• 농촌의학ㆍ지역보건
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• 제36권4호
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• pp.227-237
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• 2011

농촌지역 재가장애인의 재활서비스 이용실태를 파악하고자 일개 농촌지역 재가장애인(3-6급 뇌 병변 지체장애) 101명을 대상으로 2011년 3월부터 4월까지 면접 조사를 실시하였다. 대상자는 여자가 65.3%였고, 70세 이상이 53.5%로 가장 많았고, 초등졸 이하가 72.3%이었다. 주관적 경제상태는 보통이상이 56.4%, 의료보장형태는 94.1%가 건강보험이었다. 대상자의 장애 및 건강관련 특성으로는 지체장애가 81.2%, 장애등급별은 3-4급이 41.6%로 가장 많았고, 동반 질환이 있는 경우가 74.3%였다. 본인이 생각하는 자신의 장애정도가 '심각하다'고 한 경우가 69.3%였다. 재가장애인의 70.3%는 퇴원 후 현재 재활서비스를 받고 있었다. 이용하지 않는 이유로는 치료의 효과성과 주변 서비스 기관의 부재, 경제적인 측면 등을 이유로 들었다. 재활서비스를 받기 위해 이용하고 있는 기관은 병의원, 재활의학과 병의원, 한의원 보건소 순으로 많았다. 현재 이용하고 있는 재활서비스 내용에 대해 19.7%가 만족한다고 하였고, 불만족의 이유로는 거리가 멀어서가 가장 많았다. 현재 재활서비스 이용여부에 영향을 미치는 유의한 변수로는 성별, 직업유무, 주관적 경제상태, 장애발생 원인이었다. 즉, 여자인 경우, 직업을 가진 경우, 경제상태가 좋은 경우, 장애발생이 후천적인 경우 재활서비스 이용이 높았다. 농촌지역 재가장애인의 70.3%가 현재 재활서비스를 이용하고 있으나 포괄성, 접근성, 지속성, 만족도 등에서 미흡한 것으로 나타났다. 현재 국가차원에서 추진되고 있는 지역사회중심재활사업을 중심으로 농촌지역 재가장애인을 위한 양적 및 질적으로 충분한 재활서비스 제공이 요구되며, 미이용 집단 및 미충족 집단을 우선 사업대상자로 선정하여 서비스를 제공하는 전략이 필요할 것으로 판단된다.

• 농촌의학ㆍ지역보건
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• 제38권1호
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• pp.14-24
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• 2013

이 연구는 건강보험공단으로부터 획득한 2001년부터 2008년까지 전국 232개 시군구 지역의 분만 및 합병증 청구 자료를 바탕으로 산모가 자신의 거주 지역 내 외에서 출산하는 비율과 산과적 합병증과의 관련성을 밝히기 위한 생태학적 연구이다. 산모가 본인의 거주 지역 밖에서 출산하는 비율인 관외분만율은 정도에 따라 저도 관외분만율 지역, 중등도 관외분만율 지역, 고도 관외분만율 지역으로 범주화하였으며, 산과적 합병증은 '유산, 자궁외 임신 및 기태임신에 따른 합병증율', '유산율', '자간증율'을 구하였다. 관외분만율에 따른 산과적 합병증의 일원배치 분산분석에서 저도 및 중등도 관외분만율 지역보다 고도 관외분만율 지역이 '유산, 자궁외 임신 및 기태임신에 따른 합병증율'과 '자간증율'이 통계적으로 의미있게 증가하는 경향을 보였고(p<0.05), 산과적 합병증 각각을 종속변수로 한 다중선형회귀분석에서 '유산, 자궁외 임신 및 기태임신에 따른 합병증율'은 고도 관외분만율 지역(분만서비스 접근 취약지역)이 기타 지역보다 유의하게 높은 것으로 나타났으며(p<0.01), '자간증율'은 고도 관외분만율 지역에서 그리고 1인당 지방세납입액이 낮은 지역에서 더 높은 것으로 나타났다(p<0.01). 이 연구를 통해 분만서비스 접근 취약지역에 거주하는 산모에서 산과적 합병증이 높음을 나타냈고 따라서 이에 대한 적절한 대책이 세워져야 할 필요성을 시사하고 있다. 특히 응급 대응 및 산전관리의 충실성을 높이기 위한 체계적인 대안이 정책적으로 고려되어야 함을 보여주고 있다. 한편 이 연구는 시군구를 분석 단위로 한 생태학적 연구이므로 산전관리 수진 및 산과적 합병증 발생에 영향을 미치는 개인수준에서의 요인들까지 고려되지 못한 점은 이 연구의 한계점으로 가지고 있다. 따라서 추후 산전관리 및 산과적 합병증에 영향을 미치는 산모 개인수준에서의 요인들까지 고려한 후속연구가 필요하겠다.

• 한국중재학회지:중재연구
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• 제12권1호
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• pp.271-321
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• 2002

Every year, many million of business transactions take place. Ocassionally, disagreements develop over these business transactions. Many of these disputes are resolved by mediation, arbitration and out-of-court settlement options. The American Arbitration Association(AAA) helps resolve a wide range of disputes through mediation, arbitration, elections and other out-of-court settlement procedures. The AAA offers a broad range of dispute resolution services to business executives, attorneys, individuals, trade associations, unions, management, consumers, families, communities, and all level of governments. The 198,491 cases composed of the 194,303 arbitration cases and the 4,188 mediation cases, were filed with the AAA in 2000. These case filings represent a full range of matters, including commercial finance, construction, labor and employment, environmental, health care, insurance, real state, securities, and technology disputes. The Korean Commercial Arbitration Board (KCAB) does more than render arbitration services. It helps facilitate settlements and guarantee implementation thereof between trading partners at home and abroad involving disputes related to such areas as the sale of commodities, construction, joint venture agreements, technical assistance, agency agreements, and maritime transport. The 643 cases composed of the the 197 arbitration cases and the 446 mediation cases, were filed with the KCAB in 2001. There are some differences between the AAA and the KCAB regarding the number and the area of mediation and arbitration case filings, the breath of service offerings, the scope of alternative dispute resolution, and the education and training. In order to apply to the proceedings of the commercial mediation and arbitration, the AAA has the Commercial Mediation Rules, the Commercial Arbitration Rules, the Expedited Procedures, the Optional Procedures for Large, Complex Commerical Dispute, and the Optional Rules for Emergency Measures of Protection as amended and effective on September 1, 2000. In order to apply to the proceedings of commercial arbitration, the KCAB has the Arbitration Rules as amended by the Supreme Court on April 27, 2000, which have been changed to incorporate the revisions of the Arbitration Act that went into effect on December 31, 1999. There are some differences between the AAA's commercial Arbitration Rules and the KCAB's Arbitration Rules regarding the clauses of jurisdiction and administrative conference, number of arbitrators, communication with arbitrator, vacancies, preliminary hearing, exchange of information, oaths, evidence by affidavit and posthearing filing of documents or others, interim measures, serving of notice, form of award, scope of award, delivery of award to parties, modification of award, release of liability, administrative fees, neutral arbitrator's compensation, and expedited procedures. In conclusion, for the vitalization of KCAB and its ADR system, the following measures should be taken : the effective case management, the development of on0-line ADR, the establishment of ADR system of electronic commerce disputes, and the variety of dispute resolution rules in each expert field.

• 한국간호교육학회지
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• 제14권2호
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• pp.294-304
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• 2008

Purpose: Cancer patients experience a range of physical and psychological sequelae. Consistent nursing support should be provided along the cancer treatment path. This study aimed to i)examine the effects of a telephone counseling program after discharge on perceived health, psychological well-being, and satisfaction with nursing services, and ii)describe symptom distress and their coping methods. Method: The study was a quasi-experimental design with a non-equivalent pre-post test. The sample included 20 women with gynecologic cancer in the experimental group and the same in the control group from a university hospital in Seoul. The telephone intervention was given once from 5 to 7 days after the chemotherapy. The General Well-Being Schedule and Symptom Distress Scale were used. Result: An effect from telephone counseling was found only in the vitality subscale of psychological well-being. Other subscores, perceived health, or satisfaction with nursing services did not differ between the two groups. Pain, skin change, decreased appetite, and constipation were the major symptoms and a relatively few coping strategies were utilized. Conclusion: Protocol of telephone counseling led by a nurse needs to be further developed in regard to best timing, amount, and target effects for follow-up care of gynecologic cancer patients.

• Journal of Preventive Medicine and Public Health
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• 제43권6호
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• pp.523-534
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• 2010

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

• 한국콘텐츠학회논문지
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• 제20권5호
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• pp.448-456
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• 2020

4차 산업혁명 시대에서 폭발적인 정보와 데이터를 얼마나 잘 다루고 활용하는가는 산업의 경쟁력과 직결되는 문제로 인식이 되고 있다. 특히, 의료 분야에서 인공지능 기술의 도입은 그 활용에 있어서나 사회적으로나 파급력이 굉장히 크다고 할 수 있으며, 활용 범위 별 인공지능의 동향을 파악하기 위해 본 연구를 진행하게 되었다. 본 연구에서는 의료 분야에서의 인공지능 활용을 크게 다음과 같이 4가지 활용범위, (1)병원 솔루션, (2)개인 건강관리, (3)보험회사, (4)신약개발로 나누어 살펴보았다. 인공지능 기술의 활용 범위 별 다양한 사례와 동향을 바탕으로 우리나라 의료 산업에서는 앞으로 어떠한 전략으로 인공지능을 발전시켜 나가야 하는지 방향성을 제시하고자 하였다. 본 연구에서는 헬스케어 산업 다양한 분야에서 인공지능의 활용 사례에 대해 알아보고, 헬스케어의 최신 이슈사항이 무엇인지 서술하여 의료산업 전반에 도움을 주고자 하였다. 인공지능 기반 의료 시스템의 발전은 보다 쉽게 만성질환자 및 환자들의 건강을 관리해주고, 암이나 질병 진단의 정확성을 높이며 신약개발을 더 빠르고 효율적으로 진행되도록 도움을 주었다. 본 연구를 통하여 한국의 의료 산업에서는 앞으로 어떠한 전략으로 인공지능을 발전시켜나가야 하는지 방향성을 제시하고자 하였다.

• 지적과 국토정보
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• 제47권1호
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• pp.267-276
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• 2017

우리나라는 황사로 인해 농업 및 산업분야, 시민건강 등 다양한 분야에 걸쳐 피해가 발생되고 있으며 이에 대한 대책 마련이 시급한 실정이다. 이에 본 연구에서는 2009년 이후 최대 황사가 나타났던 2015년 2월 23일을 기준으로 전후 11일간의 황사 관련 트윗 데이터를 수집하고, 이슈어 분석, 건강과 관련된 트윗 데이터 그룹 재구성, 질병과의 연관규칙 분석 등을 걸쳐 황사발생과 관련 질병의 유의성을 검정한 결과 다음과 같은 결론을 얻었다. 황사관련 트윗 데이터로부터 도출된 질병과 건강보험심사평가원에서 취득한 환자실태 자료를 종합하여 비염, 천식, 결막염 환자에 대한 유의성 검정을 실시한 결과, 유의확률 5%에서 결막염은 16개 시 도 중 13개 지역에서 유의하게 나타났으며, 비염은 6개 지역에서, 천식은 3개 지역에서 질병 발생에 유의한 것으로 나타났다. 이상과 같이 트윗 데이터와 같은 SNS데이터로 부터 시민들의 건강에 대한 정보를 취득할 수 있었으며, 이를 활용한 시민건강 관리 대책을 수립하는데 유용한 정보를 제공해 줄 수 있을 것으로 판단된다.

• 보건행정학회지
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• 제26권2호
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• 대한족부족관절학회지
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• 제23권3호
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• pp.121-130
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• 2019

Purpose: To investigate the spatial distribution of diabetes-related lower limb amputations and analyze the relationship between the spatial distribution of diabetes-related lower limb amputations and regional factors. Materials and Methods: This study was performed based on the data from the Korean Health Insurance Review and Assessment Service, in 2016. The unit of analysis was the administrative districts of city·gun·gu. The dependent variable was the age- and sex-adjusted incidence of diabetes-related lower limb amputations and the regional variables were selected to represent two aspects: socioeconomic factors, and health and medical factors. Along with traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for spatial analysis. Results: The age- and sex-adjusted incidence of diabetes-related lower limb amputation varied according to region. OLS regression showed that the incidence of diabetes-related lower limb amputation had significant relationships with the health and medical factors (number of healthcare institution and doctors per 100,000 population). In GWR, the effects of regional factors were not consistent. Conclusion: The spatial distribution of the incidence of diabetes-related lower limb amputations and the effects of regional factors varied according to the regions. The regional characteristics should be considered when establishing health policy related to diabetic foot care.

• 보건행정학회지
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• 제26권4호
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• pp.359-372
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• 2016

Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, $R^2$ values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.