• Title/Summary/Keyword: Claims Analysis

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Analysis of Influencing Factors on the Outpatient Prescription of Antipsychotic Drugs in the Elderly Patients (노인환자의 항정신병 약물 원외처방 내역에 미친 영향 요인 분석)

  • Dong, Jae Yong;Lee, Hyun Ji;Lee, Tae Hoon;Kim, Yujeong
    • Korean Journal of Clinical Pharmacy
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    • v.31 no.4
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    • pp.268-277
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    • 2021
  • Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)'s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year's old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient's characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients' and medical institutions' characteristics, is needed.

Study on the distribution in major disease category and frequency of clinical usage of national health insurance herbal prescription based on analysis on KCD8 disease code of indications (적응증의 KCD8 상병코드 분석 결과를 기반으로 한 보험한약제제의 질병 대분류 분포 분석과 사용 빈도 연구)

  • Dong Woo Lim;Jung Yun Ahn;Ga Ram Yu;Jai Eun Kim;Won Hwan Park
    • The Journal of Korean Medicine
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    • v.44 no.1
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    • pp.1-15
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    • 2023
  • Objectives: National health insurance herbal prescription of Korean medicine has been serving important role in public healthcare in spite of continuous demand on revision of system. However, the categories of insurance herbal prescriptions are not equally distributed throughout the KCD-based major disease categories. We analyzed statistical database of claimed national health insurance classified as major disease categories by years. We classified all 56 herbal prescriptions as per their total medical indications into 22 major disease categories to analyze their distribution. Significant increase of M and S-T code claims were found, whereas decrease of U code claims by years. We figured out that the 56 prescriptions were unequally distributed along with enrichment of certain codes such as K and J. Meanwhile, the insurance claim of each prescription was positively correlated with number of code types of their indications. As a result, we believe that the reform of national health insurance herbal prescription list is necessary to promote use of it in clinic.

High Speed Korean Morphological Analysis based on Adjacency Condition Check (인접 조건 검사에 의한 초고속 한국어 형태소 분석)

  • 심광섭;양재형
    • Journal of KIISE:Software and Applications
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    • v.31 no.1
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    • pp.89-99
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    • 2004
  • This paper proposes a morphological analysis method that enables morphological analysis by checking conditions between two adjacent morphemes. These conditions are fed from a dictionary. This method eliminates a code conversion module and the application of transformational rules for candidate generation. The method claims that very high speed morphological analysis is attainable through simple bit operations for adjacency condition check. MACH, an implementation of the proposed method, is a supersonic Korean morphological analyzer which is able to analyze a document of 1 GB in 5 minutes on a PC with 1.13 GHz Pentium III CPU. The analysis accuracy of MACH is 99.2 %.

A Cost-Utility Analysis of Home Care Services by using the QALY (QALY를 이용한 가정간호서비스의 비용효용분석)

  • 임지영
    • Journal of Korean Academy of Nursing
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    • v.34 no.3
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    • pp.449-457
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    • 2004
  • Purpose: The aim of this study was to analyze economical efficiency of home care service by comparing a cost-utility ratio(CUR) between home care and hospitalization. Method: The analytic framework of this study was constructed in 5 stages: Identifying the analytic perspectives, measurement of costs, measurement of utility, analysis of CUR, and sensitivity test. Data was collected by reviewing medical records, home care service records, medical fee claims, and other related research. Result: The mean of the annual total cost was 23,317,636 Won in home care and 73,739,352 Won in hospital care. QALY was 0.389 in home care and 0.474 in hospital care, so CUR was 299,712,545 QALY in home care and 777,841,266 QALY in hospital care. Conclusion: The findings affirmed that home care had an economical efficiency in the aspect of utility compared to hospitalization. Therefore, the findings of this study can be used to develop a governmental health policy or to expand the home care system. In addition, the cost-utility analysis framework and process of this study will be an example model for cost-utility analysis in nursing research. Therefore, it will be used as a guideline for future research related to cost-utility analysis in nursing.

Regression Analysis on the Dispute Cost Property in Apartment Housing Claims (비용항목의 희귀분석을 통한 공동주택 하자분쟁의 비용특성연구)

  • Kang, Yu-Mi;Kim, Beop-Su;Park, Jun-Mo;Choi, Jeong-Hyun;Seo, Deuk-Seok;Kim, Ok-Kyue
    • Proceedings of the Korean Institute of Building Construction Conference
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    • 2010.05a
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    • pp.225-228
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    • 2010
  • It is an social issue that is various claim related on the defect of apartment house. The cost of defect repair is the most important matter that residents dispute constructers with the huge time wasting and cost loss. For resolve the matter of defect claim, it must to be analyze to the cost property that study and find to pending issue about the cost of defect repair. Therefore this study is investigated the cost property of defect repair relation on correlation analysis and regression analysis around the judgement cost. Consequently, cost of the judgment is associated with cost of the accusation and cost of the defect repair, is recognizable as them that is closely connected. Meanwhile, the more time of take effect and time of lawsuit increase, the more cost of the judgment decrease by draw the regression equation. On the contrary, there are same aspects in the case on the cost of the accusation and cost of the defect repair.

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A Study on Substantiation Methodology for Extension of Time in International Mega-Project Claims (해외 대형건설공사 공기지연클레임의 공기연장기간 입증방법)

  • Kim, Young-jae;Kim, Tae-kyoung;Jo, Duk-sang;Lee, Hwang-ku
    • Korean Journal of Construction Engineering and Management
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    • v.16 no.3
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    • pp.165-176
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    • 2015
  • Recently many Korean large-sized construction companies as well as specialty contractors have been expanding their business in the overseas market to mitigate impacts from long-term stagnation in the domestic market. Such as a result, it has been arisen as a major issue that contractors effectively manage the delays which have been commonly faced with in international mega-projects. Therefore it can be said that the ability of the delays management leads a success of project. This paper presents a review of literature for delay analysis methods such as time impact analysis(TIA) and raises practical problems to rationally substantiate the duration of extension of time(EoT) in international mega projects which have wide scope of works as well as complicated and detailed contract baseline programs by taking theoretical approaches. We suggest the two improvement concepts to substantiate the EoT claims which are effectively applicable to practical projects. The first is to sort out dominant delays among numerous delays in advance of applying a delay analysis. The second is to set up the delay sections with the advanced concept for analysing delays' effects by TIA. This study performed a case study on an actual international mega-project. to confirm the effectiveness of improvement concepts that this practical approach is applicable for the assessment of EoT. In conclusion, this paper supposes to provide practitioner in charge for an EoT claim with an advanced substantiation methodogy when they not only analyse the construction delays by using TIA, but also negotiate with stakeholders about with the assessment of EoT.

Exploring the Practical Value of Business Games: Analysis with Toulmin's Sensemaking Framework

  • Joo Baek Kim;Edward Watson;Soo Il Shin
    • Asia pacific journal of information systems
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    • v.32 no.4
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    • pp.803-829
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    • 2022
  • With the advances in technology and the trend towards increased computer-based experiential learning in education settings, business games are being increasingly used by business educators. This article utilizes Toulmin's Sensemaking Framework to investigate the sensemaking process of business professionals to reveal how they consciously reason about the value of business games for learning complex business concepts and principles. Using the analysis of responses from 43 business professionals, our study identifies key areas where business professionals find value in business games and the limitations of using business games. First, business games are found to be an effective tool when teaching practical business skill sets to business professionals. Second, business games enhance the overall learning process in professional business training. Third, despite the advantages, some pitfalls in applying business games to practice are found. We also found sub-themes, claims, and argument patterns of how business professionals evaluate the value of business games through a grounded theory qualitative analysis method. Analysis results show several ground-warrant patterns exist in the arguments on values of business games including general principle - causal reasoning, personal experience - generalization, and personal projection - generalization. With these findings, we believe this paper contributes to the theory and practice of business game design, development, and the game playing and learning process.

Construction of Fuzzy Logic Based on Knowledge for Greenery Warranty Systems (그린 보증시스템을 위한 지식기반 퍼지로직 구축)

  • Lee, Sang-Hyun;Lee, Sang-Joon;Moon, Kyeong-Il
    • Journal of the Korea Society of Computer and Information
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    • v.16 no.3
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    • pp.17-25
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    • 2011
  • Green IT, composed term with Green and Information Technology(IT), use IT for energy savings and carbon emission reductions. Green IT went beyond the scope of greening IT, and recently it's concept is expanded as far as counterplan of climate change including greening other industries by IT. 85% of total greenhouse gas emissions from the energy sector and 20% of them comes from transport parts, so it is time to research IT for automotive industry. In this paper, we take up the knowledge based fuzzy logic to provide life cycle analysis associated with greenhouse gas emissions for industry produced warranty claims frequently such as automobile industry. We propose a analysis method of warranty claims using expert knowledge about the warranty in car exhaust systems related to greenhouse gas emissions, past test results of malfunction, analysis of past field data, and warranty data. Furthermore, we propose life knowledge-based GWS (Greenery Warranty System). We demonstrate the applicability of IT in eco-friendly automotive industry by implementing knowledge-based fuzzy logic and applying.

An Convergence Study of the Factors Affecting the Knowledge Level of Dental Health Insurance for Some Dental Workers (일부 치과 종사자의 치과 건강보험의 지식수준에 미치는 요인에 대한 융합연구)

  • Lee, Sun-Mi;Son, Hwa-Kyung
    • Journal of the Korea Convergence Society
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    • v.12 no.10
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    • pp.137-144
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    • 2021
  • The purpose of this study is to analyze the factors affecting the education experience, education needs, and knowledge level of calculation criteria for dental workers. It was conducted on dental workers in Daegu and Gyeongbuk province and an online survey was conducted using Google Survey. We used frequency analysis, crossover analysis, and ANOVA analysis method to find out general characteristic, education experience, education needs, and knowledge level according to education experience and education needs of candidates. As a result of in the knowledge level survey of dental health insurance, there were high rates of incorrect answers to the calculation criteria when the claim program automatically processes it or notifies you through an error window. The level of knowledge of candidates who are experienced, on a claim, and with experience in dental insurance training in the last six months was high. In conclusion, it seems that accurate and correct insurance claims are possible when the dental workers are familiar with the calculation criteria changed through regular dental health insurance education. We look forward to this study providing basic data in preparation of education system for professional dental insurance claims for dental workers.

The Impacts of Guideline for Digestives on Physicians' Prescription of GI medication (소화기관용약제 처방지침이 의사의 소화기관용약 처방률에 미치는 효과분석)

  • Kim, Dong-Sook;Park, Choon-Seon;Jang, Sun-Mee
    • Korean Journal of Clinical Pharmacy
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    • v.18 no.2
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    • pp.124-131
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    • 2008
  • The impacts of guideline for digestives on physicians' prescription of GI medication Clinical practice guidelines provide benefits to physicians, patients, and researchers. It also helps doctors to make decisions in medical services. In many countries, practice guidelines lead to activities of quality improvement and are developed using evidence based methods. This research was to assess the impacts of Korean Medical Association's guideline for digestives on the change of physicians' behavior. This study was progressed as one-group pre-test post-test quasi-experimental design using health insurance claims data. The unit of analysis was institution. Data was analyzed using paired t-test for change of prescription rate before and after the distribution of practice guidelines. And the multiple regression analysis was performed to examine the independent impact of the guideline on the prescribing rate of GI medication. Prescription rates of GI medication per claim by medical institution increased significantly, 1.98%point (from 50.27% to 52.25%) and multivariate regression analysis showed significant increase in the prescription rate of GI medication after the distribution of guideline (p<0.001). In conclusion, the distribution of guideline for digestive might not have the effects on the change in provider's behavior. Furthermore, to activate the use of practice guideline, it would be necessary to educate the contents to physicians as well as to develop practice guideline.

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