• Quality Improvement in Health Care
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• v.18 no.1
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• pp.37-55
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• 2012

Objectives : This study was conducted to evaluate the effect of fixed critical pathway with emr (electronic medical record) on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a university hospital and to develop flexible critical pathway with emr which can be used excluded or drop-out patients. Methods : Thirty-eight patients with gastrectomy were included as case group and Thirty-four patients included as control group. The comparison between control and case with using fixed critical pathway were done. To develop and to evaluate usefulness of flexible critical pathway with flexible data base, simulation was done for flexible critical pathway with drop-out patients. Result : The major results of this study were as follows: There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. The length of hospital stay was 11 days in control group, 8 days in path group(P<0.01). The total costs during the hospital stay were reduced in path group. However the cost per day was significantly increased from reduction of hospital stay(554,352 won in control, 645,669 won in path group). One hundred percentage of drop out patients(60) in the simulation of flexible critical pathway was successful. Conclusion : Computerized critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care. The flexible critical pathway program can be used as one of the powerful management tools for reducing the practice variations and increasing the efficiency of care process and decreasing the workload of doctors and nurses in Korean hospital settings.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.281-290
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• 2019

This study analyzed the recognition types of the economic burden for cancer treatment and the characteristics of each recognition type by employing Q methodology. For this study, we determined the final 45 Q statements by conducting literature surveys, internet searches and in-depth interviews. The P samples are 35 people of cancer patients, their family members, and experts. The Q statements were classified according to the forced normal distribution method and the collected data was analyzed using the PC QUANL program. For the analysis results, we extracted four recognition types on the economic burden of cancer treatment, and we named them 'uncertain anxiety', 'acceptance by family burden', 'object to challenge with active response' and 'insurance preparation', depending on their characteristics. The results of this study can be used as a basis for preparing the clinical intervention plan and the policies for cancer patients and the families involved in the fields of medicine, nursing and social welfare.

• Journal of Home Health Care Nursing
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• v.10 no.1
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• pp.58-72
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• 2003

The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18,

• Quality Improvement in Health Care
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• v.7 no.1
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• pp.32-45
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• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• Journal of Korean Academy of Nursing
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• v.29 no.2
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• pp.336-345
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• 1999

This study looks at the various alternative therapy methods used in day to day life by elderly, over 60 years of age. The elderly have come to know and practice these methods for the following reasons it is good for the health ; it is the method used in the of fen days when there wesn't modern medicine ; it has been passed down from generations ; it can be done at home without having the need to go to the hospital ; acupuncture or poulticing can be used ; it can be done at home, which was an important factor in rural areas where hospitals are few and far between ; and 〔herbal〕 medicine could be prepared at home at no cost ; it derives from experience ; it is impossible to ignore tradition passed down through the generations. Diet control and plants (herbs) are methods most often used. as they are easy to find and can be readily used in critical situations. Other methods include oriental medicine practices of moxibustion with moxa cone, negative therapy, hand and finger acupunture, finger press method. ordinary acupunture, manual healing methods of massage. diaphoretic therapy and meditation to reach a state of calm, and qigong dirigation. The reasons for its use are as follows ; it has been used before ; it is effective ; there is some improvement after the treatment ; it is not harmful to the body ; medicine cannot be obtained and it is the only thing available ; it is not good for an old person to go to the hospital everyday. the symptoms are not serious enough to go to a hospital : and acupuncture is for these things. The means that the elderly have come to practice these methods are : it has been used since the past ; it has been told by the elders ; they have been told by friends ; it was part of their knowledge ; and they have come to know by watching their mother. Further, to regain vitality lost through old age, the elderly have relied on hot soup. a hearty meal. brewed honey water, pumpkin, or ginseng. Humans, by instinct. would rub or massage the areas that caused pain. These actions, combined with a breathing technique have been recognized in Tong-Eui-Bo-Gam(the essential of eastern medicine), the complete work of early modern medicine, are a useful means to revive chi(기). This knowledge is thought to have greatly affected our heathy lifestyle. Furthermore, though the demand for medical services would increase with age, the elderly have not always been able to tend to their needs at the hospital for reasons economic or other. Hence, these alternative therapy methods seem to have been practiced as a temporary means of relief. The excellence of our traditional therapeutic custom has not received full recognition due to the argument relating to its scientific merits. As a result, it has become vital to prove their effectiveness through scientific and other experimental means. The potency of moxibustion with moxa cone and hand and finger acupunture have been proven scientifically. but diet and herbal methods appear to be practiced as a result of customs passed down from generations. In addition, it is submitted that the effectiveness of the traditional methods of disease control and our heathy lifestyle that are easily found in the nursing field must be verified.

• Journal of Hospice and Palliative Care
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• v.13 no.2
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• pp.81-88
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• 2010

Purpose: This study was conducted to study the attitude of Korean lawyers toward withdrawal of life sustaining treatment, and compare and analyze different types of their attitudes. Methods: Research design of this project was Q methodology approach. The study population was 24 lawyers, aged from 32 to 69 years. Q sample to investigate the attitude of the lawyers toward withdrawal of life sustaining treatment included 34 statements obtained from literatures, TV debate, and depth interviews of 5 lawyers among the lawyers included. After listening to the purpose and method of the study, the 24 lawyers agreed to fill out a survey asking sociodemographic information, and the information was distributed in 9 scale Q-sample. Results: The collected data were processed through QUANL PC program and sorted into 5 types as follows: The first type was 'Choosing to withdraw life sustaining treatment', the second 'Withholding life sustaining treatment' regardless of the cost, the third is neutral type that claims that humans have the right to decide the death and life, and demands the proper legalization to protect such rights, the fourth type agrees to withdrawal of life sustaining treatment, nevertheless, admits that one has a rigt to withhold one's own life treatment, categorized as self contradiction type. The fifth type believed that 'Life and death are providential' with the faith, therefore, such authority to decide life and death belongs to God, but not human beings. Conclusion: In conclusion, the lawyer's attitudes toward withdrawal of life sustaining treatment were grouped into five different types as follows: 'Choosing to withdraw life sustaining treatment', 'Withholding life sustaining treatment', 'Demanding legalization', 'Self contradiction type', and 'Life and death are providential'.

• Journal of the Korean Dietetic Association
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• v.12 no.4
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• pp.313-328
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• 2006

This study was objectively performed to identify dietitians' job in the elderly health-care facilities, to assess facilities and dietitian's demographic characteristics, and to determine performance and importance of dietitian's job including the demand of therapeutic diet development. Survey was conducted by mail and samples were the dietitians working in 376 facilities which capacity is over 50 members from nationwide 583 the elderly health-care facilities. Returned questionnaire was 102 and used for statistic analysis. The distributions of the elderly health-care facilities showed 39 the elderly nursing facilities(38.2%), 32 skilled nursing facilities (32.4%), 13 geriatrics hospital facilities(12.7%) and 9 the elderly cost nursing facilities(8.8%). 60.0 percent of the samples showed its menu price as 1,000 to 1,500 won. A cycle-menu program was in-use at the 79.0% facilities, but only 7.1% facilities have been introduced a selected menu system. 92.9% facilities employed only one dietitian. In the demographic characteristics of dietitian only 14.7% dietitian had a clinical dietitian license and 51.5% of respondents answered at least 1 to 3 months internship program is needed. Job activities of the dietitian in the elderly health-care foodservice were identified as 45 activities with 9 dimensions. Job performance score evaluated dietitian oneself was 4.71 of 7 points. The average importance score that the dietitian evaluated their own job was 5.66 points of 7. The job activities shown higher importance but lower performance were therapeutic diet development for in-patients, menu development suitable for taste of the elderly, and leadership. Job performance score by characteristics of dietitian and their elderly health-care facilities was significantly associated with experience of dietitian in elderly health-care (F=4.480, p<0.05), education of dietitian(F=2.659, p<0.01), number of dietitian(F=2.245, p<0.05), and number of employee in foodservice(F=2.607, p<0.05). Most common diseases of the aged was proved as hypertension(81.7%), diabetes mellitus(71.4%), and dementia(65.0%). The therapeutic diets frequently provided were diabetes mellitus diet, dysphagia diet, low sodium diet, high fiber diet, and high protein diet, in order. For those reasons, dietitian in the elderly health care emphasized that the information about therapeutic diet development such as diabetes mellitus diet, dysphagia diet, low sodium diet and hypertension diet must be continuously developed and provided. The result from this study can be applicable to enlarge and enrich job activities of dietitian in elderly health-care foodservice.

• Quality Improvement in Health Care
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• v.7 no.1
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• pp.18-31
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• 2000

Background : This study is to identify the inappropriate hospital services for elderly inpatients over 65 years in general hospital with acute care functioning. Consequently elderly inpatient care and the management of long-term care facilities are key issues for current government health policy. Method : The survey was conducted for two months for all inpatients over 65 in 7 general hospitals, 6 work sampling days randomly selected. In each survey day, the subjective judgement by medical staff on the degree of acute care needs and by nursing unit manager on hospital services of each inpatients was also conducted. Result : The total number of cases collected are 2,541 elderly inpatients, according to subjective judgements by medical staff on inpatient condition. However 46.8% of cases are turned out to be non-acute care group. The frequency of medical services provided to non-acute group are 2~3 vital sign checks per day 78.2%, IV injection 40.1%, antibiotics medication 20.2%. Conclusion : Lots of elderly patients' who are staving in acute hospitals, at present need to be transferred to long-term care facilities. However, there was been shortage of long-term care facilities. It is expected to identify the need of elderly inpatients and therefore, to provide cost-effective, appropriate and good quality health services to elderly inpatients depending on their needs.

• Quality Improvement in Health Care
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• v.15 no.1
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• pp.101-111
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• 2009

문제: 병동 처치수가 산정 부정확 및 누락으로 인한 부적절한 재고관리로 진료차질, 불필요한 업무발생 및 수익이 감소한다. 목적: 병동 처치수가 산정 정확화를 위한 업무 표준화 도구 및 시스템을 개발하여 적정 재고관리를 통한 수익증대 및 직무만족도를 향상시킨다. 의료기관: 서울시 종로구에 소재한 대학병원 질 향상 활동: 병동중심의 처치 산정지침 개발 및 수가물품의 적정재고 관리방안을 모색하였다. 개선효과: 병동중심의 처치수가 산정 지침서를 제작하여 업무표준화를 기하였음. 응급청구 품목 및 수량이 '07년 대비 71%감소하고 타 병동 차용품목이 활동 전에 비해 61% 감소, 수량은 77% 감소함. 응급청구 총소요시간이 활동 전에 비해 '07년 대비 77% 감소하고 타 병동 차용 총 소요시간이 61% 감소함. 전년 동기간 대비 수익이 4% 증가하였으며 또한 54병동과 보험 심사팀에서 직원들의 직무만족도가 향상되었다.

• The Journal of Korean Society for School & Community Health Education
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• v.7
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• pp.87-99
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• 2006

Objectives: This study is to draw the design of the program which is improve school health promotion participation by applying the Social Ecological Model based on the literature review on the health promotion. Methods: Literature review was carried out based on 5 factors of social ecological model using computer search engines of Google, ProQuest, and Riss4U. Results; Social Ecological Model is consist of individual, interpersonal, institutional/organizational, community, and policy. Individual sphere is drawn from Health Belief Model, interpersonal sphere is Social Support Theory, institutional/ organizational sphere is institutional resources theory, community sphere is community model, and policy sphere is Social Marketing Theory. The literature review show that the important variables affecting health promotion exist in each sphere. Individual sphere has social economic status, age, sex, sensitivity and specificity of illness, self-efficacy. Interpersonal sphere has support and use of family, friend and neighbor. Institutional/Organizational sphere has environment service reliability and utility. Conclusions: Community sphere has distance, neighborhood safety, interrelationship among institutions. Policy sphere has cost, legislation advertisement, lobby and concern and leadership of Institution.