• Quality Improvement in Health Care
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• v.7 no.1
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• pp.46-58
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• 2000

Background : Despite favorable effects of guidelines on patient care, guidelines often fail to achieve their objectives. Poorly implemented medical practice guidelines can produce only weak effects on the process of health care delivery. Therefore, we performed this study to investigate barriers related development of clinical practice guidelines. Methods : Cardiopulmonary resuscitation was selected as a target problem. Self questionnaires about management of cardiopulmonary resuscitation were developed by a researcher with advisory 8 experts. The questionnaires were designed as a unstructured methods. The data were collected from March 1 to May 31, 1999. A total 50 death case admitted inpatient to Inha University Hospital were subjected to evaluate the development and application of clinical practice guidelines for cardiopulmonary resuscitation. The data were examined by frequency, t-test with SPSS. Result : The article reviewed several common barriers that might limit successful implementation of guidelines in clinical practice, as illustrated by evaluating recommendations for cardiopulmonary resuscitation clinical practice guidelines. Some major problems with guidelines were characterized as follows (1) ethical problem : euthanasia, (2) occurrence on various emergency event and setting, (3) non-medical problems (4) unreliable of medical record etc. Conclusion : Careful analysis of guideline attributes, anticipated effect on medical care, and organizational factors revealed several barriers to successful guideline implementation that should be addressed in the design of future guideline-based interventions.

• Perspectives in Nursing Science
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• v.6 no.1
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• pp.77-83
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• 2009

The number of nurses per bed at acute-stage hospitals is quite low in Korea compared with other OECD countries. In order to prevent the degradation of the quality of inpatient nursing services due to insufficient nurse staffs, the national health insurance introduced the differentiated nursing care fee system. This did not work as a motive for inducing the employment of nursing staff due to insufficient cost compensation. Because of insufficient nursing staff, family members have to stay with the patient or patients have to hire a personal care attendant. This increases the burden and cost to families. For the activation of hospitals without guardians, there should be policies for raising additional nursing staff such as standardizing jobs among nursing staff, particularly between nurses and nursing assistants, setting adequate standards of staffing in nursing according to medical service, substantiating the cost of nursing under the differentiated nursing care fee system, improving the medical fee system of hospitals without guardians including health insurance payment, supplying nursing staff stably through improving their working conditions such as providing child rearing services and salary increase, clarifying the qualification of personal care attendants working at acute.stage hospitals, developing indexes for assessing the quality of nursing care services, and monitoring for the management of uniform quality.

• Journal of Korean Academy of Nursing
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• v.39 no.5
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• pp.741-750
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• 2009

Purpose: The purpose of this study was to identify the prevalence of cognitive impairment, behavioral problems, and the state of mental health for elderly Korean people who have been institutionalized. Methods: A cross-sectional, nationwide survey was performed using an anonymous questionnaire. The participants in this study were 2,521 institutionalized elderly Korean people. A proportional stratified random sampling method was employed. Results: 1) Elders admitted to subacute hospitals and long term care (LTC) facilities showed a higher level of cognitive impairment compared to elders admitted to acute care hospitals. 2) Elders confined in LTC facilities showed a higher level of behavioral problems compared to elders in acute or subacute hospitals. 3) Elders admitted to subacute hospitals and LTC facilities showed more serious mental health problems, such as depression or suicidal ideation, compared to elders in acute care hospitals. Conclusion: The results of this study indicate that the severity of cognitive-behavioral or mental health problems do not match well with type of care setting. Therefore, health personnel working with elderly people should be provided guidance on detection and management of cognitive-behavioral and mental health problems. The necessity of a decision support system for eligibility and placement in long-term care is also discussed.

• Korean Journal of Health Education and Promotion
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• v.16 no.1
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• pp.137-148
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• 1999

The necessity of school health promoting projects is well known to many researchers, however, there is a lack of research on the development of strategies for school health programs and the evaluation of the effectiveness of the programs. The results of our previous study in 1996 identified poor eyesight as one of the several health problems among elementary school children in urban areas. The main objective of this study is to develop, implement, and evaluate vision care for elementary school children. The research method utilized a quasi experimental design using non-equivalent group, pre-post comparison. The sample consisted of all second grade children in two elementary schools in Kyung-giProvince. In order to prevent a contamination effect of the vision care program, one school was selected as a control and the other school was selected as a treatment group. The experimental school had 467 children and the control school had 402 children. The visual acuity of children in both group was measured and a survey questionnaire was sent out to parents on the knowledge, attitude, and behavior related to vision care before the program was implemented. The children of the experimental school received the following programs; separate education on proper nutrition and care of eyesight for children and parents, daily eye exercises using video tape, and an essay and poster contest on healthy eyesight. The eye exercise program lasted from March, 1997 to November, 1997. On November, 1997, visual acuity was measured again from children in both schools. The data was analyzed by using SAS statistical package. The results indicate that the children in the experimental group had significantly (p〈0.001) better eyesight than the children in the control group. Also, some of the behavior highly related to the poor eyesight are poor maternal eyesight and watching TV from a short distance. In conclusion, one of the significance of this project is that the vision care program was developed after the need assessment. It will be encouraged in the future that more school health program should be developed after a need assessment. Also, inclusion of family members was important in health promoting projects within a school setting since healthy behavior needs to be reinforced at horne as well as at school.

• Health Policy and Management
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• v.29 no.4
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• pp.445-453
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• 2019

Background: This study is to investigate the association between the distribution of multimorbidity and length of stay and medical expenses among inpatients in a municipal hospital to achieve an integrated care setting. Methods: We used the exploratory factor analysis and the generalized estimating equation model to analyze the data from patients living in the northeast region of Seoul, who were hospitalized from January 2017 to December 2017 in a municipal hospital. Results: As a result of the factor analysis, seven types of multiple chronic diseases were classified. Among the elderly patients admitted to municipal hospitals, the burden of medical expenses was mainly influenced by the length of stay (B=310,719, p-value <0.0001), not the type of disease (all not significant). Length of stay were mainly due to psychiatric illness (factor 1: B=4.323, p-value <0.0001) related to the brain and metabolic diseases (factor 2: B=2.364, p-value=0.003). Conclusion: This study showed that the medical expenses of the elderly patients were largely due to prolonged hospitalization, not multimorbidity. Therefore, it is necessary to develop an integrated care paradigm strategy cope with the multimorbidity of the elderly in the community and to alleviate the socio-economic burden.

• Journal of The Korea Institute of Healthcare Architecture
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• v.27 no.4
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• pp.51-60
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• 2021

Purpose: Tuberculosis(TB) care unit in public health center should be carefully considered to be re-designed as an infection safety environment for both patient and healthcare workers. So, for the enhancement, this study analyses the facility requirements for co-using the screening clinic as a TB and other respiratory disease care unit. Methods: Not only screening clinic facility guidelines from "A Study for Standard Triage Design and Construction Document" but also the guidelines of TB care and related medical facility are reviewed; KDCA, CDC, ECDC and WHO as a TB care, and FGI and NHS for facility. The facility requirements are summarized space, approach, and mechanical requirement in order. By comparing the summary and screening clinic facility guidelines, supplementations are proposed for TB care unit setting. Results: The result of this study shows that both the space program and mechanical requirement of the screening clinic and that of TB care unit are almost identical and could be share, which include direct airflow or negative air pressure in an exam room. To increase functional and economical efficiency, however, it is necessary to consider a multi-functional negative pressured room, So care process may be re-designed based on a room type; face-to-face room or glass wall inbetween. Implications: The facility guidelines for TB care unit of a public health center should be developed to build a safe environment for infection control by reflecting its medical plan and budget.

• Korean Institute of Interior Design Journal
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• v.27 no.2
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• pp.186-195
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• 2018

In Korea, there is a need for safe and convenient elderly housing so that older people can enjoy a good quality of life and perform various daily activities while they maintain their health and well-being. Thus, this study is to suggest community -based housing settings for the elderly. We analyzed living space characteristics of the Continuing Care Retirement Communty(CCRC) in the U.S. In particular, we focused on CCRCs in the Oregon area and examined two types of settings: 1) a tower setting and 2) a town setting. The CCRC living arrangements include independent living, assisted living, nursing care, and memory care. We visited six CCRCs in Oregon during January through May in 2015. The field observations and floor plan surveys were conducted for data collection. The data analysis revealed that there are two types of arrangements: the suburban type and the urban type. Element analysis of the living unit designs for each CCRC type demonstrated typical space configurations. It was found that home care services were provided from local communities. It is suggested that community-based housing for the elderly should include mixed housing types so that community facilities can be shared. Medical services in the community were offered through healthcare institutions, disease prevention centers, welfare centers, and sports facilities. In order to apply these community-based care systems to elderly Korean housing, it is important to develop a community based on independent homes that share services and welfare facilities.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.8 no.2
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• pp.148-158
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• 2001

Purpose: This study is to investigate the attitudes on the Home Health Care among the physicians and nurses in P University. Method: Data were gathered from 71 physicians and 264 nurses. working at P University Hospital. from May 1 to May 15, 2001 and analyzed using descriptive statistics and Fisher exact test. Results: 1) As to the previous information about home health care program, those who have been familiar to it were 100% of physicians, and 99.6% of nurses, and 39% of the physicians and 66.1% of the nurses. were found to have responded with right answers, 2) As to the acceptance of the home health care program, 87% of physicians and 98.5% of nurses were found to be positive and there showed a significant difference(p= .019), 3) The main reasons for accepting the system were: the alleviation of the family burden of time, the maintenance of continuity of care, and the reasons for opposing the system were incomplete legal assurance. the possibility of providing illegal medical services. 4) The physician's intention rate of patient referrals to home care program reveled 49.2%. 5) According to the services related to Home Health Care. the orders of acceptance rates were medical tests related services (77.8%, 92%); therapeutic nursing interventions(69.0%, 88.2%): and services for medication(68.3%, 82.5%) among physicians and nurses. respectively. Conclusion: For the stabilization and successful implementation of home health care system. it should be accompanied with education for physicians about home care. setting specific laws and regulations for home care. legal assurance of home care business. outcome research for home care recipients. and support systems of hospital administration.

• Health Policy and Management
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• v.14 no.2
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• pp.34-57
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• 2004

Universal health insurance normally requires a basic benefit package, whose design intersects with almost all other aspects of the health insurance debate. Despite its central importance, basic benefit package has not received the analysis it deserves in Korea. The issue of how to decide which health services should be delivered and to whom has been a matter for consistent policy debate. Many industrialized countries observed in this study have been dealing explicitly or implicitly with the basic benefit package. The methods vary from having a specific positive list of services (Bismarkian countries) to the use of guidelines (Beveridgian countries). The purpose of this paper is to form the underlying principles and process for determining what is included or left out by getting accurate and representative responses from health-related personnel. Mail survey is used. Economic burden for treatment, seriousness of disease and urgency of treatment are ranked at the first three priorities. Services that had been suspended because of financial crisis in health insurance scheme in 2001 were selected as items which should firstly be expanded into coverage. Diagnostic test against heart disease and vaccination were also selected as items which should additionally belong to the list of covered services.

• Journal of The Korea Institute of Healthcare Architecture
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• v.14 no.3
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• pp.23-33
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• 2008

The purpose of this study was to propose the Guidelines for the Program and Space of Adult Day Care Center. Recently the Adult Day Care Center is extremely on demand caused by the increasing population of the elderly. In order to provide the affordable and efficient rehabilitation program the architectural setting should be turned to that purpose. In particular, the adult day center program must have the programs for three kinds of the elderly in terms of health status, for example, Altzheimer's disease, paralysis, and sickly elderly. Therefore this study propose the way of planning the program and spaces to give the appropriate care for Adult Day Care Center.