• Journal of Preventive Medicine and Public Health
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• 제23권4호
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• pp.451-464
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• 1990

The variation in resource utilization for hospitalized patients who had a group of similar diseases -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utillization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs : o the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs ; o the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs : o the ratio of the maximum and the minimum among the mom LOS of hospitals was greater than 2 in 82 KDRGs ; o the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.14-17
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• 2013

Purpose: The open abdomen is now the standard of care in various clinical situations, especially it is used to treat abdominal compartment syndrome. Many techniques have been reported for closure after an open abdomen, but most take a long time for complete definitive closure and are associated with various problems. We describe a technique using biologic mesh that can achieve early definitive closure after an open abdomen. Methods: A 45-year-old man presented to the emergency room with a painful hip and painful lower extremities after a fall from 80 feet. Radiologic examination revealed multiple fractures of the pelvis and low extremities. Abdominal compartment syndrome caused by a retroperitoneal hematoma developed during the orthopedic surgery. We performed exploration immediately and closed abdomen temporarily. A peritoneal graft of porcine dermal collagen with anterior myofascial approximation of the rectus abdominis muscles and sliding skin flap was performed three days after the previous surgery. Results: There were no complications related to the wound. The patient was transferred to the Department of Orthopedic Surgery seven days after the initial surgery. Conclusion: Early definitive closure using porcine dermal collagen is a feasible method that can reduce the length of hospitalization and the number of operations for an open abdomen.

• 품질경영학회지
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• 제41권4호
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• pp.623-635
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• 2013

Purpose: The recent major recalls of hazardous products caused consumer product safety acts to be strengthen worldwide. Although the recall system of hazardous products in Korea has been operating based on Framework Act on Product Safety since 2011, the evaluation of product risk has been relied on not the results of objective incident data but the results of illegal product investigations. The purpose of this paper is to propose a product risk assessment model for Korea using injury data. Methods: The authors derived Korea's risk assessment method by analysing the advantages and disadvantages of the most widely used models in advanced countries such as EU's RAPEX RAG and Janpan's R-MAP. In this study, the level of relative frequency and severity of injury are determined based on the objective incident data and the length of hospitalization respectively. In addition, the injury data occurred during 2011 is applied to the proposed risk assessment model for case study. Results: The data analysed in this paper can be classified as high risk, medium risk, low risk, acceptable risk, and safe products through the matrix f rom the combination of the relative frequency and the severity derived. Conclusion: The proposed risk assessment model in this study has advantage obtaining reliable objective results because it uses actual injury data and redeems the drawbacks of the existing models used in advanced countries. Furthermore, because the proposed model shows the high risk products among many, it is expected to be useful especially for customs whose main job is inspecting the imported goods and the government when selecting the target product groups for safety investigation.

• 대한디지털의료영상학회논문지
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• 제8권1호
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• pp.21-26
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• 2006

Hospitals these days are trying to introduce the a practice has recently been generalized in the test or diagnosis process, where test results and images from different test labs are interlinked together. This process is identical to that of physical aspect in EMR process, which computerizes the paper results within the hospital. One of the prerequisites for the process of computerizing test results is the interface between clinical test devices in the test labs. However, due to the variety of prescription inputs, disparity of test result papers, complexity of job in test labs and diversify of interfaces among the different devices, interconnection with the hospital information system is a complicated job. A universal control of clinical test devices which have independent communication protocols has become possible by connecting them with an interface workstation. As for the patients, waiting time for test has been reduced, and, thanks to the synchronized result retrieval system, it has become possible to check the test results on the very day of the test. As a result, the length of hospitalization has been reduced, too. In terms of workflow, as the transfer of charts and transfer of result papers are separated, the embarrassing job of collecting result papers has disappeared. As patients' test appointment and the results processing can be made on-line, extra work for doctors have disappeared. And, thanks to the computerization of test results information management, the job of statistical processing has become convenient.

• 근관절건강학회지
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• 제7권2호
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• pp.258-268
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• 2000

The purpose of this study is to describe anxiety, depression and disease activity index(SLEDAI) and correlations among these variables, to provide the basic information developing apporiate nursing interventions for the lupus patients. In this study, authors evaluated anxiety, depression and SLEDAI from 39 lupus patients at one university hospital in Seoul. Data were collected by using questionnaires and reviewing medical records. Frequencies, t-test, Duncan's multiple range test after ANOVA were evaluated with SAS program. The key results were as follows : 1. The average age of the subjects was 31.0 years and ranged from 20 to 51. Female comprised 70.9% and 79.5% were unemployed and housewife. Fifty one point nine percent of the sample had a spouse and above junior college graduates. 74.4% of the sample had a religion and average length of suffering from lupus was 66.59 months. Majority(94.9%) of the subjects had experience of hospitalization, and 55.3% had experience of learning about lupus and average number of learning was 3.9. 2. The average anxiety score of the subjects was 44.53, showing significant relationship with educational background(t=2.27, p< .05), monthly income(F=4.56. p< .05). 3. The depression score was 41.85, showing significant relationship with monthly income(F=3.81 p=0.0236) experience of learning about lupus(t=2.09, p< .05). 4. The SLEDAI score was 12.36, showing no significant relationship with demographical variables. 5. Anxiety showed positive correlations with depression(r=0.76, p< .001), SLEDAI(r=0.48, p< .01), and depression showed positive correlations with SLEDAI(r=0.42, p< .001).

• Clinical Endoscopy
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• 제56권3호
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• pp.340-352
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• 2023

Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

• 대한한방내과학회지
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• 제45권3호
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• pp.429-443
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• 2024

Background: The study reports the effect of Korean medicine treatment on a patient with left facial palsy caused by Wegener's granulomatosis. Case information: The patient was receiving steroid treatment for facial palsy and was hospitalized for 21 days. He received acupuncture, electroacupuncture, bee venom pharmacopuncture, and moxibustion treatment along with Ssanghwa-tang and Cheongansohabwon herbal medicine treatment. During hospitalization, the Sunnybrook facial grading scale, House-Brackmann scale and length of time for the eye to completely close were evaluated at 11/16, 11/21, 11/27, 12/1, and 12/6. Post treatment, the degree of the movement in the left eyelid was improved, it took less time for the eye to close completely, the movement of the forehead wrinkle muscles improved, but that of the facial muscles under the eyes and left orbicularis oculi muscle showed little improvement. Conclusion: Korean medicine treatment for facial palsy caused by Wegener's Granulomatosis helps restore mobility of the forehead and orbicularis oculi muscles.

• 한국병원경영학회지
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• 제29권3호
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• pp.1-10
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• 2024

Purposes: When rehabilitation services are provided remotely using information and communication technologies to patients living at home, there is an advantage in providing rehabilitation services to individuals in their everyday social and physical environment, which can improve functional outcomes and satisfaction. The purpose of this study was to analyze the effectiveness of the pilot project by analyzing the outpatient and inpatient medical use and expenses of patients who participated in the rehabilitation patient home-based care pilot project. Methodology: To analyze the effectiveness of the home-based care pilot project for rehabilitation patients, health insurance claims data from the Health Insurance Review and Assessment Service was used. The subjects of analysis were patients who had undergone major lower extremity joint replacement surgery, including hip, knee, and ankle joint replacement surgery, and patients who had lower extremity fracture surgery, which were the targets of the rehabilitation patient home-based care pilot project. To compare medical use and expenses between patients participating in the rehabilitation patient home-based care pilot project and those not participating, chi-square test, t-test, and multiple regression analysis were performed. Findings: As a result of analyzing the number of medical use cases and expenses of patients who participated and those who did not participate in the rehabilitation patient home-based care pilot project, the average outpatient medical use and outpatient medical expenses per person for participating patients were lower than those for patients who did not participate. The average hospitalization cost per person and the average length of stay per person were also lower than those of patients who did not participate. Practical Implications: Home-based care for rehabilitation patients continues to provide medical services at home, not at medical institutions, and can be expected to reduce readmissions and complications by resolving patients' emergency situations at home or on their own, thereby reducing medical use.

• 종양간호연구
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• 제4권2호
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• pp.110-123
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• 2004

The purpose of this study was to develop a clinical pathway for the allogeneic bone marrow transplantation donor. For this study, a conceptual framework was developed through a review of the literature including six steps which are using in Jones Hopkins Hospital. USA. The researcher reviewed 129 medical re-cords of donor who had bone marrow donation between January 2002 to January 2004, to identify the overall service contents required by these patients and to make a preliminary clinical pathway. A content validity test was done for the preliminary clinical pathway, a professional group screened 51 medical re-cords and adopted with 3 hospitalization days as the clinical pathway framework. In the fifth step, clinical pathway test was also done to 7 donors from April 28th to July, 2004. After these processes the final clinical pathway was developed. The results of this study are as follows: 1. The vertical axis of the clinical pathway Includes the following 9 items: vital signs, nursing assessment, activity, diet, intervention, medication, test, consultation and patient teaching. The duration of the horizontal axis was 3days from admission to discharge 2. Analysis of the 129 medical records indicated that the average length of stay was 3 4 days. The medical performance according to the vertical axis in the preliminary clinical pathway consisted of 51 items After clinical validity test, it steel consisted of 51 items in the final form. 3. Clinical Validity test was done to 7 bone marrow donors. During these process, The first patient was deleted because he was out of the criteria the investigate set and 6 patients were used, finally The result of this study indicated all of 7 donors were discharged on expected day. 4. Clinical pathway enables to improve the quality of care, multidisciplinary team work It also helps nursing bone marrow donor, effective education to donor or medical member. The results of this study suggest that clinical pathway may be able to improve the quality of nursing care for bone marrow transplantation donors.

• 대한영양사협회학술지
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• 제15권2호
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• pp.168-178
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• 2009

Hematopoietic stem cell tranntation is being widely used in an attempt to treat many hematological diseases such as leukemia, anemia, and lymphoma. To evaluate the success of hematopoietic stem cell transplantation, it is very important to determine how rapidly engraftment occurs. Therefore, this retrospective study was conducted to determine which factors affected the term of engraftment during hematopoietic stem cell transplantation, while focusing on the oral intake status. To accomplish this, 416 patients who underwent transplant operations at St. Mary's hospital from May 2006 to April 2008 were evaluated. The long-term engraftment group was characterized as having longer fasting days and more frequent vomiting, diarrhea, and oral mucositis incidences than the short-term engraftment group. In addition, the inhibitors of oral intake such as vomiting, diarrhea, and oral mucositis developed frequently between the pre-transplantation and 2 weeks after transplantation. A significantly negative correlation was observed between the oral intake volume and the duration of the oral intake inhibitors. A multiple regression analysis revealed that the frequency of vomiting and oral mucositis during hematopoietic stem cell transplantation, the length of hospitalization, and the hematocrit level in the 2 weeks after hematopoietic stem cell transplantation were significant predictors of engraftment. The results of this study could be used to establish a guideline for nutritional assessment, nutritional goals, and nutritional support for patients during hematopoietic stem cell transplantation.