• Quality Improvement in Health Care
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• v.26 no.2
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• pp.95-103
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• 2020

Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

• Korean Medical Education Review
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• v.9 no.2
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• pp.57-66
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• 2007

Purpose How can be a great doctor with excellence and ethics? In this study, I wanted to find out the characteristics of human environment to make a great doctor. Methods: First, I researched factors and construct of the human environment. So I conceived a model for analyzing human environment with two construction model : Howard Gardner's System Model and Bron-fenbrenner's ecological systems model. Second, I analyzed the life of the Oliver R. Evison M.D. and Ki Ryu Jang M.D. Oliver R. Evison was the pioneer of medicine of Korea and establisher of the Severance Hospital and medical college. Dr KiRyu Jang, who was called 'Schweitzer of Korea', was a good doctor of the poor and weak patients in Korea. Third, I tried to find out a new human environment model to make a great doctor. Results One model for analyzing human environment was made of relationship based on emotion. relationship teaching knowledge and skill, and relationship communicating on value. In the light of analyzing of two great doctors. Oliver R. Evison M.D. and KiRyu Jang M.D, I found out special interrelationship, Hardie, Allen, Severance for Evison, Kyosin Kim, Kyucheol Choi etc. for Ki Ryu Jang These special people were religious actors or social thinkers. Conclusions: To be a great doctor to excel and innovate medical field, medical students should have the chance to meet with people based on religious, ethical and social action, discuss on value across social fields, and can construct the idea to make and realize higher value of medical action. In sum, another important human environment for medical students would be a person who could be communicate with true value.

• Health Policy and Management
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• v.9 no.1
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• pp.1-29
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• 1999

The Government has recently planned to improve the medical insurance drug price systems by removing the drug margin occurring from the difference between the official and purchasing prices, and instead by setting prices through adding drug administration casts calculated to the purchasing costs. In the circumstances, the major policy and implementing issues are how to define the drug administrance cost and how to calculate them. This study attempts to provide for the conceptional and operational definitions and thereby develop a costing model for the cost. The relationship between the current systems of medical services costs and prices were reviewed to define the concept of the costs. The study defined the costs from the narrow and wide prospective of meaning, and three operational definitions were provided. The costing model was developed applying the departmental costing principles. Finally, several prerequisites that have to be considered for the implementation of the definition and the model from the practical viewpoint.

• Journal of Intelligence and Information Systems
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• v.7 no.1
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• pp.123-133
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• 2001

Medical domain is very applicable for multi-agent system because medical information systems need much knowledge and close relationship with medical staff, In this paper, we describe design and implementation of an intelligent medical multi-agent platform that provides medical images'information services. This platform supports a physical environment that medical agents can be deployed following FIPA(Foundation for Intelligent Physical Agent)\`s agent management reference model. To use a variety of components on Windows, COM(Common Object Model) interfaces and XML(extensible Markup Language) for encoding ACL(Agent Communication Language) are used for multi-agent communications. Since many kinds of diverse and close relationships with medical staff) are essential, a medical staff is conceptualized as an agent and integrated with multi-agent systems. Also it provides an infrastructure applicable to share necessary knowledge between human agents and software agents in order to make intelligent medical information services easier.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.42 no.3
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• pp.176-183
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• 2019

The environmental changes in the Korean cosmetic medical service industry in the $21^{st}$ century are forming intense competition among medical institutions due to the quantitative expansion of its market. For stable growth of the cosmetic medical service industry, continuous quality improvement is necessary based on empirical research on the quality of cosmetic medical services rather than external expansion. The purpose of this study is to classify the quality attributes of cosmetic medical service using Kano model and to derive the degree of satisfaction and dissatisfaction of each quality attributes through Customer Satisfaction Coefficient (CSC). Through this, the study identified strategic priorities and suggested specific step-by-step approaches and quality improvement priorities that can increase customer satisfaction using the Potential Customer Satisfaction Improvement Index (PCSI Index). Based on SERVPERF, this study used measurement tools consisting of five dimensions : tangibles, reliability, responsiveness, assurance, and empathy. In addition, it was used of measurement items reconstructed into positive, negative, and satisfaction questions for Kano model analysis, CSC analysis, and PCSI Index analysis. A total of 300 medical consumers who experienced cosmetic medical services for the past one year in medical institutions such as plastic surgery and dermatology were collected with convenient sampling. As a result, urgent items for improving the quality of service using the PCSI Index, 'Consideration for customer benefits' in empathy category was followed by 'Immediate help' and 'Sincere response' in responsiveness category, and 'Understanding customer needs' in empathy category, respectively. That is, it is required to improve human service quality attributes such as empathy and responsiveness rather than physical service quality attributes. This study contributes practically in that it provides specific and discriminatory approaches to improve customer satisfaction on cosmetic medical service quality and suggests improvement priorities.

• Journal of Information Technology Applications and Management
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• v.12 no.2
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• pp.129-143
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• 2005

In recent years, two major streams in medical information systems are：1) system integration among OCS(Order Communication System), EMR(Electronic Medical Record), PACS(Picture Archiving and Communication System), and ERP(Enterprise Resource Planning) and 2) system integration through medical collaboration between East and West medical service providers. One of the characteristics which differentiate the Korean medical industry from the western medical industry is the East-West medical collaboration. In many respects there are many differences between East and West medical treatment. Although East and West medical treatment have developed from different medical philosophies and standards, we assume that the better medical care can be provided by integrating their medical procedures effectively. The two possible approaches to the integration of East and West medical information systems are suggested in this paper：One is loosely coupled model and the other is tightly coupled model. EMR improves the quality of medical record which reflects the quality of clinical practice. It provides more efficient and convenient way of input, retrieval, storage, communication and management of medical data. We abstracted the standard medical procedures from the two medical procedures performed in Daejeon Oriental Hospital and Hehwa Clinic at Daejeon University and also abstracted database schema by analyzing the characteristics of information needed in East-West medical collaboration. Our EMR is composed of two types of data：one is structured data and the other is unstructured data, which are formalized by SOAP(Subjective, Objective, Assessment, Plan) format. Currently the integrated system is implemented and operated successfully for six months.

• Journal of Convergence for Information Technology
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• v.9 no.3
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• pp.140-145
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• 2019

With the development of IT technology, many changes are taking place in the health service environment over the past. However, even if medical technology is converged with IT technology, the problem of medical costs and management of health services are still one of the things that needs to be addressed. In this paper, we propose a model for hospitals that have established the IoT system to efficiently analyze and manage the personal information of users who receive medical services. The proposed model aims to efficiently check and manage users' medical information through an in-house IoT system. The proposed model can be used in a variety of heterogeneous cloud environments, and users' medical information can be managed efficiently and quickly without additional human and physical resources. In particular, because users' medical information collected in the proposed model is stored on servers through the IoT gateway, medical staff can analyze users' medical information accurately regardless of time and place. As a result of performance evaluation, the proposed model achieved 19.6% improvement in the efficiency of health care services for occupational health care staff over traditional medical system models that did not use the IoT system, and 22.1% improvement in post-health care for users who received medical services. In addition, the burden on medical staff was 17.6 percent lower on average than the existing medical system models.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.9
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• pp.4109-4115
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• 2014

Background: Accurate assessment of disease progression requires proper understanding of natural disease process which is often hidden and unobservable. For this purpose, disease status should be clearly detected. But in most diseases it is not possible to detect such status. This study, therefore, aims to present a model which both investigates the unobservable disease process and considers the error probability in diagnosis of disease states. Materials and Methods: Data from 330 patients with gastric cancer undergoing surgery at the Iran Cancer Institute from 1995 to 1999 were analyzed. Moreover, to estimate and assess the effect of demographic, diagnostic and clinical factors as well as medical and post-surgical variables on transition rates and the probability of misdiagnosis of relapse, a hidden Markov multi-state model was employed. Results: Classification errors of patients in alive state without a relapse ($e_{21}$) and with a relapse ($e_{12}$) were 0.22 (95% CI: 0.04-0.63) and 0.02 (95% CI: 0.00-0.09), respectively. Only variables of age and number of renewed treatments affected misdiagnosis of relapse. In addition, patient age and distant metastasis were among factors affecting the occurrence of relapse (state1${\rightarrow}$state2) while the number of renewed treatments and the type and extent of surgery had a significant effect on death hazard without relapse (state2${\rightarrow}$state3)and death hazard with relapse (state2${\rightarrow}$state3). Conclusions: A hidden Markov multi-state model provides the possibility of estimating classification error between different states of disease. Moreover, based on this model, factors affecting the probability of this error can be identified and researchers can be helped with understanding the mechanisms of classification error.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8567-8571
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• 2016

Background: The Cox model is known as one of the most frequently-used methods for analyzing survival data. However, in some situations parametric methods may provide better estimates. In this study, a Weibull parametric model was employed to assess possible prognostic factors that may affect the survival of patients with breast cancer. Materials and Methods: We studied 438 patients with breast cancer who visited and were treated at the Cancer Research Center in Shahid Beheshti University of Medical Sciences during 1992 to 2012; the patients were followed up until October 2014. Patients or family members were contacted via telephone calls to confirm whether they were still alive. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. The log-rank test and the Weibull parametric model with a forward approach, respectively, were used for univariate and multivariate analyses. All analyses were performed using STATA version 11. A P-value lower than 0.05 was defined as significant. Results: On univariate analysis, age at diagnosis, level of education, type of surgery, lymph node status, tumor size, stage, histologic grade, estrogen receptor, progesterone receptor, and lymphovascular invasion had a statistically significant effect on survival time. On multivariate analysis, lymph node status, stage, histologic grade, and lymphovascular invasion were statistically significant. The one-year overall survival rate was 98%. Conclusions: Based on these data and using Weibull parametric model with a forward approach, we found out that patients with lymphovascular invasion were at 2.13 times greater risk of death due to breast cancer.

• Annals of Geriatric Medicine and Research
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• v.20 no.3
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• pp.125-130
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• 2016

Background: Conventionally, elderly hip fracture patients are assessed by orthopedists to decide whether they need geriatric intervention. We aimed to evaluate the effect of perioperative geriatric intervention on healthcare outcomes in patients undergoing surgery for hip fractures. Methods: Our care model for hip fracture surgery resembles a combination of a routine geriatric consultation model and a geriatric ward model. We retrospectively reviewed the medical records of patients aged ${\geq}65years$ undergoing surgery for hip fracture at a single tertiary hospital from January 2010 to December 2013. We assessed comorbidity, indwelling status, fracture type, and mode of anesthesia. We also evaluated in-hospital expenditure, duration of admission, disposition at discharge and 1-year mortality as clinical outcomes. We developed a propensity score model using the variables of age, cholesterol, and creatinine and examined the effect of perioperative geriatric intervention on intergroup differences of clinical variables. Results: Among 639 patients, 138 patients received the geriatric intervention and 501 patients received the usual care. Univariate analysis showed that factors such as age; Charlson comorbidity index; and serum levels of cholesterol, albumin, and creatinine differed significantly between these 2 groups. There was no significant difference between the groups in terms of 1-year mortality, disposition at discharge, and in-hospital expenditure in the propensity matched model. However, the duration of hospitalization was shorter in the intervention group ($8.9{\pm}0.8days$) than in the usual care group ($14.2{\pm}3.7days$, p=0.006). Conclusion: This care model of geriatric intervention for patients with hip fracture is associated with reduced hospitalization duration.