• 한국의료질향상학회지
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• 제1권2호
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• pp.44-59
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• 1994

의료소비자인 환자들은 바쁜 일상생활 때문에 야간외래진료를 원하고 있다. 이것은 환자의 편의 측면 및 서비스 개선 차원에서 병원에서는 긍정적인 검토를 해야 하나 현재의 수가 체계와 환자의 수요 및 추가 인건비를 포함한 비용면을 고려할 때 실행에는 어려운 문제점이 있다. 이에 본 저자는 환자의 요구와 병원의 경제적인 면을 모두 해결할 수 있는 교대제 근무에 의한 외래진료 제도를 개발해서 그 효과와 야간외래진료의 대안으로서의 가능성을 분석하기 위하여 본 연구를 하였다. 본 연구는 기초조사, 개입 및 효과분석으로 구성되다. 기초조사는 야간외래진료의 수요에 대한 기초조사, 병상, 의사, 직원 수에 대한 조사, 진료및 근무시간 조사, 94년 1월 시간별 환자수를 조사하고 개입(intervention)은 진료시간 변경, 시간대별 환자수를 고려한 각 부서별 근무시간 조정, 최소한 인원 증원이며 효과 분석은 시간대별 환자수, 각 부서별 시차제 근무 효과, 외래와 입원 환자수를 개입 연구 전후로 비교하고 7-8시, 18-20시의 환자수 분석, 교대제 근무에 의한 외래진료에 대해서 의사, 직원, 환자들의 의견을 설문 조사하였다. 교대제에 의한 외래진료의 진료시간은 오전반은 오전 7시에 출근하여 오후 3시까지 근무하고 오후반은 12시부터 20시까지 점심, 저녁 시간 없이 진료를 하는 제도이다. 실시 과는 내과, 일반외과, 정형외과, 산부인과이고 증원된 인원은 24명이고 진료지원 부서는 환자의 내원시간과 부서별 특성을 고려하여 탄력적으로 조정하였다. 이 제도 실시후 환자의 시간대별 분포는 비슷했으나 7-8시 18-20시의 환자 수가 약간 증가했다. 특히 야간 외래진료 시간대인 18-20시의 환자 수는 25-30명으로 1개과당 6-7명이었다. 환자수는 전년 대비 외래는 평균 13%, 입원은 10% 증가했다. 이 제도 실시에 대한 설문조사에서 의사는 100% 직원은 94.6% 환자는 86.4% 찬성했고 장점은 여유시간 활용, 진료시간 연장, 환자의 분산및 대기시간 단축, 응급환자 신속 처리 등이었으며 단점은 인력 부족으로 일이 힘들다, 전과 불실시로 인한 문제, 진료의 연속성, 점심 저녁 시간이 없다, 회진 시간이 불규칙하다 라고 하였다. 현재까지는 야간에 외래진료를 이용하는 환자가 많지 않기 때문에 초과근무수당 및 인력 투입하는 야간외래진료 보다는 교대제 근무에 의한 외래진료가 효율적인 것 같다. 이 제도의 실시는 환자의 실 외래 진료 이용 시간을 5시간 30분 증가시켰다. 이 제도의 효과를 높이기 위해서는 전과 실시가 필요하나 병원의 경제적인 여건 미비로 힘들다. 만약 정부에서 정책적으로 전과 실시때문에 발생한 손실에 대한 한시적인 보조가 있다면 이 제도의 조기 정착에 도움이 될 것이다.

• 핵의학기술
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• 제13권1호
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• pp.9-14
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• 2009

최근 영상 처리 기법의 발전으로 영상의 질은 저하시키지 않고 검사 소요시간을 단축시키는 방법들이 개발되고 있다. 특히 단층 촬영의 경우 영상 재구성 방법을 개선하여 영상의 질이 우수한 영상을 획득할 수 있게 되었다. Philips사의 PRECEDENCE 16 감마카메라를 이용해 보편적으로 시행하고 있는 분석법에 의한 FBP 방법과 반복법에 의한 Astonish, 3D OSEM 방법을 이용해 각각 영상을 재구성하여 정성적인 분석과 정량적인 분석을 통해 영상 획득시간을 다르게 한 영상간의 비교와, 동일한 시간으로 획득한 영상을 비교하여 영상의 질이 우수한 재구성 방법에 대해 연구 하였다. 정성적인 분석을 위해 blind test를 한 결과, 영상 획득시간에 따른 영상의 질은 거의 차이가 없는 것을 확인할 수 있었다. 또한 정량적인 분석을 통해서도 영상 획득시간에 따른 영상의 질은 통계적으로 유의한 차이가 없었다. 하지만 영상 획득시간이 동일한 영상을 재구성 방법에 따라 분석한 결과는 통계적으로 유의한 차이가 있음을 확인할 수 있었다. 영상의 질은 반복법을 이용하는 Astonish에 의해 재구성된 영상이 해상력이 좋고 임상적으로 진단적 정보를 제공하는데 우수한 영상으로 판단된다. 영상을 재구성하기 위한 소요시간이 길고 저장 공간의 부족 등으로 현재까지 많이 사용되지 않던 반복법에 의한 재구성 방법이 영상의 질은 향상시키고 검사시간은 단축 할 수 있는 방법이 될 수 있음을 확인하였다.

• 한국병원경영학회지
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• 제6권2호
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• pp.115-137
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• 2001

The purpose of this study is to find out the successful way of the hospital management focusing on the OCS. More than 40 educational hospitals have OCS. However, only five of them were chosen for the research. Questionnaires are collected from more than 750 persons working in five educational hospitals and some of them were interviewed. The major conclusions of the study can be summarized as follows: o The OCS has simplified the treatment procedure for outpatients, and the outpatients' waiting time has been shortened. o Higher rate of satisfaction was found among the personnel in general. o The number of patients who visited outpatients clinics has increased, so as the hospital profits: the personnel are rescheduled or sent to other departments the number of employees in hospitals have decreased. o The system has the positive effect on large hospitals with over 1000 beds, highly invested hospitals, well computerized hospitals and where the personnel are much interested in the system. o The managers' and the doctors' intention to utilize the OCS is the most important factor influencing the patients' convenience, the simplification of the work and the rate of the employees' satisfaction about their duties. The suggestions for more efficient hospital management through the OCS are as follows ; o The managers and the doctors are need to decide to make active use of the OCS. o The hospital can be run more effective under the clear management purpose. o The work in the hospital must be standardized based on patients' needs. o The OCS must be built and developed mainly for the users' utility. o The education of the personnel and the inspection of the program are necessary before the OCS is introduced. o The hardware should be thoroughly benchmarked before the purchase.

• 대한방사선기술학회지:방사선기술과학
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• 제44권2호
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• pp.133-140
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• 2021

This study aims to analyze the quality and satisfaction of healthcare perceived by patients using hospitals and to provide basic data necessary for expanding and settling Vietnamese healthcare services by analyzing the impact on recommendation intentions. The research method selected one hospital in Vietnam and collected data from patients using the hospital and used a total of 286 effective samples as data for hypothesis verification. The research model and hypothesis verification were analyzed with the statistical data from SPSS and AMOS. The findings show that, first, tangibility, accessibility, and reliability all have a positive effect on the quality of healthcare. Second, it has been shown that only accessibility among the quality of healthcare has a positive effect on recommendation intentions. Third, customer satisfaction has been shown to have a positive effect on recommendation intentions. Fourth, when looking at the mediating effect, reliability among the quality of healthcare was shown as a full-mediated effect, but accessibility was shown to have a partial mediating effect and tangibility to have no mediating effect. Contact management is important because customer satisfaction is highly regarded when customers feel positive emotions at the interface from the provision of convenience facilities that support medical services to the reduction of waiting time for patients, employees kindness, treatment, medication, and inspection. It is also confirmed that the demand for convenient and rapid use of hospitals is increasing in Vietnam. In addition, if customer satisfaction is increased through friendly medical staff's response, the intention of recommendation will be even greater.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.510-516
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• 2013

Background This paper discusses the treatment protocol for patients with frostbite. Methods We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. Results Our clinical series of patients (n=17) included 13 men and four women, whose mean age was $42.4{\pm}11.6$ years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of $12.7{\pm}3.3$ days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of $35{\pm}4.3$ days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. Conclusions With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.

• 근관절건강학회지
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• 제3권2호
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• pp.166-176
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• 1996

This is a study through survey with the purpose of analysing of treatment cost for arthritis. Treatment cost can be devided Into two characteristics, one is the direct cost and the other is the indirect cost. Direct cost contains fees of medical treatment Including cost of self treatment & purchsing price of herb durg. On the other hand indirect cost means the using money of tansportation, lodging charge & labor-losing-time cost. For the succession of medical treatment of chronic diseases patients have to control themselves to go shopping around for the cure remeadies. And also it is important that the cost for unefficient or probably hamful folk remeadies should be reduced in order to distribute appropriatively the limited financial resources. As the result of this study, the fees for self treatment & herb drug are two times as much as those of regural medical treatment. Within the direct cost, there are the mean cost of regural medical treatment 59,630 won/mon., self-treatment 42,790 won/mon., and herb drug 78,380won/mon. therefore total mean direct cost is 180,800won per month. Moreover patients intermittently pay the cost of prostheses If folk remedies, these are added to the direct cost as above mentioned. Attributes of folk remedies are various from cure & analgesics to nutrients and their virtues as medicine are not clear in view of scientific knowledge. But 56% of arthritis patients have ever been experienced folk remedies. the cost for these remedies has wide ranges from 40,000 won to 1,000,000won. Total mean indirect cost including the transfortation fee, lodging charge & labor-losing-time cost has the range from 82,825won/month to 106,150won/month. Among these cost, labor-losing-time cost has a mojority because the waiting times are too long for seeing a doctor. In conclusion those patients having arthritis have a large burden against the treatment cost for continuous care. Therefore health professional should make effort to guide the patient to determine themselves informed choice about the treatment process.

• 한국정보통신학회논문지
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• 제14권3호
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• pp.655-662
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• 2010

로터스 노츠 서버/클라이언트 시스템을 통하여 방사선종양학과에서 방사선치료를 받는 환자의 선상 정보, 모의 조사, 질병 정보 및 방사선치료와 관련된 모든 정보를 전산화하기 위한데이터 베이스를 구축하고 정보 입출력을 위한 사용자 인터페이스를 개발하였다. 방사선종양학과 내 전자차트의 개발을 통하여 그 동안 문서상에서 운영되던 진료 및 치료 업무를 전산화하고 과내의 업무를 유기적으로 연결함으로서 치료자가 치료 정보를 쉽게 얻고 분석하여 치료의 정확성, 환자대기 시간의 단축, 진료예약 및 치료업무의 편리성을 도모하고자 한다.

• 보건행정학회지
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• 제5권1호
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• pp.1-30
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• 1995

This study was conducted to investigate the distribution of private medical practitioners' income from the medical insurance and its determinants. Total amount of the medical service fee paid by the medical insurance to 1,268 private clinics(767 in Taegu and 510 in Kyungpook that had been in practice at least for one year) in 1993 was compared by the characteristics of practitioner, clinic, patient and population. The practitioners in 40-49 years of age and 6-10 years inpractice had the highest income. Total income of a clinic was increased with the number of physicians, employees and equipments. The largest income differentials were observed among obstetrics and gynecology clinics and the least differentials were among pediatrics clinics. The characteristics of practitioner, clinic and population accounted for 41.7% of the total variance of income. The important determinants of income were specialty of the clinic, age of the practitioner and number of the employee and equipments. The large income differentials among clinics imply a skewed distribution of patients and thus long waiting time, inefficient utilization of manpower and inadequate quality of care. Effective measures to reduce the income differentials need to be developed.

• 한국의료질향상학회지
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• 제15권2호
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• pp.65-71
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• 2009

문제: 환자가 수술장 내에서 수술을 기다리면서 느끼는 불안감을 최소화할 수 있도록 해야 하지만 수술실의 효율성 및 의료진 편의성 위주로 운영되고 있어 수술실 내 대기시간이 연장되고 있다. 목적: 수술장 내 대기시간을 단축시키기 위해 수술환자의 이동경로에 따른 지연요인과 문제점을 파악하고 개선하여 환자가 수술을 기다리면서 느끼는 불안감을 최소화하고자 한다. 의료기관: 부산시에 소재한 481병상의 종합병원 수술실 질 향상 활동: 수술환자의 대기시간 지연요인과 문제점을 파악하고 개선을 통해 질 향상을 도모하였다. 개선효과: 대기시간 수행율에서 수술장 도착까지의 수행율이 개선전 95%에서 개선후98%로, 수술방 입실까지의 수행율이 개선전 88%에서 개선후 94%로, 마취시작까지의 수행율이 개선전 93%에서 개선후 96%로 수행율이 높아졌다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권10호
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• pp.4637-4642
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• 2016

Purpose: To evaluate palliative care for patients with gynecologic cancer in Japan. Materials and Method: A questionnaire asking facility characteristics, systems to coordinate palliative care, current status of end-of-life care, provision of symptom relief, palliative radiation therapy and chemotherapy, and cases of death from gynecological cancer, was mailed to facilities treating gynecologic cancer. Results: A total of 115 facilities (29.3% of the total) responded to the questionnaire. Of these, 33.0 (29.0%) had a palliative care ward. End-of-life care was managed by obstetricians and gynecologists in 72.0% of the facilities. The site where end-of-life care was provided was most often a ward in the department where the respondent worked. The waiting period for transfer to a hospice was 2 weeks or more in 52% of facilities. Before the start of primary treatment, pain control was managed by obstetrians and gynecologists in 98.0% of facilities. Palliative radiation therapy or chemotherapy was administered at 93.9% and 92.0% of facilities, respectively. Of the 115 facilities, 34.0 (29.6%) reported cases of death from gynecological cancer. There were 1,134 cases of death. The median time between the last cycle of chemotherapy and death was 85 days for all gynecological cancers. The proportion of patients receiving chemotherapy in the last 30 and 14 days of life were 17.4% and 7.1%, respectively. Conclusions: This large-scale survey showed characteristics of palliative care given to patients with gynecologic cancer in Japan. Assessment of death cases showed that the median time between the last cycle of chemotherapy and death was relatively short.