• Journal of Korean Academic Society of Home Health Care Nursing
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• v.24 no.2
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• pp.151-159
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• 2017

Purpose: The purpose of this study was to identify nursing demands according to general characteristics and diseases of inpatients to whom comprehensive payment systems apply. Methods: This study was designed as a retrospective research study using the electronic medical records of Hospital Information Systems (HIS). Participants were 836 subjects who received seven Diagnostic-Related Group diagnoses among inpatients of one tertiary hospital from January 1, 2015 to June 30, 2015. Data were analyzed using SPSS 23.0. Results: Nursing demand among inpatients'seven Diagnostic-Related Group diagnoses was relatively higher for appendectomy, cataract surgery, and hysterectomy, while there was a significant difference depending on the age, duration of admission, admission path, hospital entry method and Diagnostic-Related Group. Conclusion: The results can be utilized as basic data on accurate nursing demands that reflect various features of patients.

• Korean Journal of Adult Nursing
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• v.22 no.3
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• pp.322-328
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• 2010

Purpose: The purpose of this study was to investigate the effects of an individualized cardiac health education on self-care behavior and serum cholesterol levels patients with coronary artery disease. Methods: Twenty-two patients in the intervention group and 22 in the control group were assigned randomly in this study. The intervention group received an individualized cardiac health education program which consisted of four different sessions for a total of four sessions. Specifically, two sessions occurred during the patients' hospitalization with a third session at the time of discharge with a fourth session scheduled via telephone one week post discharge. Data were collected through a questionnaire for self-care behavior and a blood test for total cholesterol at the time of admission and the two weeks after discharge. The questionnaire for self-care behavior was a standardized instrument and serum cholesterol was measured by Accutrend GC (Roche, Germany). Results: Self-care behavior scores included diet, medication, exercise, risk factor, blood pressure measurement, and visits to hospital were significantly more in the experimental group compared to the control group. Conclusion: The above findings indicate that the individualized cardiac health education was effective in increasing of self-care behavior.

• Korean Journal of Adult Nursing
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• v.16 no.2
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• pp.222-232
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• 2004

Purpose: The purpose of this study was to identify the change in foot care knowledge, self care behavior, and physiologic indexes after foot reflexomassage education program, and the related factors. Method: Data were collected from 20 patients who were visited out patients clinic. The change and difference were analyzed with non-parametric statistics. Result: There were significant differences in foot care knowledge(P=.001), self care behavior(P=.000), dosalis pedis blood flow volume (P=.011), skin temperature of foot(P=.001), dorsalis pedis pulse(P=.000), capillary filling time of foot (P=.000) between pre and post. The level of changes of foot care knowledge was significant differences according to admission experience (P=.049), and negative related to systolic blood pressure(P=.028). The level of changes of self care behavior was related to age(P=.049), that of dosalis pedis blood flow was significant difference according to smoking(P=.042), that of skin temperatureof foot(P=.002) and dosalis pedis pulse(P=.038) were significant difference according to weight. The level of changes of capillary filling time of foot was related to diagnosis period(P=.014). Conclusion: Foot-Reflexo-Massage education program is an effective nursing intervention to promote foot care in diabetic patients. And the related factors can be recommended for the management of diabetic patients.

• The Korean Journal of Rehabilitation Nursing
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• v.9 no.2
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• pp.145-152
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• 2006

Purpose: The purpose of this study was to investigate the depression, anxiety, stress response and self-care, to analyze the correlation among depression, anxiety, stress response and self-care by gender, and to determine factors associated with self-care in diabetic patients. Method: The subjects of this study were 103 participants with diabetes mellitus. Data were analyzed by chi-square test, t-test, Pearson correlation coefficient and multiple regression analysis by using SAS program. Result: Items for self-care evaluation by gender were significant differences in hospital visit, hypoglycemia preparation, proper hygiene, taking a rest, foot injury check, drinking, and smoking. The female patients are more likely to have higher self-care score than the male patients. However, there were no differences in depression, anxiety and stress response by gender. In male patients, there were positive correlations between the degree of depression and stress response, the degree of anxiety and stress response. In female patients, there were positive correlations between the degree of depression and stress response, the degree of anxiety and stress response. In multiple regression analysis, gender and experienced admission is associated with self-care. Conclusion: We should consider integrated approaches for psychological problems in the management of diabetic patients.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.113-118
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• 2010

Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was $5.2{\pm}7.1$ hours and the average length of the ED stay was $9.0{\pm}11.5$ hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was $2.1{\pm}1.5$ hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.

• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.15 no.4
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• pp.522-530
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• 2008

Purpose: In this study active surveillance culture for ICU patients, in whom the risk of VRE infection was high were conducted, and through this the VRE colonization rate and the characteristics of the colonization were examined and risk factors involved in VRE colonization and acquisition were analyzed. Method: This research was performed with 635 patients admitted to ICU between July 1 and December 31, 2006. Results: On admission to ICU, the VRE colonization rate was 2.36%, 93% identified from active surveillance culture. The VRE colonization rate was significantly higher in those patients with cancer (OR=9.43; 95% CI=1.38${\sim}$62.50; P=.022), liver cirrhosis (OR=55.5; 95% CI=7.29${\sim}$500; P=.005), transferred from other hospitals (OR=200; 95% CI=22.73${\sim}$1000; P=.000), high APACHE II score (OR=1.107; 95% CI=1.010${\sim}$1.213; P=.029), or antibiotics within the last 3 months (OR=15.87; 95% CI=2.27${\sim}$111.11; P=.005). The VRE acquisition rate was 5.2%. It was significantly higher in those who were using a ventilator (OR=26.31; 95% CI=5.13${\sim}$142.86; P=.000), three or more kinds of antibiotics during admission (OR=58.82; 95% CI=16.13${\sim}$200; P=.000), or high APACHE II score (OR=1.16; 95% CI=1.08${\sim}$ 1.24; P=.000). Conclusion: The results of this study show that active surveillance culture can detect VRE colonization on admission to ICU and those who have acquired VRE in ICU. The analyzed VRE colonization and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing VRE infection in ICU.

• Quality Improvement in Health Care
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• v.10 no.2
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• pp.216-231
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• 2003

Objectives: To develop a model that predicts a death probability of acute myocardial infarction(AMI) patient, and to evaluate a performance of hospital services using the developed model. Methods: Medical records of 861 AMI patients in 7 general hospitals during 1996 and 1997 were reviewed by two trained nurses. Variables studied were risk factors which were measured in terms of severity measures. A risk model was developed by using the logistic regression, and its performance was evaluated using cross-validation and bootstrap techniques. The statistical prediction capability of the model was assessed by using c-statistic, $R^2$ as well as Hosmer-Lemeshow statistic. The model performance was also evaluated using severity-adjusted mortalities of hospitals. Results: Variables included in the model building are age, sex, ejection fraction, systolic BP, congestive heart failure at admission, cardiac arrest, EKG ischemia, arrhythmia, left anterior descending artery occlusion, verbal response within 48 hours after admission, acute neurological change within 48 hours after admission, and 3 interaction terms. The c statistics and $R^2$ were 0.887 and 0.2676. The Hosmer-Lemeshow statistic was 6.3355 (p-value=0.6067). Among 7 hospitals evaluated by the model, two hospitals showed significantly higher mortality rates, while other two hospitals had significantly lower mortality rates, than the average mortality rate of all hospitals. The remaining hospitals did not show any significant difference. Conclusion: The comparison of the qualities of hospital service using risk-adjusted mortality rates indicated significant difference among them. We therefore conclude that risk-adjusted mortality rate of AMI patients can be used as an indicator for evaluating hospital performance in Korea.

• Journal of Korean Public Health Nursing
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• v.19 no.1
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• pp.129-138
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• 2005

As the patients who need to undergo liver transplant operation continues to grow. the number of livers that are donated can not keep pace with the demand. With the development of surgery skills, the necessity for operations from living donors is increasing. Nevertheless, satisfactory research has been conducted on the factors which generally affect the living donors. In this article. therefore. researchers focused on the factors which generally affect the donating liver donor in order to design a plan for recommending liver donation from living donors. The subjects were 91 living liver donors in C university hospital from October 1. 2000 to December 31. 2003. The results on the uncertainty of living donor, by test sheet. were analyzed with SAS program. The final results were as follows: 1. The uncertainty of the living donors was 51.54 marks per full credit 100. 2. The factor with the greatest effect on donation was the possibility of survival of the donor, followed by the admission period. marriage status and age. In recommending the living donation, the rate of donor survival after the operation was 5.2 times higher than death, 5.2 times higher when the admission period was under 20 days. 5.0 times higher when married. and 27.3 times higher when the family-related donation was very active at the age of 20s than in the 50s. These results suggest that all medical staffs should care for living donors with more interest and activity to give them the least complaints in admission and the lowest possibilities for complication. To enhance the survival rate and improve the surgical success rate. on-going monitoring should include regular health-checks. and continual efforts and education should be made to care for the health condition of the living donors after donation.

• Journal of Digital Convergence
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• v.11 no.10
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• pp.459-467
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• 2013

The purpose of this study was to identify the differences in medical care utilization by regional economic status using the National Hospital Discharge Patients Injury Survey. In order to determine economic status of each region, 234 cities and counties were categorized 5 quintiles according to their financial self-reliance ratio. The main results are as follows. First, low economic region has high age-standardized admission rate and standardized mortality rate. Second, of 16 major diseases, cerebrovascular and heart diseases, lung cancer, and stomach cancer reported greater changes in standardized mortality rate by regional economic status. Third, the rate of admission via emergency room in low economic region is higher than that of high economic region. Lastly, in the major illnesses, lower economic status led to an increase in average length of stay. Therefore, In order to bridge the gap in health inequality across regions, a regional medical policy tailored for each region and characteristics of the economic status should be established.