• Korea Journal of Hospital Management
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• v.14 no.2
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• pp.60-74
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• 2009

This study purports to verify managerial effectiveness of the integrated delivery system(IDS) of Japanese health care institutions through comparing the managerial performance between hospital groups providing with both acute and nursing care and those with acute care only. Data on the managerial performance of 697 hospitals providing with nursing care together and 819 hospitals providing with acute care only were collected from Japanese Central Social Insurance Medical Councils 2001, 2003, 2005, and were analyzed using mean comparison test(t-test) between the two groups. The results revealed that there were significant differences between the two groups in such indicators as ratio of material cost, labor cost, depreciation rate, total margin, operating margin, average number of outpatient per day, average revenue of an inpatient per day, total amount of labor cost, gross revenue per employee, and labor productivity. However, we could not find out any consistent evidence which support the effect of integrated delivery system on the hospital managerial performance. Further discussion was made on the limitation of the study and future research agenda relevant to the topic.

• The Korean Journal of Health Service Management
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• v.11 no.3
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• pp.91-104
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• 2017

Objectives : This study was a methodological study to verify the validity and reliability of the translated and modified Older Patients in Acute Care Survey-US (OPACS) tool, which was originally developed by Dikken and his colleagues. Methods : The OPACS was translated into Korean, and the content validity, composition validity, and reliability were verified using 348 nurses working for hospitals with over 200 beds and located in C city, B city, and K province. Results : The analysis showed that the Korean version of the OPACS had of eleven questions in the practice experience section and twelve in the general opinion section for older patients in the acute phase. Cronbach's ${\alpha}s$ were 0.84 for practice experience and 0.81 for general opinion. Conclusions : The study showed that the OPACS could measure the practice and opinion of Korean nurses who cared for elderly patients in the acute phase. The significance of the study was that it provided baseline data information regarding the performance and opinion of these nurses for nursing managers to improve the nursing environment.

• Korean Journal of Adult Nursing
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• v.26 no.1
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• pp.89-97
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• 2014

Purpose: During hospitalization, confusion occurs in 15~20% of older adults and persists in 5~10% of them. This study was designed to investigate effects of a five-day nursing intervention program designed to reduce confusion in hospitalized older adults. Subjects were inpatients over the age of 60 years old and were admitted in a surgical care unit. Methods: Data were collected from 111 patients. Subjects divided into one of two groups, 58 patients of the control group which received the usual nursing care; and 53 patients of the intervention group which received the usual nursing care plus nursing intervention program for reducing acute confusion. The Delirium Observation Screening Scale (DOS) and the Korean Mini-Mental Screening Examination (MMSE-K) were utilized. Results: 1) Acute delirium was significantly reduced in the intervention group compared to the control group ($x^2$=4.22, p=.034) as well as the duration of the delirious state was significantly shortened (F=56.62, p<.001). Cognitive function of the intervention group was improved (F=21.14, p<.001). Conclusion: The nursing intervention program reduced the incidence and duration of acute delirium of the elderly inpatients, as well as it helps them keep better cognitive function than the control group.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.2
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• pp.86-92
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• 2005

Purpose: The main cause of death due to acute organophosphate (OP) poisoning is believed acute respiratory failure caused by cholinergic reactions. Recently, advances in respiratory and intensive care make it possible to maintain the respiratory function of patients with OP poisoning, but the mortality rates remain high. The present study clarified the hemodynamics of patients with acute lethal OP poisoning. The purpose of this study was to analyse the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive care. Methods: We reviewed medical and intensive care records of patients with acute OP poisoning admitted to emergency department and ICU between March 1998 and Aug 2005. We collected patient information regarding poisoning, clinical, and demographic features. Results: During the study period, 67 subjects treated with intensive care and ventilator management in addition to gastric decontamination standard therapy with atropine and 2-PAM. Of 67 patients, 13 died. Kaplan-Meier survival analysis demonstrated a steep decline in the cumulative survival to $86.6\%$ during the first week. Mean arterial pressure < 60 mmHg within the first 24 hours was recognized as a poor prognostic indicators among mechanical ventilated patients. Conclusion: Most OP poisoning-related deaths occurred within the first week of poisoning. Mean arterial pressure lower than 60 mmHg might be the best predictor of poor outcome. We speculated that the refractory hypotension is the leading cause of death in patients with lethal OP poisoning that receiving mechanical ventilation and maximal supportive care.

• Korean Journal of Adult Nursing
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• v.15 no.2
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• pp.287-295
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• 2003

Purpose: This descriptive study was conducted to project the number of critical care APNs needed in critical care units in an acute care hospital setting, up to the year 2020. Method: Necessary data and information were collected from various funded reports, professional literature, web-sites and personal visits to national and private institutions. The demand of critical care APNs were projected based on two critical care APNs per critical care units. Result: The projected number of critical APNs for the critical care units in acute care hospital settings as follows: 1) The total projected number of critical care APNs needed for critical care units were 1,270 in 2001. 2) By the year 2020, total number of projected critical care APNs needed in critical care units will be 1,080-1,700. Conclusion: In order to match the supply to the need, the professional organization should direct their efforts toward enacting legislation. Educational systems should identify strategies in initiation of critical care APN programs in masters level as well as standardizing curriculums across the programs.

• The Journal of Korean Academic Society of Nursing Education
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• v.5 no.1
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• pp.97-105
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• 1999

Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.

• Clinical and Experimental Pediatrics
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• v.64 no.5
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• pp.188-195
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• 2021

Acute fulminant myocarditis (AFM) occurs as an inflammatory response to an initial myocardial insult. Its rapid and deadly progression calls for prompt diagnosis with aggressive treatment measures. The demonstration of its excellent recovery potential has led to increasing use of mechanical circulatory support, especially extracorporeal membrane oxygenation (ECMO). Arrhythmias, organ failure, elevated cardiac biomarkers, and decreased ventricular function at presentation predict requirement for ECMO. In these patients, ECMO should be considered earlier as the clinical course of AFM can be unpredictable and can lead to rapid haemodynamic collapse. Key uncertainties that clinicians face when managing children with AFM such as timing of initiation of ECMO and left ventricular decompression need further investigation.

• Journal of Preventive Medicine and Public Health
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• v.18 no.1
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• pp.41-50
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• 1985

To find out the differences in medical practice according to the environment of patient care and managerial situation of the medical care institutions, normal spontaneous vaginal delivery and acute appendicitis were selected, which is suitable for comparison because of their high comparability. A total of 473 cases of normal spontaneous vaginal delivery and 408 cases of acute appendicitis was sampled from the claims to Korea Medical Insurance Cooperations during January to June 1984. Complicated cases were excluded from population and sampling was restricted from 40 to 60 percentile for total charges by the type of medical care facility in order to rule out the influence originating from case mix. Important items representing type and quantity of medical care service were compared by type of facility. Major findings are as follows : 1. University hospital shows the highest in charges per case and decrease in order of general hospital, and clinic. 2. In case of normal spontaneous vaginal delivery, average length of stay shows statistically significant difference by type of facility. 3. Charge amount for each service item affected by practice pattern shows statistically significant difference mostly by type of facility. It is suggested that medical practice pattern is different by type of facility for medical services. 4. Difference in total medical expenditure by type of facility is affected more with charges for materials, consumables and drugs than with fee for service activity. 5. In administering drugs to patients, hospital and clinic show higher injection rate than university and general hospital. 6. Clinical Laboratory tests were common in order of uninalysis, hemoglobin, hematocrit, white blood cell count, urine microscopic examination in cases of normal spontaneous vaginal delivery; white blood cell count, urinalysis, hemoglobin, hematocrit, urine microscopic examination, white blood cell differential count, in cases of acute appendicitis. 7. The result for Laboratory test and Radiologic study shows extreme difference by type of facility. Test rate is lowest in clinic and increase hospital, general hospital, and university hospital in order, both in type and frequency.

• Quality Improvement in Health Care
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• v.10 no.1
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• pp.42-56
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• 2003

Background : The purpose of this study is to investigate the influencing factors on the length of emergency department stay of patients with acute myocardial infraction. Methods : we reviewed medical records of all patients who were Hospitalized with acute myocardial infraction from March 1, 2002 to February 28, 2003. Results : The average length of stay in the emergency room of the subjects was 182.74 minutes. After the emergency room treatment, 48.1% of the subjects were transferred to intensive care unit. The hospitalization through emergency room mostly took place in the office hours. There were more patients on Monday. The influencing factors on the length of stay in the emergency room of patients with acute myocardial infraction were emergency room arrival time which was classified in seasons, treatment hours of specialized doctors, medical care insurance and required time of radiologic examination. Conclusion : In order to reduce the length of emergency room stay, it might be an available solution secure enough spaces, facility, and staff of the radiologic test only for the patients of the emergency room. And the effective use of emergency facility and space, establishment of standardized treatment guideline, and provision of emergency treatment support system are also needed.

• Health Policy and Management
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• v.1 no.1
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• pp.116-135
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• 1991

Few studies have been conducted on the detailed routes of medical care utilization under the National Health Insurance. This study was undertaken to identify the utilization patte군 of health care facilities among industrial workers and their dependents. One of the largest health insurance association was purposively chosen for this objective. The association had 345, 757 members as of 31 December, 1990. The study sample of 297, 948 subjects have been drawn from the membership pool on the basis of their continuous membership status during 1 January through 31 December 1990. This study has tried to identify differential utilization patterns between acute and chronic conditions, and among standard income classes. All the diagnoses were recoded in a manner to achieve the objective of this study. As for acute diseases, most age group had used one medical facility as much as by 60% except the age group of 1-4, This young age group had used over three different health facilities as much as by 10.9-15.8%. The finding suggests that some policy measures by sought for remedying the excessive/inappropriate use of services. In addition, mid-income classes(between 17 and 48) were more likely to use multiple sources of care than lower income classes(between 1 and 16) and upper income classes(above 49). This study has revealed that chronic cases are more likely to pursue multiple sources of care, however those with chronic conditions tend to use single health facility more than those with acute conditions(67.9% versus 52.4%). As many as 12.2% have visited more than three health facilities in chronic conditions, but 5.9% for acute conditions. The most likely source of care was primary clinics for both acute and chronic conditions. Compared with the role of general hospital, small-size hospitals found to play a minimal role in the care and referral of patients. This indicates the need of strengthening the function of small-size hospitals. While a minor cross utilization of western medicine and pharmacy was noted, no significant boundary crossing was identified between western medicine and oriental medicine, or between pharmacy and oriental medicine. It is too early to confirm that whether there is substitutability or cross utilization among these alternative sources of care. A further study is needed to identify these relationship.