• 보건행정학회지
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• 제19권2호
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• pp.51-70
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• 2009

Background : Previous studies have reported that enhanced continuity of care prevented a sudden worsening in progress among chronic disease patients, and as a result was favorable for efficient spending of health care funds. This study aims to estimate the continuity of care of Korean with diabetes and to identify factors affecting the continuity of care. Methods : This study used the Korean National Health Insurance Claims Database which includes E11 (ICD-10) as a primary or secondary disease as of 2006. Study population is 1,160,725 type 2 diabetics (20-84 years). Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC) were used as indexes of continuity of care. Results : The continuity of care in the study population was $0.94{\pm}0.10$ as calculated by MMCI, $0.91{\pm}0.16$ as calculated by MFPC and $0.86{\pm}0.23$ as calculated by COC. The lower continuity of care was shown in the patients who were female, 65 and over years old, Medical Aid recipients, 13 times or more visitors, hospital users as main attending medical institution, patients experienced hospitalizations or comorbidities. Conclusion : The continuity of care for adult patients with type 2 diabetes was high in Korea, and showed variation according to patients' characteristics. This result provides empirical evidence for policymakers to develop or strengthen programs for managing patients showing low continuity of care.

• 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.

• 센서학회지
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• 제19권4호
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• pp.278-284
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• 2010

Indoor localization for pedestrian is the key technology for caring the elderly, the visually impaired and the handicapped in health care districts. It also becomes essential for the emergency responders where the GPS signal is not available. This paper presents newly developed pedestrian localization system using the gyro sensors, the magnetic compass and pressure sensors. Instead of using the accelerometer, the pedestrian gait is estimated from the gyro sensor measurements and the travel distance is estimated based on the gait kinematics. Fusing the gyro information and the magnetic compass information for heading angle estimation is presented with the error covariance analysis. A pressure sensor is used to identify the floor the pedestrian is walking on. A complete ambulatory system is implemented which estimates the pedestrian's 3D position and the heading.

• 간호행정학회지
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• 제8권2호
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• pp.309-321
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• 2002

Purpose: A cost analysis for nursing services in operative nursing unit, emergency nursing unit, and ambulatory nursing unit was performed using patient classification system by nursing intensity in order to determine an appropriate nursing fee schedule. Method: The data were collected from 4 secondary hospitals and 5 tertiary hospitals from November 14th 2000 to January 15th 2001. The study was conducted through four phases as follows: 1) Nursing hours of each nursing service in special nursing units were measured using three kinds of patient classification systems by nursing intensity. 2) The nursing cost of nursing services in operative nursing unit, emergency nursing unit, and ambulatory nursing units was estimated based on patient classification system by nursing intensity. Results: As a result, nursing hours by nursing intensity of each special nursing unit were measured, and every nursing cost by nursing intensity in operation room and emergency room was estimated, meanwhile, the cost of nursing services in ambulatory care units was estimated only per visit as shown in chapter 4. Conclusion: Future research on nursing cost should be extended to other special nursing units such as various intensive nursing care units, delivery room, and so on. In addition, the patient classification system should be refined for its appropriateness to apply all levels of medical institutions.

• 한국임상약학회지
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• 제26권3호
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• pp.238-244
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• 2016

Background: Mupirocin, a topical antimicrobial agent has been used for patients with methicillin-resistant Staphylococcus aureus and recently mupirocin resistance was issued in some studies. The objective of this study was to analyze prescription patterns of topical mupirocin, to evaluate appropriateness of prescriptions in the ambulatory setting, and to compare frequency of mupirocin usage in South Korea with that in United States. Methods: Topical mupirocin prescription patterns (the number of prescription and a prescription period), and appropriateness of prescription (including a prescription rate over 10 days, a repeat prescription rate within 30 days and a prescription rate within labeled indications) were analyzed using the 2012 Health Insurance and Review and Assessment service-National Patient Sample dataset of South Korea. The National Ambulatory Medical Care Survey dataset was used to quantify topical mupirocin prescription in United States for comparison. Results: In South Korea, the prescriptions rate for use over 10 days was 3%, the repeat prescription rate within 30 days was 8.87% and the prescription proportion within labeled indications was 33.84%. The most frequent diagnostic code was nonbacterial infection. The prescription rate per 1000 population of topical mupirocin in South Korea was calculated to be 46.07, whereas in United States was calculated to be 13.10. Conclusion: Topical mupirocin has been used frequently and inappropriately, so further studies are required to investigate the rationale behind such prescribing mupirocin patterns.

• Journal of Preventive Medicine and Public Health
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• 제37권2호
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• pp.150-156
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• 2004

Objectives : To investigate the utilization patterns of non-steroidal anti-inflammatory drugs (NSAIDs) among the elderly with osteoarthritis (OA) undergoing primary ambulatory care in Busan metropolitan city, Korea. Methods : OA patients, aged 65 years and over, were identified from the Korean National Health Insurance Review Agency drug prescription database. The subjects had at least one episode of claim for OA (ICD-10-CM: M15-M19) between August 1, 2000 and February 28, 2002. Trends in the determinations of NSAIDs utilization were identified using chi-squared tests for trend. Results : There were 47,711 osteoarthritic patients. The total number of visits by these patients was 177,443, with a total frequency for NSAID prescriptions of 214,952. Seventy-nine percent of the OA patients were female. NSAIDs were prescribed on 133,284 visits (75.1%) and the proportion of prescriptions was significantly increased with age. Only the proportion of visit when NSAIDs were prescribed decreased, from 65.1 to 43.5%, during the study period (p<0.001). However, the proportion of combined treatments with anti-ulcer drugs was increased. The use of NSAIDs injections was decreased. Of the individual NSAIDs, diclofenac (28.7% of total frequency of NSAID prescriptions), piroxicam (15.0%) and talniflumate (8.7%), were the most frequently prescribed. Among the NSAIDs prescribed OA visits, 45.7% used two or more NSAIDs. Conclusion : The total proportion of NSAIDs prescribed to the osteoarthritic patients was higher than in other studies. The decline in the use of NSAIDs during the study period, and the frequent selection of safer medications, such as combination therapy with anti-ulcer drug, may reflect the risk awareness of the use of NSAIDs.

• 가정간호학회지
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• 제16권2호
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• pp.98-107
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• 2009

Purpose: The objective of this study was to identify the effects of a telephone follow-up program on patient compliance, urea kinetic modeling and incidence of infection in patients with continuous ambulatory peritoneal dialysis (CAPD). Method: A pretest-posttest design with a nonequivalent control group was used to examine the effects of a telephone follow-up program for 12 weeks in a group of 39 CAPD patients. The telephone follow-up group of 17 patients received telephone follow-up 10 min once a week for 1 month and 10 min twice a month for 2 months during 12 weeks compared to control group of 22 who patients received usual care. Results: The telephone follow-up group showed no significant changes in patient compliance and urea kinetic modeling, although patients with CAPD receiving a telephone follow-up showed reduced incidence of exit site infection during the intervention compared with the control group. Conclusion: Telephone follow-up program for CAPD patients may decrease the incidence of exit site infection. Future studies with a larger sample be done utilizing diet and exercise reinforcement program combined with telephone follow-up as a nursing intervention for patients with CAPD.

• 간호행정학회지
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• 제19권4호
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• pp.437-448
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• 2013

Purpose: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. Methods: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. Results: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. Conclusion: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

• Journal of Preventive Medicine and Public Health
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• 제27권2호
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• pp.366-376
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• 1994

환자 만족도의 증진은 의료 제공의 궁극적인 목적의 하나이며, 의료의 질적 수준 향상을 위해서는 환자의 만족도 평가가 매우 중요하다. 따라서 판자의 만족도를 타당도와 신뢰도가 높은 도구를 이용하여 측정하고, 환자의 만족도에 영향을 미치는 요인을 규명할 필요가 있다. 이 연구는 우리 나라 실정에 적합한 표준화된 설문서의 개발에 필요한 기초자료를 제공하기 위하여 환자의 만족도를 평가하는 설문지를 개발하고 한 3차 병원 외래를 방문한 827명의 환자를 대상으로 이의 신뢰도와 타당도를 평가하였으며, 환자의 만족도에 영향을 미치는 요인을 파악하였다. 외래 방문 환자가 질을 평가하는 차원은 인자 분석을 통하여 병원 환경 및 편의 시설에 관련된 요인, 원무관리 및 보조 서비스에 관련된 요인과 의사진료에 관련된 요인으로 분류되었으며, 이 3개의 병원내 과정에 대한 척도들은 비교적 높은 신뢰도와 타당도를 나타내고 있었다. 전반적인 진료 결과를 나타내는 3개 문항은 신뢰도가 낮아, 서로 다른 별도 차원의 개념임을 의미하고 있었다. 로지스틱 회귀분석 결과 전반적인 만족도에 영향을 미치는 요인은 최근의 건강 상태, 진료비에 대한 인식과 진료에 따른 건강상태의 변화였고, 타인에게 병원을 추천할 의향에 영향을 미치는 요인은 환자의 성, 초 재진 여부, 진료에 따른 건강상태의 호전에 대한 기대, 진료비에 대한 인식과 진료에 따른 건강상태의 변화였다. 앞으로의 환자 만족도에 대한 연구에서는 이 연구 결과를 참고로 하여 조사 대상의 확대, 포괄적인 설문 문항의 개발, 조사 방법의 보완 등이 필요할 것이다. 이 연구에 사용된 설문지의 입수를 원하시는 분은 저자에게 개인적으로 연락하여 주시면, 설문지를 보내드리겠습니다.

• 디지털융복합연구
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• 제11권10호
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• pp.609-618
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• 2013

본 연구는 당뇨병 환자의 의료이용 현황과 삶의 질에 영향을 미치는 요인을 살펴보는 데 목적이 있다. 2009년 한국의료패널조사 자료를 이용하였으며, 삶의 질 조사에 응한 만 50세 이상 응답자 6,146건을 대상자로 하였다. 분석대상자의 의료이용 현황을 파악하기 위하여 기술통계를 실시하였으며, 당뇨 환자의 삶의 질에 영향을 미치는 요인을 파악하기 위해 다중 회귀분석을 실시하였다. 연구 결과, 당뇨 환자의 건강관련 삶의 질은 성, 연령, 교육수준, 보험유형, 가구소득, 당뇨질환 외래진료비, 기타질환 외래이용 건수 등과 유의하게 관련이 있었다. 여성, 연령이 높을수록, 교육수준이 낮을수록, 의료급여 환자인 경우, 가구소득이 낮을수록, 당뇨질환 외래 진료비가 높을수록, 기타질환 외래 이용 건수가 많을수록 삶의 질이 유의하게 낮은 것으로 나타났다. 따라서 당뇨 환자들의 삶의 질 향상을 위한 보다 적극적인 사회적 프로그램을 도입하고, 문제의 원인과 대상에 맞는 구체적인 접근방안을 모색하는 노력이 필요할 것이다. 이러한 결과들은 향후 보건의료정책 수립에 기초 자료로 의미 있게 활용되어질 수 있으리라 여겨진다.