• Journal of Preventive Medicine and Public Health
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• 제21권2호
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• pp.390-403
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• 1988

The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Korea Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and counties were classified into 5 district groups by factor analysis results of K-DRGS. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct funtional district groups. Group A(18 districts) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns : inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaters, but Group C and D were inflow or outflow types according to the disease tracers.

• 간호행정학회지
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• 제10권1호
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• pp.1-9
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• 2004

Korean health insurance has adopted preliminary DRG payment system through 8 DRGs from 1997. But present DRG payment system gives economic incentives for hospitals to hire less nurse. This study was attempted to develope DRG adjust index to differentiate DRG price by nurse staffing level for nursing care quality. Method: We analyzed inpatient care cost by medical institute and developed DRG adjust index to differentiate DRG price by nurse staffing level. Results: Among same medical institute, inpatient care cost are very different according to hospital's nurse staffing level. In the case of casarean section, inpatient care cost of the 1st grade general hospital are more expensive 85,732won than the 6th grade hospital. The cost difference are 8.24% of total casarean section DRG price and 16.48% of DTG variable price. We developed DRG adjust index-a to apply DRG variable price and index-b to apply DRG total price for compensation cost difference of hospitals. Conclusions: DRG price adjust index will give economic incentive for hospitals to hire more nurse and improve nursing care quality.

• 보건의료산업학회지
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• 제10권1호
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• pp.1-11
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• 2016

Objectives : Medical service specialization could have positive effects on their profits and medical service quality. This study was to examine the relationship between medical service specializations and operational performance in hospitals. Methods : We used the National Inpatient Sample data provided by the Health Insurance Review and Assessment Service from 2010 to 2013. The hospital operational performance was determined by measuring the specialization level of the hospital based on DRGs. Results : The information theory index was 2.38 in 2010, 2.38 in 2011, 2.37 in 2012, and 2.37 in 2013. A multiple regression model was constructed which showed that if the specialization level becomes higher, it decreases the length of stay per case with an increase in medical expense. Conclusions : Differentiation and concentrated medical service specialization strategy have had a positive effect on the operational performance of hospitals.

• 보건행정학회지
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• 제20권3호
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• pp.21-35
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• 2010

This study examined the changes in the service mix of Korean hospitals in 6 metropolitan cities between 2003 and 2005, and assessed whether the sample hospitals exhibit consistent trend or chance variation in multiple years. Three measures of hospital service mix, focusing on the specialization of services, were applied: information theory index, internal Herfindahl index, and number of distinct diagnosis-related groups (DRGs) treated. National Health Insurance claims were used to calculate the indexes. Specialization indexes were calculated in each year, and then examined to identify the pattern over time. Kappa analysis was applied to assess the agreements of specialization score between two years after hospitals were categorized into 4 groups with quartiles. Kappa score showed that the service mix of hospitals were changed during the study years. Specialization scores were increased given the market structure for three years. Hospitals which showed higher or lower specialization scores than the average of the scores consistently classified into the same group. Specialization indexes showed relatively consistent pattern over 3 years, and such consistencies were evident for hospitals regardless of the specialization status. Policy makers can identify the degree of specialization with the indexes, and it could provide a picture of how hospital services were mixed and changed over time.

• 한국ITS학회 논문지
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• 제11권4호
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• pp.10-18
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• 2012

본 논문은 최근 지능형교통시스템에서 중요한 수단으로 간주되고 있는 차량 간 통신을 이용한 분산식 첨단 교통정보시스템을 개발하고자 한다. 또한 독립자동유고감지 기능을 통해서 제안된 첨단 교통정보시스템의 효과를 개선하고자 한다. 이상적인 통신 환경을 가정한 단순화된 교통네트워크에서 미시적 시뮬레이션 모델인 VISSIM을 통해 제안된 첨단 교통정보시스템을 구현하였으며 특히 비반복적으로 일어나는 교통상황(예를 들면, 교통사고)을 사용하여 모델의 효과를 관찰하였다. 결론적으로 본 연구에서는 차량 간 통신을 통한 첨단 교통정보시스템의 효율성을 확인함과 동시에 독립자동 유고감지 기능이 시스템의 성능을 향상시키는 것을 보여주고 있다.

• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.98-105
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• 2016

Objective : Lumbar disc herniation can induce sciatica by mechanical compression and/or chemical irritation. The aim of this study was to compare the effects of GCSB-5 (Shinbaro$^{(R)}$) and NSAIDs on pain-related behavior and on the expressions of microglia, astrocytes, CGRP, TRPV1, IL-6, and CX3CL1 in a rat model of lumbar disc herniation. Methods : 112 male Sprague-Dawley rats underwent implantation of nucleus pulposus to a dorsal root ganglion (DRG). Rats were divided into five groups as follows; a saline group (the vehicle control group) (n=27), a 10 mg/kg aceclofenac group (the aceclofenac group) (n=22), and 100, 300 or 600 mg/kg GCSB-5 groups (the GCSB-5 100, 300, or 600 groups) (n=21 for each group). Rats were tested for mechanical allodynia at 3 days after surgery and at 1 day, 3 days, 7 days, 14 days, 21 days, 28 days, 35 days, 42 days, 49 days, and 56 days after treatment commencement. Immunohistochemical staining of microglia (Iba1), astrocytes (GFAP), CGRP, and TRPV1, and PCR for IL-6 and CX3CL1 were performed on spinal dorsal horns and DRGs at 56 days after medication commencement. Results : After 56 days of GCSB-5 300 administration, mechanical withdrawal thresholds were significantly increased (p<0.05), and immunohistochemical expressions of Iba1, GFAP, CGRP, and TRPV1 were reduced than other groups, but this difference was not statistically significant. Conclusion : These results indicate GCSB-5 reduces mechanical allodynia and downregulates neuroglial activity and the expressions of CGRP and TRPV1 in the spinal segments of a rat model of lumbar disc herniation.

• 여성건강간호학회지
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• 제2권1호
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• pp.25-39
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• 1996

The Korean government has a new system for charging patient care for patients in hospital, on hold for the present(9 / 1995) but to start implementation in certain areas of patient care next year. From the latter half of next year the Ministry of Health and Welfare would like to start demonstration projects for hospitals who want to start using DRGs for frequently seen medical diagnosis and for patients with a course that is predictable and for whom non-insurance costs are minimal : such as the patient who has a delivery, cesarean deliveries, cataract surgery, tonsillectomy or an appendectomy, and apply the DRG system of payment for hospital care for these patients. The purpose of this study was to establish a recording system to give effective home health care to postpartum women and their newborns. Recently the government announced a DRG system to apply to postpartum women for pilot purposes starting next year. This gives impetus to the need to develop home care records that will allow for systematic recording and provide continuity and consistency in care across all health professionals and with in-depth communication between the professions to assure high quality care. There has been a rise in medical costs and a shortage of patient bed space in hospitals, particularly since the introduction of national medical insurance. The study focused on developing client selection criteria, a primary assessment tool, progress notes and nursing diagnoses applicable to postpartum and newborn clients. Selection criteria for home health care, assessment tool content, nurses progress notes and diagnoses were developed through a review of the literature, advice from professionals who are expert in home health care and actual practice in the use of recording tools through workshops. The recommendations based on the research results are as follows : 1) Replication and application of these tools is needed to test the validity of the tools 2) In order to have systematic nursing records standardization of records has to be done after nurses have had experience using them. 3) Reliability and validity of the tools has to be established through applicability to actual care situation.

• 대한교통학회:학술대회논문집
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• 대한교통학회 1996년도 제30회 학술발표회
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• pp.81-108
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• 1996

첨단교통정보시스템(ATIS)의 핵심 요소라 할 수 있는 동적경로안내 시스템(Dynamic Route Guidance System : DRGS)은 운전자가 목적지에 도착하기까지 실시간 교통정보를 토대로 최적경로를 안내해 줌으로써 날로 심화되어 가고 있는 교통혼잡을 최소화할 수 있으리라 기대를 모으고 있다. 특히 교통사고나 긴급도로공사 등으로 인해 발생하는 돌발적 교통혼잡하에서는 DRGS의 역할이 더욱 커질 것으로 예상되고 있다. 본 논문은 돌발적 교통혼잡하에서 보다 효과적인 DRGS의 경로 안내 알고리즘을 개발하는 데 그 목적이 있다. 이를 위해서 우선 하부구조기반(Infrastructure Based) DRGS와 개인차량기반(In-vehicle Based)DRGS의 장단점을 운전자, 교통행정당국, 그리고 교통체계관점에서 비교하였고, 시스템 아키텍쳐와 경로안내 알고리즘간의 상호관계를 규명하였다. 또한 효율적인 경로안내를 위해 사용자 평형(User Equilibrium)경로안내전략과 시스템최적화(System Optimal) 경로안내전략을 이상형 교통망(Idealistic Network)을 통해 비교분석하였다. 여기에는 현재 ITS-America에서 System Architecture 평가를 위해 사용한 INTEGRATION이라는 ITS Simulation Model과 그 통행저항함수를 사용하였다. 이를 토대로 돌발적 교통혼잡상황 아래서 사용자평형 경로안내를 제공할 경우 야기될 수 있는 Braess` Paradox 문제와, 총통행시간을 최소화하기 위한 시스템최적 경로안내를 제공할 경우 일어날 수 있는 사용자 호응도(User Compliance)문제를 동시에 고려한 적응형 동적경로안내 알고리즘을 개발하였다. 여기에는 돌발적 교통혼잡하에서 통행시간을 동적으로 예측하기 위해 이산형 확정적 대기행렬모형(Discrete Deterministic Queueing Model)이 사용되었다. 한편 알고리즘의 효율성을 평가하기 위해 이상형 교통망과, 실제 미국 Virginia 주의 Fairfax County에 소재한 주간 고속도로 66번(I-66)과 인접 교통망의 교통자료를 사용하여 각종 돌발교통 혼잡 상황을 전제로 한 Traffic Simulation과 정보제공시나\리오를 INTEGRATION Model을 이용해 실행하였다. 그 결과 적응형 알고리즘이 개개인의 최단시간 경로를 제공하는 사용자 평형 경로안내전략에 비해 교통혼잡도와 정체시간의 체류정도에 따라 3%에서 10%까지 전체통행시간을 절약할 수 있다는 결론을 얻었다.

• Journal of Preventive Medicine and Public Health
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• 제36권2호
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• pp.147-152
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• 2003

Objectives : To develop a Diagnosis-Related Group (DRG) fraud candidate detection method, using data mining techniques, and to examine the efficiency of the developed method. Methods ; The Study included 79,790 DRGs and their related claims of 8 disease groups (Lens procedures, with or without, vitrectomy, tonsillectomy and/or adenoidectomy only, appendectomy, Cesarean section, vaginal delivery, anal and/or perianal procedures, inguinal and/or femoral hernia procedures, uterine and/or adnexa procedures for nonmalignancy), which were examined manually during a 32 months period. To construct an optimal prediction model, 38 variables were applied, and the correction rate and lift value of 3 models (decision tree, logistic regression, neural network) compared. The analyses were peformed separately by disease group. Results : The correction rates of the developed method, using data mining techniques, were 15.4 to 81.9%, according to disease groups, with an overall correction rate of 60.7%. The lift values were 1.9 to 7.3 according to disease groups, with an overall lift value of 4.1. Conclusions : The above findings suggested that the applying of data mining techniques is necessary to improve the efficiency of DRG fraud candidate detection.

• 대한교통학회지
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• 제22권2호
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• pp.121-130
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• 2004

통행자들에게 과거, 실시간 혹은 예측 노선 정보 제공을 위한 정보 생성과 교통정보에 의한 교통영향 분석이 가능한 시뮬레이션 프로그램 개발에 관한 연구가 ITS 분야의 활발한 연구와 함께 과거 10여년에 걸쳐 진행되어 왔다. 또한 링크기반(link-based)이 아닌 경로기반(Path-based)인 동적 확률적 노선배정 기법이 ITS 정책의 교통체계 상의 영향을 분석하는데 적합성이 높고, 또한 현실적 현상에 대한 설명력이 높다고 고려되어 이 분야에 대한 연구가 역시 활발해지고 있다. 이와 같은 현실적 노선정보의 생성, 교통체계분석을 위한 시뮬레이션 프로그램 개발 및 확률적 노선배정 기법 개발을 위한 핵심적 알고리즘 중의 하나가 합리적인 다경로 탐색 알고리즘인 것이다. 다경로 탐색 알고리즘에 대한 필요성과 요구가 커짐에 따라 현재까지 K-shortest path 알고리즘에 관하여 여러 학자들이 연구하여 왔다. 기존 연구 대부분의 알고리즘이 링크 제거 방법, 링크 저항가중 방법 및 시뮬레이션 방법에 의한 것이거나, 노선선택의 기준을 다양하게 변화시키는 방법 등을 적용하여 다경로를 탐색하는 방법을 제안하였다. 하지만 아직도 이 중에 어떠한 방법도 학자들 간에 공론화되어, 실무적으로 보편화되어 적용하는 방법은 없다고 고려된다. 본 연구에서는 기존의 K-shortest 탐색 알고리즘보다는 좀 더 행태적 접근방법을 접목시키는 다른 접근방법을 제안하였다. 즉 링크를 제거하는 등과 같이 교통 네트워크를 변경하지 않으며, 링크의 속성을 임의적으로 변경하지도 않으면서, 노선 선택의 동일한 기준을 일관되게 적용하면서도 다경로를 탐색하는 알고리즘을 제안하였다. 제안된 알고리즘의 핵심은 각 노드에 도달하는 각 방향별 경로에 대해 "이성적 한계범위(rational upper boundary)"라는 통행자들의 행태적 개념을 도입하여, 합리적인 대안 경로의 집합을 선정하는 방법인 것이다. 기존에 개발된 수정형 덩굴망 최단경로 탐색 알고리즘을 기반으로 한 다경로 생성 알고리즘을 제안하였다. 또한 본 논문에서는 다경로 생성 알고리즘의 개념의 이해를 돕기 위해 단순 네트워크를 예제로 합리적 대안경로 집합을 역추적 생성하는 과정을 단계별로 추가 설명하였다.