• Journal of Preventive Medicine and Public Health
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• v.34 no.3
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• pp.244-252
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• 2001

Objective : Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. Methods : The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHE III and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. Results : The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and $R^2$ than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. Conclusion : These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.3 no.2
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• pp.80-86
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• 2007

A critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multi-disciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical and dental services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical/dental staff after implementation of a critical pathway for dental treatment of disabled children under general anesthesia and its cost effectiveness. Ten patients who underwent dental treatment under general anesthesia were included in the CP group between August and December 2006. The pre-CP group included 20 patients who underwent the same procedure from February 2003. The satisfaction of parent of child patient and medical staff members were compared between two groups. The parents' satisfaction was significantly improved after the implementation of CP and medical/dental staff members were highly satisfied with the usefulness of the critical pathway. In conclusion, the critical pathway for the dental treatment of disabled treatment under general anesthesia can highly improve the satisfaction of parents and medical/ dental staff members.

• Health Policy and Management
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• v.23 no.2
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• pp.145-151
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• 2013

Background: The objective of this study was to explore patient family's evaluation of emergency department (ED) service satisfaction and to compare these with ED staff perception of patient family's evaluation. Methods: Based on two surveys of the National Emergency Medical Center: the 2008 National Survey for Recognition and Satisfaction towards Emergency Medical Services and the 2008 Opinion Survey of Emergency Medical Service Providers, satisfaction gaps among physicians, nurses, and patient family were evaluated by Kruskal-Wallis tests and Wilcoxon-Mann-Whitney tests. Furthermore, the factors associated with satisfaction of emergency medical service were identified by ordinal logistic regression models. Results: There were statistically significant gaps among physicians, nurses, and patient family in overall satisfaction with ED visit, length of stay in ED, enough explanation, physicians/nurses kindness, and ED facilities. Age and income in the patient family model, the number of beds in hospital, job satisfaction and year of service in the physicians model, and the number of beds in hospital, job satisfaction and the number of patients per duty hour in the nurses model were statistically significant factors associated with evaluation/ perception of ED service satisfaction. Conclusion: Patient satisfaction is an important indicator of the quality of care and service delivery in the ED. To improve and understand satisfaction in ED service, a dyadic view of the evaluation of service quality and satisfaction-that is, from the perspectives of both the patient and the emergency medical service providers-should be concerned.

• Journal of Hospice and Palliative Care
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• v.25 no.2
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• pp.76-84
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• 2022

Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

• International Journal of Advanced Culture Technology
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• v.9 no.1
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• pp.16-21
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• 2021

As the average age of national veterans has increased from 69 years old(2011) to 71 years old(since 2015) over the past five years, the overall medical service cost of veterans has increased by about 20%. The main cause of this phenomenon is 'ultra-aging', which accounts for 67% of veterans, while the proportion of health insurance patients aged 70 or older is 9%. Therefore, it is judged that the analysis of the trend of use of medical services at veterans hospitals in each region that is in charge of severe medical services of national veterans can serve as an opportunity to seek countermeasures for the severe medical system of national veterans. First of all, based on the details of major medical expenses (hospitalization, outpatient, pharmaceutical expenses) by region for the last 10 years(2010-2019), data significance was performed through a chi-square test, and the Central Veterans Hospital and Non-Central Veterans Hospital using EXCEL. 'Expected frequency' was calculated by year. By applying the CHITEST(observation frequency, expected frequency) function again, the p-value(p<0.05) was calculated, and the profit bias of each region's veterans hospital could be determined. The specific research method is for the last 10 years(2010-2019) for state-sponsored patients_outpatient treatment income, state-sponsored patients_hospitalization income, exempt patients_outpatients at the Central Veterans Hospital, Busan Veterans Hospital, Gwangju Veterans Hospital, Daegu Veterans Hospital, and Daejeon Veterans Hospital. A one-way analysis of variance was conducted to verify the significance of the difference between group averages on the status of 5 medical revenues of veterans hospitals in each of the 5 regions, including medical treatment income, reduced patients_hospitalization income, and reduced patients_medicine expenses. It was found to be significant(p<0.05) at all levels, including region and type. Finally, the bias in the profit structure of regional veterans hospitals was the highest in 2017(p=0.0004) and the lowest in 2013(p=0.0349). In addition, in the profit structure of the Veterans Hospital, the year in which the'regional' variable worked the most was 2019, and the year with the least affected was 2010. The order of the former is Jungang(=31,674,713), Busan(=12,314,614), Gwangju(=11,957,038), Daegu(=10,168,015), and Daejeon(=6,991,034), and the order of the latter is Jungang(=57,868,791), and Busan(=19,183,194). Gwangju(=17,904,712), Daegu(=15,656,034), and Daejeon(=14,377,395). In conclusion, the profit bias of veterans hospitals repeatedly raced the lowest(p=0.01986) and highest(p=0.03499) for the past five years(2010-2014) year by year, with the 'regional' variable being the most in the veterans hospital's profit structure It was identified as a major influence factor. On the other hand, for the last 5 years (2015-2019), the influence factors of the'regional' variable every year were in 2015(p=0.02015), 2016(p=0.01741), 2017(p=0.00045), and 2018(p=0.00394). in 2019(p=0.00227), a significant difference was confirmed at a very low level.

• Journal of Convergence for Information Technology
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• v.10 no.5
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• pp.36-41
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• 2020

This study is a descriptive study to investigate the presenteeism of nursing in long-term care hospital and general hospital. Data collection was conducted from October 01, 2019 to December 30, 2019. 74 nursing in long-term care hospital and 75 nursing in general hospital in this study. The collected data were analyzed using SPSS Win 21.0 program. Long-term care hospital nurses perceived higher health problems, job loss and perceiver productivity than general hospital nurses. This shows that there is no difference in work intensity according to the classification of patients in long-term care hospitals and general hospital nurses. In order to improve the quality of nursing care services in long-term care hospitals, it is necessary to manage the organizational aspects of long-term care hospital nurses' presenteeism.

• Journal of Preventive Medicine and Public Health
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• v.32 no.3
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• pp.289-296
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• 1999

Objectives: This study describes the risk factors affecting the unexpected readmission of 261 patients who were discharged from a university hospital in Seoul. Methods: This case-control study reviewed medical records of inpatients who had been discharged from a hospital between 1 August 1995 and 31 October 1995 after the treatment for general diseases. The cases were 68 patients who were readmitted unexpectedly within 28 days of discharge from an index stay, and the controls were 193 Patients who were discharged without readmission during the study period. Results: Logistic regression analysis results were as follows; Patients who had no operation during their hospital stay were more likely to be readmitted unexpectedly than patients who had operation. Patients who had 1 or 2 parts of their body being involved in treatment were more likely to be readmitted unexpectedly than patients who hand more than 3 parts of their body being involved in treatment. Patients who had complications after surgery were more likely to be readmitted unexpectedly than patients who had no complications. Insufficient discharge planning caused unexpected readmissions. Conclusions: Discharge planning education should be extended to health care providers. And the assessment of discharge planning should be evaluated. Readmission is often necessary for the treatment of related problems of originating from initial hospitalization, which causes cost problems. Unexpected readmission is preventable and the models for readmission can serve as a valuable clinical tool for high risk patients.

• Journal of the Korean Society for Industrial and Applied Mathematics
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• v.2 no.1
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• pp.131-139
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• 1998

With the rapid development of communication technology and widespread uses of internet service, utilization of internet-based medical information systems which transmitts moving pictures of medical objects is becoming a common practice. The internet-based medical information service prvovides richer information than conventional services such as touch-tone telephone, personal computers e-mails, or pagers, because "a picture is worth a thousand words". However, the systems passively transmits moving pictures of the medical objects to the users, and thus the system cannot intelligently adjust itself to provide better service. As the tradeoff exists between transmission speed and quality of the image, there is a need that moving pictures be analyzed to adjust the trnasmission speed and image quality. When very little difference between consecutive images are detected, the system can automatically increase the size of the image files, thus enhancing the quality of image. In contrast, the system should increase the number of images to send more pictorial information by sacrificing the quality of each individual image, when a significant difference is detected. In this paper an adaptive filtering technique is introduced which adjusts the quality of image and transmission speed according to a clinical situation in hospital.

• Journal of Digital Convergence
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• v.19 no.2
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• pp.307-314
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• 2021

This study was to analyze the satisfaction and intention to recommend a hospital for spinal and joint patients. Using a structured questionnaire at a spinal and joint hospital in Seoul in 2019, and the relationship between demographic and social characteristics and patient satisfaction, factors influencing hospital satisfaction, and recommendation intention were analyzed. In outpatients, hospital satisfaction was higher in neatness and cleanliness of staff, kindness and facility environment comfort, and hospital satisfaction was low in questions related to waiting time. In inpatients, women's satisfaction was higher in the nursing and hospital environment areas. The correlation analysis between the satisfaction and the willing to recommend, there was a positive correlation. In the sub-analysis, hospital satisfaction was higher in the group that responded with respect and courtesy, listening, satisfaction of the nurse, hospital cleanliness and safety. This study is can be used to improve the quality of hospital care services in related hospitals.

• Korean Journal of Occupational Health Nursing
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• v.31 no.2
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• pp.86-94
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• 2022

Purpose: This study aimed to determine the effects of grit, nursing work environment, and job esteem on the intent to stay among military hospital nurses. Methods: This study employed a descriptive cross-sectional design. Data were collected from February 7 to 18, 2022 from 232 nurses working at four military hospitals under the Armed Forces Medical Command. The analysis was conducted using the SPSS/WIN 26.0 program, and descriptive statistics, t-test, ANOVA, Pearson coefficient correlations, and multiple regression analysis were performed. Results: Factors affecting the intent to stay included job esteem (β=.44, p<.001), total clinical experience of more than 10 years (β=.24, p=.001), and nursing work environment (β=.17, p=.009). Conclusion: The results can be used to ensure personnel quality at military medical institutions and can contribute to improving patient safety and medical services. Further, nursing managers need to formulate and implement strategies to foster a positive nursing work environment.