• 정신신체의학
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• 제25권1호
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• pp.46-55
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• 2017

연구목적 외래치료명령제는 정신질환을 앓고 있는 사람이 특정한 외래치료 프로그램에 참여하도록 법에 의해 명령을 내리는 사회적 강제 제도이다. 본 연구에서는 외래치료명령제 및 정신질환자들의 치료 순응도에 영향을 미치는 요인들에 관해 알아보고자 하였다 방법 정신건강의학과 전문의 60명을 대상으로 2016년 10월에서 11월까지 외래치료명령제 및 치료 순응도에 관한 설문조사를 실시하였다. 설문지 각 문항은 문헌조사를 통하여 초안을 작성하고 3명의 정신건강의학과 전문의 및 1명의 법학전문대학원 교수의 의견 조회 과정을 거쳐서 최종적으로 확정하였다. 설문에 응답한 대상자들의 답변을 기술 통계를 이용하여 분석하였으며, 외래치료명령제의 실효성 점수에 대해서는 중앙값과 최고치, 최저치를 알아보았다. 결과 60명의 정신건강의학과 전문의 중에서 45명(75.0%)이 외래치료명령제를 알고 있었지만, 지난 12개월 중에 이를 이용한 전문의는 2명(4.0%)이었고, 주관적 실효성 점수는 40점/100점으로 그 실효성은 매우 낮게 나타났다. 또한 재입원 환자 중 외래 치료를 지속적으로 받았던 환자의 비율은 37.7%, 외래치료를 임의 중단한 환자 비율은 53.1%로 임의 중단 환자가 차지하는 비율이 더 높았다. 퇴원 환자 중에서는 약 2/3가량이 지속적인 치료를 받고 있었다. 임의로 치료를 중단한 환자의 관리방법으로 '아무런 조치를 취하지 않는다'(n=27)와 '파악하지 않음'(n=15)가 대부분이었지만 '정신건강증진센터 연락한다'는 의견은 2명으로 매우 저조하였다. 또한 임의 중단 환자에 대한 효율적인 조치로서는 '정신건강증진센터에 연계해야한다'는 의견이 가장 많았다(n=30). 결론 현재 시행되는 외래치료명령제는 실효성이 낮고, 외래치료 환자의 치료순응도 또한 매우 저조하였다. 따라서 이에 대한 효과적인 개입을 위해 제도적, 행정적 개선이 필요하며, 향후 정신건강증진센터의 역할이 중요할 것으로 판단된다.

• 한국경영과학회지
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• 제37권4호
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• pp.139-151
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• 2012

This paper introduces an Internet-based generic simulator for outpatient clinics, named PIOS (Postech Internet-based Outpatient Simulator). Unlike other simulation tools, PIOS is operated on the Internet, is straightforward to use for outpatient process analysis, and is open to public via http://logistics.postech.ac.kr/pios with free of charge. Therefore, non-simulation expert users such as hospital administrators and managers can easily access to PIOS and conduct simulation study by themselves. In this paper, we describe the main components and programming logic of PIOS, and demonstrate its validity by comparing the output results of PIOS and a commercial software package.

• 산업공학
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• 제23권1호
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• pp.1-11
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• 2010

There are various ways to manage the patient flow of the hospital outpatient system. However, it is difficult to apply many implementation solutions to the real outpatient system at once. Because first, the expected effects of each different solution are very much depend on the real situation of the system and applied other solutions, and second, owing to the limited resources, each solution should be implemented according to the priority. In order to overcome these difficulties, this paper focuses on proposing the comprehensive subset of implementation solutions, which is one of the most effective among various kinds of subsets, and verifying the effects of it. The comprehensive subset of solutions is derived from conducting design of experiments and simulation which determine the optimum set of different solutions and analyze the particular interactions and priority order among them. This implementation strategy can solve the difficulties of applying different kinds of various solutions to the hospital outpatient system.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제21권2호
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• pp.45-53
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• 2015

Purpose: This study is to derive the behavioral characteristics of the users appear in the outpatient department of psychiatry. Methods: By referencing John Zeisel's Tools for environment-behavior research, observation of user behavior and expert interviews as a method of the study has been carried out. Results: The results of this study are as follows. First, adjacent placement among children, youth and regular the outpatient department of psychiatry is necessary and easy access to internal medicine department and family medicine department is required in order to allow cooperated treatments. Secondly, depending on the characteristics of the outpatient department of psychiatry treatment, adjustment of space requirement or the change of kinds of necessary space is required. Third, considering the psychological and behavioral characteristics of mental illness and guardians, various search for the environment that can support this. Implications: This study is a basic research for space improvement and evaluation of the outpatient department of psychiatry, and need to be followed by further study using various perspectives and methods.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제12권2호
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• pp.31-39
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• 2006

Much has changed in the healthcare field since the beginning of the industrial age. In the healthcare field changes are occurring so rapidly and dramatically that yesterday's paradigm will not be tomorrow's paradigm, creating the need above all else to stay fluid and flexible as strategies(included healthcare architecture planning) for the future are developed. The purpose of this study is to analyze the latest architectural trends of general hospital outpatient department based on the healthcare environment changes in Korea. The major healthcare environment change is to change the object of hospital's healthcare services from inpatient to outpatient. In conclusion, the first, medical faculties of outpatient department are subdivided specialized small faculty. The second, clinic systems for medical examination and treatment of specific disease are activated in the most outpatient department. The third, specialized medical centers for chronical disease(Cancer, Cardiac etc.) control are arranged in existed outpatient department or freestanding facility. Specialized medical center for preventive medicine is regionally decentralized for corresponding with the healthcare paradigm shifts.

• 보건행정학회지
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• 제31권2호
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• pp.207-216
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• 2021

Background: Good patient experience is positively associated with adherence to treatment recommendations, better clinical effectiveness, and health outcomes. This study aims to find out the key factors affecting positive patient experience to improve the quality of care using nationally representative survey data. Methods: The data was collected from the 6th National Health Nutrition Survey in 2015. Four patient experience items were investigated for patients with visiting outpatient care over the past year. Positive patient experience was defined as a case of responding always or usually yes. The t-test, chi-square test, and multiple logistic regression were performed to determine the key factors affecting the outpatient experience. Results: More than 80% of the respondents reported their care experience as positive excluding doctor spending enough time during the consultation. Male, poor health status, and single/divorced, and the longer time interval between outpatient care visit and survey were found to be significantly correlated with negative care experiences in the multiple logistic regression. Patients who received outpatient care at the oriental medicine clinic had a positive experience compared to those received outpatient care at the general hospital. However, patient factors including age, income, job, and insurance type had no significant association with patient experience. Conclusion: Health care providers should prioritize patients who report negative patient experiences and implement management decisions to improve the patient experience.

• 가정간호학회지
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• 제27권3호
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• pp.259-270
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• 2020

Purpose: This study aimed to identify nursing competencies of outpatient nurses, to develop a tool to assess the same, and to verify the validity and reliability of the tool. Method: Preliminary items of the scale were developed based on a literature review and nurses' interviews. The tool's content validity was verified by an expert panel and by conducting a pilot study. Subsequently, to verify the validity and reliability of the scale, data were collected from 233 outpatient nurses from 7 certified tertiary hospitals. Data were analyzed using exploratory factor analysis, independent t-test, and internal consistency and correlation analysis. Result: The factor analysis revealed the following 9 factors for the 48 items of the scale: organizational management, customer orientation, personality and ethics, problem solving, nursing practice, interpersonal relationships, communication, crisis management, and professionalism. The Cronbach's α coefficient of the final instrument was .97. Conclusion: The tool developed in this study exhibited adequate validity and reliability. It was effective in reflecting the changing roles of outpatient nurses. Therefore, in future, this tool is expected to help improve outpatient nurses' competencies and nursing quality.

• 대한한의학회지
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• 제35권3호
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• pp.93-102
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• 2014

Objectives: This study aimed at revising the Korean Out-patient Groups for Korean Medicine (KOPG-OM, version 1.0) based on clinical similarity and resource use, by using the accumulated claims data, and evaluating the validity of the revised classification system. Methods: A clinical specialist panel involving 19 specialists from 8 Korean medicine (KM) specialty areas reviewed the classification tree, diagnosis groups and procedure groups in terms of clinical similarity. Several models of outpatient grouping were formulated, with the validity of each tested based on the $R^2$ coefficient of determination for the treatment costs of all visits. To add age splits, the variances of treatment costs by age groups were also analyzed. These statistical analyses were performed using KM claims data of National Health Insurance from 2010 to 2012. Results: The classification tree designed via panel discussions was used to allocate outpatient cases to 26 diagnosis groups, with cases involving procedures such as acupuncture, moxibustion and cupping, then allocated to 9 procedure groups in each diagnosis group. The cases without procedures were categorized into the visit index - medication group. This process resulted in 298 outpatient groups. The $R^2$ values for treatment costs of all visits ranged from 0.38 to 0.69 depending on the providers' types. Conclusions: The revised model of KOPG-KM has a higher validity for outpatient classification than the current system and can provide better management of the costs of outpatient care in KM.

• 임상간호연구
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• 제14권2호
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• pp.31-45
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• 2008

Purpose: The purposes of this study were: (a) to identify role definition, tasks, and duties of the nurses who work in outpatient department (OPD), (b) to do Development a Curriculum(DACUM) chart, and (c) to compare duties and tasks among nurses, nurse's assistants, and doctors. Method: The DACUM committee was organized with 10 nurses who worked in OPD. The committee derived the duties and tasks of OPD nurses from what they had done at workplace. Validity of the derived duties and tasks was tested by 23 nurses at 15 university hospitals. Results: Eleven kinds of duties were identified: preparation for outpatient's medical examination; support for outpatient's medical examination; management of outpatients; outpatient education; outpatient counseling; special examination of outpatient; OPD administration; management of OPD supplies; management of facilities and environments of OPD; management of OPD personnel, and self-improvement. Ninety-two tasks were classified. Conclusion: The abilities for education and emergency care of OPD nurses should be empowered. The results of this study would not only contribute to the effective OPD nursing care, but also be useful as basic data in hospital management.

• 보건행정학회지
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• 제21권3호
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• pp.397-413
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• 2011

Purpose: The purpose of this study is to examine the relationship between the income level and the healthcare utilization by health insurance type in all cancer patients in year 2005. Methods: The target population was cancer patients with health insurance who used healthcare as a diagnosis code (C00-C97) from January 1 to December 31 of 2005. The Korea Central Cancer Registry Center's Cancer Patient Registry Data, the list of cancer patients of the National Health Insurance Corporation, and the claim data of the Health Insurance Review & Assessment Service were used. The I was the wealthiest, followed by II, III, IV. The V was the poorest in this study. For the analysis, the $x^2$-test, ANOVA (and Kruskal-Wallis test), and regression were used. Results: Outpatient and hospitalization medical expenses, and outpatient visit days of cancer patients with self-employed health insurance were highest in I (p<.001, respectively), and the hospitalization days were the highest in II (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days of cancer patients with occupational health insurance were the highest in I (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days in cancer patients were higher in I compared to V, and higher in II and III, IV compared to V (p<.001, respectively). Conclusion: Supporting plan for cancer patients' outpatient healthcare utilization are necessary. Moreover, we should make specialized strategy for low income cancer patients with self-employed health insurance when we develop quality improvement policy for inpatient service.