• 한국의료질향상학회지
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• 제25권1호
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• pp.11-28
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• 2019

Purpose: The purpose of this paper is to derive implication on the adoption of PROMs (Patient-Reported Outcome Measures) to improve quality of care in South Korea. With this purpose, the paper examines the status of PROMs in South Korea and other countries including OECD's PaRIS (Patient Reported Indicators Survey) initiative, and reviews policy cases that have adopted PROMs to improve performance of healthcare system. Methods: We conducted literature review on OECD reports on PaRIS, peer-reviewed journals, and information from the websites of relevant institutions such as ICHOM, NQF and OECD. Results: To identify healthcare services of best values and support patient-centered health system, OECD has initiated PaRIS which develops, collects and analyzes patient-reported indicators for cross-countries comparison. PaRIS is implemented on two work streams: 1) collect, validate and standardize PROMs in the areas where patient-reported indicators already exist such as breast cancers, hip and knee replacement, and mental conditions, 2) develop a new international survey on multiple chronic conditions. Countries like England, U.S., Sweden and Netherlands use PROMs for measuring performance of hospitals and performance evaluation at the national level, and provide the financial incentives for reporting PROMs. Conclusions: The use of PROMs can support the current policy agenda that is the patient-centered healthcare system which has been emphasized to reinforce the primary and the community-based care. For the use of PROMs, it is recommended to actively participate in PaRIS initiative by OECD, select appropriate instruments for PROMs, and continue on standardization of them. This will assure patients' involvement in improving health system performance, systemize information generated in the process of adopting PROMs, and develop a system to evaluate performance.

• 사상체질의학회지
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• 제26권2호
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• pp.194-204
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• 2014

Objectives The aim of this study was to examine significant improvement of gait ataxia, vertigo and tremor after treatment with Sipyimigwanjung-tang, Hyangsayangwi-tang in a Soeumin Greater Yin Symptomatology patient Diagnosed as Cerebellar ataxia. Methods The patient was diagnosed with Soeumin Greater Yin Symptomatology and treated with Soeumin's constitutional medications and acupuncture. The primary outcome measures for this study were the Unified Multiple System Atrophy Rating Scale(UMSARS) and Cerebellar function test to assess the overall function of patient. Secondary outcome assessment included Global Assessment Scale(GAS), change of patient's sleep, stool and digestion. Results The symptoms of gait ataxia, vertigo and tremor decreased from GAS 100 to GAS 0~40 after treatment, and the UMSARS score decreased in Part I, II. Conclusions This case showed that Sasang Constitutional medicine treatment can be effective treatment method for cerebellar ataxia. We consider that consistent treatment can contribute to improve the patient's quality of life.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.173-182
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• 2019

Background: Patient reported outcome measures assess clinical progress from the patient's perspective. This study explored the relationship between shoulder outcome measures (The Disability of the Arm, Shoulder and Hand [DASH], American Shoulder and Elbow Surgeons Standard Shoulder Assessment score [ASES], and Constant score) by comparing the best possible scores obtained in an asymptomatic population compared to overall perception of health, as measured by the SF-36 outcome measure. Methods: Volunteers (age range, 20-69 years) with asymptomatic shoulders and no history of shoulder pain, injury, surgery, imaging, or pathology (bilaterally) were included. The DASH and ASES measures were completed by 111 volunteers (72 female, 39 male), of which 92 completed the Constant score (56 female, 36 male). The SF-36 was completed by all volunteers (level of evidence: IV case series). Results: The mean (${\bar{x}}$) score for ASES measure on the right shoulder was higher for the left-hand dominant side (${\bar{x}}=100.00$ vs. 95.02, p-value<0.001); no other significant differences. Better SF-36 scores were associated with better DASH scores. Our prediction models suggest that perception of overall health affects the DASH scores. Sex affected all three shoulder measures scores. Conclusions: Comparing scores of shoulder outcome measures to the highest possible score is not the most informative way to interpret patient progress. Variables such as health status, sex, and hand dominance need to be considered. Furthermore, it is possible to use these variables to predict scores of outcome measures, which facilitates the healthcare provider to deliver individualized care to their patients.

• 대한물리의학회지
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• 제13권3호
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• pp.49-60
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• 2018

PURPOSE: This study was conducted to investigate the intervention effect obtained by applying an ICF tool to improve the dressing in a patient with rotator cuff syndrome to schematize the problems and approaching with PNF to solve the problems. METHODS: The subject of this study was a 44-year-old patient who underwent surgery after complete right rotator cuff tear. To treat his symptoms, the processes of clinical practice were implemented in the order of examination, assessment, diagnosis, prognosis, intervention, and outcome. During examination, patient information was collected using the ICF core set. In the assessment, the problems were schematized, and an ICF assessment sheet was used to identify the interaction of the problems. The diagnosis was made by clearly describing the causal relationship derived from the assessment in ICF terms. To solve the problems, the intervention was given in the order of indirect, direct, and task based on the philosophy of PNF. To evaluate the outcome, the differences before and after the intervention were compared. Additionally, the comparison for the ICF qualifier is presented with the ICF evaluation display. RESULTS: The results of the study showed clinical advantages in shoulder strength, eccentric control, range of motion, scapular stability, and shoulder pain. Overall, our patient with rotator cuff syndrome showed improvement in dressing and undressing activity in response to the PNF strategy. CONCLUSION: Application of the PNF intervention strategy after complete rotator cuff tear would have a positive effect on patient upper extremity function.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.116-122
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• 2018

Background: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Methods: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Results: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. Conclusion: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1218-1220
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• 1992

Pneumonectomy on a patient with documented poor pulmonary function indicating a contraindication to surgery can be associated with a high risk of serious postoperative morbidity or mortality. However the usual criterias, on the performance of a pneumonectomy on a high risk patient based on the preoperative assessment of the pulmonary function may not sometimes predict with accuracy the operative outcome in the postoperative period. We recently performed pneumonectomy with good results on a patient with poor pulmonary function that would otherwise have been an absolute contraindication to surgery by usual criteria.

• Clinics in Shoulder and Elbow
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• 제6권2호
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• pp.143-148
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• 2003

Objectives: To analyze the postoperative functional outcome of shoulder in patients with arthroscopically assisted repair of large to massive rotator cuff tears with or without acromioplasty and role of acromioplasty. Materials and Methods: From June 1996 to June 2002, twenty six patients with large to massive rotator cuff tears were undergone arthroscopically assisted repair. Mean follow up was over one year. Fourteen were male and twelve were female. Mean age was 51 years old(39-66). Mean duration was 9 months. Acromioplasty was done in 14 cases concomitantly. They were divided into two groups. Group I: arthroscopic cuff repair with acromioplasty(14 cases). Group II: arthroscopic cuff repair without acromioplasty(12 cases). Each shoulder was evaluated at preoperative and final follow-up with Visual Analogue Scale(VAS), University of Pennsylvania Patient self-assessment of pain, University of Pennsylvania Patient self-assessment of function, ASES standardized shoulder assessment form, Simple Shoulder Test, UCLA score and range of motion(ROM). We analyzed the differences between the two groups. Shoulder ROM and acromioplasty were determining factors. Statistics was tested by correlation analysis and repeated measure ANOVA test. Results: At the final follow up, functional outcome and pain were improved but they had no statistical significance between the two groups(p>0.05). Combined procedure, acromioplasty, didn't affect on VAS. UCLA score, University of Pennsylvania Patient self-assessment of pain, University of Pennsylvania Patient self-assessment of function, ASf:S standardized shoulder assessment form and Simple Shoulder Test(p>0.05). In group II, forward flexion and abduction were statistically improved at the final follow up than in group I(p<0.05). Conclusions: It appears that arthroscopic repair is satisfactory procedure in patients with large to massive cuff tears. Combined procedure, acromioplasty, doesn't affect on postoperative functional outcome of shoulder.

• 사상체질의학회지
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• 제25권4호
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• pp.442-453
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• 2013

Objectives This case study was about a Taeeumin patient with advanced Parkinson's disease diagnosed as Dry-heat symptomatic pattern. In this study, we reported significant improvement of motor and non-motor symptoms of this patient after Sasang constitutional medicine treatment. Methods The patient was diagnosed with Taeeumin Dry-heat symptomatic pattern and treated with Taeeumin's constitutional medications and acupuncture. The primary outcome measure for this study is Unified Parkinson Disease Rating Scale(UPDRS) to assess the overall function of patient. Secondary outcome assessments include Global Assessment Scale(GAS), change of patient's sleep, stool and urine. Results and Conclusions The patient treated with Taeeumin's constitutional medications and acupuncture had reduction in UPDRS (specifically Part II, Part III and Part IV) and GAS of motor symptoms. Furthermore, patient's sleep, stool and urine were reported to be normal after treatment. In conclusion, this study shows that Sasang constitutional medicine can be effective treatment for Taeeumin patient with Advanced Parkinson's disease diagnosed as Dry-heat symptomatic pattern.

• 한국의료질향상학회지
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• 제28권2호
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• pp.50-60
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• 2022

Purpose: To examine the degree of recognition regarding the concept of patient safety, as perceived by the patient, using a focus group discussion. Methods: A focus group discussion was conducted with a patient group comprising seven patients. Results: When the participants heard the term "patient safety" they seemed to understand it to be related to the hospital environment or satisfaction with the overall hospitalization experience. The participants emphasized communication between the medical staff and the patients in relation to the explanation of treatments, as well as the provision of information regarding prevention, experience, and the treatment of incidents with patient safety. They agreed on the need for indicators reported by patients. However, they emphasized that additional items and a questionnaire method that considers the patients' point of view are needed. Conclusion: It is necessary to establish and implement various strategies that can raise the awareness of patient safety using patient safety indicators and increase participation in patient safety activities.

• 대한후두음성언어의학회지
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• 제19권2호
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• pp.89-95
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• 2008

주관적 음성평가는 음향분석기기를 이용한 객관적 음성 평가와 함께 음성분석에 유용하고 의미있는 평가방법이며 현재 알려진 검시법정 중에서 GRBAS 음성평가, VHI, patient self-perceptual voice rating이 가장 널리 사용되고 있고 인정받는 방법이다. 주관적 음성평가는 음성의 상태를 모두 대변할 수은 없으며 객관적인 음성평가에 대한 보완적인 의미를 가진다. 현재 개발되어 있는 주관적 음성평가 방법들이 유용한 평가도구이긴 하지만 나름대로의 문제점과 제한점을 가지고 있기 때문에 이에 대한 개선과 보완을 위한 지속적인 연구와 개발이 요구된다.