• Korea Journal of Hospital Management
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• v.12 no.2
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• pp.1-24
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• 2007

The medical fee reimbursement denied by HIRA(Health Insurance Review Agency) amounted to about 1.2% of the total medical fee claim to HIRA for reimbursement. Most of the denials stem from the inappropriate prescriptions of medical staff violating the medical fee review standards issued by HIRA. Considering the significant impacts of the standards observance behavior on the hospitals' financial viability, we attempted to analyze the predisposition factors of medical staffs' review standards observance behavior. The TPB(Theory of Planned Behavior) was adopted as the theoretical framework of the analysis. Data were collected by administrating a survey on the concepts included in TPB model to the 187 medical staff of a tertiary care hospital. Of the 187 questionaries distributed, 150 were responded resulting 80.2% of response rate. The mean differences among the groups classified by age group, years of experience, medical specialty and gender were analysis using ANOVA. The relationships among the TPB concepts were analysed by applying the Structural Equations Modeling method. The TPB model consists of three exogenous concepts (attitude toward the behavior, subjective norm, and perceived behavioral control) and two endogenous concepts (intention and the behavior). The results of ANOVA indicated significant mean differences among the groups classified by the medical staff's age, years of experience, and medical specialty. The older and the more experienced had the higher mean of observance behavior score. The results of Structural Equations analysis showed that the subjective norm and perceived behavioral control had statistically significant influences on intention, but the influence of attitude to intention was not statistically significant. The influences of perceived behavioral control and intention on behavior were significant. Based on these results the theoretical and practical implications were discussed.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.86-109
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• 1995

Clinical trials of drugs on humans is the final and most important stage in evaluating the safety and efficacy of the drugs. Good Clinical Practice(GCP) standards were announced in 1987 to protect testees' rights as well as to ensure validity of the clinical trial results, but its implementation has been delayed until now. The purpose of this study is to evaluate the preparedness of the designated institutions to abide by GCP standards during clinical trials, and thereby to determine GCP implementability at the institutions. Survey on the status of clinical trials was conducted for the designated 83 clinical trial hospitals. Response rate was 95.2%. Donabedian's quality assessment model was applied as the basic framework for the study. And the relative - weights for the evaluation items were determined by expert's evaluation. Among the designated 83 hospitals, 39 conducted clinical trials to obtain drug manufacturing approval from 1990 to 1994. Only 19 institutions are found to be able to meet the requirements of KGCP. Structure variables - manpower, organization, and facility -, which are the basic elements for GCP, are evaluated as unsatisfied in many hospitals. Institutions which established IRB accounted for 41 or 51.9%, but those who have a protocol evaluation guideline, or Adverse Drug Reaction(ADR) reporting system were only 12 and 21 institutions, respectively. Also, the institutions providing educational programs on conducting clinical trials are few - 20. The study results indicates that the level of conducting KGCP is unsatisfactory. However, more institutions are expected to be able to meet the standards soon because GCP standards does not require so much regulation on facilities, but stress importance on research methodology and human right. At present as the institutions for clinical trials are primarily training hospitals with residency programs, such efforts as education will accelerate the implementability of GCP in Korea. Institutions must build the appropriate infrastructure and government must prepare to strongly enforce KGCP before it can successfully take place.

• Journal of Korean Academy of Nursing Administration
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• v.1 no.2
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• pp.338-348
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• 1995

We need to continuously evaluate for nursing quality and the outcome to reflect nursing, to repair and improve of nursing. The first problem for nursing quality improvement is development of evaluation tool for the quality of nursing care. We need a system for quality assurance evaluation that is, development and framework of evaluation tool for nursing care quality. The purpose of this study was attempted to develop an evaluation tool for the quality of nursing care in musculoskeletal disorder patients. The approach method of nursing quality for the development of the tool in this study was process evaluation framework. The study were devided dvelopment process and reliability, validity verification process. The subjects of development process of this tool are three nursing export groups, and the subject of reliability, validity verification process are 20 samples of two university hospital in seoul, who were within discharge 3 months after admission treatment in musculo-skeletal disorder. Data for this study was collected from March 10 to April 13, 1995. The development process of the tool were as follows : 1. Make preliminary list of the tool by focal group were constituted 12 clinical nurses. 2. Modify and add preliminary list by 4 nursing expert panel. 3. Calculate content validity of the tool by 25 nursing expert panel of judge. 4. Verify reliability and validity of the tool. 5. Finalize an evaluation tool for the quality of the nursing care in musculo-skeletal disorder. The results of this study were as follows : 1) Development an evaluation tool for the quality of nursing care in musculo-skeletal disorder. (1) The evalution tool of this study was developed 5 standards, 33 criterias and 133 indicators. (2) 5 standards were divided according to Nursing Process. from standard 1 to standard 5, involved criterias were each 6(18%), 3(9%), 3(9%), 15(46%), 6(18%). 2) Verify reliability and validity of the tool. (1) Score of adequate degree for content validity of 33 criterias and 133 indicators were every average 2.82. (2) Inter-rater reliabilities(consentaneity score) of the tool by pearson correlation coefficient between three raters were : r=.7506, r=.8934, r=.6695. and Inter-rater reliabilities by single-facet crossed design were : r=.7464. (3) The alpha coefficient relating to internal consistency was .8524 over all 30 items of 33 criterias of developed tool. (4) Score of the quality of nursing care following to generaal characteristics of this study subjects were stastically significant differences according to educational level (F=2.93, p=.029)and diagnosing classification (F=2.50, p=.042). Through this study, I'm sure that the developed tool for the quality of patient care in musculo-skeletal disorder will show the way of more improvement of the quality of nursing care and effective nursing interventions.

• Journal of the Korean Dietetic Association
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• v.4 no.2
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• pp.225-234
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• 1998

Nutrition during childhood is essential for growth and maintenance of health. Good food habits developed during the childhood will contribute both to the healthy growth and the prevention of the degenerative disease of later life. Both parents and the providers in child care centers play an important role for children's good eating behavior. Therefore all child care programs should achieve recommended standards for meeting children's nutritional and educational needs in a safe, sanitary, and supportive environment to promote the healthy growth and development of children. The purposes of this study were to evaluate the foodservice management practices and assess the needs for a Central Production Unit by contacting the child care center' providers. This approach was achieved using a variety of qualitative and quantitative information including the general foodservice management practices and the needs for a Central Production Unit. An indepth face-to-face interview with structured-questionnaires was undertaken at 32 representative child-care centers in Seoul. Statistical data analysis was done using the SAS program for descriptive analysis and ANOVA. The number of national/public and private sectors were 11 respectively, followed by 10 licensed home day-care centers. Total average number of children in child-care centers was 54.3 $\pm$48.5. The foodservice productivity index in child-care centers was 4.8 minutes per meal for public child care centers, 6.0 for private child-care centers, and 9.8 for home child care centers. Home child care centers were found to have the lowest productivity index which indicated inefficient foodservice practice. The important factors in group purchasing were menus(39.6%) or close distance(39.6%) > type of foodservice operation(32.8%) > total number of meals(19.9%) > food costs(16.2%) in order. Average score of the efficiency for central food production in child-care centers was 3.80 $\pm$0.84 out of 5.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.6 no.2
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• pp.222-248
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• 1996

This study was designed to survey misused expression in 37 KS (Korean Industrial standards) related to personal protective equipment. The results were as follows: 1. One hundred and twenty five misused expressions were found - 44 expressions were used illogically (35.2 %). 80 expressions were wrongly described (64.0 %) The types of illogically misused are: 10 illogical cases, 4 cases of a wrongly designated provision when cited, 12 cases of the lack of provisons for KS, 7 cases of a inappropriate uses of units, 8 cases of an overlapped sizes between standards. - The types of expressions wrongly described are: 30 cases of confusion in using an terms, 4 case of making an error when proofreading, and 29 cases of choosing words not appropriate to describe technical standard, 18 cases of unclear provisons due to missing phrases and terms, and 11 cases of provisons described differently from original intended purposes. 2. There is one case, where the same standard is categorized as two different names. There are three major causes of the misused expressions as seen from the following summary: - Imitated the developed countries' standards without filtering them by considering domestic law and ocher KS standards. - Tended to create each definition for each standard instead use of the basic standard. - Insufficiency of synthetic examination to the correlation between standards.

• The Korean Journal of Health Service Management
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• v.8 no.3
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• pp.49-61
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• 2014

Due to the rapid population's aging, the life span's expansion and social & cultural characteristics, the standards of age classes in senescence are changed. Thus, this study aimed to identify the influential factors on health care utilization in the elderly by age class, and targeted 2,937 adults in their ages over 55 years old from the Korea Health Panel's 2009 Yearly Integrated Data. This study investigated the target health care utilization in the elderly in relation with the gender, the education level, the health-care insurance type, the income, the current job state, the chronic disease. In order to analyze the influential factors on health care utilization in the elderly, the multiple linear regression analysis was conducted to the data. As the results from this study, Concerning the influential factors on the health care utilization, the income, the subjective health state, the chronic disease and the regularly meals for the young-old influenced. Concerning the influential factors on the health care utilization, the subjective health state for the old. Concerning the influential factors on the health care utilization, the subjective health state, the income for the older-old influenced. Concerning the influential factors on the health care utilization, the education level, the spouse, the economic activity and the drinking oldest-old influenced. Therefore, it will need to provide systemic health-care & medical services, to develop health-care & medical programs and the health-care & medical policies and to execute them according to the age classes in senescence.

• Quality Improvement in Health Care
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• v.22 no.1
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• pp.59-69
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• 2016

Objectives: Healthcare Accreditation Program in Korea started in 2011. The aim of this study is to contribute to the development of the Healthcare Accreditation Program in Korea by comparing the perception of the Healthcare Accreditation Program for the accredited hospitals and the surveyors. Methods: This study was performed targeting 77 accredited acute care hospitals and 245 surveyors who have surveyed acute care hospitals from 2010 to February 2014. They responded to our questionnaire via a survey website, and we analyzed the results. Results: We found that the hospitals rated the professionalism of surveyors more positively than surveyors. While average score of the hospitals was higher for 'The understanding of the accreditation standards and survey methods was correct' than that of the surveyors (p<0.01), average score of the surveyors was higher for 'Mediation and collaboration between surveyors were smooth' than that of the hospitals (p<0.05). And we found that the surveyors rated the Accreditation Program more positively than hospitals. While average score of the hospitals was higher for 'Surveyors have the professionalism' than that of the surveyors (p<0.05), average score of the surveyors was higher for 'It is easy to understand the accreditation standards and evaluation items' than that of the hospitals (p<0.01). Conclusion: In order to development of the accreditation program, it is necessary to strengthen the professionalism of surveyors and improve the acceptability of the accreditation program.

• Journal of Korean Academy of Nursing Administration
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• v.22 no.3
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• pp.209-219
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• 2016

Purpose: To analyze the proportion of medical institutions meeting the legal standard for nurse staffing. Methods: Data collected from 29,282 institutions between 1996 and 2013 were analyzed. Nurse staffing was measured as daily patient census per registered nurse (RN). The standard for general hospitals, hospitals, and clinics is 2.5 or less, and that for long-term care hospitals is 6.0 or less of the daily patient census per RN. Clinics may substitute nursing assistants for RNs by 50% or 100% depending on their daily inpatient census; long-term care hospitals may substitute nursing assistants for RNs by two thirds of the required number of RNs. Results: The proportion of general hospitals, hospitals, clinics, and long-term care hospitals meeting the standards was 63%, 19%, 63%, and 94%, respectively, in 2013. While general hospitals had an increase in the proportion during the 1996-2013 period, small changes were found in hospitals and clinics. In 2013, nurses were estimated to care for 16 (interquartile range: 12~24) patients per shift in general hospitals. Three quarters of clinics had no RNs in 2013. Conclusion: Many medical institutions did not meet the legally mandated minimum staffing level. The government must implement policy actions for all medical institutions to meet the legal standards.

• Quality Improvement in Health Care
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• v.25 no.2
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• pp.44-55
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• 2019

Purpose: To investigate whether changes in Medical Aid (MA) status are associated with unmet need and catastrophic health expenditure (CHE). Methods: Data from the 2010 to 2014 Korea Health Panel (KHP) were used. The impact of changes in annual MA status ('MA to MA,' 'MA to MA Exit,' 'MA Exit to MA,' and 'MA Exit to MA Exit') on unmet need (all-cause and financial) and CHE (10% and 40% of household capacity to pay) were examined using the generalized estimating equation (GEE) model. Analysis was conducted separately for MA type I and II individuals. Results: In 1,164 Medical Aid type I individuals, compared to the 'MA to MA' group, the 'MA to MA Exit' group had increased likelihoods of all-cause and financial unmet need. This group also showed higher likelihoods of CHE at the 10% standard. The 'MA Exit to MA Exit' group showed increased likelihoods at the 10% and 40% CHE standards. In 852 type II recipients, the 'MA to MA Exit' group had higher likelihoods of CHE at the 10% standard. Conclusions: Type 1 MA exit beneficiaries had higher likelihoods of all-cause and financial unmet need, along CHE at the 10% standard. Type I 'MA Exit to MA Exit' beneficiaries also showed higher likelihoods of CHE at the 10% and 40% standards. In type II recipients, MA exit beneficiaries had higher likelihoods of CHE at the 10% standard. The results infer the importance of monitoring MA exit beneficiaries as they may be vulnerable to unmet need and CHE.

• Journal of Korean Public Health Nursing
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• v.24 no.1
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• pp.5-18
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• 2010

Purpose: The purpose of this study is to understand nurses' perception of visiting nursing services of long-term care insurance. Method: The descriptive survey study involved 188 nurses selected by the convenient sampling of visiting nurses who participated in professional education sessions. Results: Of the 188 participants, 149 (79.3%) were aware of long-term care insurance. Awareness of aspects of long-term care services was 78.7% for facility service, 77.7% for ordinary visiting care service, 85.1% for visiting nursing service and 77.7% for visiting bathing service. Concerning visiting nursing service provision, the majority of the study subjects considered nurse-aid not to be the appropriate route for delivery of services including nasogastric tube exchange, tracheostomy tube management and stitch removal. Conclusion: Continuous evaluation and research on the standards and requirements of the nursing workforce is needed to secure and maintain the high quality of visiting nursing services. Exhaustive studies concerning task division and workforce separation according to nursing services type and level of difficulty should be done to develop the appropriate job description for visiting nursing service staff.