• The Korean Journal of Health Service Management
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• v.11 no.3
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• pp.23-35
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• 2017

Objectives : This study analyzed the trends of patient costs in 7diagnosis-related groups(DRG) since July 2013 when the government made it mandatory for all hospitals and clinics. Methods : Data were collected from the 7DRG score chart published by the Ministry of Health and Welfare(MoHW) from July 2013 to January 2017. The average value of the weekday relative value scale was multiplied by unit price, referred to as'- "patient costs by disease group"-' and they were analyzed by time series. Results : Patient costs had increased among all patients with a comprehensive disease. Small and medium-sized hospitals (hospitals and clinics) showed a slight increase in patient costs. Conclusions : Enforcement of the Korean diagnosis-related groups has led to management crisis in small and medium-sized hospitals and deterioration medical service quality. To solve this problem, The weekday relative value scale of small and medium-sized hospitals should be increased significantly.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.13-24
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• 2014

This study analyzes the effects of hospital caseload on medical charges and length of stay for inpatients. Hospital caseload, representing the level of concentration of patients, was measured with the Internal Herfindal Index for three diagnosis related group (DRG) codes (appendectomy, operations on anus, and operations on uterus and adnexa). Ordinary least squares regression was used for analysis. Results showed that medical charges per inpatient and average length of stay significantly differed with respect to hospital concentration indices, and that hospital caseload was inversely related to operational performance for appendectomy and operations on uterus and adnexa. The significant negative relationship between concentration index and length of stay may decrease the total medical charges. The results imply that the expansion of the DRG payment system to hospitals will have a negative influence on their gross sales.

• Journal of Korean Academy of Nursing Administration
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• v.18 no.2
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• pp.176-188
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• 2012

Purpose: The purpose of this study was to examine nurses' cognition of the diagnosis related group (DRG) in long-term care hospitals and changes in nursing care after application of the DRG system. Method: This study was a descriptive survey involving 161 nurses working in 12 long-term care hospitals located in Gwangju city and Chonnam area. Data were analyzed using the SPSS 18.0 version program. Data analyses utilized descriptive test, chi-square test, Fisher's exact probability test, t-test, and one-way ANOVA. Result: There was no change in cognition of DRG in 55.3% of the nurses, and 26.1% takes to 'change positively'. More than half of the respondents (57.8%) agreed to the application of DRG. After application of DRG, the nurses responded 'there were changes in nursing care' in 23 of the 25 care items. Two items had an increase in nursing care. Conclusions: No distinct changes in nursing care were evident after DRG application. Therefore, there is need to provide education programs related to DRG for nurse in long-term care hospitals.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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• pp.361-368
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• 1998

In order to evaluate the clinical features of the rcurred patients with temporomandibular disorders, 52 patients were subjected at the Dept. of Oral Medicine, PNUH from 1985 through 1996. As related to gender, duraton and diagnosis, Ll the relate factors-multiple diagnosis, emotinal problem, history of treatment, parafunctional habit, life distrubance, and trauma were analyzed. The obtained results were as follows : 1. The patients with multiple diagnosis were 83 percent and more often seen in women, chronic group and muscle-joint disorder group. 2. Duration of retreatment in chronic group and muscle-joint disorder was longer. 3. The patients with oral parafunctional habits were 89 percent and more often seen in women, chronic gorup, muscle-joint disorder group. 4. the Recurred patients showed 46 percent in history treatment, 42 percent in life distrubances, 39 percent in macrotrauma and 12 percent in emotional problem.

• The Journal of Korean Medicine
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• v.38 no.3
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• pp.185-196
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• 2017

Backgrounds: Inpatient Classification System for Korean Medicine (KDRG-KM) was developed and has been applied for monitoring the costs of KM hospitals. Yet severity of patients' condition is not applied in the KDRG-KM. Objectives: This study aimed to develop the severity classification methods for KDRG-KM and assessed the explanation powers of severity adjusted KDRG-KM. Methods: Clinical experts panel was organized based on the recommendations from 12 clinical societies of Korean Medicine. Two expert panel workshops were held to develop the severity classification options, and the Delphi survey was performed to measure CCL(Complexity and Comorbidity Level) scores. Explanation powers were calculated using the inpatient EDI claim data issued by hospitals and clinics in 2012. Results: Two options for severity classification were deduced based on the severity classification principle in the domestic and foreign DRG systems. The option one is to classify severity groups using CCL and PCCL(Patient Clinical Complexity Level) scores, and the option two is to form a severity group with patients who belonged principal diagnosis-secondary diagnosis combinations which prolonged length of stay. All two options enhanced explanation powers less than 1%. For third option, patients who received certain treatments for severe conditions were grouped into severity group. The treatment expense of the severity group was significantly higher than that of other patients groups. Conclusions: Applying the severity classifications using principal diagnosis and secondary diagnoses can advance the KDRG-KM for genuine KM hospitalization. More practically, including patients with procedures for severe conditions in a severity group needs to be considered.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.53-58
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• 1995

Open lung biopsy still has important roles for the marking of diagnosis of diffuse infiltrative lung disease even though transbronchial bronchoscopic lung biopsy and percutaneous needle aspiration biopsy gain popularity nowadays. This is clinical retrospective review of the 56 patients with diffuse infiltrative lung disease undergoing open lung biopsy by minithoracotomy from 1984 to Dec. 1992 in the Department of Thoracic & Cardiovascular Surgery of Catholic University Medical College. 27 men and 29 women, aged 17 to 73 year [mean 49 year , were enrolled & divided into 2 groups;Group A consisted of patients with immunocompromised state [n=19 , Group B patients with non-immunocompromised state[n=38 . Pathologic diagnosis was made in 54 cases[96.4% of these two groups and as follows: infectious; 12 patients[21.4% , Neoplastic; 10 patients[17.9% , granulomatous; 4 patients[7.1% , interstitial pneumonia; 12 patients[21.4% , Pulmonary fibrosis; 8 patients[14.3% , others; 3 patients[5.4% , nonspecific; 5 patients[8.9% , and undetermined; 2 patients[3.6% . Therapeutic plans were changed in 39 patients[69.6% after taking of tissue diagnosis by open lung biopsy. Group B has higher incidence of infectious diseases and change of therapeutic plan than the Group A. The postoperative complications developed in 8 cases[14.3% ,and there is no difference of incidence between the 2 groups. 4 patients belongs to group A, died of respiratory distress syndrome [2 and sepsis [2 which were not related with open lung biopsy procedure. In conclusion, open lung biopsy is a reliable method to obtain a diagnosis in diffuse pulmonary infiltrates and can be performed safely, even in acutely ill, immunosuppressed patients.

• Journal of Oral Medicine and Pain
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• v.49 no.3
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• pp.57-64
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• 2024

Purpose: The aim of this study is to analyze the final diagnosis and the pain characteristics of patients with suspected nonodontogenic toothache and to contribute to the knowledge on differential diagnosis. Methods: A retrospective analysis was conducted based on medical records from 185 patients. The following data were collected: age, sex, pain characteristics, radiographic results, initial diagnosis and treatment, and final diagnosis and treatment. The final diagnosis and the pain characteristics of the 3 most common final diagnoses were analyzed. Results: Myofascial pain (MFP) was the most prevalent diagnosed condition accounting for 37.8% of cases, followed by pulpal pain (P) at 31.4%, and trigeminal neuralgia (TN) at 18.9%. There were significant differences in age, onset of the pain, and pain intensity across the 3 groups (all p<0.01). TN group exhibited a lower frequency of spontaneous and continuous pain than the MFP and P groups (all p<0.001). The proportion of patients reporting pain alleviating and aggravating factors related to dental pain was significantly higher in the P group than in the MFP and TN groups (all p<0.001). A concordance rate of 57.0% was observed between the initial and the final diagnosis. Twenty-six patients underwent tooth extractions and 24 patients had root canal treatments. Conclusions: It is important to differentiate between dental pain and nonodontogenic toothache to avoid unnecessary dental treatments. Comprehending the pain characteristics of each condition, taking a thorough history taking, and performing diagnostic tests can help differential diagnosis.

• Korean Journal of Oriental Medicine
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• v.14 no.3
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• pp.121-126
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• 2008

Pulse diagnosis refers to the process of diagnosing a patient by feeling an artery on the wrist based on the shape that the pulse take s while the hold-down pressure increase. The styloid process artery on the wrist is usually felt, and the pulse is taken on Chon, Gwan and Cheok using three fingers. This study is to examine the structural difference in the location of pulse diagnosis by measuring and analyzing blood diameter, blood depth, and blood flow velocity of the location of pulse diagnosis by using ultrasonic wave (VOLUSION730 PRO, GE Medical, U.S.A). This study also attempted to grasp whether the characteristics of blood vessels differ depending on Body Mass Index (BMI) and analyzed their correlation with Oriental medical pulse diagnosis. The male subjects without cardiovascular diseases were divided into the normal BMI group, the underweight group and the overweight group and 10 people of each group were measured, Blood depth, blood diameter and blood flow velocity at the location of pulse diagnosis (Chon, Gwan, Cheok) of the wrists of left and right hands were measured and the pulse wave was measured by using pulse diagnosis instrument (3-D Mac, DaeyoMedi, Korea).The results of this study showed that the characteristics of blood vessels differ depending on the degrees of obesity, and the characteristics of floating pulse and sinking pulse of Oriental medical pulses were related to the degrees of obesity. This shows that the characteristics of the blood vessels of subjects and BMI information are the major indicators for diagnosis and are the matters that must always be considered when developing the algorithm of pulse diagnosis.

• Health Policy and Management
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• v.27 no.3
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• pp.211-218
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• 2017

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.

• Health Policy and Management
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• v.30 no.2
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• pp.178-184
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• 2020

Background: Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance. Methods: This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695. Results: The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356). Conclusion: The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.