• 한국병원경영학회지
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• 제7권1호
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• pp.88-104
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• 2002

According to the change of mandatory referral system in July 1, 2000, the effect to the medical utilization of outpatient clinic and medical income in ophthalmology of tertiary care medical institute, S Hospital in Seoul was evaluated for 6 months before(1999. 12$\sim$2000. 5) and after(2000. 12$\sim$2001. 5). The results were as follows: 1. The number of outpatients was reduced by 16.6%. The number of patient with blindness low vision, retina, glaucoma increased and that of patient with accommodation refractive error, cataract decreased. 2. The number of cataract patients was reduced by 36.6%. The major location of patient's address was changed to nearer to the hospital. The number of cataract surgery reduced in 4.1%, the waiting time reduced in 42.2%, however surgery time increased in 20.2% and number of postoperative complications increased in 11.4%. 3. The income of outpatient clinic and cataract surgery reduced. Among items of outpatient clinic income, the most increased was ocular examination and the most reduced was injection and drugs. Among items of cataract surgery income, the most increased was operation fee and the most decreased was doctor's fee. In conclusion, for the patient, due to the lowered density of outpatient population more space was provided to the patients with more severe disease entity such as blindness' low vision, retina and glaucoma. For the hospital, the need for the expansion of ophthalmology was not found, however that for creation of the special clinics dealing with more severe disease entity was found. Due to reduced income and increased need of financial investment for the equipment and manpower for the more severe disease entity, the ophthalmology of tertiary care medical institute is faced with financial disaster. It is strongly suggested that the cost of medical practice of more severe disease entity be raised to achieve the success after change of mandatory referral system in ophthalmology.

• 한국산학기술학회논문지
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• 제11권6호
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• pp.2078-2087
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• 2010

본 연구는 수술환자의 타지역 의료이용과 관련된 요인을 규명하기 위하여 2004년부터 2006년도의 퇴원손상 환자조사뿐 아니라, 인구센서스 및 보건의료자원 실태조사자료를 이용하여 교차분석, 로지스틱 회귀분석을 실시한 결과 다음과 같다. 첫째, 수술환자의 의료이용은 수도권 중심으로 집중화 현상이 뚜렷하다. 이를 개선하기 위해서 정부에서는 의료기관 및 병상수를 공급하는 일 뿐만 아니라 의료의 지역화를 위해 지방에서의 의료의 질적 수준을 올리는 정책이 필요하다. 둘째, 눈 및 부속기 질환 및 암환자의 타지역 수술률이 높으므로 질병에 따른 의료의 지역화를 위한 특정 질환의 지역화 정책추진이 요구된다. 셋째, 산재환자 수술환자의 타지역 진료율이 시간이 갈수록 증가하므로 손상환자를 위한 지역화 정책도 필요하다 할 것이다.

• 여성건강간호학회지
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• 제25권3호
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• pp.329-344
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• 2019

Purpose: This study aimed to identify utilization of the work-family support policy (WFSP) and factors affecting retention intention among Korean female military officers. Methods: This cross-sectional survey recruited 103 married female officers from the Korean Army, Navy, and Air force with preschool-aged children through convenience and snowball sampling. Via online surveys from June to November, 2018, the participants self-reported retention intention, work-family conflict, job satisfaction, and utilization of the WFSP. The data were analyzed using descriptive statistics, independent t-tests, one-way analysis of variance, Pearson's correlation coefficient, and multiple linear regression. Results: Retention intention ($22.29{\pm}5.98$) was reported at the mid-level, lower than scores reported in the literature for female workers. Work-family conflict ($32.51{\pm}5.29$) and job satisfaction ($63.10{\pm}7.45$) were above the midpoint levels. Use of maternity leave (100.0%) and parental leave (92.2%) was high, especially compared to the rates of child-care day off (20.4%) and parenting time (20.4%). 'Noticeable increases in childcare services within the army' (22.8%) was reported as the supportive measure needed the most by female military officers. Job satisfaction (${\beta}=.43$, $p{\leq}.001$), the use of parenting time (${\beta}=-0.29$, p=.002), living type (${\beta}=-.18$, p=.043), and service type (${\beta}=-.16$, p=.035) significantly influenced retention intention. Conclusions: The findings highlight the priority areas of importance within the WFSP and suggest that a family-friendly culture can improve female officers' retention intention. Accordingly, policy changes at the Ministry of National Defense improving the system to enhance a family-friendly culture in the military is expected to strengthen the retention intention of female officers and contribute to excellence in the military workforce.

• 치위생과학회지
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• 제2권1호
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• pp.1-9
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• 2002

2001년 4월 25일부터 6월 9일까지 서울시내 치과대학 병원 2곳과 서울시내 치과의원 2곳을 임의적으로 선정하여 그 곳에 방문한 환자에게 설문조사를 실시하였다. 설문내용은 치과 병 의원에 방문한 환자의 일반적인 특성, 치과 의료 환경에 대한 기대, 치과 인력에 대한 기대, 편의시설에 대한 기대, 치과정보에 대한 기대, 예약/정산에 대한 기대, 대기시간에 대한 기대로 구성되어 있다. 환자의 일반적 특성에 따라 치과의료서비스 기대를 분석한 결과는 다음과 같다. 1. 치과 의료서비스의 기대도 분석결과는 치과 병 의원의 환경에 대한 기대와 인력에 대한 기대가 가장 높게 나타났다. 2. 치과 의료서비스의 각 요인별 기대수준은 다음과 같다. 1) 환경에 대한 기대요인 중 '치과 의료기관의 편리한 교통'의 기대가 가장 높았다. 2) 인력에 대한 기대요인 중 '치과의사의 친절'의 기대가 높게 나타났다. 3) 편의시설에 대한 기대요인 중 '어린이만을 위한 시설'에서 기대가 가장 높게 나타났다. 4) 치과정보제공에 대한 기대요인 중 '치료방법 및 치료비 설명'에서 기대가 가장 높았다. 5) 예약/정산에 대한 기대요인 중 '예약/정산의 신속성'에서 기대가 가장 높았다. 6) 대기시간에 대한 기대요인 중 '대기시간을 알려주는 배려'에서 기대가 높게 나타났다. 3. 환자의 일반적 특성에 따른 총 치과 의료서비스 기대분석 결과로서는 여자가 남자보다, 연령이 낮아질수록, 그리고 교육수준이 높을수록 치과의료서비스의 기대가 높았다. 본 연구 결과를 통해 소득의 증대와 의료서비스 이용의 기회가 증가하면서 의료에 대한 개념이 바뀌고 고객들이 원하는 요구도 매우 다양해지고 복잡해지고 있음을 추측할 수 있었다. 이에 맞추어 치과 병 의원은 치료서비스 이외에 환자가 요구하는 여러 가지 부가적인 서비스를 포함하여 포괄적인 개념의 의료서비스를 제공하는 방법으로 접근을 시도해야 한다. 그리고 병원자체의 의료서비스 평가를 통해서 고객의 기대와 실제로 환자에게 제공된 의료서비스간의 갭을 파악하고 그 갭을 줄이기 위해 다양한 방향으로 노력하여 고객만족을 실현해야 할 것이다.

• 한국산학기술학회논문지
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• 제10권11호
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• pp.3444-3450
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• 2009

본 연구의 목적은 환자가 거주지가 아닌 타 지역에서 입원의료를 이용하는 요인을 규명하여 주민들의 의료 이용에 대한 지역적 접근성을 향상시킬 수 있는 방안을 제시하는데 있다. 2005년 환자조사 입원자료 523,782건을 연구 대상으로 하였으며, 2004년 의료기관평가 자료, 2005년 인구센서스, 2006년 보건의료자원실태조사를 이용하였다. 자료분석은 기술통계, 카이제곱 검정, 로지스틱 회귀분석을 실시하였다. 타 지역 입원의료 이용의 가장 큰 요인은 의료기관 소재지의 의료서비스 수준으로, 인구 10만 명당 의료기관평가 점수가 9.5점 이상인 지역이 9.5점 미만인 지역에 비해 타지역 입원의료 이용확률이 8.3배가 높았다. 반면 인구 10만 명당 병상수가 910병상 이상인 지역이 910병상미만인 지역에 비해 타지역 입원의료 이용확률이 2.0배 높았다. 정부는 지역주민의 의료의 접근성을 높이기 위해 의료공급량의 확충과 분배보다는 지역의료의 질적 수준을 향상시키는 방향으로 정책을 펼쳐야 한다.

• 가정간호학회지
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• 제6권
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• pp.5-18
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• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• 한국지역지리학회지
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• 제3권2호
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• pp.163-193
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• 1997

복지사회를 지향하는 오늘날, 건강 중진에 직접 관계되는 의료시설의 접근성 문제는 주요 과제이다. 특히 삶의 질이라는 측면에서 질병의 치료 외에 건강진단, 예방과 회복, 요양 및 응급서비스의 비중이 커지고, 인구의 노령화 현상이 진전되면서 의료시설의 효율적인 입지가 주 관심사로 대두되고 있다. 의료시설은 주민의 생존과 직접 관계되는 기본적이고도 필수적인 중심시설로, 지역 주민은 균등한 혜택을 받을 수 있어야 한다. 이를 실현시키기 위해서는 기본적으로는 효율성과 평등성을 기반으로 1차 진료기관이 균등 분포해야 한다. 이에 본 연구에서는, 광주시를 사례지역으로 선정하여 의료시설의 입지와 그에 대한 주민의 효율적 이용에 관하여 분석하였다. 분석에 있어서는 통계자료와 기존의 연구 성과 외에 설문 및 현지조사 자료를 기반으로 시설 측면과 이용자 측면을 동시에 고찰하였다. 우선 의료 환경의 변화 및 의료시설의 변화 과정을 고찰하고, 이어서 의료시설의 유형별 입지 특성과 주민의 분포 특성을 고려한 지역별 의료수준을 분석하였다. 그리고 유형별 의료시설의 이용행태와 그 요인을 구명한 후, 마지막으로 장래 이용 유형의 예측과 문제지역의 추출, 나아가서는 시설의 합리적인 입지와 경영 방향을 제시하였다. 본 연구 결과는, 앞으로 신설될 의료시설의 적정 입지에 관한 기본 자료로서는 물론 지역 주민의 불평등성 해소라는 응용적 측면에서 의의를 지닌다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2717-2720
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• 2012

Background: The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. Methods: A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio-demographic predictors of mammography utilization among participants. Results: The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (all P<0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P<0.05) with mammography participation. Conclusions: The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women, after adjusting for all other demographic variables in the model.

• 지역사회간호학회지
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• 제9권1호
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• pp.89-103
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• 1998

The elderly population will increase from 5.8% in 1996 to 12.5% in 2020. The related problems of health will also become a very important issue in the future. Therefore it is important to address the problems of geriatric nursing and geriatric health. 87.6% of the aged were ill with chronic degenerative diseases in 1994. In 1995, hospital admission rates (86.8) for those aged 60 or older were higher than that (56.3) of the total age group. Such high medical utilization will increase national health costs. For the development of geriatric nursing, active nursing intervention in various settings combined with education and research should be developed. Considering the health and welfare of the aged and the present status and views in Korea, I suggest the following: First, the health needs of the elderly in the institution, must be met by a plan that fosters geriatric nurses and programmed service development. Second, health service for the residential elderly must be provided in day care centers, short stays, nursing homes and geriatric hospitals. Geriatric nursing services should be provided in home residential areas, public health centers, public health subcenters as well as having, community health practitioners in primary health care posts and home health nurses. Third, geriatric nursing curriculum must be developed adjust to situations and culture of Korea and be included in the nursing curriculum. And gerontological nurse practitioner or geriatric specialist must be fosteraged to provide the professional care for the aged. Geriatric nursing research should be also achived for geriatric nursing improvements.

• PNF and Movement
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• 제15권2호
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• pp.115-124
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• 2017

Purpose: Researchers found that blocks of evidence-based practice (EBP) implementation lacked opportunities for EBP education. The study found that physical therapists had negative views of research as well as their roles in EBP, lacked confidence in EBP, and had limited access to web-based materials. The purpose of this study was to highlight the importance of information research technology for efficient EBP in a clinical environment. Methods: The web-based information research technologies that should be used for sustainable EBP include: the clinical practice guideline (CPG) and PubMed's My NCBI service. Journal mailing services and other academic information sources should also be used to gather information from RSS feeds. An EBP library or archive must be created. A site that provides EBP-specific information is also needed. Results: We should usually do EBP. Practitioners must learn and use information technologies that will help them improve their EBP skills. Conclusion: Facilitating EBP implementation and building an EBP system require related education as well as a practical work environment and equipment. However, the highest priority is individual efforts and trial. Information technology will complement the lack of time. It is important to use information research technology to overcome real obstacles. Lasting EBP must use a number of web-based information research technologies to overcome the practical challenges encountered in EBP implementation.