• The Journal of Korean Medicine
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• v.35 no.3
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• pp.93-102
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• 2014

Objectives: This study aimed at revising the Korean Out-patient Groups for Korean Medicine (KOPG-OM, version 1.0) based on clinical similarity and resource use, by using the accumulated claims data, and evaluating the validity of the revised classification system. Methods: A clinical specialist panel involving 19 specialists from 8 Korean medicine (KM) specialty areas reviewed the classification tree, diagnosis groups and procedure groups in terms of clinical similarity. Several models of outpatient grouping were formulated, with the validity of each tested based on the $R^2$ coefficient of determination for the treatment costs of all visits. To add age splits, the variances of treatment costs by age groups were also analyzed. These statistical analyses were performed using KM claims data of National Health Insurance from 2010 to 2012. Results: The classification tree designed via panel discussions was used to allocate outpatient cases to 26 diagnosis groups, with cases involving procedures such as acupuncture, moxibustion and cupping, then allocated to 9 procedure groups in each diagnosis group. The cases without procedures were categorized into the visit index - medication group. This process resulted in 298 outpatient groups. The $R^2$ values for treatment costs of all visits ranged from 0.38 to 0.69 depending on the providers' types. Conclusions: The revised model of KOPG-KM has a higher validity for outpatient classification than the current system and can provide better management of the costs of outpatient care in KM.

• Health Policy and Management
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• v.28 no.4
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• pp.339-351
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• 2018

Background: The purpose of this study is to estimate empirically whether there is a difference in medical use among income groups, and if so, how much. This study applies econometric model to the most recent year of Korean Medical Panel, 2015. The model consists of outpatient service and inpatient service models. Methods: The probit model is applied to the model which indicate whether or not the medical care has been used. Two step estimation method using maximum likelihood estimation is applied to the models of outpatient visits, hospital days, and outpatient and inpatient out-of-pocket cost models, with disconnected selection problems. Results: The results show that there was the inequality favorable to the low income group in medical care use. However, after controlling basic medical needs, there were no inequities among income groups in the outpatient visit model and the model of probability of inpatient service use. However, there were inequities favorable to the upper income groups in the models of probability of outpatient service use and outpatient out-of-pocket cost and the models of the number of length of stay and inpatient out-of-pocket cost. In particular, it shows clearly how the difference in outpatient service and inpatient service utilizations by income groups when basic medical needs are controlled. Conclusion: This means that the income contributes significantly to the degree of inequality in outpatient and inpatient care services. Therefore, the existence of medical care use difference under the same medical needs among income groups is a problem in terms of equity of medical care use, so great efforts should be made to establish policies to improve equity among income groups.

• Korean Journal of Occupational Health Nursing
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• v.22 no.2
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• pp.83-92
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• 2013

Purpose: This study was to compare job stress and job satisfaction between ward nurses and outpatient nurses, and to identify the correlation between job stress and job satisfaction. Methods: The subjects of this study were 200 ward nurses and 85 outpatient nurses in G and I University Hospital in Incheon. The data were collected in March 2010 and analyzed with t-test and Pearson correlation coefficient. Results: There was no significant difference in overall job stress between two groups, but slightly higher stress level for ward nurses. In sub-area of job stress, 'nursing duty' was primary for both groups. And in 'nursing duty' (t=2.05, p=.041), 'conflict with patients' (t=2.73, p= .007), and 'working environment' (t=3.37, p<.001) ward nurses showed significant higher level of stress than outpatient nurses. For job satisfaction, outpatient nurses showed higher level significantly (t=-2.98, p=.003). And both groups of nurses' job satisfaction was negatively correlated with job stress significantly (r=-.31, p<.001). Conclusion: It will be possible to reduce job stress and promote job satisfaction level for both groups of nurses by adding staffs, and specifically for ward nurses by improving facilities for relax and appropriate supply, and for outpatient nurses by managing interpersonal stress and reducing side tasks.

• Journal of Preventive Medicine and Public Health
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• v.27 no.1 s.45
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• pp.135-144
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• 1994

The purpose of this study compares determinants of eldery medical cost inflation with those of other age groups by analysing aggregated data with a deterministic model. The deterministic model of per capita medical cost inflation consists of increases in price, intensity of services, and medical utilization. We used a time series data($1985{\sim}1991$) from National Medical Insurance and analyzed by age groups. In total population, the average increase rates of inpatient and outpatient medical costs were respectively 9.5% and 8.8% during 6 years and the major cause of inflation was the increase in service intensity in both of inpatient and outpatient cases. But in the population of 65 years old and over, the average increase rates of inpatient and outpatient medical costs were respectively 13.8% and 14.8% and the major cause of inflation was the increase in per-capita medical utilization in both of inpatient and outpatient cases. Also, the increase in service intensity of 65 years old and over was the highest of other age groups. This pattern was similar during study periods. We concluded that the level of medical cost-inflation and the determinants in eldery was the highest-especially in per capita medical utilization, therfore, the inflation of medical costs in eldery will be higher than other age groups for the furture in Korea.

• Korean Journal of Health Education and Promotion
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• v.28 no.1
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• pp.81-92
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• 2011

Objectives: The purpose of this study is to evaluate the influence of depression symptom on the self-rated health status(SRHS), the outpatient health service utilization and quality of life(QOL) also the relationship depression symptom with socio-demographic and health related factors. Methods: We selected 9,550 participants without chronic diseases from a total of 18,104 in the '2009 community health survey in Gyeongnam. They were assessed by using a Korean version of the Center for Epidemiological Studies-Depression Scale(CES-D). Those with CES-D scores of 21 or greater were defined as having probable depression. Results: A probable depression were associated in bivariate analysis with gender, age, educational status, monthly household income, marital status, current smoking status, drinking habit, physical activities and body mass index. After adjustment for covariates, probable depression groups predicted a lower status in SRHS. Likewise probable depression groups predicted a higher utilization in outpatient health service. Also probable depression groups predicted a lower score in QOL. Conclusions: Probable depression influence SRHS, outpatient health service utilization and QOL even after adjusting for the socio-demographic, health related factors and chronic medical illness. Programs for prevention and management of depression will be helpful to promote health and QOL.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.380-389
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• 2023

Background: Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. Methods: A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. Results: One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. Conclusions: TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.

• Health Communication
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• v.13 no.2
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• pp.175-183
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• 2018

Purpose: The purpose of this study was to compare communication competence, nursing professionalism, work environment and job satisfaction between outpatient nurses and ward nurses, and to identify the correlation among variables. Methods: The participants were 90 outpatient nurses and 98 ward nurses at the two general hospitals. Data were collected using self-administered questionnaires. Data were analyzed using descriptive statistics, ${\chi}^2-test$, independent t-test and Pearson's correlation coefficient. Results: There were statistically significant differences between two groups in nursing professionalism, possibilities for development, commitment to the workplace, social support from colleagues, social community at work and job satisfaction, outpatient nurses showed higher level than ward nurses except commitment to the workplace. The work environment variables and nurses' job satisfaction were mostly correlated. Job satisfaction showed significant negatively correlated with quantitative demands, emotional demands and role conflicts in both groups nurses. Conclusion: These findings showed that nursing work environments were the most important factor for job satisfaction of both group nurses. Therefore, it is necessary to put efforts in improving nursing work environment and to develop diverse strategies for human resource management.

• Korean Institute of Interior Design Journal
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• v.25 no.4
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• pp.113-124
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• 2016

This research examines domestic and oversea's barrier-free design guidelines provided exclusively for children and their implementations in the common spaces of the outpatient clinics in two pediatric rehabilitation hospitals in Seoul. Based on literature review, a checklist was developed to compare various barrier-free design guidelines in consideration of children's accessibility in space. In addition, four spatial areas in the outpatient clinics of the two hospitals were investigated based on the checklist. As a result, the domestic and Japanese guidelines were aiming primarily to all user groups regardless of ages. Whereas in other oversea's guidelines, a number of barrier-free design standards exclusive for children were found in the facility items such as handrail, sink, urine, toilet, water fountain, chair, table, shelve, and so on, throughout the indoor waiting and sanitary spaces. Concerning implementations, most of the items in the indoor passage, waiting, and sanitary spaces of the two hospitals were not sufficiently facilitated enough to meet with the barrier-free design standards exclusive for children. As such, it is recommended to review and improve the current domestic barrier-free design guideline to accommodate various physical and spatial needs of children in all age groups and regardless of disability types, in the design of a pediatric rehabilitation hospital in the future.

• Journal of Preventive Medicine and Public Health
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• v.43 no.6
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• pp.496-504
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• 2010

Objectives: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. Methods: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. Results: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. Conclusions: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

• 한국사회복지학회:학술대회논문집
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• 2004.10a
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• pp.461-492
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• 2004

This study examined the effects of gender, parental support and treatment type on the treatment outcome of adolescent substance abusers. Outcome variable was the successful graduation (or drop) from an Intensive Adolescent Outpatient Program. Adolescents with their parents' support were treated in one of three treatment models (2-weeks Inpatient plus 6 week Intensive Croup-Oriented Outpatient, 8-weeks Intensive Croup-Oriented Outpatient, and 8-weeks Individual-Family Therapy) within a private hospital-affiliated treatment center by managed care practice allowing their own choice (non-random natural assignments). Several hypotheses were tested for main effects by the Log-Linear Analyses for a multi-dimensional contingency table with 440 adolescents (284 boys and 156 girls treated during 1992-l997) from middle-class families with private health insurances. The following results were found. Odds of graduating versus dropping out of the treatment program among : (1) girls were 1.7 times higher than those among boys; (2) adolescents with two-parent were 2.2 times higher than those among adolescents with one-parent ; (3) adolescents with Inpatient plus Outpatient was 1.7 times higher than that of those with Outpatient; (4) adolescents with Individual-Family Therapy was 2.3 times higher than that of those with Outpatient Model. There was no statistically significant outcome difference between the Individual-Family Therapy and the Inpatient plus Outpatient. Implications from the results were discussed. Suggestions were made to improve the treatment components in the areas of gender sensitivity, securing more parental support, alternatives for separation from peer group and integrating new peer groups, and flexibility for the unique needs of individual family. Also, some research questions for future studies were suggested.