• 한국의료질향상학회지
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• 제7권2호
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• pp.190-202
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• 2000

Background : The objectives of this study were to examine patients' satisfaction with the DRG based payment method and its association with their awareness of the method, to examine patient reported changes in doctors' caring attitude, level of their out-of-pocket payments, providers' acceptance of patients' request for additional services after the program, and to examine changes in service utilization recorded in medical records. Method : One hundred-four patients who had cesarean sections before and after the demonstration program at two hospitals located in Seoul participated in the study. Patients were surveyed before discharges when their charges were finalized. Their medical records were reviewed as well to collect data for service utilization during hospital stays. The association between patients' satisfaction with the payment method and their awareness of the method was analyzed by ${\chi}^2$-test, and the significance of changes in providers' acceptance of patients' request for additional services and service utilization after the program were examined by ${\chi}^2$-test and t-test, respectively. Results : A large proportion of patients did not know of the DRG based payment method at the time of survey and a significantly larger proportion of patients who came to the hospitals with the knowledge satisfied with the method. About the same proportion of patients reported improvement and deterioration in doctors' caring attitude compare to the previous hospitalizations and a similar result was found concerning out-of-pocket payments. Providers' acceptance of patients' request for medication, PCA and painless delivery decreased significantly after the program whereas the acceptance for additional hospital days and laboratory and radiology tests did not. Length of stay, the numbers of days on antibiotics and antianemic medication, and the number of blood tests decreased significantly after the program, however, decreases in the rate of antianemic medication and the number of urine analyses were not statistically significant. Re-operation, in-hospital death, and complications were not observed before and after the program. Conclusion : The study findings indicated a need for better patient education and publicity about the newly introduced payment method to improve their satisfaction with the system. Other study findings concerning service utilization and quality of care indicators were consistent with the government funded evaluation studies.

• 한국병원경영학회지
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• 제8권3호
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• pp.161-177
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• 2003

The purpose of this study is to find out the present conditions of the facilities in terms of their quality and quantity and to suggest a better way to improve the system. The main results of this study can be summarized as follows ; 1. A few subjects knew there were how many kind of facilities in the hospital. 2. Convenience facilities should be available to the patient and their aids whenever they want to use. 3. There were statistically significant difference between the recognition and utilization on convenience facilities of subjects. 4. Some managers of administration considered that the recognition on convenience facilities of subjects be increased.

• 대한간호학회지
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• 제36권4호
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• pp.652-661
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• 2006

Purpose. The purposes of this study were to apply data mining tool to nursing specific knowledge discovery process and to identify the utilization of data mining skill for clinical decision making. Methods. Data mining based on rough set model was conducted on a large clinical data set containing NMDS elements. Randomized 1000 patient data were selected from year 1998 database which had at least one of the five most frequently used nursing diagnoses. Patient characteristics and care service characteristics including nursing diagnoses, interventions and outcomes were analyzed to derive the meaningful decision rules. Results. Number of comorbidity, marital status, nursing diagnosis related to risk for infection and nursing intervention related to infection protection, and discharge status were the predictors that could determine the length of stay. Four variables (age, impaired skin integrity, pain, and discharge status) were identified as valuable predictors for nursing outcome, relived pain. Five variables (age, pain, potential for infection, marital status, and primary disease) were identified as important predictors for mortality. Conclusions. This study demonstrated the utilization of data mining method through a large data set with stan dardized language format to identify the contribution of nursing care to patient's health.

• 대한간호학회지
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• 제35권3호
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• pp.535-545
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• 2005

Purpose: This paper reports a study exploring factors related to patient satisfaction and dissatisfaction with inpatient care. Method: A cross-sectional study design was used, employing data from the National Health and Nutrition Survey conducted in 2001. Socio-demographic factors, utilization, self-rated health status, and disease characteristics were assessed by employing univariate comparisons and multivariate logistic regression analyses. Result: Out of 37,769 respondents, 1,043 aged 20 years and over had been admitted to a hospital or clinic at least once during the past year. About a quarter of the respondents were discharged from tertiary hospitals and $21\%$ from clinics. The majority of patients ($58\%$) were satisfied with inpatient care received, whereas $11\%$ were dissatisfied. Greater satisfaction was found in patients aged 45-64 years and those having formal education, discharge from tertiary hospitals, national health insurance as a payer, medical expenses not being burdensome, good self-rated health status, and neoplasm. Living in non-metropolitan urban areas, shorter length of stay, and musculoskeletal diseases were associated with greater dissatisfaction. Conclusion: Different factors were related to patient satisfaction and dissatisfaction with care. Those factors need to be taken into account when evaluating and comparing satisfaction levels between health care institutions.

• 근관절건강학회지
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• 제24권2호
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• pp.89-100
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• 2017

Purpose: The aim of this study was to examine the utilization of and satisfaction with the smart bedside station (SBS) system among users in a hospital. Methods: A cross-sectional descriptive design was used. The participants were 190 patients, 186 family caregivers, and 154 nurses in a hospital. Results: Around 78.1% of patients or family caregivers used the SBS system at least once during their hospital stay. The commonly used items on the SBS system menu were "lab findings", "hospital cost", "today's medication", and the "alarm message". Satisfaction with the SBS system of patients and family caregivers were significantly higher than those of nurses (F=39.88, p<.001). Conclusion: A patient-centered SBS system was a useful system that could increase patient satisfaction and comfort. More specific and technical service contents reflecting the current healthcare system should be added.

• 한국의료질향상학회지
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• 제12권2호
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• pp.75-83
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• 2006

Background : Utilization review has been adopted as a vehicle for cost and utilization control of health care services. Its role was further stressed and expanded through the establishment of Health Insurance Review Agency in 2001. This article is to introduce concept, activities, and effect of utilization review based on the experiences of U.S. and to suggest important characteristics for ideal utilization review activities at the national level in Korea. Method : Twenty-five articles related with utilization review were reviewed after being selected through web site search through Med Line and Richis. Result : Utilization review was introduced mainly for health care expenditure control either by insurer, provider or the third parties under the pressure of increasing health care cost. It's activities can be categorized to prospective, concurrent and retrospective review according to the time of service provision. Based on most of studies, utilization review has been effective in controling rising health care cost and utilization. However it's effectiveness assumes a reimbursement structure of managed care like capitation payment. More worse, it is still unknown it's effectiveness on quality of care. Conclusion : Utilization review should be employed to increase the cost effectiveness of medical care by optimizing quality and patient's outcomes while also attempting to reduce the use of resources. So, it should consider outcomes before expenditures, check for both under and over-use, and construct an structure in which consumption is reduced equitably. Aggressive adoption of utilization review in Korean health care setting with fee-for-service reimbursement structure might not be a cost-effective approach before adoption of prospective payment system such as D.R.G. and capitation.

• 한국임상약학회지
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• 제31권2호
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• pp.153-159
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• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.

• 한국의료질향상학회지
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• 제9권1호
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• pp.66-73
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• 2002

The current health care system demands provisions for patient care in perspectives of a cost-effectiveness and patient satisfaction. Critical pathway implementation facilitates optimal sequencing and intervention timing of patient care, and makes medical team and patients participate in a treatment actively. In this study, a critical pathway was developed and implemented to patients with osmidrosis who undertake operation. Sixty patients were included in the study. The critical pathway was implemented for care of 26 patients while the traditional care was implemented for 34 patients. In the critical pathway implemented group, time needed for charting and unessential working was reduced. Mean time amount of time for patient nursing was increased. The critical pathway implementation is an effective method to utilize time of medical team. Also it increases the satisfaction index of patients and medical team simultaneously.

• 대한물리치료과학회지
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• 제3권2호
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• pp.1021-1036
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• 1996

The purpose of this study are ( i ) to examine operating situation of physical therapy department and job satisfaction of physical therapists in health centers, (ii) to analyze utilization patterns and patient satisfaction of physical therapy services among health center visitors, and finally, (iii) to suggest policy implications in facilitating improvement on physical therapy services of health centers. The materials are collected from 105 physical therapists among nationwide health centers and 203 patients of 5 health centers in Pusan, Korea. The survey is conducted from February 13 to March 30, 1996 with a structured self - administered questionnaire. Major results of the study are as follows. First, the result of regression analysis between job satisfaction and affecting factors identify following variables as the significant determinants; self-development(+), job itself(+), and co-worker support (+). Second, the current operating situation of physical therapy department shows such problem as; i )shortage and unstable job security of physical therapists, ii )absence of rehabilitation specialist, iii )lack of understanding on physical therapy of co-workers, iv)shortage of physical therapy equipment and facility, v)burdensome task of physical therapists, and vi) inappropriate purchase process of equipment. Third, patient satisfaction for physical therapy services are revealed relatively high. And the result of regression analysis between patient satisfaction and affecting factors identify following variables as the significant determinants; credibility of physical therapist(+), satisfaction for waiting time(+), cleanliness(+). Fourth, the patients appeal about physical therapy services such problem as; i) shortage of physical therapists, physical therapy equipment, and facility, ii) inconvenient administrative procedure for utilization physical therapy services. Fifth and last, recommendations for the improvement of physical therapy services of health centers are as follows; i )recruiting more physical therapists, ii )regular employment of physical therapists instead of daily use employment, iii )re-arrangement of facility for patient's convenience, iv )establishing reasonable purchasing system of equipment for physical therapy, v) reforming administrative procedure for patient focused care.

• Journal of Preventive Medicine and Public Health
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• 제24권3호
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• pp.400-413
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• 1991

The purpose of this paper is to identify factors affecting the optimum mix of required inputs and other relevant factors which account for the variation in physician's productivity in general hospitals, and to find out their implications for the efficient health planning and management. An extended version of Cobb-Douglas production function and cross sectional data of one day patient census from all general hospitals in Korea in 1988 were used in the analysis. Main results of the analysis and their implications could be summarized as follows : (1) The production function for physician's inpatient service shows the evidence of economies of scale, but the production function for physician's outpatient and adjusted-patient service, which combines both out- and in-patient service, shows that of dis-economies of scale. (2) The physician's role for production for all service is smaller than auxiliary personnel's, which imply that more intensive utilization of nurses, nursing aides and other auxiliary personnel is desirable for improving general hospital productivity (3) In case of physician's inpatient and adjusted-patient service, nurses' role is greater than nursing aides'. Therefore, more extensive utilization of nurses is recommended for the efficient operation of general hospitals. (4) The factor of hospital beds plays the leading role among required inputs in the production for physician's in- and adjusted-patient service. (5) The physician's productivity of general hospitals in rural area is lower than that in urban area. And the productivity of teaching hospitals is lower than that of the other hospitals. Further analysis was made in physician production function based upon the size of hospitals, namely those hospitals below 250 beds and those above. Explained variances by the factor of hospital beds was significantly increased in the case of those hospitals above 250. A more detailed and thorough investigation is needed for verifying factors influencing physician's productivity in general hospitals in Korea.