• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.145-153
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• 2023

Objectives: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. Methods: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. Results: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). Conclusions: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

• 한국콘텐츠학회논문지
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• 제21권8호
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• pp.329-336
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• 2021

본 연구는 대표적인 공공병원인 지방의료원 및 적십자병원을 포함하여 종합병원의 특성을 대변할 수 있는 지표들을 선정하여 군집분석을 하고 각 군집에서 벤치마킹할 수 있는 기관을 제시하였다. 분석결과 전국의 276개의 종합병원은 13개의 군집으로 분류되었으며, 지방의료원과 적십자병원은 규모가 작기 때문에 전체 13개의 군집 중에서 1에서 7사이의 군집으로 분류되었다. 각 군집별 우수한 병원으로 선정된 지방의료원과 적십자병원은 지역환경 및 진료실적이 유사함에도 불구하고 경영성과에서 커다란 차이가 나타났으며, 그 중에서 외과 및 내과 진료 비율과 입원과 외래환자 비율이 의미 있는 차이를 보였다. 지방의료원과 적십자병원이 지역 내 2차 급성기 병원으로서 제 역할을 하기 위해서는 입원서비스를 활성화하고, 더불어 외과 기능을 활성화해야한다.

• International Journal of Oral Biology
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• 제35권4호
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• pp.185-190
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• 2010

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent pathogens in hospitals. To investigate cross contamination by this bacterium in both dental and medical settings, the pathogens that cause acute pyogenic infection and one of the major microbes responsible for nosocomial infection were isolated from health care providers, nurses and patients. We used VITEK II to measure drug sensitivity, and we further performed biochemical testing, coagulase serotype testing and pulse-field gel electrophoresis (PFGE) for isolated MRSA colonies. The isolation rate of Staphylococcus aureus from nasal swabs was 75.0% from dental health care providers and 18.8% from the medical health care providers. A total of 10 MRSA strains were isolated from 40 health care providers and 2 patients and the prevalent coagulase serotype from patients and health care providers was VII. The antimicrobial drug resistance and partial PFGE types of the isolated MRSA strains showed a similar pattern. These results suggest that MRSA may be one of the principal causes of nosocomial infection in dental and medical hospitals.

• Journal of Hospice and Palliative Care
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• 제22권3호
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• pp.125-133
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• 2019

목적: 요양병원 간호사의 생애말 환자간호 역량과 임종간호 스트레스 수준을 파악하고 상관관계를 확인하여 요양병원 간호서비스의 질 향상을 위한 기초자료를 제공하고자 하는 것이다. 방법: 충청남도 A시, C시 소재 요양병원에서 근무하고 있는 6개월이상 경력의 임종간호 경험이 있는 간호사 140명을 대상으로 하였고 설문지는 2018년 1월 17일부터 3월 3일까지 수집되었다. 수집된 자료는 연구 목적에 따라 SPSS WIN ver. 21.0 프로그램을 이용하여 기술통계 및 t-test, One way ANOVA, Scheffe-test, Pearson's correlation coefficient, multiple stepwised regression을 실시하였다. 결과: 연구 대상 간호사의 생애말 환자간호 역량은 5점 척도의 평균 $3.54{\pm}0.46$점이며 임종간호스트레스는 평균 $3.77{\pm}0.50$점으로 보통 수준 이상이었다. 연령, 총임상경력, 죽음교육 또는 호스피스 완화의료 교육, 직계가족의 임종경험 여부에 따라 생애말 환자간호 역량에 유의한 차이가 있었다. 생애말 환자간호 역량과 임종간호 스트레스 수준과의 상관관계를 분석한 결과 총점평균의 상관관계는 유의하지 않았으나 생애말 환자간호 역량은 임종간호 스트레스 중 전문지식과 기술부족으로 인한 스트레스와 음의 상관관계가 있는 것으로 나타났다(r=-0.260, P=0.002). 결론: 이상의 연구결과를 볼 때, 요양병원 간호사의 임종간호 스트레스는 보통 수준 이상으로 높으며 생애말 환자간호 역량이 높을수록 전문지식과 기술부족으로 인한 스트레스는 낮아지므로 간호사의 특성에 맞춘 생애말 환자간호 교육프로그램이 실시되어야 한다.

• Journal of Preventive Medicine and Public Health
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• 제23권3호
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• pp.345-357
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• 1990

Accumulated data on medical care utilization among the insured in Korea Medical Insurance Corporation can explain the health status of the population. The purpose of this study was to analyze a change of the disease-mix and utilization pattern by controlling the size of the population enrollment. Major findings of the study are as follows : 1. The changes of inpatient disease-mix a. Utilization rate was 139.2% in 1988 against 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. Meanwhile, disease groups seen less often were infections and parasistic diseases, diseases of blood and bloodforming, diseases of the digestive system etc. c. Utilization rate was up 106.3% in 1988 compared to 1985, and diseases above that average level were ill-defined intestinal infections, chronic liver disease and cirrhosis, diabetes mellitus, essential hypertension, etc. d. The disease-mix by institution in 1988 compared to 1985 shows that chronic disorders rank high in general hospitals whereas opthalmologic, obstetric, and orthopedic diseases rank high in private clinics. 2. The changes of outpatient disease-mix a. Utilization rate was up 175.2% in 1988 compared to 1980. b. Disease groups higher than the average utilization rate included neoplasms, endocrine, nutritional and metabolic diseases and immunity disorders, mental disorders etc. And disease groups seen less often were infections and parasistic diseases, diseases of the respiratory system, diseases of the genitourinary system. etc. c. Utilization rate was up 104.0% in 1988 compared to 1985, and diseases above that average level were gastric ulcer, diseases of hard tissues of teeth, etc. And diseases seen below that average level were acute nasopharyngitis(common cold). acute upper respiratory infections of multiple or unspecified sites, etc. It was concluded that medical care utilization level was increased, and that, from 1980 to 1988, disease-mix shifted to the chronic disorders. Chronic disorders accounted for more medical care utilization in general hospitals.

• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.148-155
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• 2012

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poorquality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

• 대한임상독성학회지
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• 제16권2호
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• pp.131-140
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• 2018

Purpose: The National Emergency Medical Center has been running a project for the storage and delivery of antidotes for acute poisoning patients of the Department of Health and Welfare, Korea. This study analyzed the results of this project over the past two years. Methods: The requests received by the National Emergency Medical Center and the data on the delivery process were analyzed. Results: This study analyzed a total of 121 patients with acute poisoning, who were requested to receive an antidote reserved at 20 key hospitals in 2015-2017, and whose age was $52.3{\pm}23.5\;years$; old; 54 were women. Intentional poisoning were 58.7%, and the home was the most common place of exposure (66.9%). The toxic substances were chemicals (32.2%), pesticides (27.3%), medicines (24.8%), and snake venom (4.1%). The patient's poison severity score was $2.4{\pm}0.7$ (median 3) indicating moderate-to-severe toxicity. Antidote administration was the cases treated in key hospitals 67.8% (82/121), in which transferred patients accounted for 57.3% (47/82). After receiving an antidote request from a hospital other than the key hospitals, the median was 75.5 minutes (range 10 to 242 minutes) until the antidote reached the patient, and an average of 81.5 minutes was required. The results of emergency care were intensive care unit (70.3%), general wards (13.2%), death (10.7%), and discharge from emergency department (5.0%). Conclusion: This study showed that the characteristics of acute poisoning patients treated with an antidote were different from previous reports of poisoned patients in the emergency department, and basic data on the time required for delivery from key hospitals was different.

• 한국간호교육학회지
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• 제5권1호
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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.

• 재활간호학회지
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• 제19권1호
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• pp.12-19
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• 2016

Purpose: This study was to examine the relationships between nurse's perception of patient safety culture and performance for safety nursing activities at rehabilitation hospitals. Methods: This study applied a descriptive research design. Participants were 194 nurses who have provided nursing services for more than 6 months at 4 rehabilitation hospitals located in B metropolitan city. Data were analyzed using descriptive statistics, t-test, ANOVA, $Scheff{\acute{e}}$ test, Pearson's correlation coefficients and multiple regression. Results: There was a positive correlation between the awareness of patient safety culture and safety nursing activity. Multivariate analysis showed that hospital work environment, experience of education, hospital climate, frequency of reported events, and marital status were significantly associated with the safety nursing activity. Overall, approximately 23.1% of total variability in the safety nursing activity could be explained by the 5 variables ($R^2=0.231$, p<.005). Conclusion: Nurses at rehabilitation hospitals are relatively positive about patient safety culture. Therefore, we need to develop safety education programs at the level of organization in order to improve patient safety through performing effective safety nursing activities in addition to increase awareness of patient safety culture among nurses. Furthermore, we need hospital's strategies at the system level for open communication and outcome reports regarding patient safety.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.86-92
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• 2018

Background: A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015. Methods: This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm were selected. Results: During the observation period, 225 patients were treated under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P<0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017. Conclusion: Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.