• 보건행정학회지
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• 제16권2호
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• pp.77-95
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• 2006

The present study was conducted to examine the degree of variation in length-of-stay (LOS) among health care institutions participating in 17 diagnosis-related groups (DRGs) payment system and to find out hospital characteristics affecting the variation. Electronic medical claims data for treatments of severity classification '0' of 17 DRGs provided for two $years(2003{\sim}2004)$ were collected. For each DRG, the degree of variation in average LOS among health care institutions were analyzed using the random effect model. For DRGs showing significant differences in LOS, multiple regression analyses were performed to find out factors associated with LOS. Significant variations in LOS were observed 9 DRGs including unilateral/bilateral lens procedures, adult/child tonsilectomy, other anal procedures, bilateral adult/child herniorraphy, unilateral child herniorraphy, and hysterectomy, and hysterectomy using laparoscopic procedure. Among the 9 DRGs, five DRGs were selected to investigate the factors explaining for the variation. It was observed that the location of institution was significant predictors for all five DRGs. Within the same DRGs, LOS was significantly shorter among the institutions located in Seoul than those in other areas. As compared to clinics, hospitals and general hospitals/tertiary care institutions showed significantly longer LOS for DRGs of lens procedures, tonsilectomy, and other anal procedures. It is recommended that the institutions located in other than Seoul area benchmark the strategies of the institution in Seoul in efficiently managing LOS. Also, significant variation within the same severity classification such as other anal procedures implies the imminent need for improvement of patient classification system.

• 디지털융복합연구
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• 제10권1호
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• pp.413-422
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• 2012

본 연구는 급성심근경색증 입원환자를 대상으로 중증도가 보정된 적정 재원일수 예측모형을 개발하여 의료의 질 관리 및 정책 개발에 필요한 기초자료를 제시하고자 하였다. 2004-2006년 퇴원손상심층조사 자료 중 급성심근경색증 입원환자 2,309명을 대상으로 급성심근경색증 입원환자의 적정 재원일수 예측모형은 데이터마이닝을 이용하여 개발하였다. 의사결정나무 모형에 따라 급성심근경색증 입원환자의 평균재원일수에 가장 큰 영향을 미치는 변수는 관상동맥우회술(CABG)과 동반질환 건수로 나타났다. 앙상블 모형을 이용하여 개발된 급성심근경색증 입원환자의 중증도 보정 재원일수 모형 결과, 적정 재원일수와 실제 재원일수의 차이는 보험유형과 의료기관 소재지가 통계적으로 유의하게 나타났다. 따라서 재원일수의 변이를 줄이고 효율적으로 관리하기 위해 의료기관에서는 다빈도 질환에 대한 중증도 보정 적정 재원일수 예측모형을 개발하여 이를 의료정보시스템에 적용하고 관리하는 활동을 전개해야 할 것이다.

• 디지털융복합연구
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• 제15권2호
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• pp.273-283
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• 2017

본 연구는 의료기관이 자체적으로 재원일수관리 활동을 하도록 유도하기 위해 외래정보로 재원일수를 예측하여 입원환자 재원일수를 예측하고 재원일수관리의 효율성을 제공할 수 있는 융복합 맞춤형 재원일수 관리 시스템을 개발 방안을 제시하고자 하였다. 외래정보 자료를 기반으로 개발된 재원일수 예측 모형을 이용한 융복합의 맞춤형 재원일수 관리 웹 프로그램은 실시간 예측 재원일수 산출되도록 구현되었다. 예측 모형을 기반으로 장기재원예측 환자군, 집중 관리 환자군 등 재원일수관리 서비스 대상이 도출되었다. 장기재원예측 환자군, 집중관리 환자군에 장기 재원 예상 알림 서비스, 재원일수 초과 알림 서비스 등을 제공할 수 있어 맞춤형 재원일수 관리 시스템이 맞춤형 재원일수 관리에 효율적인 시스템인 것이 확인되었다. 이에 융복합 맞춤형 재원일수 관리 시스템 웹 활용을 위해서는 재원일수 예측 질환의 확대와 국가 차원의 시범운영 정책 추진 방안이 필요하다.

• 보건행정학회지
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• 제21권1호
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• pp.44-60
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• 2011

Background : Surgical site infection(SSI) is one of the important nosocomial infections with pneumonia, urinary tract infection. SSI increases mortality, morbidity, length of stay, and costs for postoperative patients. The purpose of this study was to estimate length of stay(LOS) and health care costs from SSI using the large observational data. The ultimate objective was to show the effect of prevention of SSI. Method : This study used antibiotic prophylaxis evaluation data and claims data of the HIRA(Health Insurance Review and Assessment Service). The study population included 18,361 patients who underwent gastric surgery, endoscopic cholecystectomy, colon surgery, hysterectomy, cesarean section in nationwide hospitals from August to October 2007. SSI group and non-SSI group were matched according to propensity score resulted from logistic regression. The paired t-test was used to compare the difference of the LOS and health care costs between SSI group and non-SSI group. Results : The 598 cases of SSI were detected of total subjects, and the crude SSI rate was 3.3%. For each surgery, SSI rates were 5.5% for gastric surgery, 4.7% for cholecystectomy, 6.6% for colon surgery, 2.6% for hysterectomy, and 1.6% for cesarean section. The 596 cases of SSI and the 596 cases of non-SSI were matched by propensity score. The LOS of SSI group was longer than that of non-SSI group, and the difference was statistically significant. Health care costs of SSI group was more than that of non-SSI group which was significant. Conclusions : SSI increased apparently the LOS and healthcare costs. The economic loss might affect the cost of national healthcare as well as patients and hospitals. This study provided the evidence that the healthcare expenditure could be reduced by preventing SSI.

• 디지털융복합연구
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• 제13권5호
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• pp.89-99
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• 2015

본 연구는 의료기관이 자체적으로 재원일수관리 활동을 하도록 유도하기 위해 타 의료기관과 재원일수 관리 수준을 비교하여 의료기관의 재원일수 수준을 평가하고 재원일수관리의 효율성을 제공할 수 있는 재원일수 벤치마킹 시스템을 개발 방안을 제시하고자 하였다. 퇴원손상심층조사 자료를 기반으로 개발된 재원일수 중증도 모형을 이용한 융복합의 재원일수 벤치마킹 웹 프로그램은 병상 규모별, 지역별 비교되도록 구현되었고, 엑셀 파일 다운로드와 함께 리포트기능도 추가되었다. 또 실시간 중증도 보정 재원일수 산출 기능도 구현되었다. 시범운영 결과, 병원 운영진 또는 해당 임상 과로부터 질환별, 지역별 비교통계를 요청받으므로, 재원일수 벤치마킹 시스템이 장기재원관리, 질환별 재원관리 등 재원일수 관리에 효율적인 시스템인 것이 확인되었다. 이에 재원일수 벤치마킹 시스템 웹 활용을 위해서는 중증도 보정 질환의 확대와 국가 차원의 정책 추진 방안이 필요하다.

• 디지털융복합연구
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• 제13권2호
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• pp.215-225
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• 2015

본 연구는 무릎관절치환술의 효율적 재원일수 관리를 위해 퇴원손상심층조사 자료를 이용하여 무릎관절치환술에 대한 중증도 보정 재원일수 모형을 개발하고, 이를 기반으로 무릎관절치환술의 재원일수 변이요인을 파악하고자 하였다. 수집된 퇴원손상심층조사 자료 중 무릎관절치환술 환자 4,102명을 대상으로 동반상병 보정 방법 및 데이터마이닝 기법을 이용하여 무릎관절치환술 환자에 대한 중증도 보정 재원일수 모형을 개발한 결과 CCS 동반상병 보정 방법을 이용한 의사결정나무 모형이 가장 우수하였으며, 무릎관절치환술 환자의 재원일수에 영향을 미치는 요인은 관절염 동반유무, 성, 입원경로 등으로 나타났다. 개발된 중증도 보정 모형을 기반으로 무릎관절치환술 환자의 적정 재원일수와 실제 재원일수의 차이를 파악한 결과 진료비지불방법, 병상규모, 의료기관 소재지 모두 통계적으로 유의한 차이가 있었다. 따라서 무릎관절치환술 환자의 재원일수 변이를 줄이고 효율적으로 관리하기 위해서는 과잉 진료에 대한 모니터링 등에 정책적 방안 마련이 필요하다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권4호
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• pp.356-365
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• 2020

Purpose: There have been many efforts to develop generalizable severity markers in children with acute pancreatitis (AP). Expert opinion panels have developed consensus guidelines on management but it is unclear if these are sufficient or valid. Our study aims to assess the effect of clinical and laboratory variables, in addition to treatment modality on hospital length of stay (LOS) as a proxy variable for severity in pediatric patients admitted with AP. Methods: We conducted a retrospective chart review of patients between ages of 0-18 years, who were admitted with AP at 2 institutions between 2013-2018, John R. Oishei Children's Hospital (Buffalo, NY, USA) and Medical University of South Carolina Children's Hospital (Charleston, SC, USA). We constructed three linear regression models to analyze the effect of clinical signs of organ dysfunction, laboratory markers and fluid intake on hospital LOS. Results: Ninety-two patients were included in the study. The mean age was 12 years (range, 7.6-17.4 years), 55% were females, and median LOS was 3 days. The most frequent cause of AP was idiopathic. Our study showed that elevated blood urea nitrogen (BUN) on admission (p<0.005), tachycardia that lasted for ≥48 hours (p<0.001) and need for fluid resuscitation were associated with increase LOS. Total daily fluid intake above maintenance did not have a significant effect on the primary outcome (p=0.49). Conclusion: Elevated serum BUN on admission, persistent tachycardia and need for fluid resuscitation were associated with increase LOS in pediatric AP. Daily total fluid intake above recommended maintenance did not reduce LOS.

• 한국전문물리치료학회지
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• 제14권3호
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• pp.81-89
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• 2007

The purpose of this study was to utilize the K-MBI (Korean Modified Barthel Index) and subscales of K-MBI in predicting the length of hospital stay (LOS) and the discharge destinations for stroke patients. The study population consisted of 97 stroke patients (57 men and 40 women) admitted to the Seoul National University at the Bundang Hospital. All participants were assessed by K-MBI at admission and discharge after rehabilitation therapy and the information available was investigated at admission. The data were analyzed by using the Mann-Whitney U test, the stepwise multiple regression and the logistic regression. The median LOS was 30 days (mean, 32.8 days; range, 22 to 43 days). The K-MBI score at initiation of rehabilitation therapy (p<.001), the type of stroke and living habits before a stroke were the main explanatory indicators for LOS (p<.05). Within the parameters of K-MBI measured at initiation for rehabilitation, feeding and chair/bed transfer were the explanatory factors for LOS prediction (p<.01). Confidence in the prediction of LOS was 20%. Significant predictors of discharge destination in a logistic regression model were the discharge K-MBI score, sex and hemiplegic side. Dressing in items of discharge K-MBI was the significant predictor of discharge destination. The K-MBI score was the most important factor to predict LOS and discharge destination. Knowledge of these predictors can contribute to more appropriate treatment and discharge planning.

• 품질경영학회지
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• 제39권3호
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• pp.391-399
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• 2011

Our study was carried out to analyze the variation factors of severity-adjusted length of stay(LOS) in coronary artery bypass graft(CABG). The subjects were 932 CABG inpatients of the Korean National Hospital Discharge In-depth Injury Survey from 2004 through 2008. The data were analyzed using $x^2$ test and the severity-adjusted model was developed using data mining technique. The results of the study were as follows: male(71.1%), older than 61 years of age(61.6%), more than 500 beds(92.8%) and admitting via ambulatory care(70.0%) appeared to have higher rate than otherwise. In-hospital mortality of CABG inpatients was 2.8%. In addition, 46.4% of the patients received their care in other residence. The angina pectoris(45.6%) was found to be the highest in principle diagnosis, followed by chronic ischemic heart disease(36.9%) and acute myocardial infarction(12.0%). We developed severity-adjusted LOS model using the variables such as gender, age and comorbidity. Comparison of adjusted values in predicted LOS revealed that there were significant variations in LOS by location of hospital, bed size, and whether patients received the care in their residences. The variations of LOS can be explained as the indirect indicator for quality variation of medical process. It is suggested that the severity-adjusted LOS model developed in this study should be utilized as a useful method for benchmarking in hospital and it is necessary that national standard clinical practice guideline should be developed.

• 대한영양사협회학술지
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• 제5권1호
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• pp.48-53
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• 1999

This study was prospectively conducted to investigate any relationship of nutritional status at the time of admission to length of hospital stay and mortality. All patients admitted to the Asan Medical Center between October 13 and November 12, 1997 who met the study criteria were included in the study. Patients were classified as Not-at-risk, At-risk Ⅰ or At-risk Ⅱ based on the levels of serum albumin and total lymphocyte count in a computerized nutrition screening program. Sixty three percent of the patients were classified as Not-at-risk Group, 29% as At-risk Group Ⅰ and 8% as At-risk Group Ⅱ. Significant correlation was observed between nutritional status and LOS (P＜0.01) as well as mortality rate (P＜0.05). The more the patient had the nutritional risk factors, the longer the LOS and the higher the mortality rate were. Further studies have to be done in order to demonstrate cost-effectiveness of medical therapy for the malnourished hospitalized patients.