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A Study on the Nurse's Due Care in Medical Malpractice (의료과오시(醫療過誤時) 간호사의(看護師)의 주의의무(注意義務)에 관한 연구(硏究))

  • Kang, Sun-Joo
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.1
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    • pp.113-136
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    • 1999
  • There are some new trends in judgments concerning medical malpractice. which include emphasis on medical professionals' explanation duty in order to materialize patient's rights of self-determination. Now, patient is not a mere subject of medical and nursing care any more, but a subject, participating in medical practice on equal terms with medical professionals. Legal accountability is no limited to nurses in advanced practice: it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital, a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to indentify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's due care, especially in nursing malpractice. To clarify nurses' due care. chapter II has focused on nursing behavior and the scope of nursing practice based on the medical law and health care related study results. Chapter III deals with the content and scope of nurse's due care. Generally. negligence is defined as not doing something which a resonable person. guided by those ordinary considerations which or dinarily regulate human affairs. would do. or doing something which a resonable and prudent man would not do. Next. it describes how we can set the standard of due care in nursing practice. There is objective factors and subjective factors. And we also discuss about the limitation of due care in nursing practice. Finally. chapter IV deals with the case studies related to nursing negligence in the situation of determination. Now', patient is not a mere subject of medical and nursing care any more, but a subject participating in medical practice on equal terms with medical professionals. Legal accountability is not limited to nurses in advanced practice; it is a recognized fact of life for every practicing nurse. whether she is an RN employed as a staff nurse in a hospital. a Certified Nurse-Midwife in independent practice or a patient's home. Therefore, it is essential for nurses to be as familiar as possible with the legal guidelines that govern their patient care responsibilities. However. there are only a few studies focused on nursing negligence. To define nurse's civil liability in medical malpractice, it is necessary to identify both legal nursing behaviors and nurse's due care in those nursing behaviors. So this paper focused on nurse's intravenous injection. post operation nursing care. blood transfusion. and patient nursing care. The result of this paper is as follows. First. there are several cases dealing with nurse's negligence in nursing practice. however, those cases didn't judge nurse's due care based on individual -specific standard but general-objective standard. Second, there is a tendency to put an emphasis on the principal of belief to distinguish who has the liability in the case of medical malpractice among medical care team. So nurses shoud practice nursing care more actively to protect themselves and patients because there is an effort to form professional nurse system and the scope of nursing practice will be deeper and broader. Third, standard of care is a necessary element in establishing negligence. If a nurse is able to meet the standard of care, no breach will be found.

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A Study on Temperature Change Profiles by Land Use and Land Cover Changes of Paddy Fields in Metropolitan Areas (대도시 외곽지역 논경작지의 토지이용 및 피복변화에 따른 온도 변화모형 연구)

  • Ki, Kyong-Seok;Lee, Kyong-Jae
    • Journal of the Korean Institute of Landscape Architecture
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    • v.37 no.1
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    • pp.18-27
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    • 2009
  • The purpose of this study is to understand the scale of temperature change following large-scale urban developments in paddy fields to present possible measures to preserve suburban area paddy fields and to lower the scale of temperature increase after developing paddy fields in urban areas. The study was conducted in Bupyeong and Bucheon of Incheon Metropolitan City. The satellite image($1989{\sim}2000$) before and after the development of old paddy fields were used to analyze the land surface temperature changes according to the land use types. Building coverage, green coverage, non-permeable pavement coverage, and floor area ratio(FAR) were selected as the factors that influence urban temperature changes and the temperature estimation model was constructed by using correlation and regression analyses. The before and after satellite images of Bupyeong and Bucheon were classified into forests, greens and plantations, paddy fields, unused lands, and urban areas. The results indicate that most of the paddy fields that existed in the center of Bupyeong and Bucheon were converted into unused lands which were undergoing construction to become new urban areas. The difference between the surface temperatures of May 17th, 1989 and May 7th, 2000 was analyzed to reveal that most land converted from paddy fields to unused lands or urban areas saw an increase in surface temperature. Han River was used as a comparison to analyze the average surface temperature changes($1989{\sim}2000$) in former paddy fields. The scale of temperature changes were: $+1.6697^{\circ}C$ in urban parks; $+2.5503^{\circ}C$ in residential zones; $+2.9479^{\circ}C$ on public lands, $+3.0385^{\circ}C$ in commercial zones, and $+3.1803^{\circ}C$ in educational zones. The correlation between building coverage, green coverage, non-permeable pavement coverage, or floor area ratio(FAR) and surface temperature increases was also analyzed. The green coverage to temperature increases, but building coverage, non-permeable pavement coverage, and floor area ratio(FAR) had no statistically significant temperature increases. The factors that influence urban temperature changes were set up as independent variables and the surface temperature changes as dependent variables to construct a surface temperature change model for the land use types of former paddy fields. As a result of regression analysis, green coverage was selected as the most significant independent variable. According to regression analysis, if farmland is converted into an urban area, a temperature increase of $+3.889^{\circ}C$ is anticipated with 0% green coverage. The temperature saw a decrease of $-0.43^{\circ}C$ with every 10% increase of green coverage.

A Study on the Effects of User Participation on Stickiness and Continued Use on Internet Community (인터넷 커뮤니티에서 사용자 참여가 밀착도와 지속적 이용의도에 미치는 영향)

  • Ko, Mi-Hyun;Kwon, Sun-Dong
    • Asia pacific journal of information systems
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    • v.18 no.2
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    • pp.41-72
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    • 2008
  • The purpose of this study is the investigation of the effects of user participation, network effect, social influence, and usefulness on stickiness and continued use on Internet communities. In this research, stickiness refers to repeat visit and visit duration to an Internet community. Continued use means the willingness to continue to use an Internet community in the future. Internet community-based companies can earn money through selling the digital contents such as game, music, and avatar, advertizing on internet site, or offering an affiliate marketing. For such money making, stickiness and continued use of Internet users is much more important than the number of Internet users. We tried to answer following three questions. Fist, what is the effects of user participation on stickiness and continued use on Internet communities? Second, by what is user participation formed? Third, are network effect, social influence, and usefulness that was significant at prior research about technology acceptance model(TAM) still significant on internet communities? In this study, user participation, network effect, social influence, and usefulness are independent variables, stickiness is mediating variable, and continued use is dependent variable. Among independent variables, we are focused on user participation. User participation means that Internet user participates in the development of Internet community site (called mini-hompy or blog in Korea). User participation was studied from 1970 to 1997 at the research area of information system. But since 1997 when Internet started to spread to the public, user participation has hardly been studied. Given the importance of user participation at the success of Internet-based companies, it is very meaningful to study the research topic of user participation. To test the proposed model, we used a data set generated from the survey. The survey instrument was designed on the basis of a comprehensive literature review and interviews of experts, and was refined through several rounds of pretests, revisions, and pilot tests. The respondents of survey were the undergraduates and the graduate students who mainly used Internet communities. Data analysis was conducted using 217 respondents(response rate, 97.7 percent). We used structural equation modeling(SEM) implemented in partial least square(PLS). We chose PLS for two reason. First, our model has formative constructs. PLS uses components-based algorithm and can estimated formative constructs. Second, PLS is more appropriate when the research model is in an early stage of development. A review of the literature suggests that empirical tests of user participation is still sparse. The test of model was executed in the order of three research questions. First user participation had the direct effects on stickiness(${\beta}$=0.150, p<0.01) and continued use (${\beta}$=0.119, p<0.05). And user participation, as a partial mediation model, had a indirect effect on continued use mediated through stickiness (${\beta}$=0.007, p<0.05). Second, optional participation and prosuming participation significantly formed user participation. Optional participation, with a path magnitude as high as 0.986 (p<0.001), is a key determinant for the strength of user participation. Third, Network effect (${\beta}$=0.236, p<0.001). social influence (${\beta}$=0.135, p<0.05), and usefulness (${\beta}$=0.343, p<0.001) had directly significant impacts on stickiness. But network effect and social influence, as a full mediation model, had both indirectly significant impacts on continued use mediated through stickiness (${\beta}$=0.11, p<0.001, and ${\beta}$=0.063, p<0.05, respectively). Compared with this result, usefulness, as a partial mediation model, had a direct impact on continued use and a indirect impact on continued use mediated through stickiness. This study has three contributions. First this is the first empirical study showing that user participation is the significant driver of continued use. The researchers of information system have hardly studies user participation since late 1990s. And the researchers of marketing have studied a few lately. Second, this study enhanced the understanding of user participation. Up to recently, user participation has been studied from the bipolar viewpoint of participation v.s non-participation. Also, even the study on participation has been studied from the point of limited optional participation. But, this study proved the existence of prosuming participation to design and produce products or services, besides optional participation. And this study empirically proved that optional participation and prosuming participation were the key determinant for user participation. Third, our study compliments traditional studies of TAM. According prior literature about of TAM, the constructs of network effect, social influence, and usefulness had effects on the technology adoption. This study proved that these constructs still are significant on Internet communities.

A METHOD OF CAPABILITY EVALUATION FOR KOREAN PADDY SOILS -Part 2. The rice yield prediction by soil fertility constituents and other characters (한국(韓國) 답토양(畓土壤)의 생산력(生産力) 평가방법에 관한 연구 -2 보(報)·비옥도(肥沃度) 구성인자(構成因子) 및 기타(其他) 특성(特性)에 의(依)한 쌀수확량(收穫量)의 추정(推定))

  • Hong, Ki-Chang;Maeng, Do-Won;Kazutake, Kyuma;Hisao, Furukawa;Suh, Yoon-Soo
    • Korean Journal of Soil Science and Fertilizer
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    • v.12 no.1
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    • pp.15-23
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    • 1979
  • In the first paper of the series the five soil fertility factors were evaluated by means of principal component analysis and varimax method. They are interpreted as representing, 1) skeletal available phosporus status, 2) organnic matter status, 3) salt status 4) base status, and 5) free oxide status. In order to resynthesize such fragmented information for the overall soil fertility evaluation, the method of multiple regression analysis was adopted, using the five factor scores and yield data for Korean paddy soils as independent and dependent variables respectively. As test of linear models with different combinations of independent variables the results of t-test of regression coefficient were revealed that the organic matter status (FII) has no relevance to the yield of paddy and that the free oxides and salt supply has by it self only an insignificant contribution to the yield. The multiple correlation coefficient (R) revealed its multiple regression analysis was as low as 0.43. Introduction of quadratic terms to the linear model bettered the result. Thus multiple correlation coefficient (R) was increased as 0.59. Therefore, a coefficient of determination 0.35 was obtained by a quadratic model with interaction terms among the five fertility constituents. Generally we think that the fertility factor has more contribution to raise the rice yield in paddy and that the failure of yield prediction by fertility factor scores was caused by one of follows; 1) the roughness of the yield inspection, and 2) missextraction of fertility constituents. The second step in this study, assuming that the residuals by multiple regression analysis were due to factors other than soil fertility, we can now proceed to predicting the yield from the field characters with the classified fertility groups by means of Hayashi's theory of quantification No. 1. Such variables as fertility groups (FTYG), water availability (WATER), soil drainage (DRNG), climatic zone (CLIZ), surface soil's stickiness (STCKT), surface soil's dry consistence (DCNST), and surface soil's texture (FTEXT) are taken up as the explanatory variables. The quantification appears reasonable; the well to extremely well in soil drainage, very sticky of surface soil, inefficiency in water availability, coarse texture, and very hard to extremely hard dry consistence in soil are detrimental to the rice yield. The R was as high as 0.90 for the set of variables. But the given explanatory variables in this study were not quite effective in explaining rice yield. The method developed seems to be promising only if properly collected data are available. Conditions that should be satisfied in the yield inspection obtained from common cultivator for the purpose of deriving a prediction equation were put forward.

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An Analysis of 'Animation Education Standards' and Recommendations for Improvement (애니메이션 교육 표준 분석 및 개선점 연구)

  • Kim, Jae-Woong;Park, Yoo-Shin
    • Cartoon and Animation Studies
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    • s.32
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    • pp.63-90
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    • 2013
  • The purpose of this study is to improve the standards for the animation education in '2011 Arts and Culture Education Standards: Cartoon and Animation'. Animation Education Standards has been developed by discussion about Arts and Culture Education, and by study of documents about animation, and by investigation about experimental recognition. And the study of domestic and foreign art education standards are reflected in these standards. These standards consist of seven categories reflecting various aspects of animation and each category is classified into five stages by age. This standard has two axes: seven categories by various aspects of animation and five stages by age, and it represents achievement requirement in animation learning. This study suggests that 'Animation Education Standards' has five features as below. First, it reflects the character of Animation as an independent subject. Second, it is studied on the basis of the framework of arts and culture education. Third, it provides basic achievement requirement, and it has no limitation in learning activities. Fourth, the achievement requirements of two or more categories can be applied simultaneously in real classroom; each category is set by themes of animation education. This study presents five methods to improve existing standard. First, independent standard for animation education must be developed. Second, categories must be established distinctly. Third, each categories and achievement requirement must reflect unique characteristic of animation. Fourth, the description of achievement requires must be systemized. Fifth, to help to adapt education standard, explanation about practical teaching and learning activities must be added. '2011 Art and Culture Education Standards: Cartoon and Animation' is important in that it is the first study that systemized animation education and presented pedagogical achievement requirements by suggesting achievement requirements for animation education by two axes -ages and categories. It will be very helpful in studying the animation education as a subject, and developing education programs, and teaching and learning in an actual class.

A Study on Hospital Staff's Perception of Death and Hospice (병원직원들의 죽음 및 호스피스 인식에 관한 연구)

  • Kim, Mi-Jeong
    • Korean Journal of Hospice Care
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    • v.7 no.2
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    • pp.15-25
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    • 2007
  • The purpose of this study was to survey the hospital staff's perception of hospice and death and thereby, suggest the ways to help them have a mature attitude towards and a better understanding of death through an effective education on hospice. For this purpose, this study was designed to provide some data useful for the hospital staff not experienced in facing the dying patients to handle the desperate situation skillfully and engage themselves more effectively in their hospice services. For this study, the researcher conducted a questionnaire survey for the staff of 'C' hospital in Seoul about their hospice philosophy, attitudes towards hospice and perception of death for the period from February, 2006 to March, 2006. A total of 751 subjects responded effectively to the survey. The data collected were analyzed using the SF55 11.0 for ANOVA and T-test in order to test the relationships among subjects' perception of death, their demographic variables, their health condition, their hospice philosophy formed from their experiences of patients' death and hospice services and their attitudes towards hospice. Besides, the correlations among their hospice philosophy, perception of death and attitudes towards hospice were tested. The results of this study can be summarized as follows; First, as a result of testing the relationships among subjects' experiences of health consulting. their experiences of patients' death and hospice and their hospice philosophy, it was confirmed that their experiences of health and death consulting and their experiences of having been educated were relevant. Second, it was found that such variables as health condition, death, experience of hospice and attitude towards hospice were not significantly correlated with each other. Third, as a consequence of testing the relationships among health condition, death, experience of hospice and perception of death, it was disclosed that only the physical health condition was significant. Fourth, it was confirmed that subjects' hospice philosophy, perception of death and attitudes towards hospice were at the usual level on average. Fifth, hospice philosophy, perception of death and attitudes towards hospice were found correlated significantly with each other. Sixth, as a result of the stepwise variable adjustment for such variables as hospice philosophy, perception of death, attitudes towards hospice, it was found that the adjusted r-square value was 0.347 when departments, experience of having been requested by dying patient for consulting, experience of having been educated on hospice, religion and marital status were set as independent variables. And the estimated value of each variable was found significant. Seventh, as a consequence of conducting the multiple regression analysis by setting 'religion' as significant independent variable, it was found that the estimated value of physical health condition was not significant statistically. This, as a result of the simple regression analysis for 'religion' only, its explanatory power was found .197, while its adjusted r-square value was 0.20. Eight, it was found that subjects' attitude towards hospice was significantly correlated with such variables of experience of patient's or relative's death, experience of having been requested for consulting about death, gender, marital status and departments. As a result of the multiple regression analysis and the subsequent stepwise adjustment for this variable, it was found that only 'experience of having been requested for consulting' had some explanatory power: its adjusted r-square value was 0.089. As discussed above, this study tested the correlations among various variables including hospital staff's attitude towards hospice and perception of death and thereby, provided for the data useful for their education on hospice. This study may be significant in that it proved that it would be essential to educate hospital staff on hospice for more effective care of hospice patients and their family members at hospital.

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Effect of Entrepreneurial Characteristics and Market Characteristics of Small Business Owners on Business Performance With the Mediation of Digital Literacy (소상공인의 창업가특성과 시장특성이 디지털 리터러시를 매개로 사업성과에 미치는 영향)

  • Shin, Ji Min;Kang, Hee Kyung
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.16 no.5
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    • pp.75-89
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    • 2021
  • Currently, small business owners are facing a situation where it is difficult to run their business in the existing way due to the spread of digital technology and the prolonged COVID-19. As a necessary competency for them, this study focused on digital literacy and examined the relationship between digital literacy and individual and market characteristics, business performance of small business owners. The specific research purpose is to examine the effect of entrepreneurial characteristics, which are individual factors, and market characteristics, which are environmental factors, on business performance and the mediating effect of digital literacy. In previous studies, various factors explaining the business performance of small business owners were reviewed, and innovation and self-determination, which are entrepreneurial characteristics of small business owners, and market competition and growth were derived as independent variables, and financial and non-financial performance were set as dependent variables. The hypothesis was established as digital literacy was expected to play a role in mediating the relationship between independent and dependent variables. For empirical research, a survey was conducted on small business owners across the country, and the analysis results are summarized as follows. It was found that the innovation and self-determination of small business owners had a positive (+) significant effect on financial and non-financial performance. In addition, it was confirmed that the degree of competition in the market had no significant effect on financial and non-financial performance, and that the growth of the market had a significant positive (+) effect on financial and non-financial performance. In the case of the mediating effect of digital literacy, it was confirmed that innovation had a partial mediating effect on non-financial performance, and digital literacy had a complete mediating effect on the effect of market competition on financial and non-financial performance. Finally, it was confirmed that digital literacy has a partial mediating effect on the effect of market growth on non-financial performance. Looking at the results, it can be seen that the entrepreneurial characteristics of small business owners, which correspond to innovation and self-determination, directly act as a factor to increase business performance, and market characteristics indirectly increase digital literacy to achieve results. Based on the above research results, the implications and limitations of the study and future research directions were presented together.

Effects of Elastic Band Exercise on Body Composition, Blood lipids and AMPK in the Elderly Women (탄력밴드 운동이 여성노인의 체조성, 혈중지질 및 AMPK에 미치는 영향)

  • Choi, Mi-Ri-Na;Ha, Soo-Min;Kim, Do-Yeon
    • Journal of the Korean Applied Science and Technology
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    • v.36 no.3
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    • pp.995-1007
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    • 2019
  • The purpose of this study was to investigate the effects of 12-week elastic band exercise on body composition, blood lipids and AMPK in 24 elderly female volunteers aged 65-75 years, and they were divided into the combined exercise group(n=12) and the control group(n=12). The elastic band exercise method was to do exercise 3 times a week for 60 minutes per session, 1-4 weeks for low intensity of OMNI-RES 3-4, 5-8 weeks for medium intensity of OMNI-RES 5-6, 9-12 weeks for OMNI-RES 7-8 of high intensity. In order to compare the differences in the groups before and after the elastic band exercise, two-way repeated measures ANOVA was used to verify the interaction between group and time. The difference in the groups of the measured data was paired t-test, the difference between the groups was paired independent t-test, and analysis of covariance ANCOVA was performed to minimize the inter-group error. The statistical significance level of each item was set to .05. As a result, body fat percentage of exercise group significantly decreased (p<.05), and skeletal muscle volume was significantly increased (p<.01). TC, TG and LDL-C were not significantly different between the exercise and control groups, and HDL-C was significantly decreased in the control group (p<.05). AMPK was significantly decreased in the exercise group (p<.001), but there was no significant difference in the control group. According to the covariance analysis to minimize the error of difference between the pre-exercise groups (p<.05), there was significant difference in AMPK of groups after exercise. These results suggest that the 12-week elastic band exercise has a positive effect on the body composition and AMPK of the elderly women.

Sensitivity analysis of the FAO Penman-Monteith reference evapotranspiration model (FAO Penman-Monteith 기준증발산식 민감도 분석)

  • Rim, Chang-Soo
    • Journal of Korea Water Resources Association
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    • v.56 no.4
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    • pp.285-299
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    • 2023
  • Estimating the evapotranspiration is very important factor for effective water resources management, and FAO Penman-Monteith (FAO P-M) model has been applied for reference evapotranspiration estimation by many researchers. However, because various input data are required for the application of FAO P-M model, understanding the effect of each input data on FAO P-M model is necessary. Therefore, in this study, for 56 study stations located in South Korea, the effects of 8 meteorological factors (maximum and minimum temperature, wind speed, relative humidity, solar radiation, vapor pressure deficit, net radiation, ground heat flux), energy and aerodynamic terms of FAO P-M model, and elevation on FAO P-M reference evapotranspiration (RET) estimation were analyzed. The relative sensitivity analysis was performed to determine how 10% increment of each specific independent variable affects a reference evapotranspiration under given set of condition that other independent variables are unchanged. Furthermore, to select the 5 representative stations and perform the monthly relative sensitivity analysis for those stations, 56 study stations were classified into 5 clusters using cluster analysis. The study results showed that net radiation was turned out to be the most sensitive factor in 8 meteorological factors for 56 study stations. The next most sensitive factor was relative humidity, solar radiation, maximum temperature, vapor pressure deficit and wind speed, followed by minimum temperature in order. Ground heat flux was the least sensitive factor. In case of ground surface condition, elevation showed very low positive relative sensitivity. Relativity sensitivities of energy and aerodynamic terms of FAO P-M model were 0.707 for energy term and 0.293 for aerodynamic term respectively, indicating that energy term was more contributable than aerodynamic term for reference evapotranspiration. The monthly relative sensitivities of meteorological factors showed the seasonal effects, and also the relative sensitivity of elevation showed different pattern each other among study stations. Therefore, for the application of FAO P-M model, the seasonal and regional sensitivity differences of each input variable should be considered.

Variation of Hospital Costs and Product Heterogeneity

  • Shin, Young-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.11 no.1
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    • pp.123-127
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    • 1978
  • The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

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