• Journal of Trauma and Injury
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• v.25 no.4
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• pp.178-187
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• 2012

Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.254-260
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• 2012

Purpose: Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients. Methods: Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared. Results: To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05). Conclusion: The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse specialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay.

• Journal of Preventive Medicine and Public Health
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• v.40 no.6
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• pp.487-494
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• 2007

Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.

• Health Policy and Management
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• v.18 no.3
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• pp.58-89
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• 2008

The purpose of this study was to evaluate comparatively the content of the Expanded National Immunization Program according to the provision method between 2005 and 2006 in Korea. We assessed the impact of the mutually exclusive vaccination policy using the result reports of the 2005 and 2006 Demonstration Project and the related references by the content analysis. The public health centers paid vaccination fees to the private clinic and hospital in the 2005 Demonstration Project in Daegu metropolitan city and Gunpo city. But, the public health centers directly supplied free vaccination services to the children in the 2006 Demonstration Project in Gangneung city, Yangsan city, and Yeongi-gun. The total budgets of 2005 and 2006 Demonstration Project were 6.57 billion won and 0.65 billion won, respectively. The computerized registration rates and timeliness rates of administration of each vaccination had improved all in the 5 Demonstration Project regions. However, the computerized registration rates of most vaccination in Gunpo city were higher than those in the 2006 Demonstration Project regions except hepatitis B. Especially, the computerized registration rate of BCG was 48.3%, but the BCG coverage rate by the follow-up telephone survey was 99.8% in Daegu metropolitan city. The community parents in all the regions were satisfied because of expanding financial and geographical access to immunization coverage. In conclusions, from the aspect of the main outcomes, the implementation of two different financial immunization aids appears to be widely accepted among these parents and to have had an impact on vaccination coverage. In the future, the government must try to enact that the national immunization policy including under-immunised or incompletely immunised groups would be achieved by the affordable method of the public-private dynamics.

• Journal of the Korea Convergence Society
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• v.8 no.6
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• pp.55-64
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• 2017

The research study focuses to analyze the result of the military personnel medical examination and identify the medical conditions of military individuals. The results of this study are as follows. First of all, for the general features of research subjects, there are 60 people who are 39-year-old or less and 60 people in the age of 40-year-old or over of the total 120 research subjects. Secondly, as a result of canonical correlation analysis in between their ages/body mass index(BMI) and the outcomes of medical examination, it derived 3 canonical functions. 2 of the functions out of the 3 demonstrated statistical significance. The research has conjured meaningful results which include that the holistic diagnosis and treatment system for the military officers needs additional enhancement. Also the medical examination is in desperate need of expansion in test items and the associated budget planning should be evaluated in government organizations related to welfare policy.

• Quality Improvement in Health Care
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• v.18 no.1
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• pp.27-36
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• 2012

Objectives : A protocol called "critical pathway" was developed to standardize the management of hospital patients the day after they underwent gamma knife radiosurgery. The quality of improvement in patient outcomes was evaluated. Methods : Critical pathway was developed, according to the regulations of the I hospital, by analyzing the medical records of 22 inpatients who underwent gamma knife surgery within the period from January to April 2011 on the day of the surgery. The study included a group of 22 patients admitted to the hospital the day after they underwent gamma knife radiosurgery, between July and September 2011. The control group included 22 patients who had surgery employing the same method within the period from May to June 2011. To measure the effects on quality improvement, the average length of stay, the execution rate of the hospital discharge notice system, daily hospital revenue, and the satisfaction of the patients and the medical team were assessed. The patient questionnaire employed a four-point Likert scale while the medical-staff questionnaire employed a five-point Likert scale. Result : The average length of stay was significantly shorter in the study group compared to the control group (2.3 days vs. 3.8 days, P<0.05). The execution rate of the hospital discharge notice system was higher in the study group (100% vs. 72%) than in the control group. Daily hospital revenues were higher by 264,178 Korean won in the study group when compared to the control group. The study group showed greater satisfaction of patients compared to the control group based on a four-point Likert scale (P<0.05). The study group showed greater satisfaction in medical team compared to the control group based on a five-point Likert scale (P<0.05). Conclusion : The development and implementation of a critical pathway protocol for hospital admission the day after gamma knife radiosurgery is an effective care process that improves the clinical quality.

• Journal of the Korea Convergence Society
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• v.10 no.11
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• pp.199-207
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• 2019

This study was a convergence study of pre- and post-treatment clinical outcomes and radiologic results of school aged flexible flat foot using insole inserted indoor sandal. Thirty five subjects were asked to wear insole inserted indoor sandals at least five times a week and at least four hours a day. Before and after the $4^{th}$ and $8^{th}$ week of the treatment, foot radiography and FAOS questionnaire were performed. Statistical analysis was performed using repeated measure ANOVA. The clinical results showed statistically significant improvement in FAOS symptom and pain category. Radiological results showed a tendency of improvement in the Anterioposterior Talo-$1^{st}$ Metatarsal angle, the Lateral Talo-$1^{st}$ Metatarsal angle, and the Talo-Horizontal angle, but no statistical significance was found. In this study, the use of insole inserted indoor sandal during the majority of the indoor life in school aged flexible flat foot patients is effective in alleviating symptoms and pain relief in the short term.

• Journal of Digital Convergence
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• v.19 no.4
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• pp.467-475
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• 2021

Purpose: When a patient with acute deterioration occurs in a ward, the decision to transfer to intensive care unit (ICU) is critical to improve the patient's outcomes. However, when available ICU resources limited, it is difficult to determine which of the deteriorating ward patients to transfer to the ICU. Therefore the purpose of this study was to identify risk factors in predicting deteriorating ward patients transferred to intensive care unit (ICU). Methods: We reviewed retrospectively clinical data of 2,945 deteriorating ward patients who referred medical emergency team. Data were analyzed with multivariate logistic regression. Results: The solid cancer that diagnosed at hospitalization (odds ratio[OR] 0.39; 95% confidence interval [CI] 0.32-0.47), when the cause of deterioration was respiratory problem (1.51; 95% CI 1.17-1.95), high MEWS (1.22; 1.17-1.28) and SpO2/FiO2 score (2.41; 2.23-2.60) were predictive of ICU transfer. Conclusion: These findings suggest that early prediction and treatment of patients with high risk of ICU transfer may improve the prognosis of patients.

• Journal of Gastric Cancer
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• v.21 no.2
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• pp.203-212
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• 2021

Purpose: The impact of the interval between previous endoscopy and diagnosis on the treatment modality or mortality of undifferentiated (UD)-type gastric cancer is unclear. This study aimed to investigate the effect of endoscopic screening interval on the stage, cancer-related mortality, and treatment methods of UD-type gastric cancer. Materials and Methods: We reviewed the medical records of newly diagnosed patients with UD gastric cancer in 2013, in whom the interval between previous endoscopy and diagnosis could be determined. The patients were classified into different groups according to the period from the previous endoscopy to diagnosis (<12 months, 12-23 months, 24-35 months, ≥36 months, and no history of endoscopy), and the outcomes were compared between the groups. In addition, patients who underwent endoscopic and surgical treatment were reclassified based on the final treatment results. Results: The number of enrolled patients was 440, with males representing 64.1% of the study population; 11.8% of the participants reported that they had undergone endoscopy for the first time in their cancer diagnosis. The percentage of stage I cancer at diagnosis significantly decreased as the interval from the previous endoscopy to diagnosis increased (65.4%, 63.2%, 64.2%, 45.9%, and 35.2% for intervals of <12 months, 12-23 months, 24-35 months, ≥36 months, and no previous endoscopy, respectively, P<0.01). Cancer-related mortality was significantly lower for a 3-year interval of endoscopy (P<0.001). Conclusions: A 3-year interval of endoscopic screening reduces gastric-cancer-related mortality, particularly in cases of UD histology.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.12
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• pp.300-309
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• 2020

This study identified the types and dimensions of faculty-student interaction (FSI). A narrative methodology was applied within the qualitative research paradigm. Data was collected using individual in-depth interviews involving 10 students who had experiences of faculty-student interaction more than 6 times over the prior 6 semesters. Data was analyzed according to actors' perspectives, the motivation of actions, and actions toward goal achievement. Three major types of faculty-student interactions emerged from our analysis. First, the initiative interaction type reflects active characteristics of the narrator within FSI and is goal achievement-oriented. Second, the stereotyped interaction was characterized as a unified reaction to the FSI and not significantly related to self-development. Lastly, the reciprocal interaction reflected characteristics of narrators who had potential and flexibility for self-development in the circumstances involving support from professors. The results of this study indicate that faculty-student interaction does not represent the best way to support students for their successful school lives. Faculty needs professionality and sensitivity for student teaching, and students must exhibit curiosity and activeness in developing their knowledge. Positive outcomes from the FSI will be expected in supportive school environments.