• 여성건강간호학회지
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• 제21권3호
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• pp.241-251
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• 2015

Purpose: The purpose of this study was to explore preserved belief system supporting Korean immigrant women's Taekyo practices and influencing factors while they observe the tradition within US sociocultural context. Methods: Leininger's exploratory focused ethnographic approach was used. Semi-structured in-depth interviews were conducted with purposive sample of sixteen Korean immigrant women who gave birth in the US within last 6 months. Researcher's observation and reflective field notes were also integrated into the interview data. Leininger and McFarland's four phases of ethnographic analysis guided data analysis process. Results: The perceived belief system supporting Taekyo practices included Taekyo as an enculturated Korean tradition, connecting parents with fetus, and positive impacts on fetal development. And Korean immigrant women's Taekyo practices were influenced by resources of information, woman's orientation toward Taekyo, pressure from local Korean community, and child order. Conclusion: The findings from this research would serve as an important knowledge base to expand US health care providers' understanding of Korean traditional Taekyo practices observed by Korean immigrant women's as important prenatal self-care practices. The findings could also aid in providing more patient-centered and culturally-tailored prenatal care plan to Korean immigrant by including Korean traditional belief system supporting Taekyo practices.

• 한국간호교육학회지
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• 제12권1호
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• pp.115-123
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• 2006

Purpose: This study is purposed to provide basic data needed in constructing the educational contents about cancer pain management for the health care professionals. Methods: This study surveyed the degree of knowledge in cancer pain management of clinical nurses and doctors. Subjects were clinical 143 nurses and 88 doctors in 3 cities. The tool used are 32-item scale for evaluation of health care professionals' knowledge modified by Kim(1997), which was originally developed by McCaffery and Ferrel(1995). Results: The level of the health care professionals' knowledge about and attitude toward pain management were insufficient. The level of the doctors' knowledge and attitude showed higher score than those of the nurses'. The knowledge of health professional who were not hesitated to administrate analgesia was showed more higher than who were hesitated to do. Conclusion: Nurses need more knowledge and effective attitude toward cancer pain management. Various and sufficient educational program about cancer pain management can be contribute to improve the nursing quality of cancer pain.

• 한국치위생학회지
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• 제21권3호
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• pp.211-225
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• 2021

Objectives: To validate the role of a new information and communication technology platform that we created for the betterment of the oral health of persons with disabilities and for providing appropriate health care services. Methods: A Delphi survey was conducted among 16 people in various professions, including academia, government agencies, and dentistry, to evaluate the validity of the information and communication technology platform. Moreover, platform satisfaction was evaluated using a user experience questionnaire among 200 people, including persons with disabilities, parents, and public institutions. Results: Experts in consensus indicated a high validity for the categories of service provider (CV=0.29, CVR=0.69), service target (CV=0.29, CVR=0.38), service contests (CV=0.27, CVR=0.63), and financial support (CV=0.30, CVR=0.63) in our information and communication technology platform. In addition, information from questionnaires on user experience and communication technology satisfaction analysis showed that both users and providers were highly satisfied with the platform. Conclusions: The provision of oral health services based on the new information and communication technology platform has numerous advantages, in addition to providing adequate oral health care for the disabled. Furthermore, the social safety net for improved oral health may be further strengthened.

• 한국의료질향상학회지
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• 제7권2호
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• pp.218-228
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• 2000

Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

• Journal of Preventive Medicine and Public Health
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• 제48권4호
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• pp.188-194
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• 2015

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

• 한국간호교육학회지
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• 제26권4호
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• pp.423-433
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• 2020

Purpose: The purpose of this study was to describe the health care experiences among patients with Parkinson's disease. Methods: Of the qualitative research methods, Colaizzi's phenomenological method was used in this study. A total of nine patients, who were diagnosed with Parkinson's disease and receiving outpatient treatment, were selected as the subjects of this study. Subsequently, data were collected through individual in-depth interview. Results: The four categories obtained as a result were 'strenuous efforts to control my own body,' 'subject of health that no one can replace,' 'focus on the current while expecting a breakthrough in health management,' and 'human dignity that cannot be lost to the end.' Conclusion: The study results are expected to help health care providers deeply understand the experiences in health care among patients with Parkinson's disease and to provide source data for nursing intervention development that can be helpful in managing the health status of patients with Parkinson's disease.

• 보건행정학회지
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• 제22권3호
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• pp.383-402
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• 2012

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(${\pm}0.71$). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

• 산업공학
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• 제17권4호
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• pp.426-439
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• 2004

This research discusses knowledge contents needed to build an OLAP system for medical sector, OLAP functionalities from past studies, and a medical intelligence system which is a kind of OLAP. The knowledge requirements which consist of nine contents and OLAP fundamental functionalities are applied to the system. Most past studies have focused on developing a medical data warehouse rather than OLAP. The medical intelligence system supplies health care providers (i.e., doctors, clinicians, researchers and nurses) and non-providers (i.e., managers and business analysts) with multidimensional OLAP functionalities. The system can be used to gain a deeper understanding of specific medical issues. In this research, we focus not on medical data warehouse, but on the technical challenges of designing and implementing an effective medical intelligence system for health care information. An architecture is applied to developing the medical intelligence system for a medical center in order to illustrate its practical usage. Six packages in the developed system are discussed in this research: Explorer, Analyzer, Reporter, Statistician, Visualizer, and Meta Administrator packages. Evaluation of the system and ongoing research directions conclude the research.

• 여성건강간호학회지
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• 제5권1호
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• pp.133-145
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• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• 보건행정학회지
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• 제23권1호
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• pp.3-18
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• 2013

This paper investigates the possibility of expanding pay-for-performance (P4P) program as a provider payment system, in terms of financial, economical, and political sustainability. In order to expand the sustainable P4P, P4P should have usefulness in terms of economic value as well as efficiency in the financial aspects of health care. More importantly, the P4P would be politically sustainable only when both providers and consumers can accept. Korea's healthcare system seems to have logical ground for the P4P program financially and economically. However, how well the P4P can work remains to be proven in its implementation. After 43 tertiary hospitals applied the P4P program for acute myocardial infarction (AMI) and C-section in 2007, the number of hospitals adopting the P4P program for AMI and C-section has increased to 316 in 2011, and an incentive for hospitals applying the P4P has risen to 2% from 1% of health insurance benefits. This shows that the P4P program introduced by Health Insurance Review and Assessment Service is quite successful. In addition, people are aware of the need for improved P4P program and policy alternatives have been already made. Therefore, it is very important to come up with politically supportable strategies that can make providers and consumers accept the P4P program while maintaining the governance of the existing health insurance policy. To this end, there are some tasks to be considered. First, the expansion of the P4P program should be placed on the agenda of the Health Insurance Policy Review Committee, the highest decision-making body, and a separate agency for P4P planning should be established. Second, for more efficient P4P program, the processes of review and assessment, currently carried out separately, should be integrated into a single process. Third, infrastructure to measure the quality of medical services should be sharply expanded. Fourth, the current paradigm for the assessment should be changed. Lastly, a P4P program for consumers should be considered. Given that the consumers in Korea can use medical services freely, the National Health Insurance Corporation could initiate the P4P program for consumers as a means of controlling excessive use of medical services and adjusting consumer's moral hazard.