• 한국의료질향상학회지
• /
• 제3권2호
• /
• pp.36-51
• /
• 1997

Background : Clinical practice guidelines define "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" and help to improve patient care. The purpose of this study is to develop a clinical practice guideline for the most effective diagnoses and treatments of benign prostatic hyperplasia based on patient preference and clinical need. Methods : For this research project, extensive literature searches (208 articles) were conducted. As well, critical reviews and syntheses (meta-analysis) were used to evaluate empirical evidence and significant outcomes of the BPH literature. Questionnaires about clinical practice for BPH patients were distributed and consensus meetings were undertaken to grasp variations in clinical practice and to reach agreement on the guideline's development. The guideline was promoted under the sponsorship of the Korean Medical Association and the Korean urological Cancer. Society. For the task, the Benign Prostatic Hyperplasia Guideline Panel was composed of multidisciplinary experts in the field. Results : BPH is a disease that affects a patient's quality of life. This Clinical Practice Guideline was developed for the typical man over age 50 with symptoms of prostatism, but with no significant medical morbidities such as diabetes or other known causes of voiding dysfunction, such as urethral stricture or neurogenic bladder. The guidelines detail the relative benefits and obstacles associated with all diagnostic and treatment approaches, including watchful waiting. Conclusion : This guideline provides a cornerstone for our medical association. It represents the most current scientific knowledge regarding the development, diagnosis, and treatment of BPH. It will be revised and updated as needed.

• 한국의료질향상학회지
• /
• 제4권1호
• /
• pp.82-103
• /
• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• 한국의료질향상학회지
• /
• 제7권1호
• /
• pp.32-45
• /
• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• 한국전자통신학회논문지
• /
• 제12권5호
• /
• pp.957-964
• /
• 2017

본 연구에서는 NCS 기반 의료정보관리 직무수행을 위한 교육과정을 수행하고, 학습자의 실무지식을 이해할 수 있는 프로그램을 제작하였다. 이 프로그램은 의무기록의 데이터를 발생시키고 저장한 후 의무기록의 데이터를 분석하여 의료정보를 생성할 수 있는 교육용 프로그램이다. 의무기록의 내용이 다양하고 의무기록의 양적 차이가 있기 때문에 교육용 데이터의 표준을 위해 퇴원분석 프로그램에 의무기록의 내용을 요약하고 저장할 수 있도록 하였다. 프로그램을 사용하여 의료정보관리 NCS 능력단위 요소인 의료용어 DB, 의료용어 관련 DB, 진료관련 DB를 구축하고 관리할 수 있다. 다음은 프로그램 운영을 통해 학습 할 수있는 내용이다. 첫 번째로 데이터베이스의 구조를 이해하여 의료정보 DB 관리규정을 작성할 수 있다. 두 번째로 퇴원분석 프로그램에 입력하는 진단코드 및 의료행위코드의 구조와 기능을 이해할 수 있다. 또한 퇴원분석 프로그램에서 입력된 진단코드 및 의료행위코드들을 각 필드별로 검색하고 분석할 수 있다. 세 번째로 데이터를 입력하고 추출하여 의료정보를 생성함으로써 의료정보관리 능력을 향상시킬 수 있다. 본 연구에서는 퇴원분석 프로그램을 이용하여 학생들이 의무기록의 데이터를 발생시키고 분석하여 의료정보를 생성함으로써 의료정보관리에 대한 지식을 습득하고 실무능력을 향상시킬 수 있는 프로그램을 개발하였다.

• 의료법학
• /
• 제20권3호
• /
• pp.235-262
• /
• 2019

전통적으로 인류를 위협해 오던 감염성 질환이 줄어드는 반면, 심뇌혈관 질환을 포함하여 암, 당뇨와 같은 만성질환이 빠른 속도로 퍼져나가고 있다. 오랜 시간에 걸쳐 발병하며 증세가 장기간 지속되지만 치료가 어려운 만성질환의 특성을 반영, 그 위험요인의 관리와 이에 대응하는 건강증진정책의 마련은 세계 각국의 중요 관심사로 부상하게 되었다. 일차 의료 시스템이 점점 더 복잡한 형태로 변화하는 현대사회의 건강요구에 부합, 건강증진 및 질병 예방 정책, 지역사회에 대응 솔루션 등 이른바 환자 중심의 다 부문 접근방식을 제공하면서 변화된 의료 환경에서 일차 의료의 가치는 다시 한 번 부각 되고 있다. 기존의 의료전달체계로는 급속한 고령화 및 질병 패러다임의 변화, 삶의 질 향상을 향한 민중의 욕구를 감당하기 어려워지면서 유럽연합국가들은 지속적이며 포괄적이고 조정된 관리를 제공하는 일차 의료 시스템을 구축, 그 품질 향상을 위하여 다각적인 노력을 기울이고 있다. 본 논문은 우리나라 보건의료 전달체계의 현황 및 문제점 등을 검토하고, 일차 의료 강화와 관련된 유럽연합의 예를 중심으로 그 시사점을 도출, 환자 중심의 미래형 의료전달체계 구축 방안에 관하여 논의하고자 한다.

• 한국산학기술학회논문지
• /
• 제16권1호
• /
• pp.576-584
• /
• 2015

본 연구에서는 치과 임플란트 환자의 구강위생 관리행태와 만족도의 관련성을 조사하여 향후 임플란트 보철물의 유지율과 만족도 향상을 위한 진료 및 교육 프로그램 개발의 기초 자료를 마련하고자 함이다. 설문지는 2014년 1월 7일부터 6월 30일까지 수집 되었으며 수집된 자료는 SAS (ver 9.2)를 이용하여 분석하였으며, 대구시, 부산시, 진주시에 소재한 6개 치과 병 의원에서 임플란트 시술을 받은 환자를 대상으로 실시하여 최종 266부를 분석 정리한 결과 다음과 같은 결론을 얻었다. 1. 치과 임플란트 보철물 장착 실태 및 관리지식에서 3점 만점에 평균 1.41점이었다. 2. 치과 임플란트 보철물 장착 후 관리행태에서 스켈링 주기는 '안 받음'이 168명(63.2%)이었다. 3. 치과 임플란트 보철물 장착 실태 및 장착 후 특성에 따른 보철물 사용 후 만족도에서 저작기능(p=0.001)의 만족도는 구강위생 보조용품을 사용한다는 군이 유의하게 높게 나타났다. 4. 치과 임플란트 보철물 관리지식, 불편감, 만족도의 상관분석에서는 구강위생 보조용품을 사용할수록(${\beta}=0.095$), 관리지식이 높을수록(${\beta}=0.069$), 구강보건교육 경험이 있을수록(${\beta}=0.032$), 만족도가 높았다. 치과 임플란트환자의 만족도 향상을 위해서는 구강보건교육을 통한 유지관리행태의 개선 및 발전이 우선시 되어야 한다고 사료된다.

• 한국의료질향상학회지
• /
• 제2권1호
• /
• pp.68-84
• /
• 1995

Background: Guideline for practice is useful because it can be the standard for assessment and way to improve quality. We need to take account of expert opinion and consensus as well as scientific evidences to develope practice guideline because it should be practical. Delphi method has been developed to gather opinions from experts fairly. This study was designed to develop practice guideline and apply it to practices as a method to improve quality in primary medical care. Methods: Hypertension(in adults over 18 years old) was selected as a target problem. Self questionnaires about management of hypertensive patients were developed by a researcher with advice of 11 experts. The questionnaires were designed to response as a 5 pont scale. The results of previous questionary were given to respondents in second and third questionnaires. If needed, the questionnaires were changed on the previous responses. The items with medium greater than or equal to 4 point in 1st and 2nd responses were accepted in guideline. The items with medium lesser than or equal to 3 point were questioned again about whether they can be excluded or not. The criteria for assessment was made with reference to guideline and applied to 85 hypertensive patients of 9 family practitioners. At 3 months after practice guideline had been given to family practitioners, performance of same practitioners was assessed with 36 new hypertensive patients. Results: 23 professors in family medicine, 22 family practitioners and 6 cardiologists, responded among 50, 50, 15 respectively. Practice guideline with 33 items was developed as a result of 3 times questionaires. The difference of responses between professors in family medicine, family practitioners and cardiologists was not significant. Performance of practice was improved in diagnosis, history taking about 6 fields, laboratory examination and decision making about time of pharmaceutical prescription. It was not improved in physical examination, life style modification, method of pharmaceutical prescription, choice of initial antihypertensives and history taking about duration of disease and diet habit. It was decreased in history taking about psychosocial factors. The assessment scores were low in history taking, physical examination and life style modification before and after use of practice guideline. Conclusion: Practice guideline for hypertension could be developed by Delphi method. Performance of practice improved partially after use of guideline.

• 대한임상검사과학회지
• /
• 제48권4호
• /
• pp.348-354
• /
• 2016

병원정보시스템에 저장되어 있는 자료들은 적절성 평가 및 질관리를 향상시키는 데 있어 많은 잠재력을 가지고 있으며 이를 기반으로 하는 데이터웨어하우스의 구축은 질 관리의 향상과 임상진료에 많은 도움을 줄 수 있는 것으로 알려져 있다. 본 연구는 감염관리 정보의 체계적이고 효과적인 자료 분석을 위한 일환으로 항생제 사용량 분석이 가능한 데이터마트를 구축하였다. 감염관리의 구성요소 및 평가 척도를 선정 후 XML DTD 방법으로 메타데이터를 설계하였고 모델링을 통해 데이터마트를 구축하여 항생제 사용량 분석을 위한 다차원 분석 도구인 OLAP를 시현하였다. 실험 자료는 1997년 7월 한 달 동안의 천안 지역의 일개 대학병원의 항생제 사용량 자료를 이용하였다. 감염관리 메타데이터의 상위요소는 항생제 내성 정보, 항생제 사용량 정보, 감염 정보, 검사 정보, 환자 정보 및 감염 관련 비용으로서 구성하였다. 이 중 항생제 사용량 정보를 스타 스키마에 적용하기 위한 데이터베이스의 설계를 하여 데이터마트를 구축하였다. 그리고 일 개월 간 사용된 항생제 사용량에 대해 OLAP을 시현하였다. 본 연구는 XML과 OLAP 기술의 구현을 통해 항생제 사용량에 대한 감염관리 데이터마트를 수립하였다. 개념적이고 구조화된 데이터마트의 구축은 감염관리 정보에 대해 신속하고 다양한 분석을 제공할 것으로 사료되었다.

• 한국의료질향상학회지
• /
• 제5권2호
• /
• pp.324-334
• /
• 1998

Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.

• Radiation Oncology Journal
• /
• 제18권3호
• /
• pp.167-176
• /
• 2000

최근의 방사선치료는 치료의 질을 향상시켜서 치료 후의 삶의 질을 높이는 것을 목표로 하고 있다. 국내에서도 방사선치료 환자와 치료 시설의 빠른 증가로 방사선종양학 분야는 많은 발전이 되고 있으며, 치료기술 또한 3-dimensional conformal radiotherapy의 보편화, liuac based stereotactlc radiosurgery의 활발한 적용과 luteuslty modulated radiation tferapy (IMRT)의 도입 준비 등 고난도의 치료 기술도입이 시도되고 있다. 저자는 최근 20년간 한국에서의 방사선 종양학의 발전을 조망하고 최근 발전되는 4차원적 방사선치료, IMRT의 현황, blologlcai conformailty치료의 개념, 항암제와 방사선치료의 병용에 대하여 살펴보고 최근 정보기술 혁명에 따른 인터넷과 방사선종양학 분야의 정보관리 시스템의 중요성 및 원격진료의 세계적 현황 등에 대해서 알아보고, 21 세기 한국에서의 방사선치료의 질을 올리기 위한 방법들을 제시하였다. 이들은 1) OA (qualify assurance) 향상, 2) 공동 프로토콜에 의한 3상 임상 연구의 필요성, 3) 특정 암에 대한 통일된 치료 프로토콜 또는 가 이드라인, 4) 전국적인 방사선종양학 관련 자료의 광역 data base구축과 중요 암에 대한 patterns of care study 등 시행의 필요성이다