• 제목/요약/키워드: Non-specialty hospitals

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척추전문병원과 비전문병원의 의료이용 비교분석 (Comparative Analysis of Medical Use of Spine Specialty Hospitals and Nonspecialty Hospitals)

  • 이영노;정윤지;이광수
    • 보건행정학회지
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    • 제34권1호
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    • pp.26-37
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    • 2024
  • 연구배경: 본 연구의 목적은 척추전문병원과 비전문병원의 건당 진료비 및 재원일수 차이를 비교 분석하고, 이에 영향을 미치는 요인을 파악하는 것이다. 방법: 본 연구는 2021년 1월부터 2022년 12월까지의 입원 환자 진료비를 포함한 건강보험심사평가원의 청구 데이터를 사용했다. 의료기관 현황 데이터는 연구대상 병원의 특성을 파악하는 데 사용되었다. 다수준분석을 통해 건당 진료비와 관련된 요인을 파악하고, 포아송 회귀분석을 통해 척추전문병원과 비전문병원 간 재원일수를 분석했다. 분석대상은 척추전문병원 32,015건, 비전문병원 17,555건이었다. 결과: 다빈도 척추 수술 5건 중 4건의 경우, 전문병원이 비전문병원보다 재원일수가 더 긴 것으로 나타났다. 다수준분석 및 포아송 회귀분석 결과, 수술유형에 관계없이 연령이 높고, Charlson comorbidity index 점수가 높을수록 건당 진료비와 재원일수 모두 유의하게 증가하는 것으로 나타났다(p<0.05). 그러나 병원이 대도시에 위치한 경우에는 유의미하게 감소하였다(p<0.05). 결론: 본 연구에서는 기존 연구결과와 달리 전문병원의 건당 진료비와 재원일수가 더 긴 것으로 나타났다. 향후 이러한 차이의 원인을 찾기 위해 추가적인 연구가 필요하다.

전문병원과 비전문병원 입원환자의 의료이용 비교 분석: 인공관절치환술(슬관절)을 대상으로 (Comparison of Inpatient Medical Use between Non-specialty and Specialty Hospitals: A Study Focused on Knee Replacement Arthroplasty)

  • 김미성;정형선;유기봉;강제구;장한솔;이광수
    • 보건행정학회지
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    • 제34권1호
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    • pp.78-86
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    • 2024
  • 연구배경: 본 연구를 통해 전문병원과 비전문병원에서 인공관절치환술(슬관절)을 받은 입원환자를 대상으로, 전문병원 지정 여부에 따른 입원환자의 의료이용을 비교하여 전문병원제도의 효과성을 파악하고자 한다. 방법: 본 연구는 2021-2022년 건강보험심사평가원(Health Insurance Review and Assessment Service) 요양급여비용 청구자료를 활용하였다. 종속변수는 입원환자의 의료이용으로, 건당 진료비와 재원일수를 선정하였다. 독립변수는 전문병원 지정 여부이며, 통제변수는 환자 단위 변수(연령, 성별, 보험자 유형, 수술 유형 및 Charlson comorbidity index)와 의료기관 단위 변수(설립 구분, 종별 구분, 소재지, 정형외과 의사 수 및 간호사 수)를 선정하였다. 결과: 건당 진료비와 전문병원 지정 여부 간 다중회귀분석 결과, 건당 진료비와 전문병원 지정 여부 간 통계적으로 유의미한 음(-)의 관계가 있었다. 이는 전문병원이 비전문병원에 비해 건당 진료비가 유의하게 낮다는 것을 의미하며, 전문병원과 비전문병원의 입원환자 간 의료이용 결과에 차이가 있음을 시사한다. 결론: 본 연구의 정책적 시사점은 다음과 같다. 첫째, 전문병원 지정기준의 완화가 필요하다. 본 연구결과, 전문병원이 비전문병원에 비해 건당 진료비가 유의하게 낮은 것으로 나타났다. 이러한 전문병원의 비용 효과성에도 불구하고 전문병원 지정에 대한 높은 진입장벽으로 인해 수도권 및 대도시 지역에 전문병원이 집중되어 있다. 전문병원의 지역불균형을 해소하기 위해 "준전문병원(가칭)"을 도입하는 등 비수도권 전문병원 지정기준을 완화한다면, 지역간 건강격차 해소 및 의료비 절감의 효과를 불러올 것으로 판단된다. 둘째, 병원 의료인력 규모의 적정성을 판단할 필요가 있다. 본 연구결과, 정형외과 의사 수 및 간호사 수에 따라 건당 진료비에 영향을 미치는 것으로 나타났다. 따라서 병원 의료인력 적정 배분을 바탕으로 의료서비스의 비용 효과성을 극대화함으로써 의료비를 절감하는 효과를 불러올 수 있을 것으로 판단된다.

전문 질환에 대한 전문병원의 권역내·외 시장점유율 비교 (Market share of specialty hospitals in the region and out of the region)

  • 함명일;김지은;강윤정;이혜원;김선정
    • 한국병원경영학회지
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    • 제28권1호
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    • pp.14-23
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    • 2023
  • Purposes: The Specialty hospital designation policy had launched in 2011 and 110 designated specialty hospitals have been operating nationwide in 2022. This study was to estimate the market share of specialty hospitals for the specific diseases compared to other types of hospitals. Methodology: Data were derived from the National Health Insurance Claim data from 2018 to 2019. Subjects were all the inpatients with MDC(Major Disease Category) that specialty hospitals specialized in. A total of 34,231,387 claims were analyzed to estimate the market share. Findings: 90 specialty hospitals were responsible for 2.4 percent of inpatient care with specific diseases for specialty hospitals. There were regional variations in the market share of the specialty hospitals as the number of specialty hospitals in regions. Specialty hospitals' market shares were relatively high in burn(31.3%), ophthalmology(16.4%), obstetrics and gynecology(7.1%), alcohol(6.0%), joint(3.7%), spine(2.7%). After adjusting the number of inpatients per hospital, hospitals specialized in burn, alcohol, ophthalmology, breast, joint, obstetrics and gynecology, and hand replantation had treated more patients than tertiary hospitals. Practical Implications: Although specialty hospitals' market share was small, some types of specialty hospitals had an impact on the regional market as well as the national level market. To improve patients' accessibility to a specialty hospital, it is necessary to government supports non-specialized hospitals to change into specialty hospitals in certain fields and regions where the number of specialty hospitals is insufficient.

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대전 일부 지역 치과종사자의 화학소독제에 관한 지식도 연구 (Knowledge on the chemical disinfectants among dental workers in some Daejeon region)

  • 민희홍;안권숙
    • 한국치위생학회지
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    • 제7권4호
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    • pp.455-470
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    • 2007
  • The usage of appropriate disinfectants is essential for infection control in dental hospitals, dental clinics. Inadequate use of disinfectants is the cause of human or environmental toxicity and is a waste of cost. This study was aimed to assess the level of knowledge on the disinfection and chemical disinfectants among dental workers in dental hospitals, dental clinics. It's ultimately intended to serve as a basis for the preparation of more effective, appropriate educational programs on the disinfection and manuals on the use of disinfectants for dental workers. This study enforced a questionnaire with 184 dental workers employed in dental hospitals, dental clinics from 15 Aug. to 15 Sep. 2007, in the area of Daejeon. The obtained result were as follows; 1. The population sociological feature of dental hospital and dental clinic showed that significant differences of dental service career(pM0.039). Dental service career of dental workers shows; below 3 years 42.9%, 4~6 years 34.7%, more than 7 years 22.4% in dental hospitals, below 3 years 30.4%, 4~6 years 26.7%, more than 7 years 43.0% in dental clinics(pM0.039). 2. The average score of dental workers knowledge in 'Critical item soaks in high-level disinfectants for 20minutes was 2.73V0.49 point, got from knowledge of dental instrument is appropriate to immerse before sterilization in the dental device disinfection(pM0.002). 3. In the general disinfection which it follows in education experience of chemical disinfectants direction for use, 'Direction for use by Spaulding process classification' responded that the correct answer was the education experience dental workers 60.0%, the education non-experience dental workers 39.5%(p=0.026). 4. In the dental device disinfection which it follows in education experience of chemical disinfectants direction for use. 'High level disinfection is not applied for the non-critical items and equipment' responded that the education experience dental workers 49.2%, the education non-experience dental workers 31.9%(pM0.045), 'Semi-critical items is applied same method in presence of the infection disease which it acts responded that the education experience dental workers 44.6% answer back, the education non-experience dental workers 24.4%(pM0.017). 5. 'A hand disinfectants of anticeptics have effect' the education experience dental workers 78.5% answer back, the education non-experience dental workers 52.9%(pM0.003). 1t uses with hand disinfectants when the instruments which be imbrued and patient contact', the education experience dental workers 78.5% answer back, the education non-experience dental workers 62.2%(pM0.026), 'Boric acid solution uses for the skin disinfectants the education experience dental workers 52.3% answer back, the education non-experience dental workers is 37.0%(pM0.016), 'Gluconate have effective difference which it follows in chemical disinfectant consistency and the solution type' education experience dental workers 72.3% answer back, education non-experience dental workers 47.9%(pM0.004). 6. The education experience dental workers were appeared higher than the education non-experience dental workers in knowledge of the disinfection and chemical disinfectants. Consequently system and the specialty education which is standardized continuously must be provided to all dental workers.

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가정간호 사업에 대한 의사, 간호사, 진료관련부서 직원 및 환자의 인식 비교 (A Study on Differences of Opinions on Home Health Care Program among Physicians, Nurses, Non-medical personnel, and Patients.)

  • 김용순;임영신;전춘영;이정자;박지원
    • 대한간호
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    • 제29권2호
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    • pp.48-65
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    • 1990
  • The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

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의료보험자료 상병기호의 정확도 추정 및 관련 특성 분석 -법정전염병을 중심으로- (Estimation of Disease Code Accuracy of National Medical Insurance Data and the Related Factors)

  • 신의철;박용문;박용규;김병성;박기동;맹광호
    • Journal of Preventive Medicine and Public Health
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    • 제31권3호
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    • pp.471-480
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    • 1998
  • This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows : 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I. : 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (41.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and fortieg age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

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Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

  • Kim, Sang Youn;Cho, Jeong Yeon;Lee, Joongyub;Hwang, Sung Il;Moon, Min Hoan;Lee, Eun Ju;Hong, Seong Sook;Kim, Chan Kyo;Kim, Kyeong Ah;Park, Sung Bin;Sung, Deuk Jae;Kim, Yongsoo;Kim, You Me;Jung, Sung Il;Rha, Sung Eun;Kim, Dong Won;Lee, Hyun;Shim, Youngsup;Hwang, Inpyeong;Woo, Sungmin;Choi, Hyuck Jae
    • Korean Journal of Radiology
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    • 제19권6호
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    • pp.1119-1129
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    • 2018
  • Objective: To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU. Materials and Methods: This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated. Results: The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose ($5.73{\pm}4.04$ vs. $8.43{\pm}4.38mSv$) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ${\geq}3$), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group. Conclusion: The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.