• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.21-27
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• 2001

Objectives : To develop a model that will predict the mortality of patients undergoing Coronary Artery Bypass Graft (CABG) and evaluate the perfermance of hospitals. Methods : Data from 564 CABGs peformed in six general hospitals were collected through medical record abstraction by registered nurses. Variables studied involved risk factors determined by severity measures. Risk modeling was performed through logistic repression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistic, $R^2$, and Hosmer-Lemeshow statistic. Hospital performance was assessed by severity-adjusted mortalities. Results : The developed model included age, sex, BUN, EKG rhythm, Congestive Heart Failure at admission. acute mental change within 24 hours, and previous angina pectoris history. The c-statistic and $R^2$ were 0.791 and 0.001, respectively. Hosmer-Lemeshow statistic was 10.3(p value=0.2415). One hospital had a significantly higher mortality rate than the average mortality rate, while others were net significantly different. Conclusion : Comparing the quality of service by severity adjusted mortality rates, there were significant differences in hospital performance. The severity adjusted mortality rate of CABG surgery may He an indicator for evaluating hospital performance in Korea.

• 디지털융복합연구
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• 제18권10호
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• pp.315-323
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• 2020

본 연구의 목적은 코로나19 원격 교육에서 간호대학 신입생의 대학생활 적응에 영향을 미치는 요인을 확인하기 위해 시도되었다. 자료는 2020년 8월 31일부터 9월 4일까지 S시 소재의 간호대학 신입생 165명을 대상으로 하였다. 자료분석은 t-test, one-way ANOVA, Pearson 상관분석, 다중회귀 분석을 이용하여 분석하였다. 일반적 특성 중 대학생활 적응과 관련된 요인은 연령, 입학 당시 학력, 입학 동기, 성적이었다. 대학생활 적응은 학업적 자기효능감, 비판적 사고 성향, 문제해결능력과 유의한 양의 상관관계에 있었으며, 이들 변수는 대학생활 적응을 37.7% 설명하였다. 따라서 코로나19로 원격 교육을 받는 간호대학 신입생의 대학생활 적응을 위해 학업적 자기효능감, 비판적 사고 성향, 문제해결능력을 고려한 수업방식과 학생지도가 필요하다.

• Journal of Preventive Medicine and Public Health
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• 제23권1호
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• pp.11-21
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• 1990

This study refers to the problem of long-term inpatient flow in a general hospital. In this study, a queueing simulation model was developed for the two departments in the hospital with a homogeneous case mix and relatively many long-term inpatients in order to increase the turnover rate and hospital charges. Before the simulation n, the model was verified by the Kolmogorov-Smirnov test. The following results were generated by three alternative models of the special bed policies. 1. Alternative I : When long term inpatients were admitted to the wards belonging to departments A and B without transfer to other departments and special beds, the average turn-over rate decreased by 2-4% and the average hospital charges decreased by 70 million won. 2. Alternative II : When long-term inpatients were transferred to department C but the transfer of wards was determined by department C in order of clinical need, the average turnover rate increased by 4-13% but the average hospital charges decreased by 30 million won. This result was not greatly different from the present state. 3. Alternative III : When long-term inpatients were transferred to the special wards and department C simultaneously, the increase in the average turnover rate and hospital charges was equivalent to the increase of two beds in the special wards. When the special wards were allocated 16 beds, the average turnover rate of departments A and B increased by about 55% and 20% respectively. Also, the hospital charges increased by about 0.44 billion won. As a result, transfer to department C and the use of 16 beds in the special wards for long-term inpatients of departments A and B is expected to maximize the hospital revenue. However, as the above special bed policy can not increase the turnover rate above 60%, there is a need for a more comprehensive policy to further increase the rate. The development of an elaborate model should include the number of long-term inpatients in all clinical departments, the special wards system or an increase of hospital beds to handle admission needs, and the resources of the hospital by department. When the alternatives are evaluated, a cost-benefit analysis in addition to the turnover rate and the hospital charges should be considered.

• 대한공간정보학회지
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• 제16권2호
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• pp.77-86
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• 2008

대학의 입시정보는 수험생뿐만 아니라 각 대학에게도 중요한 정보이며, 해당 정보를 이용하여 다양한 분야에 활용할 수 있다. 수험생에게는 자신의 점수를 통하여 자기에게 가장 알맞은 지역의 대학을 선택할 수 있으며, 대학의 경우 대학당국의 입학 및 홍보정책을 결정하고, 나아가 학생들의 생활복지를 향상하는데 중요한 자료로 활용될 수 있다. 따라서 해당 정보들을 수험생과 대학이 공유할 수 있는 대학입학관리시스템의 도입이 절실히 요구되는 실정이다. 본 연구에서는 Web 2.0을 기반으로 일반인들에게 공개되어 있는 Naver Map API를 이용하여 대학입학관리시스템을 개발하였다. 본 시스템은 공개되어진 지도데이터를 이용하여 대학입시 지원자, 합격자 및 등록자의 자료에 대해 분석할 수 있도록 하였으며, 지원자 대비 합격률 및 최근3년간 지원자 변화율을 분석할 수 있도록 하였다. 또한 대학의 홍보이력을 관리함으로서 대학의 입학홍보정책을 지원할 수 있도록 하였으며, 대학의 입학정보를 기반으로 하여 수험생에게 점수별 입학대학의 정보를 제공하도록 하였다. 이를 통하여 공개되어진 Web2.0 기반의 지도와 연동을 통한 다양한 데이터의 관리 및 활용이 가능하였으며, 이를 바탕으로 기존의 제공자 중심의 GIS 시스템이 아닌 사용자 중심의 GIS 시스템을 구축함으로써 지도를 기반으로 보다 다양한 정보를 표현 할 수 있을 것으로 사료된다.

• 지역사회간호학회지
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• 제10권1호
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• pp.80-92
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• 1999

The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.

• 디지털융복합연구
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• 제18권1호
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• pp.257-263
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• 2020

본 연구는 건강보험심사평가원 자료를 이용하여 조현병 환자의 인구사회학적 특성, 의료기관 특성, 입퇴원 특성이 재원일수에 미치는 영향을 분석하여 국가 보건 정책 질 향상을 위한 기초 자료로 활용하고자 시행하였다. 건강보험심사평가원 2016년 환자 데이터셋(HIRA-NIS)에서 조현병이 주진단인 4,692명의 진료비 명세서를 연구대상으로 하였다. 조현병 환자의 재원일수 영향 요인을 확인하기 위하여 인구사회학적 특성, 의료기관 특성, 입퇴원 특성을 설명변수로, 재원일수를 종속변수로 회귀분석을 실시하였다. 연구결과 재원일수에 주요하게 영향을 미치는 요인은 여자, 연령, 의료 급여, 병원급, 요양병원, 강원도, 정신질환 부진단, 기타 부진단 등으로 밝혀졌다. 공공 데이터를 이용하여 조현병 환자의 재원일수에 영향을 미치는 요인을 찾고자 함에 의의가 있으며, 중증도는 고려하고 있지 않아 향후 중증도에 따른 재원일수의 차이에 대한 연구가 진행되어야 할 것으로 보여 진다.

• 디지털융복합연구
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• 제15권9호
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• pp.55-64
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• 2017

소프트웨어의 중요성이 널리 인지됨에 따라 대학에서도 소프트웨어 교육이 필수 교과로 지정되어 운영되고 있다. 하지만 비전공 학습자에 대한 충분한 이해가 없는 상태에서 교육이 이루어져, 교육 목표 달성에 어려움이 있다. 따라서 본 논문에서는 소프트웨어 기초 교육 과정을 수강한 인문대학생들의 의견을 분석하여 학생들의 디지털 마인드 변화를 확인하고, 이를 바탕으로 비전공 학생 대상 소프트웨어 기초 교육의 고려 사항을 제안한다. 설문 분석 결과, 입학 전 소프트웨어 교육은 대학에서의 교육에 기여하는 바는 크지 않은 반면, 학생들은 자신이 친숙함을 느끼는 주제를 활용한 실습 위주의 교육에 긍정적인 응답을 보였다. 따라서 비전공 학습자를 대상으로 한 소프트웨어 기초 교육에서는 학습자에게 실습을 바탕으로 한, 보다 많은 소프트웨어 접근 기회를 제공함으로써 학습자 스스로 자연스럽게 디지털 마인드를 함양할 수 있는 환경을 제공하는 것이 바람직하다.

• 보건행정학회지
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• 제30권3호
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• pp.418-429
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• 2020

Background: This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions. Methods: The data was collected from Korean National Health Insurance Service's customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed. Results: The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50-59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010. Conclusion: The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

• 보건행정학회지
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• 제8권2호
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• pp.58-75
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• 1998

The hospital is characterized by it's remarkable labor industry and human resources input by unit. Recently, the administrative personnel are recognized as important staff to provide a hospital guidance to consumer and also easiness for consumer's visit to hospital. The objectives of this study is to find the performance of the administrative personnel in hospitals. The unit of analysis is the hospitals and data was collected form 144 staffs in 5 hospitals. Self administered questionnaire was given to analyze the general characteristics of staft such as age, sex, education, experience, and performance level in terms of frequency, ability, necessity of tasks. The major findings are as follows: 1. The 5 major tasks such as general affairs, insurance related affairs, hospital statistics, admission/discharge, and analysis of treatment cost were analyzed. Performance level of these tasks were not showed consistent level. It means that the same task was showed both high level performance and low level one. 2. The higher rates of performance level, ability and necessity were found, below 29 years of age, junior college graduates and university hospital than that of general one. 3. Factors mostly affected to performances were found as characteristics of hospital, age and education. 4. Concerning the various manpower management, On the job training, incentive mechanism and colose relationship among units were somewhat lack. In conclusion, most responded administrative personnel have performed actively in dealing with their tasks. however, the performance level and ability of the same task were showed differently, it means that such routine works were not standardized. Therefore, standardization and specification of tasks should be developed to strength the performance. Finally, this study is the first attempt to find out the performance of the administrative staffs and the study results imply that further study could be neeed to promote the performance of administrative personnel efficiently and effectively.

• 보건행정학회지
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• 제32권2호
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.