• Journal of Korean Academy of Nursing Administration
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• v.7 no.2
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• pp.265-284
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• 2001

The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

• Journal of Korean Academy of Nursing
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• v.4 no.1
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• pp.64-80
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• 1974

The social understanding of the rehabilitation and welfare work for the handicapped children is nearly devoid in Korea. Especially the medical rehabilitation or nursing for them is left ign. ored as well as the literature preferential to this study is wanted. For the purpose of conducting the study of this thesis Sam Yook Children's Rehabilitation Center, Inc. and Crippled Children's Center, Yonsei University Medical center sampled out; covering three months from Aug. 1 to Oct. 30, 1973, the problems of children's rehabilitation, the characteristics of the children, the medical rehabilitation, nursing, education, and vocational rehabilitation were interviewed and widely grasped. This thesis aimed at developing the rehabilitation, the professional nursing and especially aimed at contributing to the improvement of welfare for the handicapped by analysing, observing the result of this study. The result is as follows: 1. Sam Yook Children's Rehabilitation Center, Inc. has, since its establishment, contributed to the advancement of the crippled children and its purpose consists in implementing services, medical rehabilitation, nursing, education and vocational training. Crippled Children's Center, Yonsei University Medical Center is, being based on Christianity, aiming at the medical treatment and education for the crippled children. 2. All of the children admitted in the children's rehabilitation centers are the crippled children. The ratio of boys io girls is three to two. Boys are more than girls. Orphan formed 55.2 per sent of them. About 60 per cent of them is receiving medical attention free of charge. But there is no orphan in Crippled Children's Center, Yonsei University Medical Center. 3. 15.7 per cent of them have received the previous medical attention before their admitting in the centers; in Sam Yook Children's Rehabilitation Center 8.6 percent, Crippled Children's Center, Yonsei University Medical Center 50 percent; there is remarkable difference between the two. 4. On the standpoint of period of being in the centers, the children who have been over three years in Sam Yook Children's Rehabilitation Center formed 48.7 per cent; in Crippled Children's Center, Yonsei University Medical Center 2.6 percent; there is also considerable difference between the two; they couldn't discharge from the centers owing to the economic conditions and being orphan. 5. Among the diagnosis of the crippled children, poliomyelitis formed highest 51.7 percent of them ; cerebral palsy formed 30 percent secondly in order. Environmental factors (67.8 percent formed about three times of congenital factors (23.7 percent). 6. The children who are capable of doing independently activity of daily living formed 87.9 percent; 73.2 percent can walk about 300 m by wearing brace and so on. The ratio of wearing brace or leg prosthesis formed 47.4 per cent: crutch 44.3 per cent. The medical rehabilitation service and education for the crippled, are comparatively well carried out. But it is desired to improve and cultivate the vocational training, vocational guidance and special nursing to the insufficiency of their implementation. In the tendency that the rehabilitation and welfare for the handicapped are today emphasized, International Handicapped Rehabilitation Association, declaring that 1970s are the decade of rehabilitation, urged to improve positively the policy of rehabilitation and welfare for the handicapped. But here in korea the handicapped, being the object of social prejudice, ignorance, disdain lives in obscurity. Therefore the government or the community should draw up countermeasure on social under-standing, financial support, and rehabilitation services for the handicapped as well as should endeavor to make them participate in social activities as the productive total- person though they are physically imperfect.

• Journal of Korean Society of Archives and Records Management
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• v.13 no.3
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• pp.151-171
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• 2013

To comprehend the importance and necessity of record management metadata standard implemented in an electronic medical records system, a survey was undertaken to 50 medical records managers in charge of 5 major hospitals in Seoul. Analysis of the survey results was performed by averaging the responses given by those who answered the survey. SPSS was utilized for statistical analysis. Managers of medical records placed importance on metadata that are related to security of records, such as "levels of security", "types of access to medical records", "levels of authorization granted to personnel", and "users accessing medical records". It shows that these managers need the functions of privacy protection in ERMS. Metadata on "external disclosure" had the lowest level but those surveyed with more than 7 years of experience placed greater importance in this area more those surveyed with less than 7 years of experience in a hospital. This shows that managers need the functions of external disclosure to meet the needs of third partiesfor medical research and medical education.

• The Journal of the Korea Contents Association
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• v.20 no.12
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• pp.635-645
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• 2020

An "OpenNote" can be defined as the sharing of medical records between patient and doctors by online, and is a new trial to allow patients to access their medical records any time. To identify the need for the introduction of OpenNotes, which is expanding medical recrods, this study has researched the awareness and attitude towards medical records and OpenNotes among hospital workers in charge of part of medical servises. One of the results in this study is that recognizing his or her own records can impact his or her understanding his or her health status. Also, the subjects who were participated in this study generally agreed with the usefulness of the OpenNote and were willing to participate in the OpenNote. Meanwhile the subjects are admitting counterfeiting the medical records or falsifying them. The conclusion has been shown that patient-doctor sharing of medical records could help patients better understand their health information and encourage their self-care. When patients can access their own medical records easily, Unnecessary misunderstandings and distrust of records between patients and medical staff can be markedly reduced then it can help to build up the trust in a doctor-patient relationship. Considering not only the health utility of OpenNotes but also the impact on the trust of doctors, the pilot project of OpneNotes for experimental verification is proposed.

• The Journal of the Korea institute of electronic communication sciences
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• v.8 no.12
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• pp.1959-1970
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• 2013

Attempts were made in this paper to compare the practice of protective actions for information of patients' medical treatment between hospital administrators who do not make direct contact with patients and occupational therapists who usually do. The comparison between jobs in charge showed that occupational therapists did not practice much protective actions for information of patients' medical treatment ($3.52{\pm}.809$) compared to hospital administrators ($3.92{\pm}.724$), even though the former had received regular education about protection, management and supervision of patients' medical information more often ($3.17{\pm}1.129$) than the latter ($3.16{\pm}1.037$). In spite of the fact that occupational therapists were exposed frequently to the danger of revealing medical information in the process of their job performance through talks and communications with patients, they displayed relatively little concern for and awareness of keeping information of medical treatment from being leaked by them. It is thus suggested to promote awareness of medical staff to protect medical information by means of flexible educational system for each occupational group, periodical monitoring, continuing public relation, training and quality control for protection of medical information, as well as routine self-examination of such practice.

• Journal of Preventive Medicine and Public Health
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• v.28 no.3 s.51
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• pp.640-650
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• 1995

After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. We analysed 90,583 outpatient claims submitted between September and October; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total charge were significantly high. The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. We build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. We applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%) and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The expected number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the new method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.

• The Korean Nurse
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• v.37 no.4
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• pp.58-71
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• 1998

The purpose of this study was to contribute the improvement of nursing staff development by implementing of effective and organized orientation program using the measure of effectiveness in the application of preceptor program with the reduction of the time of New entry nurse orientation. The subjects were comprised of 116 new entry nurses(59 new entry nurses were employed at June, 1996 and 57 at May & July, 1997) and 79 preceptors, who were in charge of new entry nurse orientation at 1997. These date were collected from June 18, 1996 to August 29, 1997. The characteristics of questionairs applied in this study were general characteristics(7 questions), knowledge of nursing care(138 questions); attitude toward her profession(40 questions) and the degree of satisfaction for the program(5 questions). The questionnairs were developed by the researchers of Asan Medical Center. The Check-list for basic nursing skill were used for the measurement of nursing skill which was developed by nursing department of AMC. The data were analyzed for the mean, standard deviation, difference of mean, ANOV A & t-test. The results of this study are as follows : 1) The changes in knowledge of nursing care : After three months of training the difference of mean between before and after the orientation was higher than the result of two month period training. However, the result was insignificant(p= .469). 2) Performance in nursing practice : Two month period orientation was more effective than three-month training period, however, the statistical significance can not be reached than 3 month period, which resulted in insignificant difference(p=.150). 3) The change in attitude toward her profession : After three-month of orientation, the difference of mean between before and after the orientation was higher than 2 month period orientation, which resulted in significant difference (p=.000). 4) The degree of satisfaction for the program with the time of new entry nurse orientation : After two-month of orientation, the mean of points was 2.57 where the score is higher than 3 month period with mean of 2.30. It resulted in significant difference(p=.000).

• The Korean Society of Law and Medicine
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• v.12 no.1
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• pp.177-225
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• 2011

Verdicts related to major medical litigation given by the Seoul Central District Court, the Seoul High Court and the Supreme Court in 2010 were analyzed. It's shown that in cases of the medical negligence regarding the occurrence of neonatal cerebral palsy, the plaintiff claims were dismissed using criteria proposed by associations of Obstetrics and Gynecology and Pediatrics in US, and thereof the burden of plaintiffs to prove the medical negligence has increased. In addition, in case of that the expected survival period of infants gets longer, payments for treatment and nursing after survival period determined by judges are made and it was judged to compensate it as a periodical indemnity. In case for the explanation obligation the most frequently mentioned in the medical litigation, in addition to cases of invoking the existing theory of explanation obligation, verdicts to mention the instructions of theory regarding instruction explanation obligation and the possibility of compensation for damages on property are given. Particularly, in cases for a liability of reparation by exaggerating the effects and not disclosing the risks related to treatment with stem cells, even if the treatment not approved by Food and Drug Administration is in violation of the Pharmaceutical Affairs Law, it's not illegal as violation in Pharmaceutical Affairs Law itself. But there is a certain verdict to present the possibility of an extension of the theory of explanation obligation by acknowledging the liability of reparation caused by illegal acts with no explanations of effects and risks of treatment with stem cell by doctors and pharmaceutical companies. In an incident in which a mental patient fell and died through the opened door of the roof at the hospital, a liability of reparation was acknowledged due to defects in structure installation management and this verdict drew an attention since the overall management responsibility about patients including structures was acknowledged to the hospital besides the obligations on medical practice. In case of the verdict without giving the opportunity to state the opinion with respect to the main legal issues, the responsibility of the court was emphasized since the court did not fulfill the explanation obligations. There were some cases in which payments for nursing and caring to a patient in vegetative state during the plastic surgery was admitted. However, in dental-related incidents, the proportion of cases in which plaintiff won was low since the difficulty of proving may be reflected. In the area of administrative litigation, unlike the existing position regarding arbitrary medical charge cover collected from patients in hospital, the verdict to admit the legitimacy of collection of medical treatment was given and attracted the attention of people. Verdict in which the expression related to medical advertisement was not exaggerated disposed the original verdict and pointed out the problem of excessive regulations on medical advertisement. The effort to analyze the trend of verdicts of court through reviewing the decisions and to organize should be continued, but the full decision should be disclosed as a base, and people and systems to enable the all time monitoring should be prepared.

• Korea Journal of Hospital Management
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• v.19 no.3
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• pp.11-28
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• 2014

This study, targeting Korean tertiary hospitals and general hospitals, aims to analyze how value chain model in health and medical institution suggested by Duncan and else influences on hospital management. A survey was conducted to verify the actual proof analysis of this study model. 880 questionnaires were distributed to entire 88 hospitals and 739 copies were returned from 76 hospitals. This study mainly consists of three steps to analyze the effect value chain activity has on management performance of general hospitals. For the first step, we analyzed the effects service delivery activity has on management performance. For the second step, we analyzed the effects service support activity has on management performance and for the third, we analyzed the effects interaction between service delivery activity and service support activity has on management performance. The main results of this study are as follows. First, in terms of the management performance of scale, the factors which influenced on daily charge of outpatient were service activity before treatment, at the moment of treatment and value chain activity, while more important factors in daily charge of inpatient were organizational culture, organizational structure and value chain activity. In terms of management performance of quality, the factors which influenced on the first medical examination rate of outpatient were service activity before, at the moment of and after treatment, while activity at the moment of treatment, organizational structure, and value chain activity which is interaction were more important factors in average length of stay. In terms of non-financial performance, the management performance factors which influenced on job satisfaction were service activity at the moment of, after the treatment and value chain activity, while organizational culture, strategy resources and value chain activity which is interaction were more important factors in job commitment. Secondly, all the service support activity, service delivery activity and value chain activity had statistically significant effect on management performance. Among the three factors, service support activity had relatively high effect than others.

• Journal of Korean society of Dental Hygiene
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• v.11 no.2
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• pp.275-289
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• 2011

Objectives : The recognition rate for issues and improving resolution for the recuperation income expense claim policy was examined. Methods : 1,135 copies of survey have been sent to the group of people who have claimed the dental recuperation income expense to dental recuperation institutions in Daejeon, Chungcheong Do that are registered to the health insurance evaluation and estimation office as of the May 2010 and 207 surveys that were regarded to be sincere for answering were analyzed. Results : Majority of respondence were belonged to the dentist institutions with more than 5 years of claim experiences as well as 10~50% of claim rate. The recognition of medical fee evaluation guideline was normal level, and negative recognition was higher to the health center with daily charge policy compare to the dental hospital and university affiliated dental center with treatment charge policy, Highest opinion for inappropriateness of dentist with significance was found (p<0.05). The openness of evaluation cases are regarded to be discharged through the transparent evaluation and most of the opinions for insurance claim evaluation adjustment are within the both 'Do not understand the evaluation guideline and program error of disease category, code and program' with significance(p<0.05). The reaction after the evaluation adjustment was high in reflection on the claim process after examining the reason for the evaluation adjustment through the evaluation and estimation office and university affiliated dental institution and dental center was regarded to be most active and deputy reclaimment was seemed to be most actively discharge the objection registration task (p<0.05). The claim error improving resolution recognition was highly prioritized to the accurate charting for the disease title and treatment description, improving the setting of claim program, and most highly recognized by the university affiliated dental hospital/dental center and comparably low by health center(p<0.05). and although the most of the responds of treatment description and browsing the medical fee was positive, 50% of dentists disagreed the idea so that this was creating a significant discrepancy with other groups(p<0.05). Conclusions : From this research, the recognition of medical fee evaluation guideline for dental (university) hospital and dentists were negative and high adjustment experience was examined as lacking of evaluation guideline understanding and error of disease name, code and programs and deputy reclaimment, university affiliated dental hospital/dental center were most actively handle the objection registration tasks and dentists have objection on the treatment description and browsing the treatment fee so that if these indexes can be referred to implement into the recuperation income claim process, this can be regarded to be a opportunity to create mutual credibility between recuperation institution, treatment pensioner and the evaluation institutions.