discharged patients from the hospitals with less than 100 beds reached 4,697,095 (9.7% of total population). In other words, 9,693 people were discharged from a hospital per 100,000 populations with 9.8 days in terms of annual mean length of hospitalization. The number of patients who returned home after hospitalization reached 4,538,861 (male: 1,784,041, female: 2,754,821) while 119,378 patients were evacuated to other hospitals. Among them, 8,970 patients were returned back to the original hospital. Based on the results of this study, they could be used in could be used in planning a project which is aimed to reduce public health costs by investigating high-risk groups with particular injuries and preventing damage. In addition, the injury monitoring data which are continuously collected could be useful in monitoring and evaluating the efficiency of an injury prevention program.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.3
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• pp.364-375
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• 2018

This study was a descriptive investigation to identify the influence of nurses' moral sensitivity and safety of their environment on compliance with standard precautions. Participants consisted of 214 nurses in one general hospital and data were collected using a questionnaire that consisted of moral sensitivity, safety of environment and compliance with standard precautions from 1-15 August 2017. Data were evaluated by the independent t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis. The mean scores of moral sensitivity, safety of environment and compliance with standard precautions were 5.05, 5.76 and 4.50, respectively. Moreover, compliance with standard precautions was significantly positively correlated with moral sensitivity and safety of environment. Additionally, multiple regression revealed an $R^2$ of 0.253 with the department (ER, ICU), age and safety environment serving as the major predictor variables for compliance with standard precautions. However, the influence of moral sensitivity on compliance was not identified. Therefore, to increase compliance with standard precautions among nurses, it is necessary to provide continuous educational programs for new nurses, customized programs considering departmental characteristics and administrative support of institutions to enhance safety of the environment.

• The Journal of the Korea Contents Association
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• v.18 no.5
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• pp.175-190
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• 2018

This was a descriptive study aiming to verify the effects of work environment, job satisfaction, and organizational commitment on the turnover intention of Clinical Research Coordinator(CRC) nurses. In the results of this study, the organizational commitment had significant effects on the turnover intention of CRC nurses. On the other hand, the work environment and job satisfaction had no statistically significant effects on the turnover intention of CRC nurses. Based on the results of this study, the main discussions were drawn as follows. In order to increase the organizational commitment, it would be necessary to have the institutional improvement like the increase of opportunity to participate in the hospital operation, administration, and the establishment of affiliated institution for improving a sense of belonging. It would be also necessary for each hospital to establish the standard of welfare, wage system for the improvement of work environment. If the organizational commitment of CRC nurses who are the actual performers, supporters of researches is ignored, it is unavoidable that the performance and quality of clinical tests would be declined. Therefore, there should be some changes, so that CRC nurses could play a pivotal role in the whole process of clinical test, by changing the employment status from contract position to more stable employment status, to increase their commitment to organization and work continuity.