• Journal of the Architectural Institute of Korea Planning & Design
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• v.34 no.10
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• pp.83-94
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• 2018

In many theoretical and empirical studies on the design issues of therapeutic healthcare facilities, spatial configuration that promotes users' wayfinding behavior, has been emphasized as a significant factor to mitigate stressful experiences and to enhance restorative quality in the healthcare environment. This is also applicable to the healthcare setting for children. However, not much evidence has been reported with regard to the relationship between spatial configuration and wayfinding behaviors in this specific setting. Moreover, healthcare facilities for children with physical disabilities need more attention to provide easy wayfinding due to various physical restrictions. The aim of this study is therefore, to unfold the relationship between spatial configuration and visual cognitive qualities of outpatient spaces in the selected children's rehabilitation hospitals in Seoul, by examining visual cognitive attributes such as visibility, accessibility, and intelligibility. In the first phase, the spatial layout of the hospitals was analyzed, with an emphasis on the major outpatient areas such as the entrance lobby, doctors' examination, and physical therapy zones. In the second phase, a space syntax tool was implemented to examine visual cognitive characteristics of the spatial configuration. The spatial configuration parameters measured were integration, integration core, visual isovist field continuity, correlation between integration and step depth, and the correlation between integration n and integration 3. As a result, the integration was higher in the hall type configuration. Circulation intersections acted mostly as integration cores for better visibility. Some areas showed the lack of continuity in the visual isovist fields overlap and irregular correlation between integration and step depth. The intelligibility was higher in the circulation area and social interaction spaces such as a cafe, reception waiting, and therapy waiting areas. Based on the analysis, design implication and possible future improvement were discussed to enhance wayfinding experiences in the hospitals for children with physical disabilities.

• Journal of The Korea Institute of Healthcare Architecture
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• v.22 no.4
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• pp.7-17
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• 2016

Purpose: As our population ages and becomes an elderly society the number of elderly care hospitals is rapidly increasing. Because physical functions and spatial perception in the elderly decrease with age, these hospitals require more systematic and intelligent space designs. The design of these spaces are even more complex because they must accommodate medical programs to treat various different diseases and ailments and also because there are many first time patients and irregular short term patients that seek out outpatient treatment services. Also by analyzing the spatial configuration systems and systematic relationships between each of the functional spaces of the outpatient treatment service departments for hospitals specialized in care for the elderly by focusing on the hallway and corridor systems of these hospitals, the according characteristics and trends were examined. Methods: Based on preceding research, the types of hallway and corridor systems of these hospitals were categorized into five types, including gallery corridors, middle corridors, hall-type, mixed type and cyclic type corridors, and into six types according to function including by medical diagnosis, patient registration, examination, administration and convenience and shared common space to derive any interconnecting relationships between the corridor systems. Also by comprehensively examining the types and combined utilization of the corridor types and the integration and the intelligibility of the space syntax, any trends within the corridor system were derived. The elderly care hospitals examined in this research study were twelve hospitals that opened after the year 2000 in Korea with more that 150 sick beds with areas larger than $1000m^2$ and with all outpatient medical service related rooms located entirely on a single floor of the hospital. Results: The following results could be confirmed based on this research study. 1) The spaces where medical diagnosis and examination occurred were adjacent, and the movement lines for first time patients and re-visiting patients were taken into consideration by separating the treatment space. 2) This research study confirmed that the larger the size of the hospital was, there were more detailed categorizations of treatment services and that there was a tendency for treatment areas to be separated and independent from examination areas. 3) There was a tendency for integration and intelligibility to decrease the more complex and diverse the combination of hall types designed into the corridor systems of these hospitals was. cyclic type corridors dramatically decreased the intelligibility of the corridor systems of these hospitals. 4) The priority rank of these spaces were confirmed to be highest in the order of registration, diagnosis, examination, treatment, administration and shared common spaces. However it was confirmed for the local integration that the diagnosis scope had the highest priority rank. Implications: There were exceptional cases confirmed where the number of unit spaces did not have an absolute effect on integration and intelligibility. These results can be interpreted to mean that this can be overcome through efficient architectural planning.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.7
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• pp.490-499
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• 2017

In recent years, the introduction of complex systems analysis based on various variables has become more active in order to identify and analyze complex problems of Modern Society. Prediction of patients' spatial perception and usability according to the spatial arrangement of the outpatient department is a very important factor for providing high quality hospital service. For objective analysis, the standard program procedure and analysis index for the diseases of the elderly were prepared and the uniformity of the atmospheric space was evaluated through heat map analysis and quantitative analysis. In this study, 73 cells were installed and simulated to analyze the uniformity of the four alternatives according to the change of the arrangement of the medical care space, receiving space, and consultation space using the complex system analysis method for the nursing hospitals. The resulting density was derived. The results are as follows. 1)The layout of the reception space has the greatest influence on the total spatial density of the waiting space. 2) The uniformity of the waiting space can be increased by separating the examination space and the examination space. 3)The closer the location of the receiving space is from the entrance, the greater the density of the waiting space. Finally, this study applied discrete event simulation to the evaluation of uniformity of atmosphere space, and proved that the actor - based model can be utilized for utilization and evaluation as spatial analysis methodology.

• Journal of the Korean Society of School Health
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• v.4 no.2
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• pp.136-145
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• 1991

In the Soviet Union School health services are provided as an integral part of the health care delivery system, which is under the Ministry of Health. This paper presents an overview of the Soviet Union's health care delivery system, the model for the delivery of school health service, the role and training of school personnel involved in school health services and implications the Soviet model may have for the countries. 1. School health services are a part overall Soviet health system under the Ministry of Health. 2. Municipal and rural health departments implement programs at the local level. Diagnosis and treatment are conducted through "polyclinics" that are outreach divisions of a district hospital. 3. Education institutions for the development of health manpower, including medical schools and nursing schools, are under the Ministry of Health, as are medical and scientific search institutes.

• Health Policy and Management
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• v.34 no.1
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• pp.48-58
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• 2024

Background: The purpose of this study was to investigate the association between external medical service use and the characteristics of Chungcheongnam-do patients. We aimed to provide evidence of external medical service use enhance the healthcare delivery system in Chungcheongnam-do. Methods: We used the Health Insurance Cohort DB 2.0 of 2016-2019, and 2,570,439 patients were included in the study. Multivariate logistic regression and multinomial logistic regression were used to identify the association between external medical service use and each patient characteristic. Generalized linear model was used to identify the association between medical costs and external medical service use area. Results: During the study period, 32.2% of inpatients and 12.5% of outpatients had external medical service use in Chungcheongnam-do. In comparison to patients living in Cheonan and Asan, the odds ratio (OR) for external medical services use was higher across all regions. Specifically, hospitalized patients from Gyeryong, Nonsan, and Geumsan (OR, 116.817) and Gongju, Buyeo, and Cheongyang (OR, 72.931) demonstrated extremely high likelihood of external medical service use in the Daejeon area. Furthermore, compared to medical expenses incurred within Chungcheongnam-do, patients with external medical service use in the capitol area (outpatient=17.01%, inpatients=22.11%) and Daejeon area (outpatient=16.63%, inpatients=15.41%) spent more on healthcare services. Conclusion: This study found the evidence of external medical service use among Chungcheongnam-do patients. Further study should be conducted taking into account variables including satisfaction of local medical services, different types of patient diseases, and others. The study's findings may serve as a foundation for policy proposals aimed at ensuring the financial stability of our health insurance system, ensuring the efficient delivery of medical care, and localization of medical care.

• Journal of The Korea Institute of Healthcare Architecture
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• v.25 no.1
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• pp.7-16
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• 2019

Purpose: Analysis on the spatial configuration characteristics of dental department in medical center through examining outpatient department of medical center is necessary for the development of architectural planning of the dental healthcare system in Korea. This study has been performed to provide data for the planning of hospital architecture. Methods: Literature review of dental healthcare system and investigation on current status of dental department in medical center have been conducted. The plan and spatial configuration of seven medical centers in Seoul area have been analyzed. Results: The result of this study can be summarized in four points. The first one is that the clinical dental spaces are classified by dental school's dental hospital, dental department in medical center, dental hospital, private dental clinic, and public dental healthcare center in Korea. The second one is that the dental department in medical center is a result from medical law regulation and it is specified and subdivided with dental specialist system. The third one is that the types of the dental department in medical center are divided into independent type or comprehensive type according to the relationship with main outpatient department. The fourth one is that the spatial configuration of dental department in medical center is planned with 5-7 specialized departments and they are allocated in the dental department. Implications: In addition to the spatial configuration of dental department in medical center, it is necessary to analyze the other factors like circulation, relationship with other facilities in medical center to develop the dental healthcare system.

• The Journal of Society for e-Business Studies
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• v.22 no.4
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• pp.53-69
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• 2017

This study focuses on analyzing no-shows associated with patients' clinical characteristics described by diagnoses in their medical data. A dataset of 7,055 patient-records from a Veterans hospital in the United States was used to test if there is difference on no-shows along with each patient's diagnosed diseases and the number of diagnoses. Patients with mental diseases such as drug dependence abuse and major depression, and chronic diseases such as hypertension are more likely to no-show. In comparisons with the number of diagnoses, the no-show decreases as the number of diagnoses increases up to four and doesn't change significantly afterwards. We provide managerial insights on clinical operations problems from statistical analysis. We believe that our results can be used to develop appropriate solutions on no-shows in clinics.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.95-100
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• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Korean Institute of Interior Design Journal
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• v.25 no.6
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• pp.40-51
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• 2016

The aim of this study is to quantitatively deduce the circulation efficiency and space arrangements of the outpatient department in geriatric hospitals in terms of spatial structure and to find a methodology that could promote the improvement of accessibility and spatial cognition while using the facilities. All space units of the selected twelve geriatric hospitals were located on the first floor. The study adopted the psychological distance concept of space syntax to the unitized spaces, and presented a set of indices, such as TD, PN, RF, PNT and TRF. These indices were calculated according to the standard clinical use procedures. The study evaluated the effectiveness of circulation. The analysis of circulation was based on the four major geriatric illnesses that were selected in this study. The study established the standard clinical use procedure with consideration of the medical treatment, examinations and space units of outpatient departments. The results are as follows: 1) Based on the statistical data, four major geriatric illnesses are examined, and space requirement and standard procedures are established. Development indicators are applied in order to quantitatively deduce the efficiency of spatial cognition. 2) The percentage of the risk of cognitive decline(TRF) has an inversely proportional correlation to the circulation efficiency(PNT) at a certain point. TRF is more influenced by the clinical use procedure than the scale. 3) The arrangement of the waiting space and types of corridor greatly affect the percentage of the risk of cognitive decline. 4) Vulnerable facilities are selected on the basis of the evaluation, and two alternatives that could promote the circulation efficiency are presented. The result of the reanalysis showed that cognitive efficiency had much improved compared to the existing facilities.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1050-1054
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• 2005

Purpose : Relactation refers to the re-establishment of a milk supply and nursing after the cessation of nursing for a variable period. We aimed to analyze the practical issues related to successful relactation in the lactation clinic. Methods : The medical records of 51 mothers who had visited the lactation clinic for relactation were retrospectively analyzed. Breastfeeding greater than 90% was considered to as relactation success. Perinatal characteristics, the number of visits to the clinic, need for medication and the breastfeeding supplementer, and the reason for failure were analyzed. Results : Relactation appears to be easier for women who had lactated previously. With optimal care, support and motivation, some who had never lactated were able to start lactation. Conclusion : Relactation is a practical method to ensure breastfeeding in motivated women. Supplemental use of drugs and the breastfeeding supplementer system contribute to the success of relactation.