• Korea Journal of Hospital Management
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• v.7 no.2
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• pp.99-123
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• 2002

This study was conducted to determine whether follow-up management is carried out continuously following CQI activity and to analyze the factors behind the success and failure of follow-up management. Past presentations from 1994-1999 of CQI coordinators and lecturers from various institutions who presented at The Korean Society of Quality Assurance in Health Care(KoSQA) on the conditions of follow-up management in each institution were analyzed. The results of this study were as follows; Since the number of subjects on CQI increased each year at symposiums, this has expanded to all medical institutions. Although medical institutions usually conduct 11-20 subjects on CQI per year, there were many such occasions where more than 31 subjects were conducted. Moreover, institutions with less than 800 beds have come up with more projects than those with more than 800 beds, thus 23.3% of these institutions had at least 1 person involved in 4 projects. This had created an overload of responsibilities for specific persons' involvement, prompting them to incline toward formalities in their work rather than substantial activities. Among the projects presented at the symposiums, 51.7% demonstrated that follow-up management could be carried out. In particular, 55.3% of the projects from provincial regions could carry out follow-up management compared to 48.8% in Seoul. Moreover, it was demonstrated that 80% of the projects from institutions with 600-799 beds carried out follow-up management most effectively. With regards to previous presentations, the older they were, it was found that follow-up management could not be effectively carried out. Some institutions that responded that follow-up management was carried out effectively in their institutions were found to have conducted follow-up management without any inspection strategies or the appropriate tools. CQI activities were executed and terminated with no consistency and team members had no real concern for it. The most important factors that contribute to an effective follow-up management are the need for concern and interest from the directors of the hospitals, from the relevant departments and team members in addition to the role of the supervising department, follow-up management through management of target goals, consistency in tasks along with communication between all team members. The biggest problems were perceived to be overload of work due to accumulation of proposed projects in addition to lack of awareness pertaining to follow-up management. CQI is beneficial for all staff for the improvement of the mind and business administration and thus it is believed to be desirable. To carry out follow-up management effectively, leadership, analysis and application of information, follow-up management and planning, as well as quality management are perceived to be essential, on the other hand, the results showed a significant difference. To prevent CQI activities from becoming just an activity, the basic system should be reconstructed and augmented based on the problems derived from the results of this study. Moreover, we hope this study will be used as reference material that would encourage the administration of follow-up management after CQI activities in most hospitals. Furthermore, various studies on follow-up management should be conducted for CQI activities in the future.

• The Korean Society of Law and Medicine
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• v.23 no.2
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• pp.171-209
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• 2022

There were also many medical-related rulings in 2021, among which the rulings reviewed in this paper are as follows. The first relates to a case in which the medical record, which is the primary judgment data regarding the presence or absence of medical negligence, has been modified. The court judged whether there was negligence on the basis of the first written medical record without considering the contents of the medical record that was later modified. Next, the ruling on the case of asking for liability for damages for prescription of anti-obesity drugs recognized negligence related to prescription, but denied liability for property damage by denying a causal relationship, and recognized only alimony for violation of the duty of explanation. The a full-bench ruling on the scope of subrogation of the National Health Insurance Corporation, which subrogates the claims for compensation for medical expenses against the perpetrator of the patient, changed the existing precedent that had taken the 'deduction method after offsetting negligence' and judged it as 'the method of offsetting negligence after deduction'. In addition, in the ruling on whether or not there was negligence, the court was not bound by the medical record appraisal result. Lastly, in relation to the National Health Insurance Service's disposition of reimbursement for medical care benefit costs, we reviewed the ruling that discretion should be exercised even when a non-medical person makes a refund to a medical institution opened by a non-medical person. And we also reviewed the ruling that the scope of reimbursement for medical institutions jointly using facilities and manpower specifically should be determined.

• The Korean Journal of Applied Statistics
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• v.28 no.4
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• pp.663-683
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• 2015

The change of the population pyramid due to low fertility and rapid aging threatens the financial sustainability of National Health Insurance. We construct statistical models for prevalence rates and medical expenses using National Health Insurance Service (NHIS) sample cohort data from 2002-2013. We then project yearly expenditures and income of national health insurance until 2060 that considers various assumptions in regards to future population structure and economic conditions. We adopt a VECM-LC model for prevalence rates and the double exponentially smoothing method for the per capita co-payment of healthcare expense (in which the two models are institution-disease-sex-age specific) to project of national health insurance expenditures. We accommodate various assumptions of economic situations provided by the national assembly and government to produce a financial projection for national health insurance. Two assumptions of dependents ratios are used for the projection of national health insurance income to conduct two future population structures by the two assumptions of aging progresses and various assumptions on economic circumstances as in the expenditure projection. The health care deficit is projected to be 20-30 trillion won by 2030 and 40-70 trillion won by 2060 in 2015 constant price.

• Journal of Preventive Medicine and Public Health
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• v.43 no.6
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• pp.523-534
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• 2010

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

• Journal of Convergence for Information Technology
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• v.10 no.9
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• pp.206-214
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• 2020

This study analyzed the impact of direct and indirect subsidies on profitability in general hospitals in Korea. The data were collected from medical institution accounting information disclosure system of 270 general hospitals from 2016 to 2018. The analysis index used the ratio of net profit to business revenue for profitability, and Subsidies index the ratio of subsidies to business revenue(state subsidies for facility investment purposes, Fund related to essential business, research revenue and contribution revenue). According to the study, the ratio of state subsidies, which are direct subsidies, was very high at 57.30 percent for public institution hospitals. ratio of Fund related to essential business, which is a tax reduction effect with indirect subsidies, had the highest at 6.69 percent for Private University Hospitals. which are Indirect subsidies for deficit or operational assistance, research revenue ratio had the highest 2.8 percent for National University Hospitals, contribution revenue ratio had the highest 36.4 percent for public institutions. As a result of looking at the impact of subsidies on profitability, Nation University Hospitals had the lower the ratio of Fund related to essential business and the ratio of research revenue, the higher the net profit ratio of Business revenue. Medical Corporation Hospitals and Foundation Hospitals had the higher the ratio of Fund related to essential business to business revenues, the higher the net profit ratio of business revenue. These results mean that profitability may fluctuate depending on the utilization of funds related to essential business.

• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.221-255
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• 2016

The Russian government enacted the 'Federal Law on the Free Port of Vladivostok' to improve the medical industry in the Far East in 2015. As a result, Korean medical institutions are increasingly interested in advancing into Free Port of Vladivostok. Increased demand for high-quality Korean medical services from Russian patients and the active government policy direction of the Russian government serve as strengths and opportunities for advancing into Free Port of Vladivostok. On the other hand, the legal imperfections caused by the delay in the establishment of sub-regulations for Federal Law on the Free Port of Vladivostok and the low reliability of the Russian government are both weaknesses and threats. Therefore, Korean medical institutions will need to carefully consider the timing of advancing into Free Port of Vladivostok by closely monitoring the process of establishing the sub-regulations of Federal Law on the Free Port of Vladivostok. And it is the most realistic model for Korean medical institutions to establish 'Professional clinic model linked with health screenings(1st stage model)'. The Korean government needs to conclude a 'MOU for Cooperation on Health and Medical Care between Korea and Russia' with the Russian government and should also carry out the 'Korean Minnesota Project'.

• Korean Journal of Social Welfare
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• v.57 no.2
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• pp.5-40
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• 2005

Social welfare centers and residential care facilities where provide the socially disadvantaged with proper social services, face financial difficulties. This is because not only of the lack of governmental support, but also of social welfare centers and residential care facilities' lack of skills in developing abundant resources from the private sector. In this context, this study tried to find factors affecting resource mobilization of the social welfare facilities to devise policies in resource development. Mail survey was conducted with the structured questionnaire. Employees in charge of community resource development were asked to answer the questionnaire. The study population were welfare centers and residential care facilities. A total of 293 community welfare centers and 632 residential care facilities responded to the survey. The response rate was about 62%. The dependent variables of the study were the amount of resource mobilization in the year 2001 which was measured as the number of donors, the total amount of donation, and estimated amount of gift-in-kind. Three types models were constructed per each welfare institution. Independent variables were selected based on the previous research findings: community environment factor, structural factor, and resource development factor. Multiple regression was utilized to analyze the data. The resource development factor turned out to be significant variable in various models. In the models of donors, the amount of donation, and the amount of gift-in-kind (except for the welfare center model), at least one out of six variables of the resource development factors was significant welfare center. Welfare centers which establish the resource development department or hire employees to take care of resource development, utilize computer softwares to file donors, and utilize donor management programs, have more donors and/or donations than their counterparts. In addition, residential care facilities located in urban area have more donors and donations, and among residential facilities those for the disables, those with longer history and more employees, receive more donations than their counterparts. As for the gift-in-kind model, the welfare centers located in high income area and residential care facilities for the elderly, children and mentally retarded receive less gift-in-kind than their counterparts Based on the above findings, this study suggested that to mobilize resources the welfare centers as well residential care facilities need to have community resource development department or resource development staffs, adopt computer software to systematically organize donors, and utilize donor mobilizing and maintaining programs.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.1
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• pp.30-35
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• 2013

The four principles of treatment of odontogenic infection are as follows : (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including proper rest and nutrition. A separate incision is required to establish drainage, especially in the case of extensive fascial space infections. There are four principle causes for active bleeding in the immediate incision & drainage phase; (1) vascular wall alteration (infection, scurvy, chemicals), (2) disorder of platelet function, (3) thrombocytopenic purpuras, (4) disorders of coagulation (liver disease, anticoagulation drug). If the hemorrhage from incision & drainage site is aggressive, the site must be packed with proper wet gauze and wound closure & drainage dressing are applied. The specific causes of bleeding may be associated with hypoxia, changes in the pH of blood & chemical changes affecting vascular contractility and blood clotting. This is a case report of bleeding control by the circumferential suture & drainage on active bleeding incision & drainage site of temporal space abscess due to advanced odontogenic infection in a multiple medically compromised disabled patient.

• Child Health Nursing Research
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• v.17 no.4
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• pp.238-246
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• 2011

Purpose: The purpose of this study was to identify pediatric nurses' attitudes to, and compliance with, standard precautions in the prevention of hospital infections by enhancing their practice of standard precautions. Methods: The participants were 206 nurses who worked in pediatric nursing departments of a general medical institution in Seoul. The questionnaire was a modification of Kim (2008) and consisted of 18 questions about hand washing, personal protective equipment, sharps, linen and patient care equipment. Collected data were processed using SPSS 15.0 WIN. Results: Mean scores for attitudes to standard precautions and for compliance with standard precautions were 4.43 (${\pm}0.83$) and 4.22 (${\pm}0.44$) respectively. This difference was statistically significant (t=3.368, p=.001). The nurses' compliance with standard precautions differed significantly according to the general characteristics of age (F=8.705, p<.001), total clinical experience (F=9.426, p<.001), current department experience (F=6.555, p<.001), and education experience (t=0.616, p<.043). There was a positive correlation between attitudes to, and compliance with, standard precautions (r=.156, p=.025). Conclusion: The results of this study indicate that educational programs and policy on infection control and standard precautions for pediatric nurses are needed. Also these results should contribute to baseline data for establishing appropriate clinical policy on infection control.

• Journal of Sasang Constitutional Medicine
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• v.24 no.3
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• pp.50-59
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• 2012

Objectives In this research, the constitutional diagnosis based on the theory of Sasang constitutions were carried out to Japanese subjects living in Japan, and the external applicability of Sasang constitutional medicine was evaluated by analyzing the physiological symptoms and the pathological symptoms according to their constitutions. Methods Total 144 Japanese subjects who live in S city were invited from Mar. 2010 to Jul. 2011 for the research, and their constitutions were analyzed with constitution diagnosing tool that was developed by Korean institution of oriental medicine (KIOM) in 2011. The collected data was analyzed in terms of the physiological symptoms and the pathological symptoms according to the sasang constitutions with computer software of SPSS 17.0. Results In the physiological symptoms related to excrements, Soyangin more frequently did not have excrements of gold color (p=.034) and feel the tenesmus (p=.047) than the subjects of other constitutions. In the physiological symptoms related to cold & heat, Soyangin more frequently felt cold in feet and hands (p=.011), and Soeumin more frequently didn't like drinking water regardless of thirst (p=.017). In the physiological symptoms, Soyangin frequently felt dryness in eyes, and Taeumin frequently felt uncomfortable because of the phlegm. Conclusions The theory of Sasang constitution which is a Korean traditional medicine can also be applied to the health care of Japanese, and it can contribute to the health promotion of Japanese subjects.