• Quality Improvement in Health Care
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• v.27 no.2
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• pp.73-82
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• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

• Journal of Preventive Medicine and Public Health
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• v.33 no.4
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• pp.426-435
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• 2000

Objectives : To determine the relationships among quality, satisfaction, value and purchase intention in health care service. Methods : The data were gathered from out-patients who had used hospital services. They were asked to assess service quality, satisfaction, service value, and purchase intention. A total of 557 usable questionnaires were gathered. The data were analyzed using SAS version 6.12. The analysis methods employed in the study were confirmatory analysis and covariance structural analysis. Results : Service quality exhibited a significant and positive relationship with satisfaction, service value, and purchase intention. Furthermore, satisfaction had a significant and positive relationship with purchase intention. And finally, service value had a significant and positive relationship with both satisfaction and purchase intention. Based on these findings, it is evident that satisfaction was a mediator between service quality and purchase intention. Also service value played a mediating role between service quality and satisfaction. Conclusions : These results suggest that service quality is an antecedent of satisfaction and sonics value, and exerts a stronger influence on purchase intentions than satisfaction and service value do. Thus, managers may need to emphasize service quality in health care.

• Quality Improvement in Health Care
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• v.22 no.1
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• pp.29-37
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• 2016

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

• Women's Health Nursing
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• v.25 no.3
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• pp.299-314
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• 2019

Purpose: This study was to identify health behavior, health service use, and health related quality of life of adult women in one-person and multi-person households. Methods: It was used data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII-2017). Subjects were 2,522 women with age of 19 to 64 years in 2017. Complex sampling design and data analysis were performed using SPSS 20.1. Results: Women in one-person households had higher rates of alcohol drinking (${\chi}^2=13.77$, p=.003), smoking (${\chi}^2=16.07$, p=.001), unmet medical care (${\chi}^2=8.77$, p=.004) and non-practice of cancer screening (${\chi}^2=13.77$, p=.003) compared to women in multi-person households. Health-related quality of life was also lower for women in one-person households (t=-2.46, p=.015). Factors affecting health-related quality of life in one-person households were household income, job status, and unmet dental care, having 32.4% explanatory power. One-person household women with low incomes, no jobs, and unmet dental care showed low health-related quality of life. In comparison, factors affecting health-related quality of life of women in multi-person household women were age, education level, unmet medical care, and unmet dental care, having 10.4% explaining power. Women in multi-person households with age of 60-64, low education level, unmet medical care, and unmet dental care showed low health-related quality of life. Conclusion: Health promotion strategies should be developed based on unique understanding of social, economic, and health of adult women in one-person and multi-person households.

• Quality Improvement in Health Care
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• v.15 no.2
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• pp.31-39
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• 2009

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.112-129
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• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• Journal of Preventive Medicine and Public Health
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• v.25 no.1 s.37
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• pp.53-63
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• 1992

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows ; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on quality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.

• Journal of Korean Society for Quality Management
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• v.27 no.2
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• pp.1-19
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• 1999

It is truism to say that today's customers demand high quality products and services; nevertheless, nowhere is this more prevalent than in the medical industry. Korea's globalization has increased it's citizen's awareness of greater life expectancies and medical improvements in other regions of the globe. Therefore, it is universally essential that in order to be successful in the medical industry, vendors must meet the ever increasing demands of better educated customers. The purpose of this study was twofold: 1) The first objective was discover what health care services are in demand and the quality factors related to these services. 2) The second objective was to determine a strategy for improving health care service through quality function deployment(QFD). One hundred and ninety-five respondents were randomly selected and asked to fill out a questionnaire after having undergone treatment at a medical clinic, located in Daejon, South Korea. The questionnaire was designed to obtain information about both he clients' satisfaction with, and their sense of the value of the medical treatment they received. Penalty-reward analysis and QFD were used to interpret the survey results and to deploy the collective voices of the customers. The results of the penalty-reward analysis illustrated that the 'communication' service quality factor was classified into an excitement factor that incurs no penalty if not achieved but adds value if the requirement is exceeded. As a result of the QFD analysis on the 'communication' service quality factor, eleven strategic alternatives were prioritized, and isolated a vital service quality characteristic. This characteristic can be implemented to bring value-added changes for the improvement of health care services.

• Health Policy and Management
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• v.3 no.1
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• pp.25-52
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• 1993

Variation in the utilization of medical services is a very important issue in cost containment and quality assurance of health care. Practice variation directly affects health care expenditure especially in fee-for-service system, which is the payment system of health insurance in Korea. In addition to cost issue it is generally accepted that variations in medical practice and the cost of inpatient care suggest the possibility of inappropriate quality of care. This study is to closely examine the patterne and degrees of variation in cost structure of inpatient care among types of hospital and individual hospitals in some tracer diseases, and also to inquire into the service items which contribute much to the variation of total medical care cost. Foru common diseases, i.e. Cesarean Section, appendectomy, cataract extraction and pediatric pneumonia, were selected as tracer diseases. In most tracer diseases there were statistically significant differences in total medical care cost among hospitals in same type of hospital as well as among types of hospital(p<0.01). When total medical care cost were subdivided into the types of service, cost of medication and diagnostic examination varied the most prominenly. When the cost of medication were subdivided again, cost of parenteral antibiotics showed the most prominent variation. Of total medical care cost, medication was most contributory to the variation of total medical care cost(58.1~82.3%), and cost of antibiotics was most contributory to the variation of medication cost(63.9~92.2%). The results of study implicated that reducing the variation of medication may plays a significant role in containing the cost of inpatient care. In order to sort out the factors affecting practice variations including drug prescription pattes further researches are required.

• Health Policy and Management
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• v.24 no.2
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• pp.153-163
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• 2014

Background: This study aims to explore the effects of quality of care, image, and role performance perceived by community residents on medical service satisfaction to public hospitals. Methods: The subjects of this study were selected in the community residents around 39 district public hospitals. The questionnaire were included 4 factors and 16 items. The data were collected utilizing call-interview by a survey company. Results: The community satisfaction was positively correlated with quality of care, image, and role performance of public hospitals (p<0.001). As the results of multiple logistic regression, the significant variables of community satisfaction were quality of care (odds ratio [OR], 1.353; 95% confidence interval [CI], 1.211 to 1.511), image (OR, 1.487; 95% CI, 1.280 to 1.727), role performance (OR, 1.240; 95% CI, 1.085 to 1.416) among subjects having use experience of public hospitals. The significant variables of community satisfaction were quality of care (OR, 1.240; 95% CI, 1.175 to 1.309), image (OR, 1.328; 95% CI, 1.232 to 1.432), age (OR, 3.051; 95% CI, 1.385 to 6.724), monthly incomes (OR, 0.420; 95% CI, 0.198 to 0.892) among subjects not-having use experience of public hospitals. Conclusion: Public hospitals have to effort to improve image and satisfaction of community through providing quality of care, and role performance. It is possible to support them by the central and local government.