• Tuberculosis and Respiratory Diseases
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• v.60 no.2
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• pp.205-214
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• 2006

Background : Acute exacerbations form a major component of the socioeconomic burden of COPD. As yet, little information is available about the long-term outcome of patients who have been hospitalized with acute exacerbations, although high mortality rates have been reported. The aim of this study was to determine predictors of long-term mortality after hospitalization for acute exacerbation of COPD. Methods : We performed a retrospective cohort study of consecutive patients admitted to the hospital for COPD exacerbation between 2000 through 2004. Patients who had died in hospital or within 6-months after discharge, had tuberculosis scar, pleural thickening or bronchiectasis by chest radiography or had been diagnosed with malignancy during follow-up periods were excluded. Results : Mean age of patients was 69.5 years, mean follow-up duration was 49 months, and mean $FEV_1$ was 1.00L (46% of predicted). Mortality was 35% (17/48). In the multivariate Cox regression analysis, heart rate of 100/min or more (p=0.003; relative risk [RR], 11.99; 95% confidence interval [CI], 2.34-61.44) and right ventricular systolic pressure (RVSP) of 35mmHg or more (p=0.019; RR, 6.85; 95% CI, 1.38-34.02) were independent predictors of mortality. Conclusion : Heart rate and RVSP in stable state may be useful in predicting long-term mortality for COPD patients admitted to hospital with acute exacerbation.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.4
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• pp.435-447
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• 2019

In order to prevent unnecessary re-admission, it is necessary to intensively manage the groups with high probability of re-admission. For this, it is necessary to develop a re-admission prediction model. Two - year discharge summary data of one university hospital were collected from 2016 to 2017 to develop a predictive model of re-admission. In this case, the re-admitted patients were defined as those who were discharged more than once during the study period. We conducted descriptive statistics and crosstab analysis to identify the characteristics of rehospitalized patients. The re-admission prediction model was developed using logistic regression, neural network, and decision tree. AUC (Area Under Curve) was used for model evaluation. The logistic regression model was selected as the final re-admission predictive model because the AUC was the best at 0.81. The main variables affecting the selected rehospitalization in the logistic regression model were Residental regions, Age, CCS, Charlson Index Score, Discharge Dept., Via ER, LOS, Operation, Sex, Total payment, and Insurance. The model developed in this study was limited to generalization because it was two years data of one hospital. It is necessary to develop a model that can collect and generalize long-term data from various hospitals in the future. Furthermore, it is necessary to develop a model that can predict the re-admission that was not planned.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.243-279
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• 2019

During the main ruling in 2018, it is difficult to find a new judiciary, which is understood to be due to a certain degree of jurisprudence established and focusing mainly on contentious disputes within the framework of damages. The cases in which the court's judgment is reversed helped to understand the reason and the judiciary, and it was confirmed that the dispute in the medical lawsuit became more and more intense. Decisions on responsibility restrictions and medical records were also noticeable, with a significant increase in the number of verdicts relating to the doubt about medical records. This is considered to be part of the increasing number of cases in which the parties raise questions about medical records, and several cases were categorized and introduced at this opportunity. We also introduce the case of forced discharge of long-term hospitalized patients and medical fee bill, because it was judicial interest after the Supreme Court ruling that the cost of treatment for the after-effects of medical malpractice can not be claimed to the patient.

• Korean Journal of Adult Nursing
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• v.19 no.3
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• pp.495-507
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• 2007

Purpose: This critical ethnography was performed to explore the experiences of nurses who are working with patients in an industrial disaster hospital. During the research process, I focused on the experiences of conflict in caring patients. Methods: Data for the study came from 13 informants with their corresponding patients through interview and observation from March 2002 to February 2004. The data was examined line by line; then compared and contrasted based on a critical discourse analysis. Results: Nurses' conflicts came from discrepancies of the world views from that of the patients. Such conflicts arose because of various issues as follows: Worker as an individual vs patients, nurse as young women vs the medical profession, hospital as an extended home vs health care setting, and hospitalization as a means to enhance work capacity vs a means of treatment. Conclusion: We need more study on the development of adaptive strategy for the nurses to overcome conflicts during their nursing career. Developing a nurses' and patient role intervention program is needed.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.195-218
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• 2017

The increase in medical expenses for convalescent hospitals is increasing abnormally, which puts enormous burden on the National health insurance finances. This is a phenomenon that has been associated with the social phenomenon of rapid aging. The fact that the convalescent hospitals are paid the fixed amount per day for hospitalization became the incentive for some hospitals to use the patients as means of making money. And these hospitals intend to get regular care or take medicines at other hospitals in order to reduce medical expenses, even when the medical fee is paid. In order to prevent such financial leaks, the Health Insurance Review and Assessment Service adjusted the patient group for inpatients in a hospital with the above behavior, and then cut the cost of medical care benefits. However, Above decision was canceled by the court on the grounds that there was no basis rule. However, based on the above case, I think that it can be an opportunity to draw up the problem and to improve of the Medical Fee System of hospital. The modified medical fee system can strengthen the medical function of the convalescent hospital. In addition, it seems reasonable to exclude admission for "physically disabled group". Even if admission is allowed for the physically disabled group due to social needs, it should be excluded from the National health insurance for the fianacial soundness and the sustainability of the system.

• The Journal of the Korea Contents Association
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• v.17 no.5
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• pp.366-375
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• 2017

The purpose of this study is to analyze the use of hospital, hospitalization, medical service, discharge and power of medical care patients who are concerned about moral hazard. We conducted focus group interview with 3 medical care patients and their families and 5 workers who had worked for more than 4 years in a nursing hospital. The main results and implications are as follows. First, admission to nursing hospitals was mostly based on the linkage between the medical institutions and the competition to attract the patients rather than the choice of the patients. Second, the main cause of the long-term hospitalization of medical assistance patients was the lack of social protection measures such as absences of residence and care giver, although there are factors that cause moral hazard such as low self-pay. Third, most of the patients were in need of treatment, but they were admitted to the hospital even though their needs were not higher than those of the health insurance patients. Fourth, the rehabilitation service is the mainstay of the medical service of the nursing hospital, and the roles of nursing staff and care givers are important. Fifth, medical care patients are paying medical expenses for nursing hospitals due to cost of living and family support, but they are exempted from the hospital expenses or the burden of their own expenses in the hospital. Sixth, public institutions and social welfare institutions have not managed continuously since commissioning patients to nursing hospitals and have neglected the connection with community services after discharge.

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.329-335
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• 2004

Background : The Sequential Organ Failure Assessment (SOFA) score can help to assess organ failure over time and is useful to evaluate morbidity. The aim of this study is to evaluate the performance of SOFA score as a descriptor of multiple organ failure in critically ill patients in a local unit hospital, and to compare with APACHE III scoring system. Methods : This study was carried out prospectively. A total of ninety one patients were included who admitted to the medical intensive care unit (ICU) in Chuncheon Sacred Heart Hospital from May 1 through June 30, 2000. We excluded patients with a length of stay in the ICU less than 2 days following scheduled procedure, admissions for ECG monitoring, other department and patients transferred to other hospital. The SOFA score and APACHE III score were calculated on admission and then consecutively every 24 hours until ICU discharge. Results : The ICU mortality rate was 20%. The non-survivors had a higher SOFA score within 24 hours after admission. The number of organ failure was associated with increased mortality. The evaluation of a subgroup of 74 patients who stayed in the ICU for at least 48 hours showed that survivors and non-survivors followed a different course. In this subgroup, the total SOFA score increased in 81% of the non-survivors but in only 21% of the survivors. Conversely, the total SOFA score decreased in 48% of the survivors compared with 6% of the non-survivors. The non-survivors also had a higher APACHE III score within 24 hours and there was a correlation between SOFA score and APACHE III score. Conclusion : The SOFA score is a simple, but effective method to assess organ failure and to predict mortality in critically ill patients. Regular and repeated scoring enables patient's condition and clinical course to be monitored and better understood. The SOFA score well correlates with APACHE III score.

• Korean Journal of Social Welfare
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• v.39
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• pp.350-373
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• 1999

The patient population of U. S. state mental hospitals has changed drastically since the 1960s, when the deintstitutionalization movement began. This paper is designed to look at what happened to the number of inpatients of state hospitals in California during the last 150 years and, from this, to explore implications for the future of the mental health system in Korea, especially for the viability of mental hospitals. The data had been collected by field research(visits to state hospitals and State Department of Mental Health, and interviews with mental health administrators) and accessing statistical publications and various reports. Since the first state hospital opened in 1851 the statewide inpatient population of individuals who were mentally disabled has grown and peaked at 37,489 in 1959. The number of patients in state hospitals, however, began declining in the early 1960s and was reduced to 10,874 by 1971, and to 4,973 by 1986. As of 1997, there were only 4, 263 inpatients remaining in the state hospital system. This dramatic decrease slowed down somewhat in 1980s and 1990s, but this trend seems irreversible except for the inpatients referred by the court. Now the beds in state hospitals are filled with more and more forensic patients, which constitutes nearly 70% of the total inpatient population. Based on these findings, it is well expected that the number of inpatients of mental hospitals in Korea will also be reduced in a significant way as the community-based mental health care system is gradually replacing the traditional one. Mental hospitals need to introduce more diversified programs for the care of the mentally ill, and concurrently more vigorous aftercare programs are required in the community.

• Journal of Preventive Medicine and Public Health
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• v.30 no.3 s.58
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• pp.497-507
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• 1997

This study was conducted to evaluate the association of various lifestyle with blood pressure. The data were obtained from the individuals who got routine health examination in Department of Occupational Medicine, Yeungnam University Hospital from June to September, 1996. Among these people, we selected 130 cases of hypertensives (97 males, 33 females) and 150 normotensives(70 males, 80 females) and study was conducted. The authors collected the information of the risk factors related to hypertension such as age, family history of hypertension, fasting blood sugar, serum total cholesterol, alcohol consumption(g/week), smoking history, relative amount of salt intake (low, moderate, high), the frequency' of weekly meat consumption, BMI, daily coffee consumption(cups/day) and the frequency of regular exercise(frequency/week) through questionnaire and laboratory test. By simple analysis, BMI was significantly associated with hypertension in male(p<0.05), and the frequency of weekly meat consumption was significantly associated with hypertension in female(p<0.05). Using logistic regression model, elevated odds ratio was noted for fasting blood sugar, serum total cholesterol, family history of hypertension, alcohol consumption, salt intake and BMI, and reduced odds ratio was noted for coffee consumption and exercise in male but fasting blood sugar(odds ratio=1.022, 95% CI=1.000-1.044), family history in both of parents(odds ratio=3.301, 95% CI=1.864-4.738), salt intake(odds ratio=1.690, 95% CI=1.082-2.298) and BMI(odds ratio=1.204, 95% CI=1.065-1.343) were statistically significant(p<0.05). In female, elevated odds ratio was noted in serum total choles terol, family history of hypertension, BMI and meat consumption. Of all these variables, the family history of hypertension in either of parents(odds ratio=4.981, 95% CI=3.650-6.312), family history in both of parents(odds ratio=16.864, 95% CI=14.577-19.151), BMI(odds ratio=1.167, 95% CI=1.016-1.318) and meat consumption(odds ratio=2.045, 95% CI=1.133-2.963) showed statistically significant association with hypertension in female(p<0.05).

• Journal of Digital Convergence
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• v.15 no.2
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• pp.273-283
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• 2017

This study aims to develop a convergence optimized LOS(Length of Stay) management system that can provide efficient by predicting LOS on outpatient information for inducing the LOS to manage their own activities. web program has been implemented to comput in real-time predicting LOS by using the predicted LOS model of outpatient information. The predict model was derived management targets of long term predicted patient group and intensive care patient group. The optimized LOS(Length of Stay) management system was confirmed efficient for optimizing management of LOS that can provide by the long-term predicting alarm and over LOS alarm service for long term predicted patient group and intensive care patient group. Therefore the trial operating policy alternative on extension of predicted LOS is needed to utilized convergence optimizing system on LOS.