• 보건행정학회지
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• 제21권2호
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• pp.195-212
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• 2011

Objectives: This study investigates the relationship between nurse staffing levels and differences in patient outcomes in terms of average length of stay, in-hospital mortality rate and 30-day death rate in order to evaluate the effectiveness of a policy that differentiates fees for inpatients on the basis of nurse-to-bed ratios. Methods: We obtained information on inpatients from health insurance claims data published by the Health Insurance Review and Assessment Service(HIRA) in 2008, organizational factors(type of hospital, ownership) from the records of the hospital report system in 2008, and nurse staffing levels, which were graded on a scale of 1 to 7, from data compiled between December 15, 2007, and September 20, 2008. The data were segregated according to type of hospital and quarter and finally 3,517 records of 1,182 hospitals were analyzed using multi-level analysis. Results: The average length of stay in grade 1~6 hospitals was lower than that in grade 7 ones, but the difference was much below one day. No significant difference was found among different grades in tertiary hospitals. Further, variations in staffing levels did not result in any significant difference in the in-hospital mortality rate and 30-day death rate. Conclusions: High nurse staffing levels did not result in better patient outcomes compared with low staffing levels. We therefore recommend modifying the above nurse staffing policy so as to make it more effective in improving patient outcomes.

• 보건행정학회지
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• 제29권2호
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• pp.237-244
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• 2019

Background: Weekend admission is known for having association with increased mortality attributed by poor quality of care and severe patients. We investigated the association between hospital admission on weekends and the in-hospital mortality rates of patients with cardiovascular disease. Furthermore, we examined this association stratified by admission via emergency room or not. Methods: We analyzed claim data provided by the Health Insurance Review & Assessment in 2013. In total, 80,817 cardiovascular patients were included in this study, which treated in-hospital mortality (early and during total length of stay) as a dependent variable. A generalized linear mixed effects model was used. We conducted subgroup analyses stratified by admission via emergency room or not. Results: Patients who admitted on weekend showed higher in-hospital mortality both early (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.23-1.78) and during total length of stay (OR, 1.17; 95% CI, 1.02-1.33) compared to those admitted on weekdays. Patients who were admitted to the hospital on a weekend by emergency room were more likely to experience early in-hospital mortality compared to those admitted on weekdays. Furthermore, we found that patients not admitted to the hospital through the emergency department were more likely to experience both early and total length of stay in-hospital mortality. Conclusion: Our study shows higher in-hospital mortality rates for cardiovascular patients admitted on weekends. Efforts to improve the quality of care on weekend are important to mitigate the 'weekend effect' and improve patient outcomes.

• 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.

• Journal of Chest Surgery
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• 제57권2호
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• pp.120-125
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• 2024

Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

• Advances in pediatric surgery
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• 제9권1호
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• pp.41-44
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• 2003

Appendicitis is the most common surgical emergency in childhood. Open appendectomy has been the standard treatment. The minimally invasive techniques have been adopted in children after experiences in various surgical conditions in adults has accumulated. It is debatable whether laparoscopic appendectomy (LA) is superior to open appendectomy (OA) in children. The goal of this study is to review the results of laparoscopy and laparotomy in the nonperforated appendicitis. The records of 22 patients under 15 years of age who were operated upon for nonperforated appendicitis at Asan Medical Center were analyzed between December 2002 and April 2003. Age, type and length of intervention, frequency of analgesic use, complication, length of hospitalization, and cost for each treatment groups (N=11) were compared. Laparoscopy patients were older (13.0 vs. 10.1 years; p > 0.05), and operative time was longer (55.0 vs. 35.0 minutes; p < 0.05). There was no conversion (OA to LA). The median length of hospital stay was significantly shorter in laparoscopy (3.0 vs. 2.0 days; p < 0.05). The median cost for LA was more expensive (W833, 836 vs. W751,398; p < 0.05). Even though there were higher costs and longer operative times with laparoscopic procedures, the shorter hospital stay was an advantage.

• 대한간호학회지
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• 제24권4호
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• pp.584-596
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• 1994

The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

• 임상간호연구
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• 제15권3호
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• pp.17-26
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• 2009

Purpose: The purpose of this study was to compare the recovery outcomes between a normal weight group (BMI<25) and an overweight group ($$BMI{\geq_-}25$$), who received laparoscopic surgery for rectal cancer, to provide information for effective decision making. Methods: Data from 76 patients who received laparoscopic surgery for rectal cancer in a university hospital were reviewed retrospectively from September 2004 to March 2007. Collected data were analyzed using Win SPSS 12.0. The recovery outcomes related to the operation were the length of the operation, the amount of bleeding during the operation, the length of stay in the recovery room, first bowel movement, the length of hospital stay, and complications. Results: There was no statistical difference between the two groups with regard to the recovery outcomes. Conclusion: From the above results, nursing information can be offered to help make effective decisions before the operation for overweight patients with rectal cancer who prefer laparoscopic surgery.

• 한국조경학회지
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• 제46권3호
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• pp.92-102
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• 2018

본 연구는 생활권 도시림의 방문이 시민들의 주관적 웰빙의 향상에 기여하는지를 검토하였다. 도시림 방문은 강한 경험이 아니기 때문에 강도 대신 빈도에 해당하는 방문회수와 체류시간을 독립변수로 사용하였으며, 종속변수는 긍정적 감정, 부정적 감정 및 삶의 만족도이었다. 서울시민을 대상으로 여론조사기관이 온라인 설문으로 수집한 600매의 자료를 분산분석한 결과, (a) 도시림의 방문회수와 체류시간 간에는 상호작용 효과가 없었으며, (b) 방문회수와 상관없이 최근 2주간 도시림을 방문한 사람들은 방문하지 않는 사람들보다 긍정적 감정이 높았으며 부정적 감정은 낮았고, 평소에 한 달에 1번 이상 도시림을 방문한 사람들은 미방문자들보다 삶의 만족도가 높았지만, (C) 방문자들의 체류시간은 긍정적 감정, 부정적 감정 및 삶의 만족도 모두에 영향을 주지 못하였다. 결과적으로, 도시림 방문이란 의도적 활동이 유전적으로 결정된 주관적 웰빙 수준을 변화시킨다는 기존 이론을 확인함으로써, 도시림의 확대와 유지관리는 시민들의 복지향상을 위한 정부의 의미 있는 투자라는 것이 밝혀졌다. 보다 신뢰성 높은 추후연구를 위해 응답자 집단의 선정과 영향변수들의 중요성을 고찰하였다.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.197-209
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• 2022

Purpose: This study systematically evaluated the implications of advanced age on post-surgical outcomes following gastrectomy for gastric cancer using a national database. Materials and Methods: The 2011-2017 National Inpatient Sample was used to isolate patients who underwent gastrectomy for gastric cancer. From this, the population was stratified into those belonging to the younger age cohort (18-59 years), sexagenarians, septuagenarians, and octogenarians. The younger cohort and each advanced age category were compared in terms of the following endpoints: mortality following surgery, length of hospital stay, charges, and surgical complications. Results: This study included a total of 5,213 patients: 1,366 sexagenarians, 1,490 septuagenarians, 743 octogenarians, and 1,614 under 60 years of age. Between the younger cohort and sexagenarians, there was no difference in mortality (2.27 vs. 1.67%; P=0.30; odds ratio [OR], 1.36; 95% confidence interval [CI], 0.81-2.30), length of stay (11.0 vs. 11.1 days; P=0.86), or charges ($123,557 vs. $124,425; P=0.79). Compared to the younger cohort, septuagenarians had higher rates of in-hospital mortality (4.30% vs. 1.67%; P<0.01; OR, 2.64; 95% CI, 1.67-4.16), length of stay (12.1 vs. 11.1 days; P<0.01), and charges ($139,200 vs. $124,425; P<0.01). In the multivariate analysis, septuagenarians had higher mortality (P=0.01; adjusted odds ratio [aOR], 2.01; 95% CI, 1.18-3.43). Similarly, compared to the younger cohort, octogenarians had a higher rate of mortality (7.67% vs. 1.67%; P<0.001; OR, 4.88; 95% CI, 3.06-7.79), length of stay (12.3 vs. 11.1 days; P<0.01), and charges ($131,330 vs. $124,425; P<0.01). In the multivariate analysis, octogenarians had higher mortality (P<0.001; aOR, 4.03; 95% CI, 2.28-7.11). Conclusions: Advanced age (>70 years) is an independent risk factor for postoperative death in patients with gastric cancer undergoing gastrectomy.

• 보건행정학회지
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• 제29권4호
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• pp.513-522
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• 2019

Background: South Korea operates a Medical Aid (MA) program targeting selected low-income individuals to ensure medical service delivery to the disadvantaged while enhancing self-sufficiency of work-capable beneficiaries. However, as reasons behind welfare exits are diverse and do not always infer poverty relief or the provision of appropriate levels of health care services, this study aimed to investigate the association between changes in MA status and health care utilization. Methods: This study used the 2006 to 2015 National Health Insurance claims data. The impact of changes in annual MA status on health care utilization (yearly number of outpatient visits, inpatient visits, length of stay, and emergency department [ED] visits) was investigated using the generalized estimating equation model. Results: In 117,943 adult subjects aged 20 to 64, compared to the 'MA to MA' group, the 'MA to MA exit' group showed general decreases in utilization (outpatient visits: β=-3.93, p<0.0001; hospital admissions: relative risk [RR], 0.87; 95% confidence interval [CI], 0.83-0.91; length of stay: β=-3.64, p<0.0001; ED visits: RR, 0.83; 95% CI, 0.77-0.90). Similar patterns were found in the 'MA exit to MA exit' group (outpatient visits: β=-5.72, p<0.0001; admissions: RR, 0.91; 95% CI, 0.87-0.94; length of stay: β=-5.87; p<0.0001; ED visits: RR, 0.81; 95% CI, 0.75-0.88). Likewise, in 74,747 older adult subjects aged 65 or above, the 'MA to MA exit' group showed reduced levels of utilization (outpatient visits: β=-1.51; p=0.0020), as well as the 'MA exit to MA exit' group (admissions: RR, 0.92; 95% CI, 0.89-0.95; length of stay: β, -5.45; p<0.0001; ED visits: RR, 0.90; 95% CI, 0.83-0.97). Conclusion: MA exit was associated with general decreases in health care utilization. Utilization patterns of individuals with experiences of receiving MA benefits should be monitored to promote the ideal use of health care services while preventing potential financial barriers present in accessing medical care.