• 간호행정학회지
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• 제7권2호
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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.

• 대한간호학회지
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• 제4권1호
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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.

• 한국기록관리학회지
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• 제13권3호
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• pp.151-171
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• 2013

본 연구는 서울 시내 5개 대학병원의 의무기록 관리자들이 생각하는 전자의무기록시스템 구현 시 기록관리 메타데이터 표준 요소의 중요도를 설문조사하였다. SPSS 20.0(ver)을 이용하여 중요도 점수는 5점 척도의 평균으로 도출하여 순위를 정하였고 응답자 특성에 따른 중요도 차이를 분석하였다. 90%의 응답자가 국가기록원에서 기록관리 메타데이터 표준을 고시하고 있음을 모르고 있었다. 가장 중요도가 높은 요소는 '비밀등급 설정' 이었으며 '의무기록 접근행위종류', '내부직원 권한 설정', '의무기록 이용접근자' 요소가 그 다음 순위를 보여 기록정보보호 측면에서의 관리 기능 강화를 필요로 함을 알 수 있다. 개인 프라이버시 보호를 위하여 '외부공개'는 중요도가 낮은 관리요소로 평가되었으나, 전자의무기록 도입 7년 이상인 기관의 관리자들은 7년 미만의 관리자 보다 유의하게 이 세 가지 요소의 중요도를 높게 평가하였다. 이는 정보 축적에 따라 의학연구, 의학교육 등에서의 정보 이용에 대한 관리 기준과 시스템상의 적용이 필요함을 보여준다.

• 한국콘텐츠학회논문지
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• 제20권12호
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• pp.635-645
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• 2020

오픈노트는 환자-의사 간 온라인 진료기록 공유라고 정의할 수 있으며, 환자가 자신의 진료기록에 언제든 접근할 수 있도록 허용한 시도이다. 진료기록의 확장으로써 오픈노트 도입의 필요성을 확인하기 위해, 본 연구는 의료서비스의 일부를 담당하는 병원 종사자를 대상으로 진료기록과 오픈노트에 대한 인식과 태도를 조사하였다. 연구 결과 자신의 진료기록을 읽어보는 것은 건강상태를 이해하는데 도움이 되며, 병원 종사자들은 오픈노트의 유용성에 대체로 동의하였고 참여의향이 있는 것으로 나타났다. 한편 대상자들은 진료기록이 위·변조될 가능성이 있다고 인식하였다. 결론적으로 환자가 자신의 진료기록을 자유롭게 읽어보도록 허용함으로써 건강상태를 이해하고 자가건강관리를 향상시킬 수 있으며, 진료기록에 대한 불필요한 오해와 불신을 해소할 수도 있다. 오픈노트의 건강상의 효용성 뿐 만 아니라 의사에 대한 신뢰에 미치는 영향을 생각할 때, 실험적 검증을 위한 오픈노트 시범사업을 제언한다.

• 한국전자통신학회논문지
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• 제8권12호
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• pp.1959-1970
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• 2013

본 연구는 환자 간접 접촉군인 병원행정관리자와 환자 직접 접촉군인 작업치료사의 환자 의료정보 보호행동 실천도를 알아보기 위해 시도되었다. 담당직무별로 비교해 보았을 때는 환자의료정보 보호 관리 감독에 대한 정기적인 교육은 병원행정관리자($3.16{\pm}1.037$)보다는 작업치료사($3.17{\pm}1.129$)가 잘 받고 있었음에도 불구하고, 환자 직접 접촉군인 작업치료사($3.52{\pm}.809$)가 환자 간접 접촉군인 병원행정관리자($3.92{\pm}.724$)보다 의료정보 보호행동 실천도는 낮게 나타났다. 작업치료사는 환자와 많은 대화 및 소통을 하는 동안 항상 의료정보 누설의 위험성에 노출되어 있으면서도, 대부분의 항목에서 의료정보 보호에 관한 관심이 비교적 적고 그 내용에 대해 거의 인지하지 못하는 것으로 나타났다. 이에 각 직업군별 맞춤형 교육시스템을 마련하고, 의료정보 보호에 관한 질 관리 활동을 정기적으로 실행하면서 지속적인 홍보와 교육을 하고, 본인들의 수준을 점검하고, 그러한 활동을 통하여 의료정보 보호에 관한 인식을 고취 시킬 필요가 있다고 제언하는 바이다.

• Journal of Preventive Medicine and Public Health
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• 제28권3호
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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.

• 대한간호
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• 제37권4호
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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).

• 의료법학
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• 제12권1호
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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.

• 한국병원경영학회지
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• 제19권3호
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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.

• 한국치위생학회지
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• 제11권2호
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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.