• 제목/요약/키워드: ACSC

검색결과 11건 처리시간 0.021초

한국의 의료기관 외래진료 민감질환 입원율: 의료이용 효율성 지표로의 활용 가능성? (Hospital Admission Rates for Ambulatory Care Sensitive Conditions in South Korea: Could It Be Used as an Indicator for Measuring Efficiency of Healthcare Utilization?)

  • 정건작;김진경;강혜영;신의철
    • 보건행정학회지
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    • 제26권1호
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    • pp.4-11
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    • 2016
  • Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. Methods: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. Results: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0%-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (${\beta}=0.986$, p<0.05), and for private corporate institutions than public institutions (${\beta}=0.271$, p<0.05). Conclusion: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.

한국형 ACSC에 대한 실증분석 및 건강보험 적용 가능성에 관한 연구 (The Empirical Ambulatory Care Sensitive Conditions Study & its Potential Health Insurance Applicability in Korea)

  • 김양균;성주호
    • 보건행정학회지
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    • 제15권3호
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    • pp.79-93
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    • 2005
  • The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

국내 반복입원의 현황과 환자 특성: 외래진료 민감질환을 중심으로 (Current Status of Repeated Hospitalization in South Korea: Focused on Ambulatory Care Sensitive Conditions)

  • 정혜민;김현주;이진용
    • 한국의료질향상학회지
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    • 제27권2호
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    • pp.45-56
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    • 2021
  • Purpose: Repeated hospitalization could be a proxy of unnecessary or preventive admission in South Korea where barriers to hospitalization are relatively low. This study aimed to estimate the current status of repeated hospitalization due to ambulatory care sensitive conditions (ACSC) in South Korea. Methods: Using the National Health Information Database, repeated hospitalization databases were constructed in units of episodes for patients who had been admitted more than twice between January 2017 and December 2018. The number of hospitalizations, total in-hospital days, and total medical expenditure were calculated and compared by patient characteristics in both of the entire patient group and the ACSC patient group. Results: Of total hospitalization episodes, 26.6% reported repeated admission, and 6.7% of repeated hospitalization was due to ACSC. A total of 183,110 patients with ACSC had been admitted an average of 2.9 times and spent an average of KRW5,630,118. In other words, KRW1,309 billion had been spent for repeated hospitalization due to ACSC. The scale of medical expenditure was relatively large in the highest and lowest socioeconomic status. Conclusion: Repeated hospitalization for ACSC can be considered a simple and intuitive indicator when assessing unnecessary hospitalizations or evaluating healthcare policy.

SPECT/CT에서 서로 다른 에너지의 방사성동위원소 사용시 영상보정기법의 유용성 평가 (The Evaluation of Image Correction Methods for SPECT/CT in Various Radioisotopes with Different Energy Levels)

  • 신병호;김승정;윤석환;김태엽;임정진;우재룡;오소원;김유경
    • 핵의학기술
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    • 제17권2호
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    • pp.53-58
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    • 2013
  • 본 연구에서는 각기 다른 에너지의 방사성동위원소를 이용하여 CT를 기초로 한 attenuation correction (AC)과 scatter correction (SC)을 적용했을 때 영상의 질을 비교분석하고 영상보정기법의 유용성에 대해 알아보고자 하였다. Resolution 평가를 위해 사용된 spatial resolution phantom 내부에 물을 채우고 각각의 동위원소 $^{99m}Tc$ (140 keV, 2.22 kBq), $^{201}Tl$ (70 keV, 2.22 kBq), $^{131}I$ (364 keV, 2.22 kBq)을 line에 주입하여 제작하였다. Contrast 평가를 위해 이용한 Jaszczak phantom은 배후방사능과 열소원통의 비율이 1:8이 되도록 각각의 동위원소를 주입하여 제작하였다. GE Infinia Hawkeye4 SPECT/CT (GE Medical System, USA)로 영상을 획득하고, non-correction (NC), AC, SC, AC와 SC가 동시에 적용된(ACSC) 4가지 조건으로 OSEM (2 iterations, 10 subsets)을 이용하여 영상을 각각 재구성하였다. FWHM값은 paired samples t-test를 통하여 유의수준 관계를 분석하였고, percent contrast (%)값은 MATLAB (Ver.7.0)$^{(R)}$과 MRIcro$^{(R)}$를 이용하여 각각의 수치를 비교하였다. $^{99m}Tc$의 resolution test에서 NC, AC, SC, ACSC를 각각 적용했 을 때 FWHM (mm)값은 각각 $4.97{\pm}0.46$, $4.73{\pm}0.27$, $49.7{\pm}0.39$, $4.60{\pm}0.26$, $^{201}Tl$에서는 $5.26{\pm}0.28$, $5.14{\pm}0.21$, $5.25{\pm}0.25$, $5.05{\pm}0.23$, $^{131}I$에서는 $6.24{\pm}0.73$, $5.84{\pm}0.57$, $6.24{\pm}0.69$, $5.98{\pm}0.52$의 값을 얻을 수 있었다. 각 방사성 동위원소의 결과 값에서 NC와 비교하여 AC, ACSC를 적용했을 때 통계적으로 유의한 차이를 보였고(P<0.05), SC만을 적용했을 때는 유의한 차이가 없음을 보여주었다(P>0.05). Contrast test에서는 percent contrast(%) 를 4개의 원통에 대한 값을 구했고, NC와 비교했을 때 AC, SC, ACSC의 percent difference (%)가 $^{99m}Tc$은 24.73, 38.10, 67.31, $^{201}Tl$은 30.90, 51.82, 86.02, $^{131}I$에서는 18.60, 46.26, 73.67의 차이를 보였다. 본 연구의 결과에 따르면 $^{99m}Tc$, $^{201}Tl$ 과 같은 낮은 에너지를 가진 핵종에 대해서는 ACSC를 동시에 적용한 영상에서 resolution 향상이 가장 크게 나타났지만, $^{131}I$ 같은 높은 에너지의 핵종에서는 AC만 적용되었을 때 ACSC를 적용했을 때보다 영상의 질이 더 향상됨을 알 수 있었다. 그러므로 SPECT/CT 검사 시 사용되는 핵종의 에너지에 따라 적절한 영상보정기법을 적용한다면 정확한 진단을 위한 최적의 영상을 얻을 수 있을 것으로 사료된다.

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BERT를 활용한 속성기반 감성분석: 속성카테고리 감성분류 모델 개발 (Aspect-Based Sentiment Analysis Using BERT: Developing Aspect Category Sentiment Classification Models)

  • 박현정;신경식
    • 지능정보연구
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    • 제26권4호
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    • pp.1-25
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    • 2020
  • 대규모 텍스트에서 관심 대상이 가지고 있는 속성들에 대한 감성을 세부적으로 분석하는 속성기반 감성분석(Aspect-Based Sentiment Analysis)은 상당한 비즈니스 가치를 제공한다. 특히, 텍스트에 속성어가 존재하는 명시적 속성뿐만 아니라 속성어가 없는 암시적 속성까지 분석 대상으로 하는 속성카테고리 감성분류(ACSC, Aspect Category Sentiment Classification)는 속성기반 감성분석에서 중요한 의미를 지니고 있다. 본 연구는 속성카테고리 감성분류에 BERT 사전훈련 언어 모델을 적용할 때 기존 연구에서 다루지 않은 다음과 같은 주요 이슈들에 대한 답을 찾고, 이를 통해 우수한 ACSC 모델 구조를 도출하고자 한다. 첫째, [CLS] 토큰의 출력 벡터만 분류벡터로 사용하기보다는 속성카테고리에 대한 토큰들의 출력 벡터를 분류벡터에 반영하면 더 나은 성능을 달성할 수 있지 않을까? 둘째, 입력 데이터의 문장-쌍(sentence-pair) 구성에서 QA(Question Answering)와 NLI(Natural Language Inference) 타입 간 성능 차이가 존재할까? 셋째, 입력 데이터의 QA 또는 NLI 타입 문장-쌍 구성에서 속성카테고리를 포함한 문장의 순서에 따른 성능 차이가 존재할까? 이러한 연구 목적을 달성하기 위해 입력 및 출력 옵션들의 조합에 따라 12가지 ACSC 모델들을 구현하고 4종 영어 벤치마크 데이터셋에 대한 실험을 통해 기존 모델 이상의 성능을 제공하는 ACSC 모델들을 도출하였다. 그리고 [CLS] 토큰에 대한 출력 벡터를 분류벡터로 사용하기 보다는 속성카테고리 토큰의 출력 벡터를 사용하거나 두 가지를 함께 사용하는 것이 더욱 효과적이고, NLI 보다는 QA 타입의 입력이 대체적으로 더 나은 성능을 제공하며, QA 타입 안에서 속성이 포함된 문장의 순서는 성능과 무관한 점 등의 유용한 시사점들을 발견하였다. 본 연구에서 사용한 ACSC 모델 디자인을 위한 방법론은 다른 연구에도 비슷하게 응용될 수 있을 것으로 기대된다.

외래의료 민감 질환으로 응급실을 내원한 환자의 특성 분석: 의료전달체계 중심으로 (Analysis of the Characteristics of Ambulatory Care Sensitive Conditions in Patients Visiting the Emergency Departments: Focused on Health-care Delivery System)

  • 허영진;김지연;이명화;이성민;오미라
    • 융합정보논문지
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    • 제10권10호
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    • pp.253-258
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    • 2020
  • 본 연구는 외래의료 민감 질환(Ambulatory Care Sensitive Conditions, ACSCs)으로 응급실에 내원한 환자들의 특성을 연령(성인 19-64세, 노인 65세 이상)으로 구분하여 그 차이를 비교 분석하였다. 2018년 1월 1일부터 12월 31일까지의 국가응급진료정보망 자료를 이용하여 응급의료기관 종별과 ACSCs의 비율, 응급실 재실시간, 입원일수, 입원율을 살펴보았다. 응급의료기관 종별에서는 지역응급의료센터의 비율이 높았고(P<0.001), ACSCs의 질환 비율에서 성인은 위장염 31.7%와 노인은 폐렴 48.2%로 높게 나타났다(P<0.001). 응급실 재실시간은 울혈성심부전과 당뇨를 제외한 모든 질환에서 노인이 길게 나타났고(P<0.001), 입원일수는 ACSCs 모든 질환에서 노인이 유의하게 길게 나타났으며(P<0.05), 입원율은 당뇨를 제외한 모든 질환에서 노인의 비율이 유의하게 높았다(P<0.01). 이와 같이 ACSCs로 인한 응급실 이용을 파악하여 외래 중심으로 치료를 유도할 수 있도록 의료정책을 강화해야 할 것이다.

거주지역 이동이 의료이용량과 의료접근성에 미치는 영향 (The Effect of Residential Migration on the Utilization and Accessibility of Medical Care)

  • 이우리;최용석;이경민;김리현;유기봉
    • 보건행정학회지
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    • 제31권1호
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    • pp.125-139
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    • 2021
  • Background: In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility. Methods: This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation. Results: Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease. Conclusion: This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

Study on the characteristics of magnetic field distribution in AC superconducting generator using normalized data

  • Jo, Young-Sik;Ahn, Ho-Jin;Hong, Jung-Pyo;Lee, Ju;Kwon, Young-Kil;Ryu, Kang-Sik
    • 한국초전도학회:학술대회논문집
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    • 한국초전도학회 2000년도 High Temperature Superconductivity Vol.X
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    • pp.216-220
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    • 2000
  • AC Superconducting Generators (ACSG) are featured by 3D magnetic flux distribution, which decreases in the direction of axis. For this reason, when ACSG is optimal designed, 3D magnetic field analysis is required. This paper proposes 2D Finite Element Analysis (FEA) results normalized by 3D FEA according to the position of armature coil and the ratio of field coil width to axial length in order to reduce the analysis time. By using the proposed data, the reasonable 3D FEA results of ACSG can be only predicted by 2D FEA results. The validity of the 3D FEA results is verified by comparison with the experimental results of 30kVA superconducting synchronous generator.

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의료급여 수급권자 확대정책이 예방가능한 입원율에 미친 영향 (The Impact of Medicaid Expansion to include population with low income on the preventable hospitalizations)

  • 신현철;김세라
    • 보건행정학회지
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    • 제20권1호
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    • pp.87-102
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    • 2010
  • The objective of this study were to examine the impact of medicaid coverage expansion policy aimed at improving access to primary care. The case-control study was conducted to compare preventable hospitalization(PH) rate in new medicaid recipients versus national health insurance(NHI) enrollees form 1996 to 2001. Rates of preventable hospitalization associated with ambulatory care sensitive conditions(ACSC) were calculated and standardized by age and sex. Multinomial logit regression model was used to control the confounding factors such as age, gender and charlson comorbidity index Annual PH rates in the new medicaid increased 1.64 times after medicaid expansion, with controling confounding factors. Meanwhile, annual PH rate in the NHI increased 1.68 times during the same period, with adjusting confounding factors. Current findings suggest that the new medicaid PH rate was less likely to rise than NHI PH rate after implementing medicaid expansion. This study is expected to provide policy-relevant evidence of medicaid expansion to include population with low income.

건강보험빅데이터의 고혈압 입원율 분석을 통한 장애인의 의료접근성 실증 분석 (Empirical Analysis of Medical Accessibility for People with Disabilities using Health Insurance Big Data)

  • 전희원;홍민정;정재연;김예순;이창우;이해종;신의철
    • 한국병원경영학회지
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    • 제27권1호
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    • pp.1-10
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    • 2022
  • Background: This study aims to empirically compare and evaluate the current status of medical accessibility and health inequality between people with disabilities and without. We calculated the ACSC hospitalization rate, which is a medical accessibility index, for hypertension, a major risk factor for cardiovascular disease that accounts for more than 20% of deaths among people with disabilities using the 2016 National Health Insurance Big Data. Methods: The subjects of the study were a total of 601,520, including 64,018 people with disabilities and 537,501 people without. Logistic regression was performed to analyze the differences in hypertension hospitalization rates adjusted for demographic and sociological characteristics and disease characteristics using SAS 9.4 program. Results: Before adjusting for the characteristics, the hypertension hospitalization rate of people with disabilities was 1.55%, and the people without disabilities were 0.49%. After adjusting, it was found that people with disabilities were 2.11 times higher than people without disabilities, and it was statistically significant. Conclusion: The preventable hospitalization rate of people with disabilities is higher than that of people without, suggesting that the disabled have problems with access to medical care and health inequality. Therefore, the government's policy improvement is required to close the medical gap for the disabled.