• Journal of Korean Clinical Nursing Research
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• v.28 no.2
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• pp.185-197
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• 2022

Purpose: This study was performed to verify reliability and validity of the Korean Pediatric Patient Classification System (KPPCS) and estimate nursing time conversion index. Methods: The study was conducted in 9 children's hospital which included various areas and size of bed settings. To verify intraclass correlation reliability and construct validity, staff nurses and nurse managers of 21 wards classified 575 patients according to KPPCS comparing differences by age, days of stay, type of stay and medical department. Direct and indirect nursing time of 575 patients were measured by 284 nursing staffs by stopwatch observation and self reports for 24 hours. Results: KPPCS has 12 categories, 55 nursing activities and 80 criterions. High agreement among nurses (r=.91, p<.001) suggested substantial reliability. Construct validity was verified by comparing differences in age, days of stay, type of stay and medical department (p<.05). The correlation of nursing time and classification score was also statistically significant (r=.59, p<.001). The nursing time conversion index was 10.78 minutes per 1 classification score. The entire patient group were classified to four groups using KPPCS. Conclusion: The findings suggest that KPPCS would be a useful tool for estimating nursing demands related to the complexity of pediatric patients.

• The Journal of the Korean dental association
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• v.53 no.2
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• pp.96-102
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• 2015

There is a need to comprehend dental accidents accurately, and construct patient-safety-system in order to prevent consistently increasing dental accident or dispute. This study is aimed to provide basic data for an efficient counterplain by looking through and classifying already occurred dental accidents from an angle of patient safety. Recently, the number of dispute on dental implant was the highest according to rapid growth of dental implant. As a result of classifying dental accidents by International Classification for Patient Safety (ICPS), it is confirmed that cause of accident is different by each type of dental treatment. It is expected to help preventing and managing dental disputes properly by studying actual state of dental disputes in perspective of patient safety. Effort to reduce dental accidents and activity to pursue patient safety have thread in connection. I believe that financial profits of dental clinic and improvement of quality in dental treatment can be achieved through these efforts.

• Journal of Korean Critical Care Nursing
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• v.10 no.1
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• pp.1-12
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• 2017

Purpose: This study aimed to estimate the appropriate nurse staffing ratio in intensive care units (ICUs) by measuring nursing workload based on patient's severity and needs, using the Korean Patient Classification System for critical care nurses. Methods: The data were collected from January 18 to February 29, 2016 using a standardized checklist by observation or self-report. During the study period, 723 patients were included to be categorized from I to IV using the patient classification system. Measurement of total nursing workload on a shift was calculated in terms of hours based on the time and motion method by using tools for surveying nursing activities. The nursing activities were categorized as direct nursing care, indirect nursing care, and personal time. Total of 127 cases were included in measuring direct nursing time and 18 nurses participated in measuring indirect and personal time. Data were analyzed using descriptive statistics. Results: Two patients were classified into Class I (11.1%), 5 into Class II (27.8%), 9 into Class III (50%), and two into Class IV (11.1%). The amount of direct nursing care required for Class IV (513.7 min) was significantly more than that required for Class I (135.4 min). Direct and indirect nursing care was provided more often during the day shift as compared to the evening or night shifts. These findings provided the rationale for determining the appropriate ratio for nursing staff per shift based on the nursing workload in each shift. Conclusions: An appropriate ratio of nurse staffing should be ensured in ICUs to re-arrange the workload of nurses to help them provide essential direct care for patients.

• The Journal of Korean Medicine
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• v.38 no.3
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• pp.185-196
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• 2017

Backgrounds: Inpatient Classification System for Korean Medicine (KDRG-KM) was developed and has been applied for monitoring the costs of KM hospitals. Yet severity of patients' condition is not applied in the KDRG-KM. Objectives: This study aimed to develop the severity classification methods for KDRG-KM and assessed the explanation powers of severity adjusted KDRG-KM. Methods: Clinical experts panel was organized based on the recommendations from 12 clinical societies of Korean Medicine. Two expert panel workshops were held to develop the severity classification options, and the Delphi survey was performed to measure CCL(Complexity and Comorbidity Level) scores. Explanation powers were calculated using the inpatient EDI claim data issued by hospitals and clinics in 2012. Results: Two options for severity classification were deduced based on the severity classification principle in the domestic and foreign DRG systems. The option one is to classify severity groups using CCL and PCCL(Patient Clinical Complexity Level) scores, and the option two is to form a severity group with patients who belonged principal diagnosis-secondary diagnosis combinations which prolonged length of stay. All two options enhanced explanation powers less than 1%. For third option, patients who received certain treatments for severe conditions were grouped into severity group. The treatment expense of the severity group was significantly higher than that of other patients groups. Conclusions: Applying the severity classifications using principal diagnosis and secondary diagnoses can advance the KDRG-KM for genuine KM hospitalization. More practically, including patients with procedures for severe conditions in a severity group needs to be considered.

• Health Policy and Management
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• v.16 no.1
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• pp.17-40
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• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

• Imaging Science in Dentistry
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• v.32 no.3
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• pp.129-134
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• 2002

Purpose : To implement the database system of oral and maxillofacial radiological images using a commercial medical image management software with personally developed classification code. Materials and methods : The image database was built using a slightly modified commercial medical image management software, Dr. Image v.2.1 (Bit Computer Co., Korea). The function of wild card '*' was added to the search function of this program. Diagnosis classification codes were written as the number at the first three digits, and radiographic technique classification codes as the alphabet right after the diagnosis code. 449 radiological films of 218 cases from January, 2000 to December, 2000, which had been specially stored for the demonstration and education at Dept. of OMF Radiology of Dankook University Dental Hospital, were scanned with each patient information. Results: Cases could be efficiently accessed and analyzed by using the classification code. Search and statistics results were easily obtained according to sex, age, disease diagnosis and radiographic technique. Conclusion : Efficient image management was possible with this image database system. Application of this system to other departments or personal image management can be made possible by utilizing the appropriate classification code system.

• Journal of Korean Academy of Nursing Administration
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• v.3 no.2
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• pp.123-136
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• 1997

The purpose of this study was to confirm the classification of nursing activity and to analyze the time of nursing workload in a new open hospital. The data were collected from 20 nurses working in 6 general nursing units by 4 trained observers. The tools used for this study were an observation recording sheet and a classification sheet of nursing activity. The classification sheet was constructed to be adaptable to each hospital system based on the instrument described in the literature. The results of the study are as follows : The direct nursing activities consisted of 6 sections, 33 subsections and the indirect nursing activities consisted of 14 sections, 53 subsections. The direct nursing activities included medication, measuring and observation, care of therapies, care of physical comfort, laboratory and treatment. The indirect nursing activities included preparation of medical utensils, collection of information and assessment, recording, phone communication, professional interaction related to patients, personal time, assigning work to staff, patient eaucation and training, interaction with lab, transfer of administration of utensils, checking physician's order, dietary service, management of pollution and contagion, guide direction. Nurses spent 127.6min for direct nursing activity during day duty. It was 24.5% of total nursing activity. Within that activity medication had the highest percentage of time(40.09%), followed by communication and education with patient(24.76%), measuring and observation (16.93%), laboratory and treatment (12.85%), care of therapies(3.21%) and care of physical comfort (2.16%). The time breakdown for indirect nursing activities is as follows ; the preparation of medical utensils 22.3%, collection of information and assessment 20.29%, recording 20.27%, phone communication 8.14%, professional interaction related to patients 7.33%, personal time 7.24%, with the remaining timeshared by staffing, patient education and training, interaction with lab, transfer of administration of utensils, checking physician's order, dietary service, management of pollution and contagion, guide direction. In the analysis of the relationships between the working time and the work allocation characters of the nurses(including nurse's experiences. nurse-patients ratio, nurse-rooms ratio, and character of nursing unit) ; There were no significant differences in direct-indirect nursing times between nurse's career years. There was significant difference in direct nursing time between assigned patient numbers. The nurses assigned larger number of patients spent significantly more time in direct nursing care than that of the smaller. On the other hand, there was no significant difference in indirect nursing workload between the assigned patient numbers. There were no significant differences in direct-indirect nursing time between an allocated patient's room numbers. There was significant difference in working time between working places. The nurse in the medical unit spent more time in direct nursing care than her counterpart in the surgical unit. However there was no difference in direct nursing time between two groups. The study results indicate that nurses spent less time in the direct nursing care than in the previous studies even though the hospital system has been modernized. On the other hand they spent much more time for the coordinating role within the interdisciplinary team and for the overlapping paperwork. Therefore it is recommended that patient oriented job description and more efficient usage of modernized utilities be made.

• Journal of Korean Academy of Nursing Administration
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• v.12 no.3
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• pp.444-453
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• 2006

Purpose: The purpose of the study was to identify critical indicators for the development of efficient patient classification system in a emergency room. Method: This study involved following five steps. Step 1. Selection of the lists direct nursing services in the ER. Step 2. Measurement of the time of direct nursing services from Aug. 31st to Nov. 30th, 2005. Step 3. Classification of the patients according to the nursing care time. Step 4. The determination the critical indicators for different patient classes. Result: Determinate indicators were as follow: 3 items in the first group (vital sign checking, IV route starting, blood sampling), 3 items in the second group (vital sign checking, fluid infusion, blood sampling), 9 items in the third group (I/O checking, $O_{2}$ inhalation, suction, fluid infusion, IV bolus, Central catheter preparation & management, blood sampling, intubation preparation & management, postmortem management), 7 items in the fourth group (EKG monitoring, BP monitoring, $O_{2}$ inhalation, fluid infusion, using the specific drugs, CPR, postmortem management). Conclusion: This study can help future studies which measure nursing services standard time or assigns value to emergency nursing services.

• KIISE Transactions on Computing Practices
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• v.21 no.7
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• pp.464-469
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• 2015

Long-term electrocardiogram data can be acquired by linking a Holter monitor to a mobile phone. However, most systems are designed to detect arrhythmia through heartbeat classification, and not just for supporting clinical decisions. In this paper, we propose an Abstracting algorithm, and introduce an analogous pateint search system using this algorithm. An analogous patient searcher summarizes each patient's typical pattern using the results of heartbeat, which can greatly simplify clinical activity. It helps to find patients with similar arrhythmia patterns, which can help in contributing to diagnostic clues. We have simulated these processes on data from the MIT-BIH arrhythmia database. As a result, the Abstracting algorithm provided a typical pattern to assist in reaching rapid clinical decisions for 64% of the patients. On an average, typical patterns and results generated by the abstracting algorithm summarized the results of heartbeat classification by 98.01%.

• The Journal of Korean Medicine
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• v.35 no.3
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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.