• Clinical and Experimental Emergency Medicine
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• 제5권4호
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• pp.264-271
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• 2018

Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.

• 한국정보컨버전스학회:학술대회논문집
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• 한국정보컨버전스학회 2008년도 International conference on information convergence
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• pp.121-124
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• 2008

One field that the information society has recently taken much interest in and has continuously implemented is medical services. Health tourism services which emphasize today's patient-oriented management rather than the past hospital-oriented management are highly value-added. As interest in physical fitness increases in keeping with such trends of the society at large as the declining birth rate and increasing life expectancy, and the medical market is opened, the added value of medical services that attract and manage domestic and foreign patients from the global market and satisfy their diverse desires with domestic medical competitiveness such as excellent medical staff and technology is on the spotlight. Hereupon, this study intends to suggest the possibility of developing competitive domestic medical services into a highly value-added industry in keeping with changing environment.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.1015-1021
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• 2014

This study aimed at summarizing published study findings on the diagnostic value of rectal bleeding (RB) and informing clinical practice, preventive interventions and future research areas. We searched Medline and Embase for studies published by September 13, 2013 examining the risk of colorectal cancer in patients with RB using highly inclusive algorithms. Data for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive predictive value (PPV) of RB were extracted by two researchers and analyzed applying Meta-Disc (version 1.4) and Stata (version 11.0). Methodological quality of studies was assessed according to QUADAS. A total of 38 studies containing 5,626 colorectal cancer patients and 73,174 participants with RB were included. The pooled sensitivity and specificity were 0.47 (95% CI: 0.45-0.48) and 0.96 (95% CI: 0.96-0.96) respectively. The overall PPVs ranged from 0.01 to 0.21 with a pooled value of 0.06 (95% CI: 0.05-0.08). Being over the age of 60 years, change in bowel habit, weight loss, anaemia, colorectal cancer among first-degree relatives and feeling of incomplete evacuation of rectum appeared to increase the predictive value of RB. Although RB greatly increases the probability of diagnosing colorectal cancer, it alone may not be sufficient for proposing further sophisticated investigations. However, given the high specificity, subjects without RB may be ruled out of further investigations. Future studies should focus on strategies using RB as an "alarm" symptom and finding additional indications to justify whether there is a need for further investigations.

• 보건의료산업학회지
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• 제7권2호
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• pp.53-67
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• 2013

This study aims to analyze the effect of quality of health care on perceived value, patient satisfaction and revisit intention. Especially, it was focused on outdoor environment, admission procedure, hospital image, service quality of physicians that patients perceived. For inpatients, hospital image and service quality of medical technicians have an effect on perceived value. Service quality of physicians has an effect on the patient satisfaction. For outpatients, hospital image and service quality of physicians and medical technicians have an effect on perceived value. Outdoor environment, hospital image, service quality of physicians and medical technicians, and perceived value have an effect on patient satisfaction. Perceived value and patient satisfaction have an effect on revisit intention. They should evaluate customer satisfaction on their services and analyze various factors that affect on it to improve specialty hospitals.

• 보건행정학회지
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• 제20권2호
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• pp.40-52
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• 2010

Health insurance fees are set by relative value scales and conversion factors. Since 2008 the conversion factor has been classified into 7 according to the provider type, and a separate contract has been made respectively. As such classification of the conversion factor reflects only the different characteristics of providers, however, further classification to reflect the different cost structures of providers is proposed. Cost varies according to the type of not only providers but also services each provider supply. In fact different cost structures of providers are the result of their different services. This study analyzed the cost structure of medical services to propose a new approach to the classification of the conversion factor. This study analyzed the cost structure of medical services using cost data constructed in the revision study of relative value scales. The cost data consist of doctor's fee, support staff's fee, cost of medical equipments, cost of medical supplies and indirect cost. The proportion of each cost component to the total cost was analyzed in terms of service department and service type. 72 service groups are defined in terms of the combination of service department and service type. Through cluster analysis, 72 service groups were reduced into 7 clusters each of which has a similar cost structure. Conversion factor is contracted annually to reflect the change in the cost of providing medical services. So the classification of conversion factor has to be based on the cost structures of medical services, not the characteristics of providers. Service clusters derived in this study can be used as a new classification for health insurance fee contract.

• 한국정보시스템학회지:정보시스템연구
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• 제29권2호
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• pp.243-263
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• 2020

Purpose The purpose of this study is to analyze the causal relationship between user satisfaction, expected satisfaction, quality of service, perceived value, and expertise that should be emphasized in personalized medical information services for the development of personalized medical information services based on big data analysis and the spread of their demand. Design/methodology/approach This study established research models and hypotheses on the basis of the theory of reuse intent, and applied the PLS methodology for analysis, the factors that make it applicable to personalized medical services in the theory of service quality and satisfaction. Findings According to the empirical analysis result, this study confirmed that it can be seen that the expertise, perceived value, and quality of medical services did not directly affect the user's intention to reuse, but formed a direct causal relationship through variables such as whether they met expectations.

• 보건행정학회지
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• 제10권1호
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• pp.126-147
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• 2000

This paper empirically explores the nature of the medical service industry and its various propagation effects on the economy in the input-output model, as revealed by a comparative analysis between Korea and Japan. The main findings of the paper are as follows; First, the growth of medical industry induces above-average effect on employment. Second, the industry is of the characteristics of weak both backward and forward linkage effects implying a 'final demand dependency industry'. When compared with public service sectors, however, the medical services industry shows stronger backward linkage effect than those sectors. Furthermore, it has strong repercussion effects on the goods industries. Third, in order to produce per unit of services, the medical services industry of Korea uses relatively more drugs and medical devices than that of Japan. In general, it has been shown that production structure of medical service industry in Korea is 'hardware-oriented' one; on the other hand, 'software-oriented' in Japan which means that, as intermediate inputs, outsourcing and informatization has been used than those of Korea. From the findings of the paper it could be emphasized that the medical organizations in Korea should put more efforts on shifting the current hardware-oriented production structure to strengthen core competence by enhancing productivity and by outsourcing to improve efficiency of production process. However, the medical organizations in Korea would not have enough incentives for high value-added production structure because they enjoy high operating surplus. Therefore, it would be necessary that government policy should be taken into account of these environments.

• 치위생과학회지
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• 제13권3호
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• pp.246-253
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• 2013

이 연구는 치과의료서비스 품질이 서비스 가치, 고객만족도, 고객충성도에 미치는 영향을 평가하고자 부산 울산광역시 소재 17개 치과병 의원에 내원한 환자 221명을 대상으로 설문지를 이용하여 조사한 결과 다음과 같은 결론을 얻었다. 1. 치과의료서비스 품질 중 의사언어에 대한 인식의 차이는 남자가 여자에 비해 높았으며, 교육수준에 따른 신체언어에 대한 인식의 차이와 신체외형에 대한 인식의 차이는 대학교 재학 및 졸업자가 높았다. 2. 서비스 가치, 고객만족도 및 고객충성도는 남자, 대학교 재학 및 졸업, 기혼에서 서비스 가치, 고객만족도, 고객충성도의 점수가 높게 나타났으나 통계적으로 유의하지는 않았다. 치과의료서비스 품질과 서비스 가치, 고객만족도 및 고객충성도는 서로 상관관계가 있는 것으로 나타났다. 3. 의료서비스 품질 중 의사언어와 언어적 커뮤니케이션에 대한 인식도가 증가할수록 서비스 가치가 증가하였고, 언어적 커뮤니케이션과 신체외형의 인식도가 증가할수록 고객만족도는 증가하였으며, 언어적 커뮤니케이션, 신체외형, 신체언어에 대한 인식도가 증가하면 고객충성도가 증가하는 것으로 나타났다. 이상의 결과를 종합해 볼 때, 치과의료서비스를 제공 시 서비스 제공자가 고객의 욕구에 맞춰 상세히 설명을 해주어야 서비스 가치를 높게 평가하며, 서비스에 만족을 느껴 타인에게 긍정적인 입소문을 내게 된다. 고객의 욕구에 맞는 상세한 설명뿐만 아니라 서비스 제공자의 깔끔한 유니폼, 바른 자세, 깔끔한 헤어 스타일 등의 신체적 외형과 고객의 눈을 바라보면서 밝은 표정을 짓고 대화 시 고개를 끄덕이는 등의 공감을 표현해주어야 본인이 이용한 치과병 의원을 지속적으로 재이용하게 되고 타인에게 자랑 및 소개를 시켜주어 치과병 의원의 경영성과를 증대시킬 수 있을 것이다.

• 한국병원경영학회지
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• 제18권4호
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• pp.18-38
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• 2013

This study aims to analyze the effect of quality of health care on perceived value, patient satisfaction and revisit intention. Especially, it was focused on outdoor environment, indoor environment, admission procedure, hospital image, service quality of physicians nurses medical technicians medical staff that patients perceived. Inpatients and outpatients were selected from three hospital in D city Questionnaire survey was employed to collect data from the subjects. For inpatients, indoor environment, admission procedure, hospital image and service quality of physicians have an effect on perceived value. Admission procedure, hospital image and service quality of physicians nurses medical technicians has an effect on the patient satisfaction. Hospital image and service quality of physicians nurses medical technicians have an effect on revisit intention. Perceived value have an effect on the patient satisfaction. Perceived value have an effect on revisit intention. Patient satisfaction have an effect on revisit intention. For outpatients, Admission procedure, hospital image and service quality of physicians medical technicians have an effect on perceived value. Indoor environment, hospital image and service quality of physicians medical technicians medical staff has an effect on the patient satisfaction. Indoor environment, hospital image and service quality of physicians medical technicians have an effect on revisit intention. Perceived value have an effect on the patient satisfaction. Perceived value have an effect on revisit intention. Patient satisfaction have an effect on revisit intention. They should evaluate customer satisfaction on their services and analyze various factors that affect on it to improve middle hospitals.

• 보건행정학회지
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• 제2권1호
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• pp.1-16
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• 1992

This study compares the physician payment of national fee schedule for Korean Medical Insurance with that of the United States based on Resource Based Relative Value Scales (RBRVS) which Hsiao developed in 1988 for the Medicare reimbursement. Through the comparison of two fees schedules, this study is purposed to evaluate the appropriateness of relative values which assigned to each physician services of Korean fee schedule. A total of 264 physician services are selected for the comparison. The ratio of Korean schedule to RBRVS is selected as an index of appropriateness. It the score of index shows large variation among services, the relative value of Korean fee schedule is inappropriate with U.S. RBRVS which was developed recently. The Ratios of Korean schedule to RBRVS are widly variated ; the range of those is 8.1 to 379.3. In subgroups which are regrouped to controll systematic differences between two national fee schedules, these ratios are also variated. Services which are relatively less compensated are management/evaluation services, while services which are relatively more compensated are invasive and imaging services. By the way, the service classification of Korean fee schedule is unclear, specially in management/evalutaion services. Therefore, Korean Medical Insurance fee schedule should be modified to be more balanced and rational.