• 제목/요약/키워드: Health Insurance Review & Assessment Service

검색결과 491건 처리시간 0.028초

국내 요양병원의 감염병 입원환자 실태 분석 (Status of Infectious Disease Inpatients at Long-Term Care Hospitals in Korea)

  • 방찌야;이한주;손예동
    • 한국산학기술학회논문지
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    • 제21권9호
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    • pp.134-143
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    • 2020
  • 본 연구의 목적은 국내 요양병원에 입원한 감염병 환자의 실태를 파악하기 위함이다. 본 연구는 국내 요양병원에 입원한 감염병 환자의 실태를 조사하기 위한 서술적 조사연구이다. 798개의 요양병원을 대상으로 14개 감염병에 대해 2016년 1월 1일부터 2017년 12월 31일까지 2년 동안 지속적으로 운영된 요양병원에 입원한 감염병 환자수, 내원일수, 총 진료비 현황을 조사하였다. 2016년에 비해 2017년에 감염병 환자수, 내원일수, 총 진료비는 증가하였고, 요양병원에 많은 감염병은 클로스트리듐디피실리에 의한 장결장염, 인플루엔자, 옴이었다. 또한 연도별로 감염병이 발생한 요양병원 수를 확인한 결과, 인플루엔자, 클로스트리듐디피실리에 의한 장결장염, 카바페넴계내성 감염증이 발생한 병원이 2016년에 비해 2017년 증가하였다. 병상수에 따른 환자수는 150병상 이상 300병상 미만인 군이 가장 많았다. 따라서 요양병원에 많이 발생하는 클로스트리듐디피실리에 의한 장결장염, 인플루엔자, 옴에 대한 관리방안이 집중적으로 이루어져야 하며, 해당 질병에 대한 감염관리방법과 교육 등 가이드라인을 제공하는 것이 도움이 될 것이다. 또한 300병상 미만 요양병원에서의 감염관리를 위해 요양병원에 적용 가능한 감염감시기준을 마련하고, 감염관련시설 및 인력 확충을 지원하는 등 감염관리 시스템 구축이 필요하다.

소아 급성상기도감염 합병증 진단의 공급자간 편차 (Provider Variation in Diagnosing Complications of Upper Respiratory Infection in Korean Children)

  • 최혁용;박정후;유도영;임명길;김민아;김남길;조현주
    • 대한예방한의학회지
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    • 제17권1호
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    • pp.181-197
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    • 2013
  • Objectives : This study aimed to assess the differences in treatment behavior by reviewing data of a medical institution that studies treatment behavior in URI and assessing the treatment efficacy in Korea. Methods : We analyzed the behavior of medical customers and providers of upper respiratory infection medications using the NPS published by the Health Insurance Review Assessment Service. We created an operational definition for complications, and confirmed the difference in complication distribution between medical specialties. We also performed a multivariate analysis using a mixed model to elucidate the factors influencing the occurrence of complications. Results : The outcomes of analyzing factors to influence the difference in practice patterns of the diagnosing URI between the physicians are as follows; (1) Analysis of antibiotics prescriptions rate showed significant difference from medical departments (pediatrics; 49.7%, internal medicine; 54.2%, otorhinolaryngology; 69.6%, family medicine; 61.6%, general surgery; 57.5%, p<0.001). Analysis of steroid prescriptions rate showed significant difference from medical departments (pediatrics; 3.8%, internal medicine; 4.5%, otorhinolaryngology; 5.4%, family medicine; 3.0%, general surgery; 11.2%, p<0.001). (2) In patients who visited medical institutes with the common cold, the complication distribution differed according to the medical specialty, which suggests that specific complications arise depending on the particular medical specialty (p<0.001). (3) Moreover, through multivariate analysis, we found that the complication rate is higher in clinics than in hospitals, depending on the institute's size. (p<0.001; odds ratio of 4.67 in clinics than in hospitals, 95% CI 2.66-8.21) Conclusions : We observe a deviation between the behavior of patients diagnosed with URI and medication providers. This may arise from the interaction between providers and consumers, wherein the complications are associated with the choice of outpatient department and the prevention of cutting incentives. These findings suggest that the health policies should be improved to prevent inappropriate medical practice in the treatment of pediatric URI.

양성전립선비대증 증상 조절을 위해 투여되는 알파차단제의 골절위헙 (The Risk of Fracture with Taking Alpha Blockers for Treating Benign Prostatic Hyperplasia)

  • 이중엽;최남경;정선영;김예지;성종미;오승준;박병주
    • Journal of Preventive Medicine and Public Health
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    • 제42권3호
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    • pp.165-170
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    • 2009
  • Objectives : We evaluated the risk of fracture associated with hypotension-related adverse drug reaction caused by taking alpha blockers to treat benign prostatic hyperplasia (BPH). Methods : We used the Health Insurance Review and Assessment Service database from January 1st 2005 to June 30th 2006 for this study. The male patients with BPH and who had a prescription for alpha blockers following any fractures were defined as the cases. We set the 20 day long hazard period prior to the index date and the four control periods whose lengths were same with hazard period. After 1:4 matching of the hazard and control periods, conditional logistic regression was used to calculate the odds ratios for the risk of fractures as related to the alpha blocker exposure. Results : Doxazosin and tamsulosin showed the increased risk of fractures, whereas terazosin did not. After stratification using the defined daily doses, a protective effect was shown for the patients who took terazosin at the doses lower than 0.4 DDD and the hazardous effect at the doses higher than or equal to 0.4 DDD. There was no significant difference for the risk of patients taking tamsulosin at the doses higher than 1.0 DDD but there was a statistically significant increase in the risk at the doses higher than or equal to 1.0 DDD. Conclusions : Alpha blockers for BPH may increase the risk of fracture in elderly patients who have comorbidities and take the concomitant medications. Alpha blockers need to be prescribed with caution, although some have high prostate specificity.

한의 표준임상진료지침 및 한의 표준임상경로에 대한 한의사의 인식 (Korean Medicine Doctor's Perception in Korean Medicine Clinical Practice Guideline and Korean Medicine Cliniical Pathways)

  • 김동수;안해인;권수현;안은지;김남권
    • 대한예방한의학회지
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    • 제26권2호
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    • pp.55-67
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    • 2022
  • Objectives : This study is aimed to survey Korean Medicine Doctors's perceptions in Korean Medicine Clinical Practice Guideline and Standard Korean Medicine Clinical Pathways for its spread(to increase utilization in clinical sites). Methods : The research population was set at 14,831 Korean medical institutions registered with the Health Insurance Review and Assessment Service for sampling representative of Korean Medicine Doctors, and the final 2,007 subjects were selected in consideration of the research period and budget. This survey was conducted based on a telephone survey, and in some cases, a fax or e-mail survey was also conducted together. Six questions were asked about the perception of 'Korean Medicine Clinical Practice Guideline and Standard Korean Medicine Clinical Pathways', and three questions about the characteristics of the respondent. Results : The rate of recognizing Korean Medicine Clinical Practice Guideline was 36.1%. Those who worked at Korean medicine hospitals, were under 39 years of age, and had less than 11-20 years of experience as an Korean medical doctor were more likely to be aware of it. Regarding the experience of using Korean Medicine Clinical Practice Guideline, the rate of 'not used in the past and not used now' was very high at 82.9%, but the intention to use it in the future was high at 60.7%. About the Korean Medicine Clinical Pathways, 79.9% of respondents answered that they did not know. 80.6% of respondents recognized the need for the development of clinical manuals such as Korean Medicine Clinical Practice Guideline and Standard Korean Medicine Clinical Pathways. Conclusion : Their low awareness of Korean Medicine Clinical Practice Guideline seems to affect its low utilization. Therefore, active education and public relations are required in the future.

소아치과 전문의 인력 현황 및 공급 적정성에 관한 연구 - 급여 진료 항목을 기준으로 (A Study on the Current State of Pediatric Dentists and the Adequacy of Supply and Demand Based on Covered Services)

  • 임여원;채용권;이고은;남옥형;이효설;최성철;김미선
    • 대한소아치과학회지
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    • 제50권3호
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    • pp.360-372
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    • 2023
  • 본 연구의 목적은 소아치과 전문의 인력 현황을 파악하고 만 19세 미만 환자의 연간 치과 이용량과 소아치과의사의 진료 생산성을 바탕으로 소아치과 전문의 인력 공급의 적정성을 평가하는 것이며 향후 정책 수립을 위한 의견을 알아보고자 하였다. 소아치과의사들을 대상으로 온라인 설문조사를 통해 '일반적인 특성', '연간 진료 횟수 및 근무 일수', '급여진료 비율', '전문의 수급 인식'에 대한 응답을 수집하였다. 대한소아치과학회, 건강보험심사평가원, 국민건강보험공단, 국가통계포털을 통해 소아치과의사 현황 및 진료 청구 횟수, 연간 출생아 수 감소 등을 조사하였다. 진료과목을 소아치과로 표방하는 치과는 전체 의료기관의 절반에 달했지만 실제 소아치과 의사가 근무하는 곳은 3.78%에 불과했다. 전체 소아치과의사의 61.36%가 수도권에 집중된 지역적 불균형을 보였다. 지난 20년 동안 소아청소년 인구는 지속적으로 감소했지만, 급여 진료 청구 횟수는 지속적으로 증가하고 있다. 지난 10년간 소아치과 전문의 적정 공급량은 4,000명 내외로 유지되었다. 소아치과 의사의 92.15%가 정부 차원의 정책 마련과 지원 방안이 필요하다고 생각하였다. 본 연구가 향후 소아치과 전문의 수요예측 방법 확립을 위한 기초자료로 활용될 수 있기를 기대한다.

An Analytic Case Study on the Management of an Upper-level General Hospital(2010-2012)

  • Park, Hyun-Suk;Lee, Jung-Min;Baek, Hong-Suck;Lee, Jun-Ho;Park, Sang-Sub
    • 한국임상보건과학회지
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    • 제2권1호
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    • pp.1-16
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    • 2014
  • Purpose. For a more efficient hospital management, this study aims to provide basic data so that the hospital management and staff in charge of hospital administration may systematically classify and collect hospital information, by analyzing the ordinary characters of an upper-level general hospital system and its common-type balance sheet, common-type profit and loss statement and financial ratio. Methods. By using information about an upper-level general hospital in C Province, provided by Alio(www.alio.go.kr), a public organization information provision site, Health Insurance Review & Assessment Service(www.hira.or.kr) and Ministry of Health and Welfare(www.mw.go.kr), this study analyzed 3 year's data from 2010 to 2012 and provided basic data by analyzing the ordinary characters of an upper-level general hospital system, and its common-type balance sheet, common-type profit and loss statement and financial ratio. Results. After analyzing the ordinary characters, common-type balance sheet, common-type proft and loss statement and financial ration of this general hospital, based on the 2010 to 2012 data, this study came to the following conclusions. Firstly, out of all the 1,069 hospital staff, there were 272 doctors working for 24 medical departments, out of whom the majority was 33 physicians. Most of the nurses were third-class ones, and about 2,000 outpatients and 600 inpatients on average were treated per day. Secondly, as a result of analyzing the common-type balance sheet, this study discovered that intangible assets out of fixed assets accounted for 41%, the majority, out of which usable and profitable donation asset buildings were of great importance, and the liquid assets increased more in 2012 than 2011. In the financial structure, the ratio of liquid liabilities was over 50% out of all the liabilities in 2012, and the ratio of purchase payables was high as well. The ratio of fixed liabilities reached up to 40%, out of which the retirement benefit appropriation fund was quite high. The capital was over 80%, but the surplus was in a deficit state. Compared to the capital, the ratio of total liabilities was about 90%, which indicates the financial structure of this general hospital was vulnerable. Thirdly, as a result of analyzing the common-type profit and loss statement, this study found out that the medical profits from inpatients were higher than profits from outpatients. The material cost was related to the medical quality of this general hospital, and it was as high as 30% out of the total costs and was about 45% of the labor cost. This general hospital showed 10% in the ratio of non-medical profits, and it seemed because of government subsidies. The ratios of medical profits and current net income were gradually changing for the better in 2012, compared to 2011. Lastly, as a result of analyzing the financial ratio, it was found that the liquidity ratio kept decreasing, from 110.7% in 2010 and 102.0% in 2011 to 77.2% in 2012. Besides, it was analyzed that the liquidity ratio and the net working capital ratio greatly decreased, while the quick ratio and the liquid ratio kept decreasing. Conclusions. 1. It is necessary to take the risk management into more consideration, and particularly, it is needed to differentiate and manage the levels of risk in detail. 2. By considering the fact that investments into hospital infrastructures were mostly based on liabilities, it is needed to deal with the scale of losses when evaluating risks. 3. By reflecting the character that investments into hospital infrastructures were based on liabilities, it is necessary to consider the ratio of ordinary profits as well as the ratio of operating profits to sales, and it is also important to consider sales productivity factors, such as the sales amount per a sickbed, by comparing them with other hospitals. As for limitations of this study, there may be some problems in terms of data interpretation because of the lack of information about the number of inpatients and the number of outpatients per year, which are needed for the break-even point analysis. Besides, to suggest a direction for the improvement of hospital management through analyses, non-financial factors should be reflected, such as the trend of economy, medical policies, and politic backgrounds. However, this study only focused on the common-type balance sheet, common-type profit and loss statement and financial ratio, so this study is actually limited to generalizing all the factors by analyzing public data only.

선천성 식도폐쇄 수술 후 열공탈장의 호발과 그 유발인자 (High Incidence of Hiatal Hernia in Esophageal Atresia and Its Etiologic Factors)

  • 손해영;장은영;장혜경;오정탁;한석주
    • Advances in pediatric surgery
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    • 제17권2호
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    • pp.170-178
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    • 2011
  • Hiatal hernia is a very rare disease in the pediatric population. However information from our esophageal atresia postoperative follow-up program has hypotheses; "Hiatal hernia may more frequently occur in postoperative esophageal atresia patients (EA group) than in the general pediatric population (GP group)" and "The tension on the esophagus after esophageal anastomosis may be an important etiologic factor of hiatal hernia in EA group". To prove the first hypotheses, we compared the incidence of hiatal hernia in the GP group with the incidence in the EA group. The Incidence in the GP group was obtained from national statistic data from Statistics Korea and Health Insurance Review and Assessment Service of Korea. The incidence in the EA group was obtained from the medical record and the imaging studies of our esophageal atresia postoperative follow-up program. To prove the second hypothesis, the presumptive risk factors for the development of hiatal hernia in EA group, such as the type of esophageal atresia, degree of esophageal gap, the stage operation and the redo-operation with resection and re-anastomosis of esophagus were analyzed statistically. The total number of patients in the EA group was ninety-nine and there were 5 hiatus hernias. The incidence of EA group (5 %) is significantly higher than incidence of GP group (0.024 %). (p=0.0001) The statistical analysis of the presumptive risk factors for hiatal hernia development in EA group failed to show any evidence of correlation between postoperative esophageal tension and the hiatal hernia. This study shows that the postoperative patients with esophageal atresia have high occurrence of hiatal hernia and should be followed up carefully to detect hiatal hernia.

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지역사회획득 폐렴의 치료지침 권고안 (Treatment Guidelines for Community-acquired Pneumonia in Korea: An Evidence-based Approach to Appropriate Antimicrobial Therapy)

  • 송재훈;정기석;강문원;김도진;배현주;서지영;심태선;안중현;안철민;우준희;이남용;이동건;이미숙;이상무;이영선;이혁민;정두련
    • Tuberculosis and Respiratory Diseases
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    • 제67권4호
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    • pp.281-302
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    • 2009
  • The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.

주거관련 협동조합의 창업유형화 및 조성방안 (Start-up Typology and Building Scheme for Housing Related Co-operatives)

  • 김민균;오동훈
    • 벤처창업연구
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    • 제9권6호
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    • pp.79-89
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    • 2014
  • 본 연구의 목적은 해외 사례 및 국내 유사 분야의 협동조합을 대상으로 활동현황을 파악하고, 국내에서 어떠한 형태의 주거와 관련되는 협동조합들을 창업할 수 있는지 이를 유형화하며, 이들을 성공적으로 조성하기 위한 필요한 요소들을 찾아 국내 주거관련 협동조합의 조성에 적합한 시사점을 도출하는 것이다. 주거관련 협동조합의 유형을 수행활동을 기준으로 주택신규공급 및 운영형, 기존주택유지관리 및 개선형, 주택설계 및 성능향상형의 세 가지로 구분하였다. 주택협동조합은 국가주택정책의 차원에서 간접적으로 접근할 수 있도록 해야 한다. 즉, 주택협동조합을 직접 조종하여 주택을 공급해야 한다는 차원보다는 자발적으로 일어나는 주택협동조합을 지원하고 간접적으로 방향을 유도하는 형태의 조치가 필요하다. 협동조합의 조직 형태가 절대적인 善이라고 할 수는 없다. 협동조합에 대한 지나친 보호나 지원정책은 오히려 민간시장영역에서 활동하는 기업체들에게 역차별이 될 수 있으며, 협동조합의 차원에서는 이러한 보호를 남용할 수도 있다. 협동조합이 기존의 경제체제를 완전히 대체할 수는 없겠지만, 보완적인 차원에서 자발적으로 노력하는 협동조합 자체의 움직임이 지역경제의 역동성을 촉진할 수 있다는 가능성에 주목할 필요가 있다.

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요양병원 입원 알츠하이머 치매노인의 재원일수 결정요인 분석 (Determinants of Length of Stay in Geriatric Hospitals - Focused on Alzheimer Dementia's Inpatients)

  • 방효중;이광수
    • 한국콘텐츠학회논문지
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    • 제13권12호
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    • pp.900-909
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    • 2013
  • 본 연구의 목적은 요양병원에 입원한 알츠하이머 치매환자의 재원기간에 영향을 미치는 요인을 분석하는 것이다. 분석 자료는 건강보험심사평가원의 2009년 환자표본데이터를 사용하여 추출하였고, 요양병원에 입원한 65세 이상의 노인이면서 알츠하이머 치매로 입원한 178개 병원의 총 538명을 분석에 이용되었다. 요인은 환자 측 변수와 요양병원의 구조특성변수이며, 환자특성변수는 성별, 연령, 중증도를 사용하였고, 중증도는 요양병원 수가처치 코드를 이용하여 5개의 그룹(의료고도, 의료중도, 문제행동군, 인지장애군, 의료경도)으로 분류하였다. 구조특성변수는 병상수, 의사수, 간호사수, 그리고 CT 보유수를 연구모형에 포함하여 분석하였다. 다중회귀분석결과에서 병원의 구조변수는 환자의 재원기간에 통계학적으로 유의한 영향은 없었다. 환자변수 중에서 중증도의 경우 의료고도와 문제행동군에서 통계학적으로 유의한 영향을 미치는 것으로 나타났으나 모두 음의 관계를 갖는 것으로 나타났다. 이는 중증도가 높은 의료고도에서 레퍼런스 그룹인 의료중도에 대해 양의 관계를 가질 것이라는 예상과는 상반된 결과였다. 이러한 결과는 알츠하이머 치매환자의 특성과 병원의 구조적특성이 환자의 재원일수 변이에 큰 영향을 미치지 않는다는 가능성을 시사하고 있다. 요양병원은 일반 급성기 병원과는 다른 환자의 질병 특성을 지니고 있고, 수가 지불체계에 대해서도 다른 특성을 가진다. 특히 최근 대두되는 '사회적 입원' 문제와 같이 환자의 사회경제적인 요인에 의한 변이가 대두되는 시점에서, 재원기간에 영향을 미칠 수 있는 사회경제적인 요인에 대한 연구가 지속적으로 필요할 것으로 보인다.