• Journal of Gastric Cancer
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• 제18권1호
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• pp.82-89
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• 2018

Purpose: Early detection of gastric cancer is important to improve prognosis. Early detection enables local treatment, such as endoscopic submucosal dissection (ESD). Therefore, we investigated whether early detection of gastric cancer could reduce healthcare costs by comparison according to stage and treatment modalities. Materials and Methods: Medical care costs were investigated according to tumor stage and initial treatment modality in 1,188 patients newly diagnosed with gastric cancer at 7 medical institutions from December 2011 to June 2012. Total medical care costs during the first-year after diagnosis (total first-year costs) were examined, including the costs of initial treatment, post-initial treatment, and inpatient and outpatient visits. Results: Stage I (75.3%) was the most common cancer stage. ESD was the second most common treatment following surgery. Total first-year costs increased significantly from stages I to IV. The costs of initial treatment and post-initial treatment were lowest in patients with stage I cancer. Among patients with stage I cancer, total first-year costs were significantly lower when treated by ESD; in particular, initial ESD treatment costs were much lower than others. Conclusions: The cost of healthcare has increased significantly with increasing cancer stages. ESD can greatly reduce medical care costs of gastric cancer. Thus, early detection of gastric cancer is important to reduce healthcare costs.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.6001-6006
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• 2015

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources. Materials and Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a pre-designed, coded questionnaire looking at patient characteristics, treatment given and outcome. Results: 101 patients were found to be eligible. Mean age was $56.7{\pm}12.8years$, the male to female ratio was 2:1 and most patients had a good performance status. More than half of the tumors were located in the head (57%, n=58) and almost all were adenocarcinomas (95%, n=96). Some 58% (n=59) received first line chemotherapy of which 49% (n=29) received gemcitabine-based regimens and 39% (n=23) received FOLFIRINOX. The median progression free survival for gemcitabine based treatment was 2.9 months (IQR=1.6-5.6) as opposed to 7.3 months (IQR=4.5-9.2) for FOLFIRINOX (P=0.02). Median overall survival was 4.9 months (IQR=2.3-9.5) for first line gemcitabine based treatment and 10.5 months (IQR=7.0-13.2) for first line FOLFIRINOX therapy (P=0.002). Patients on FOLFIRINOX had better survival across all subgroups. Inpatient admissions and dose reductions were more frequent with FOLFIRINOX but the difference between the two regimens was not statistically significant. FOLFIRINOX could be successfully administered as outpatient therapy to a number of patients. Conclusions: FOLFIRINOX remains a suitable first line option in patients with metastatic pancreatic cancer with good performance status even in a resource-poor country where diagnostic and supportive care facilities may be less than optimal and cost is a limitation.

• Journal of Hospice and Palliative Care
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• 제2권2호
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• pp.109-113
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• 1999

목적 : 말기 암 환자들을 위한 적절한 의료서비스가 제공되지 않음에 따라 비정상저인 의료행태가 발생되고 있어 말기 암 환자의 관리를 위한 포괄적인 프로그램의 필요성이 제기되고 있다. 고가의 생명유지장치의 무익성과 말기 암 환자 관리의 고 비용에 대한 관심이 늘어나고 있다. 본 연구는 의료보험에서 말기 암환자들에게 지출된 의료비용을 분석하고자 하였다. 방법 : 1997년 1월부터 1998년 6월까지 사망한 암 등록환자 중 공무원 교직원 의료보험 자료 이용이 가능한 151명의 급여내역을 추출하여 입 내원 일수와 의료보험 진료비를 조사하였다. 결과 : 사망 전 6개월 동안의 암 환자 일인당 평균 입원일수는 39일 외래일수는 14일이었다. 진료 일당 평균 진료비는 85,362원이었으며 입원 일당 평균 진료비는 105,908원, 외래 내원 일당 평균 진료비는 40,173원이었다. 진료비의 95%가 종합병원에서 지출되었으며, 진료비의 85%가 입원을 통해 지출되었다. 사망 전 6개월 동안의 진료비는 점차 증가하는 경향을 보여 사망에 가까울수록 사망 전 2개월 동안에 약 50%, 1개월 동안에 약 30%가 지출되었다. 외래진료비는 사망 전 3개월 전까지는 증가하다가 2개월 전부터는 감소하는 반면, 입원진료비는 사망에 가까울수록 증가하는 경향을 보였다. 결론 : 본 연구의 사망 전 6개월간의 의료비 분포는 미국의 메디케어의 자료와 비슷한 분포를 보였다. 향후 보다 큰 규모와 세부적인 진료서비스 내용의 분석을 통해 말기 암 환자의 관리에 대한 정책적 대안을 제시할 필요가 있다.

• 간호행정학회지
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• 제6권1호
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• pp.123-134
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• 2000

This study intended to analyze the effectiveness to obtain by developing the critical pathway presented as the method to improve the quality-betterment and cost effectiveness the through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. This study was designed to develop and effect the critical pathway for hysterectomy patients in the way to be possible the intergrated in patient management. It was adopted the process of seven phase to develop a critical pathway. To analyze the application effect of the developed critical pathway, this author offered health care service applying the critical pathway to the hysterectomy patient from July. 20 to Oct. 19. 1999. The study method had been done by investigating the experimental group and control group through the questionnaire on 40 patients who had been inpatient hysterectomy. Dependent variables were measured by modified from satisfaction, and cost and length of hospital stay. The data anlyzed by frequency, x2-test, t-test. The results of this study was as follows; 1. It was decided that the vertical line of the critical pathway was made up of eight items such as monitoring/assessment, treatment, activity, medication, consult. Lab test, diet, patient teaching and horizontal line was 7days from admission to discharge. 2. After the verifying the validity of the expert group about the critical pathway, the horizontal line was amended from hospitalization to five postoperative days and taking their consensus, some contents of the horizontal line was amended and deleted. 3. There was no significant differences in the experimental group and control group in the satisfaction, and significant differences in the cost, the length of hospital stay.

• 대한예방한의학회지
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• 제26권1호
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• pp.11-23
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• 2022

Objectives : The aim of this study was to develop a clinical pathway (CP) model for the integrative treatment of non-invasive breast cancer, with western medicine and Korean traditional medicine. Methods : The checklist model was composed in four types according to the target patients: DCIS inpatients, DCIS outpatients, LCIS inpatients, LCIS outpatients. The vertical axis of the pathway consists of 11 categories of actions applied to the patient. The horizontal axis was in accordance with the flow of time, comprising three periods during inpatient care and seven periods during outpatient care. In addition, CP was also composed in flow chart form. The pathway model was developed through a literature review of clinical practice guidelines, conference publications, papers, books, and websites. Results : The integrative CP model for non-invasive breast cancer was developed. Conclusions : The goal of the CP suggested in this study was to improve non-invasive breast cancer patients' quality of life and to supplement conventional treatment, by alleviating the side effects. The model developed through this study could serve as the basis when developing CPs in a real-world integrative medical environment. This could lead to a reduction in cost and time for CP development, thus bringing about efficiency in the clinical setting.

• 보건행정학회지
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• 제23권2호
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• pp.103-111
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• 2013

Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.

• 한국의료질향상학회지
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• 제5권2호
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• pp.176-189
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• 1998

This study was conducted to evaluate the subjective ideas about the determinants of quality in ambulatory care unit among outpatients and medical staff of a university hospital, and to compare the differences of the ideas, between patients themselves and hospital staff. A self-administered questionnaire survey was conducted covering 799 outpatients and 190 hospital staff in March, 1998. The questionnaire included general characteristics and 26 determinants of ambulatory care quality. The following are summaries of the findings: 1. Both of outpatients and hospital staff perceived, "Physician's knowledge" as the most important determinant of medical care quality. 2. In respect of 7 determinants related to physician's knowledge and skill, both outpatients and hospital staff perceived "physician's knowledge and skill" as important determinants. The scores of determinants such as, "Not doing unnecessary examinations", and "Assignment of adequate number of patients and duty schedule for the physician" were significantly different between outpatients and hospital staff. 3. In respect of 4 determinants related to doctor-patient relationship, both outpatients and hospital staff perceived "attention to patient's complaints" as the most important determinant. The scores related to the determinants such as "kindness of physician" and "explanation of treatment outcome" were significantly different between outpatients and hospital staff. 4. Among the amenities related determinants, "Modern facilities and equipments" were perceived as the most important determinant in both group. 5. In respect of 8 determinants related to non-financial accommodation, outpatients perceived, "Waiting hours for treatment" as the most important determinant, and hospital staff perceived, "Kindness of hospital staff". 6. In respect of 4 determinants related to financial accommodation, outpatients perceived, "Fare account of medical cost" as the most important determinant, and hospital staff perceived, "Increasing reimbursements". Further comprehensive research should be made on the evaluation of perceptions of medical care quality, both of outpatient and inpatient care, among patients and hospital staff. So good quality in medical care will be achieved based on clients' needs.

• Journal of Oral Medicine and Pain
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• 제34권1호
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• pp.63-79
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• 2009

본 연구는 건강보험심사평가원(Health Insurance Review and Assessment Service, 이하 심평원)에서 전산화되어 관리되는 보험대상 환자들의 진료기록을 이용하여 턱관절장애(temporomandibular disorders, TMD)로 인해 병원을 찾고 있는 환자의 유병률과 진료양태를 파악하고자 하였다. 연구를 위하여 심평원 전산시스템에 등록된 국내 보험대상 환자 중 2003년, 2004년, 2005년의 3년에 걸친 환자 자료를 사용하여 턱관절장애 (K07.6)를 주상병으로 하여 진단과 치료를 받은 환자에 대하여 성별 및 연령별 진료인원, 지역별 진료인원, 요양기관종별 진료인원, 치료기간 및 진료건수, 진료과목별 진료건수와 평균치료기간, 진료과목별 1인당 소요비용, 원외처방 치료약제 약효분류코드(효능군)별 연간 투약일수, 외과적 수술 실시 횟수 등을 분석조사한 연구결과는 다음과 같다. TMD로 인해 병원을 찾는 평균 환자수는 전체인구의 0.15%이었으며, 3년간 매년 증가하는 추세를 보였다. 그 중 99.8%가 여자였고, 20대의 유병률이 가장 높고 연령이 증가하면서 감소하는 양상을 보였다. 3년간의 변화추이를 볼 때 20대의 유병률은 감소하고 40대 이후 증가하는 양상을 보였다는 점이 특징적이었다. 16개 시도별 분포에서는 인구가 많은 서울, 경기 지역의 환자수가 많았고, 매년 전체 환자수가 증가하면서 각 지역별로 유사한 비율로 증가하였다. 그러나 부산과 대구에서는 감소세가 뚜렷하였고 울산, 경기, 전남의 증가세가 관찰되었다. 의료기관별로 내원한 환자 수는 치과를 포함한 일차의료기관에 내원하여 진료한 경우가 평균 56.8%로 전체의 과반수를 차지하였고 TMD와 관련한 입원건수는 치과 입원(86.6%)이 의과전체(13.4%) 보다 훨씬 많았다. 외래내원건수에서는 치과가 전체 건수의 38.4%로서 가장 많았으며, 정형외과(28%), 이비인후과(13.6%)의 순서였다. 약물치료에서는 해열소염진통제가 가장 빈번하게 투여되었고 정신신경용제, 골격근이완제의 순서였다. 심평원의 자료는 TMD때문에 병원을 찾는 환자들의 역학적 특성과 진료양태에 대한 포괄적이고 광범위한 정보를 제공하고 있지만, 진료실에서 정확한 진단과 표준화된 치료가 이루어지고 있는지에 대한 평가가 함께 이루어질 때 더욱 신뢰할 수 있는 정보가 될 것으로 생각된다.

• 대한소아치과학회지
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• 제25권3호
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• pp.506-512
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• 1998

심신장애자, 심한 불안과 공포가 있는 경우, 너무 어려서 의사소통이 되지 않는 환자 등, 일반적인 행동조절방법이 가능하지 않은 경우에 전신마취를 고려하게 된다. 이런 환자들은 대부분 소아 치과에서 치료하게 되므로 소아치과의사의 역할이 중요하다. 전신마취하에 시행되는 치과치료를 고려할 때, 환자의 전신적 건강상태, 환자의 현재 구강 형태, 필요한 치과치료의 종류, 책임감 있는 보호자의 유무에 따라서 입원없이 행해지는 외래환자수술을 고려할 수 있다. 전신마취하에 치과치료를 시행하고자 할 때, 치과의사나 보호자의 편의를 위해서 사용되어져서는 안되며, 적절한 환자 선택하에 시행된다면, 보통의 방법으로 치과치료를 받기 어려운 장애아동에게 유리한 치료가 될 수 있다.

• Clinical Endoscopy
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• 제57권1호
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• pp.105-111
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• 2024

Background/Aims: The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed. Methods: The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes. Results: Endoscopic drainage was the most commonly used drainage modality in 2018-2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001). Conclusions: Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs.