• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.31 no.4
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• pp.13-21
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• 2018

Objectives : This study was aimed to find significant prognostic factor of inpatients with severe atopic dermatitis (AD) who treated in a Traditional Korean Medicine (TKM) hospital. Methods : A retrospective review of medical records of 39 patients with severe AD who hospitalized for more than 7days was performed. All patients were treated with acupuncture, herbal decoction and herbal wet wrap dressing. Therapeutic effect was assessed by difference of objective SCORing of Atopic Dermatitis index (${\Delta}OSI$) at admission and at discharge. Patients were divided into two groups: improvement group (${\Delta}OSI{\leq}5$) and no-improvement group (${\Delta}OSI>5$), and clinical characteristics, severity, infectious complication, serum total IgE, eosinophil counts, adherence and concomitant treatment were investigated. Results : There were 7 cases in no-improvement group. There was no significant difference in OSI or infectious complication between the two groups. Also, there was no significant difference in total serum IgE and eosinophil counts, which are known to be related to severity of AD. However, the proportion of adherence group was significantly lower in no-improvement group than improvement group. Conclusions : This study suggest that treatment adherence is a significant prognostic factor for treatment outcome in inpatients with severe atopic dermatitis. If the adherence to treatment is improved, the therapeutic effect of hospitalization would increase in spite of severe AD or infectious complication.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.13-24
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• 2014

This study analyzes the effects of hospital caseload on medical charges and length of stay for inpatients. Hospital caseload, representing the level of concentration of patients, was measured with the Internal Herfindal Index for three diagnosis related group (DRG) codes (appendectomy, operations on anus, and operations on uterus and adnexa). Ordinary least squares regression was used for analysis. Results showed that medical charges per inpatient and average length of stay significantly differed with respect to hospital concentration indices, and that hospital caseload was inversely related to operational performance for appendectomy and operations on uterus and adnexa. The significant negative relationship between concentration index and length of stay may decrease the total medical charges. The results imply that the expansion of the DRG payment system to hospitals will have a negative influence on their gross sales.

• Journal of Home Health Care Nursing
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• v.18 no.1
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• pp.40-47
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• 2011

Purpose: This study investigated changes in neurocognitive function over a 2-month period of board game therapy in patients with schizophrenia. Method: Twenty-one schizophrenic patients treated with board game therapy and nineteen control schizophrenic patients were evaluated with neuropsychological and clinical tests, such as the Wisconsin Card Shorting Test (WCST). The same tests were re-administered after 2 months of board game therapy. Results: At the first series of neuropsychological tests, no difference was seen in performance, demographical aspects, or clinical severity among both patient groups. After 2 months, the group receiving board game therapy showed significant improvement of WCST performances compared to the controls. However, no difference was observed in clinical symptoms between the groups. Conclusion: The results of cognitive enhancement in patients playing board games indicates that board game play, easily used in an inpatient setting, is a promising tool for executive function improvement in chronic schizophrenic patients.

• Health Policy and Management
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• v.27 no.3
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• pp.211-218
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• 2017

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.

• Quality Improvement in Health Care
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• v.27 no.1
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• pp.26-42
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• 2021

Purpose: This study aimed to explore frontline nurses' experience of patient-centered care and understand the factors affecting its implementation in hospitals. Methods: Four focus group interviews were conducted with 30 nurses in two university hospitals. The following theoretical framework of patient-centered care was used: 1) Respect for patients' values, preferences, and expressed needs, 2) Care coordination and integration, 3) Information, communication, and education, 4) Physical comfort, 5) Emotional support and alleviation of fear and anxiety, 6) Involvement of family and friends, 7) Care transition and continuity, and 8) System issues. We performed a directed content analysis. Results: The most frequent patient-centered nursing practices of the hospital nurses were "promoting physical comfort" in inpatient settings and "providing information and communicating" in outpatient settings. The factors influencing patient-centered nursing included the health professionals' mindfulness, work overload and staff shortage, and unreasonable social demands and regulations. Conclusion: A more comprehensive patient-centered nursing practice should be implemented by improving "care transition and continuity," "family/caregiver involvement," and "system building." Health professionals' mindfulness is significant, and organizational supports addressing work overload and staff shortage are needed alongside change in social awareness.

• Journal of Korean Academy of Nursing Administration
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• v.6 no.1
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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.

• Korean Journal of Biological Psychiatry
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• v.24 no.2
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• pp.68-74
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• 2017

Objectives It is well known that problem drinking is associated with alterations of brain structures and functions. Brain functions related to alcohol consumption can be determined by the resting state functional connectivity in various resting state networks (RSNs). This study aims to ascertain the alcohol effect on the structures forming predetermined RSNs by assessing their cortical thickness. Methods Twenty-six abstinent male patients with alcohol dependence and the same number of age-matched healthy control were recruited from an inpatient mental hospital and community. All participants underwent a 3T MRI scan. Averaged cortical thickness of areas constituting 7 RSNs were determined by using FreeSurfer with Yeo atlas derived from cortical parcellation estimated by intrinsic functional connectivity. Results There were significant group differences of mean cortical thicknesses (Cohen's d, corrected p) in ventral attention (1.01, < 0.01), dorsal attention (0.93, 0.01), somatomotor (0.90, 0.01), and visual (0.88, 0.02) networks. We could not find significant group differences in the default mode network. There were also significant group differences of gray matter volumes corrected by head size across the all networks. However, there were no group differences of surface area in each network. Conclusions There are differences in degree and pattern of structural recovery after abstinence across areas forming RSNs. Considering the previous observation that group differences of functional connectivity were significant only in networks related to task-positive networks such as dorsal attention and cognitive control networks, we can explain recovery pattern of cognition and emotion related to the default mode network and the mechanisms for craving and relapse associated with task-positive networks.

• Health Policy and Management
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• v.26 no.4
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• pp.289-304
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• 2016

Background: Rehabilitations in subacute phase are different from acute treatments regarding the characteristics and required resource consumption of the treatments. Lack of accuracy and validity of the Korean Diagnosis Related Group and Korean Out-Patient Group for the acute patients as the case-mix and payment tool for rehabilitation inpatients have been problematic issues. The objective of the study was to develop the Korean Rehabilitation Patient Group (KRPG) reflecting the characteristics of rehabilitation inpatients. Methods: As a retrospective medical record survey regarding rehabilitation inpatients, 4,207 episodes were collected through 42 hospitals. Considering the opinions of clinical experts and the decision-tree analysis, the variables for the KRPG system demonstrating the characteristics of rehabilitation inpatients were derived, and the splitting standards of the relevant variables were also set. Using the derived variables, we have drawn the rehabilitation inpatient classification model reflecting the clinical situation of Korea. The performance evaluation was conducted on the KRPG system. Results: The KRPG was targeted at the inpatients with brain or spinal cord injury. The etiologic disease, functional status (cognitive function, activity of daily living, muscle strength, spasticity, level and grade of spinal cord injury), and the patient's age were the variables in the rehabilitation patients. The algorithm of KRPG system after applying the derived variables and total 204 rehabilitation patient groups were developed. The KRPG explained 11.8% of variance in charge for rehabilitation inpatients. It also explained 13.8% of variance in length of stay for them. Conclusion: The KRPG version 1.0 reflecting the clinical characteristics of rehabilitation inpatients was classified as 204 groups.

• The Journal of Korean Obstetrics and Gynecology
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• v.25 no.1
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• pp.93-105
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• 2012

Objectives: This study explored the relationships between Bone Mineral Density (BMD), Body Mass Index(BMI), Age, pain duration outcomes of treatment for Low Back Pain(LBP) in 3 groups(normal,osteopenia,osteoporosis) of female patients. Methods: We evaluated 32 cases of normal, 30 cases of osteopenia and 38 cases of osteoporosis based on BMD, BMI, Age, pain duration among the female inpatients with LBP caused by lumbar disc herniation, admitted at Jaseng Hospital of Oriental Medicine from January 2010 to December 2011. And we measured VNRS(Verbal Numeric Rating Scale) to evaluate the conservative treatment effects. Results: In improvement of female LBP caused by lumbar disc herniation, BMD(T-score), BMI had not proved correlation(P-value>0.05). Female patients' age was negatively correlated with T-score. In pain improvement, BMD normal group showed more reduction of NRS(numeric rating scale) than osteoporosis group, but that had not proved correlation(p-value=0.893). Conclusions: Statically, among the female inpatients with LBP caused by lumbar disc herniation, had no significant differences between the normal group, osteopenia group and osteoporosis group's improvement rate, depending on treating period.

• Journal of Preventive Medicine and Public Health
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• v.30 no.2 s.57
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• pp.437-461
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• 1997

Because of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 30 years, the life expectancy of the Korean people has lengthened considerably and as a result, the number of the elderly has markedly increased. Such an increase of the number of aged population brought about many social, economic, and medical problems which were never seriously considered before. This study was conducted to assess the trend of medical care utilization and medical expenditure of the elderly. The data of each patient in the study were taken from computer database maintained for administrative purpose by the Korea Medical Insurance Corporation. The study population was 132,670 who were 60 years old or more and registered in Korean Medical Insurance Corporation from 1989 to 1993. The study subjects were predominantly female(56.3%) and 10,000-20,000 Won premium group(50.6%). The following are summaries of findings : The total increase of the number of inpatient cases was 40.5% from 1989 through 1993. The average annual increase was 3.7% in inpatient medical expenditures per case, 4.4% in inpatient medical expenditures per day and 0.08% in length of stay per case from 1989 through 1993. Cataract was the most prevalent disease of 10 leading frequent diseases in all ages from 1989 through 1993. The case mix in 1993 compared to 1989 revealed that cataract and ischemic cerebral disease were increased whereas essential hypertension and pulmonary tuberculosis were decreased . The average annual increase of medical expenditures was 3.8% in general hospitals, 6.3% in hospitals and 2.4% in clinics. From 1989 through 1993, medical expenditures used by high-cost patients accounted for about 14% to 20% of all expenditures for inpatient care, while they represented less than 2.5% of the elderly population. Time series analysis revealed that total medical expenditures and doctor's fee for inpatient will be progressively increased whereas drug expenditures for inpatient will be decreased. And there will be no change in length of stay. Based on the above results, the factors increasing medical cost and utilization should be identified and the method of cost containment for the elderly health care should be developed systematically.