• 한국의료질향상학회지
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• 제7권1호
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• pp.118-131
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• 2000

Background : A continuous healthcare quality improvement is needed to provide high quality healthcare service as well as to maintain trust in terms of satisfying the needs of the patients. Recently it also became an essential issue. in hospital management, recognized for it's competitive potentiality among healthcare organization groups. This study was conducted to analyze patient complaints and issues received by the Quality Improvement Department. Its purpose is to improve healthcare qualities within the hospital, as well as establish policies and appropriate strategies in hospital management. Method : From July 1st to September 30th of the year 1999, we analyzed all complaints and issues made by various patients and their families, which were received through 24 hour phone consultation, numerous suggestion boxes, letters and E-mails, The issues were classified into 16 different categories based on a Patient Satisfaction Assessment Tool. All data were segregated according to the departmental frequencies and their contents. To come up with for environmental and patient satisfaction improvement, all complaints or issues were communicated with hospital administrators, medical and nursing staff and employees. Comprehensive customer satisfaction activities including improving phone etiquette were discussed in Customer Satisfaction Team, CQI Team and each Department. All opportunities for improvement were implemented. Feedback actions were discussed. Results : A total of 317 cases were collected. Issues regarding parking and other accommodation facilities were most common complaints that were 14.5% of total. Issues regarding admission rooms (10.7%), admission procedures (10.7%), waiting room environment (8.8%), nurses and nurse assistants (7.6%), physicians (6.6%) and others (23%) followed. Thirteen of 45 departments received more than 8 complaints. The Nursing Department had the most complaint, receiving 9.8% of total complaints. Complaints regarding the Nursing Department were predominantly related to the environment of patient rooms. The Department of Psychiatry for phone etiquette (4.7%), Department of Otolaryngology for the nursing staff's attitude and phone etiquette (4.4%), and the Admission Department followed. As a part of efforts to improve patient satisfaction, a new parking structure was built and reallocation of the parking space was done. Renovation of other accommodation facilities were carried out by hospital administration, Monthly phone call and answering attitude survey was done by QI Department. Based on this survey we made a phone etiquette manual and distributed throughout the hospital. Compare to the last year, Patient Satisfaction Index measured by Korea Productivity Center using National Customer Satisfaction Index was improved 7 points. According to our organization's own study, we confirmed the phone etiquette was improved 11% than last year. Conclusions : Issues related to parking and other accommodation facilities ranked first followed by complaints made regarding the patient care area, the admission and cashier process, and nurses' and doctors' attitude. The Nursing and Psychiatry Departments need improvement regarding phone etiquette. Results were shared and played a vital role in policymaking and strategic planning of the hospital. It is imperative that we keep our database updated by listening to and solving the needs of each patient. The CQI activities can be achieved only by full commitment of the hospital top management supported by related personal.

• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 한국인구학
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• 제4권1호
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• pp.105-130
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• 1981

This study was conducted to compare the characteristics of high performane areas for family planning with that of low performance areas and to find factors which strongly affected contraceptive practice behavior. For the study, eight areas were selected from 274 rural family planning canvassing areas of Korean Population Policy and Program Evaluation Study, which was an action study operated in all areas of Cheju Island from July 1, 1976 until December 31,1979. As a first step of the action study, Cheju Island was devided up 318 family planning canvasser areas Each area was consisted of 200 households in rural district and 300 households in urhan one Duriog the period of project, each canvassing area had been managed by a female family planning canvasser, selected by director of health center considering several individual conditions needed for family planning activities Basic activities of canvassers were to counsell all the eligihie couples in own charged area about family planning methods and also to distribute contraceptives such as condoms and oral pills. In case couples desire to accept sterilization including vasectomy and tubal-ligation, the canvassers played a linking role connecting potential client with family planning field workers. Canvassng areas shows significant differentce in performance for family planning, nevertheless they are supposed to have almost the same conditions regarding family planning distribution channel. Because the purpose of the Cheju project was to eliminate all the problems that existed in governmental distribution system, that is to remove geographic, economic, cognitive and administrative barriers Accumulated performances of family planning methods accepted by residents in each area were calculated by eligible women aged 14-49. And then canvassing areas were ranked according to performance score. Consequently, 4 areas in extremely high and low family planning performance areas were selected respectively. Major results were obtained by comparing characteristics of high performance area with that of low performance areas, which are as follows: 1. The mean number of living children was about the same both in high and low performance areas for family planning. But respondents' mean age (38.5) in high performance areas was higher than that (37.0) in low performance areas 2. Respondents' perception in the expectant educational level of others' children in high performance areas was higher than that in low performance areas, although respondents educational level, monthly expenditure and ratio of children in high school and above was not different. 3. Ratio of ownerships of TV and newspaper in high performance areas was highen than that in low performance areas 4. The duration of canvasser' charge in high performance areas was longer than that of low performance areas, showing the fact that canvassers didn't move cut in high performance areas 5. In high performance areas, canvassers' houses were relatively located in the center part of the village. And so villagers resided in near distances from the anvasser's house 6. 4H clubs' activities in high performance areas were more active than those in low performance areas Therefore it was assumed that cohesiveness of community in high performance areas were stronger than that in low areas. 7. Canvassers' family planning practice rate was higher than that in low performance areas, and also canvassers' human relationship was more sociable than that of canvassers in low performance areas. 8. Fourteen variables which showed relatively high significance level in $X^2$ and F test were selected as independent variables for stepwise regression analysis. According to the results of regression analysis. five of 14 variables-distributors education level ($R^2$=.4439), duration of distributor's charge ($R^2$=.6166), 4H club activities ($R^2$=.6697), canvasser's contraceptive practice ($R^2$=.7377) and location of distributions house ($R^2$=.8010) explained 80.1 percent of total variance.

• 환경정책연구
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• 제4권1호
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• pp.93-111
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• 2005

토양의 질(Soil Quality)에 대한 개념은 과거 식량생산을 위한 기반으로서의 토양에 대한 연구부터 1970년대 후반 Warkentin and fletcher(1977)에 의해 제안된 환경의 구성 요소로서의 토양에 대한 연구에 이르기까지 수많은 변화를 거쳐 왔다. 토양의 질에 대한 개념은 그 관점에 따라 다르지만 토양이 본래의 기능을 효과적으로 수행할 수 있는 용량으로 요약할 수 있다. 국제경제협력개발기구(OECD)에서도 토양의 질을 농업환경의 주요지표로 설정하여 토양유실과 토양탄소를 토양질 평가의 세부지표로 제시하였으며, 각 국가별로 활발한 연구가 수행 중에 있다. 본 논문에서는 현재까지 제안된 토양질의 주요 개념을 살펴보고 국내외의 토양질 평가체계를 비교 분석하고자 하였다. 토양질의 평가 체계는 최소자료군(Minimum Data Set)을 이용한 토양질 지표의 선정, 선별된 지표의 표준점수화함수(Standard Scoring Function), 각 지표의 통합을 통한 토양질의 점수화의 세 단계로 구분하여 분석하였다. 토양의 질 지표는 물리 화학 생물학적 지표로 분류할 수 있으며, 이 중 토양침식, 전용적밀도, 토심, 입단안정화도, 토성, 수분보유력, 유효수분함량은 물리적 질 지표로 주로 사용된다. 화학적 질 지표로는 유기물, pH, 전기전도도, 질소 인산 가리, 중금속 등이 있고, 생물학적 지표로는 미생물탄소 질소, 무기화 가능한 질소, 토양호흡이 주로 사용된다. 또한, 토양질 지표의 직접적인 측정이 어려운 경우에는 토양특성 환산식(Pedotransfer Function)을 이용하여 각 지표의 값을 추정할 수 있다. 현재 선진국에서는 SINDY를 비롯한 다양한 프로그램을 구축하고 있으며, 국내에서도 국가적인 차원의 자료구축을 통해 선별된 최소자료군의 계량화모델을 확립하여 웹기반의 프로그램을 구축해야 할 것이다. 현재까지 토양질의 계량화에 대한 연구는 주로 작물의 수량을 중심으로 이루어졌지만 향후 지속가능한 토양환경의 관리를 위해서는 환경의 질과 인간의 건강을 종합적으로 고려한 토양의 질 지표 개발에 대한 연구가 필요할 것이다.

• Journal of Nutrition and Health
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• 제7권2호
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• pp.53-63
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• 1974

서울시내 아파트중에서 경제적인 수준을 볼 때 상(上), 중상(中上), 중(中), 하(下)의 계등별 특색이 나타날 수 있는 한강 멘숀아파트, KIST 아파트, 문화촌 아파트, 북아현 시민아파트 주민의 일반적인 식새활 현황및 영양과 식품 섭취 실태 조사결과는 다음과 같다. A. 조사대상자(調査對象者)의 일반환경(一般環境) 세대주의 학력이 제일 높은 KIST 아파트가 한강 멘숀 아파트보다 식생활비는 오히려 적은 펀이었으나 가족영양 및 기타 영양문제를 항상 고려하고 계획성 있는 식생활을 하는 경향이었다. 고기류, 생선류의 섭취 빈도는 한강멘숀, KIST, 문화촌 아파트는 하루에 한번 섭취하는 경우가 많은 것으로 나타났다. 조리할 때 조미료나 식품의 양은 대부분 눈짐작으로 하지만, 계량컵, 제량스픈, 저울을 사용하는 경우는 KIST 아파트가 제일 많은 편이었고 식사할 때 개인접시 및 napkin의 사용은 한강 멘숀과 KIST 아파트에서 많은 편이었다. 먹고 남은 음식은 조금 남은 것은 버리는 경우가 대부분이고 냉장고에 식품을 보관할 때는 대개 뚜껑을 덮거나 싸서 넣는 경우가 많았다. B. 영양섭취실태(營養攝取實態) 1인(人) 1일(日) 열량 섭취량은 한강멘숀, KIST, 문화촌, 시민아파트 순으로 경제적인 생활수준과 거의 비슷한 경향을 보여 주었으나 총열량 섭취량중 탄수화물, 지방, 담백질의 비율은 이상 권장량인 탄수화물 65%, 지방 20%, 만백질 15%에 거의 비슷한 경향으로 나타났다. 대체적으로 단백질, Fe, Vit. A, Niacin의 의섭취량은 권장량 이상을 취하고 있으나 Ca, Thiamin, Riboflavin, Vit. C의 섭취량은 권장량에 미달되는 경향이 있었다. C. 식품섭취실태(食品攝取實態) 1인(人) 1일(日) 섭취하는 식품의 양은 북아현 시민아파트가 가장 많고 한강 멘숀아파트가 가장 적게 나타나 경제적인 생활수준 혹은 총 Calorie 섭취량과는 반대되는 경향을 나타내었다. 식품 총 섭취량에 대한 각 식품군의 섭취 비율을 보면 어느 아파트나 곡류의 섭취율이 $45{\sim}50%$로서 가장 높은 수치를 나타냈다. 그외의 식품군 중에는 한강 멘숀과 KIST 아파트는 육류의 성취율이 가장 높았고 문화촌과 북아현 시민아파트는 김치류의 섭취율이 가장 높았다. 채소류와 과일류의 섭취율은 한강 멘숀과 KIST 아파트가 높은 반면 저류의 섭취율은 한강 멘숀아파트가 가장 낮았다. 단백질 급원으로서 한강멘숀과 KIST 아파트는 주로 육류를, 문화촌 아파트에서는 곡류와 생선류를 그리고 북아현 시민 아파트에서는 주로 두류를 많이 섭취하는것으로 나타났다.