• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 산업경영시스템학회지
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• 제32권4호
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• pp.17-24
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• 2009

The purpose of this research is to find the reasons of overcrowding in the emergency department of an hospital, then to shorten the total stay time of patients. The fact that main causes of the overcrowding exist in the process of the emergency department was discovered by analysis of the data. In order to improve these process, simulation model was developed by ARENA 7.0. Staff's service time, staff's organization, process ratio, and patient's waiting time were estimated in the simulation model in consideration of the decision of the patient's course of action. Several scenarios such as the simplification of the process, the setup of dedicated pathology lab, and mixed method were suggested and evaluated. Total stay time of the patients would be reduced up to 28.45%.

• 보건의료산업학회지
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• 제5권1호
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• pp.31-44
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• 2011

The objectives of this study were first to inspect the background information of an incentive pay system in hospitals, which provide specialized services for the public, the current status of hospitals with the system, as well as effects produced by introducing it, and then to come up with measures to invigorate the system. According to the findings of a survey, a total of 123 out of 150 hospitals responded that they applied the system to their HR management, some fully or some partially, which accounts for 82.0 percent. This study suggested that the following strategies to invigorate the incentive pay system: having a clear objective when adopting the system; concerted performance targets; practical yet worth challenging business objectives; transparent information disclosure; and establishing a confidence-building system between labor and management. Mutual trust between labor and capital should be a key factor for the successful implementation of the incentive pay system.

• 대한영양사협회학술지
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• 제8권4호
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• pp.387-397
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• 2002

Foodservice information systems management practices were assessed in hospital foodservice operations. A total of 46 dietetic departments were responded for the study and their practices of foodservice information systems were analyzed. The respondents were questioned about general characteristics of respondents as well as hospital foodservices implementation status of information systems. Statistical data analysis was completed using the SPSS package program for descriptive analysis, factor analysis, t-test and ANOVA test. 43.2% of total respondents gained informations by benchmarking of other hospital foodservice operations, but 7.8% gained through career education. They expected the enhanced efficiency of their tasks through implementing information systems. Based on factor analysis, information systems were divided into 6 management areas such as database management, meal management, nutrition management, purchasing management, production management and foodservice management. The average implementing scores were : database management 3.77, meal management 3.26, nutrition management 3.52, purchasing management 3.26, production management 2.73 and foodservice management 3.70 (score 1 indicates very poor and score 5 is very good). Among database management areas, standard recipe database and food item specifications database build-up scores(3.91) were relatively very high, but meal assessment and foodservice management reporting scores(2.43) were very low. The results suggest that it is necessary to build up automated foodservice management reporting system for the improvement of efficiency and productivity of operational tasks.

• 간호행정학회지
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• 제11권4호
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• pp.401-414
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• 2005

Purpose: This study was to evaluate the utilization of health care service and to provide supportive data for health care policy making in one urban area in Korea. Method: This study tested the significance of public health service using the database of an university hospital and public health center from Feb. 2000 to Dec. 2004. Data were analyzed by multidimensional analysis and data mining technique and produced the information on the classification of utilization characteristics by main disease and the total cost of use and disease association with the users of the public health center. Results: The Results were as follows: 1) Top 10 diseases in the area accounted for 22.4% of total frequency for the most recent 5 years in university hospital, while 59.0% in public health center. 2) There were significant correlations between university hospital and public health center user's insurance type and place of residence: It showed higher use of public health center for free service beneficiaries residing in Seoul than residents in nearby or local area. The medical insurance types for hospital users were more various than those for public health center users. 3) The use of hospital for patients of hypertension, diabetes mellitus and hyperlipidemia was tended to concentrate in mostly autumn and winter since August 2000, while the cost of using public health center for those patients has been steadily reduced since July 2000. 4) As a result of cluster analysis, there were classified into three homogeneous groups according to the total cost of using public health service, age, and the frequency of use. 5) The association analysis on patients with chronic disease in public health center produced a detailed information on accompanying diseases related to the incidence rate of disease of high frequency due to aging, information on drug abuse and immune disease. Conclusion: The health care policy for local community should be evaluated continuously. And the policy to build an integrated data warehousing by public health indicator system and to enhance the faithfulness of data is required.

• 농촌의학ㆍ지역보건
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• 제14권1호
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• pp.16-29
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• 1989

The general objective of this study is to grasp the treatment expenses of common diseases by character of medical care institutions. The specific objective is to find out the treatment expenses for selected common diseases by type of medical care institutions and also by level of symptom. A record review method was employed to obtain required information for the analysis of expenses. A total of 40,000 cases treated by 85 medical care institutions were selected by the study team during the period 22 June to 14 July 1988. The 85 medical care institutions were sampled by stratified proportionate random sampling method. The major findings obtained from the information collected by the study team are as follows ; 1) Treatment expenses were composed of physical examination, medication, injection anesthesia, rehabilitation surgical intervention, lab test, X-ray and diagnosis. The highest expenses was for medication, accounted for 36.7% of the total: 13.9%, injection; Lab, tests respectively: 10.5%, physical examination : 8.6% surgical intervention; 7.9% admission : 6.3%, X-ray and diagnosis: 1.5%, rehabilitation. 2) Treatment expenses per case of common diseases were quite different from not only type of medical care institutions, such as university hospital, general hospital, hospital and clinic, but also from level of symptom. 3) Treatment expenses per case for the aged were higher than that of the young. The treatment cases for over 60 years of age accounted for 19.4% of the total, however the proportion of treatment expenses accounted for 23.8% of the total. 4) Duration of treatment and visits for same diseases varied from type of medical cara institutions. Based on these study findings, the following further research should be conducted: (1) Establishment of health care delivery system. (2) Feasibility of the development of health care programme for the aged. (3) Strengthening for primary health care approach.

• 대한한의학방제학회지
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• 제25권2호
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• pp.135-143
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• 2017

Objectives : This trial aimed to determine if Wasong (Orostachys japonicus) extract can enhance immune system and is safe enough to be approved as a health functional food. Methods : Total 62 people, aged 45 and older, will be recruited to participate in a randomized, double-blind, placebo-controlled clinical trial. This study will compare Wasong extract and placebo. Wasong group will take 1g of Wasong extract, once a day, for 8 weeks. Placebo group will take 1g of crystalline cellulose as placebo, once a day, for 8 weeks. Outcomes will be measured at the baseline, the end of 4th week, and 8th week. Primary outcomes are the ratio of NK cells/total lymphocytes and the ratio of T-helper cells/T-suppressor cells. Secondary outcomes are total white blood cell count, the ratio of neutrophils, lymphocytes, and monocytes in total leukocytes, the ratio of total T cells, T-helper cells, T-suppressor cells, and B cells to lymphocytes, the amount of blood IgM, IgG, IgA, and cytomegalovirus (CMV) IgG, and blood metabolite target &global analysis. Results : This trial was approved by institutional review board of Pusan National University Korean Medicine Hospital (registry number: 2016006), and registered in Clinical Research information Service, one of WHO International Clinical Trials Registry Platform (registry number: PRE20161006-002). Recruitment opened in February 2017 and is supposed to be completed by August 2017. The result is expected to be published by June 2018. Conclusion : This trial will provide clinical information to determine the efficacy and safety of Wasong in enhancing immune system of middle-aged and older people.

• 한국화재소방학회논문지
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• 제24권1호
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• pp.64-71
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• 2010

이 연구를 위해 2009년 1월1일부터 2009년 2월 8일 까지 일개 종합병원에 119구급대로 내원한 모든 환자의 구급활동일지 255부를 조사하였다. 구급활동일지의 전체 기재율 62.1%, 가장 높은 항목은 환자 인수자에 대한 기록으로 100.0%, 가장 낮은 항목은 의사지도에 관한 항목으로 0.4%로 나타나 기대치에 미치지 못한 것으로 조사되었다. 효율적인 응급의료 정보전달매체로서의 119구급활동일지의 기재율을 높이기 위해서는 전문 인력의 확충과 의료진의 적극적인 관심 및 피드백, 구급활동일지의 항목 배열의 규칙성, 기록의 중요성에 대한 지속적인 교육이 필요할 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.259-263
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• 2015

Background: In the field of cancer, the ICD-10 coding convention is based on the site of a neoplasm in the body and usually ignores the morphology, thus the same code may be assigned to tumors of different morphologic types in an organ. Nowadays, all general (provincial) and center hospitals in Thailand are equipped with the hospital information system (HIS) database. Objective: This study aimed to find the characteristics and magnitude of agreement represented by the positive predictive value (PPV) of provisional cancer diagnoses in the HIS database in Pattani Hospital in Thailand in comparison with the final cancer diagnosis of the ICD-10 codes generated from a well established cancer registry in Songklanagarind Hospital, the medical school hospital of Prince of Songkla University. Materials and Methods: Data on cancer patients residing in Pattani province who visited Pattani Hospital from January 2007 to May 2011 were obtained from the HIS database. The ICD-10 codes of the HIS computer database of Pattani Hospital were compared against the ICD-10 codes of the same person recorded in the hospital-based cancer registry of Songklanagarind Hospital. The degree of agreement or positive predictive value (PPV) was calculated for each sex and for both sexes combined. Results: A total of 313 cases (15.9%) could be matched in the two databases. Some 222 cases, 109 males and 113 females, fulfilled the criteria of referral from Pattani to Songklanagarind Hospitals. Of 109 male cancer cases, 76 had the same ICD-10 codes in both hospitals, thus, the PPV was 69.7% (95%CI: 60.2-78.2%). Agreement in 76 out of 113 females gave a PPV of 67.3% (95%CI: 57.8-75.8%). The two percentages were found non-significant with Fisher's exact p-value of 0.773. The PPV for combined cases of both sexes was 68.5% (95%CI: 61.9-74.5%). Conclusions: Changes in final diagnosis in the referral system are common, thus the summary statistics of a hospital without full investigation facilities must be used with care, as the statistics are biased towards simple diseases able to be investigated by available facilities. A systematic feedback of patient information from a tertiary to a referring hospital should be considered to increase the accuracy of statistics and to improve the comprehensive care of cancer patients.

• 대한의용생체공학회:의공학회지
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• 제15권3호
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• pp.333-340
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• 1994

임상병리과 정보관리시스템은 임상병리과에서 검사결과를 관리하는데 필수적인 요소이다. 저자들은 일반혈액 검사실의 전반적인 업무와 백혈구 감별검사에 대해 개인용 컴퓨터인 IBM 486 PC의 호환기종과 SCO foxbase 데이터베이스를 사용하여 일반 혈액검사실 정보관리시스템을 개발하였다. 사용한 컴퓨터는 주 기억용량이 16MB이고 하드디스크가 210MB, 9개의 RS-232C를 가진 IBM 호환 486 개인용 컴퓨터이고, 출력은 24핀 도트 프린터를 사용하였다. 이 시스템은 두대의 자동혈구분석기와 연결하여 검사결과를 자동으로 입력받고 병원의 주 컴퓨터와 API 기능을 사용하여 검사정보 및 검사결과를 전달할 수 있도록 하였다. 프로그램의 개발은 SCO foxbase에 내장된 Xbase 언어를 사용하였으며, 병원 주 전산기와 자동혈구분석기와의 연결은 C언어를 사용하였다. 이 시스템은 저렴한 비용으로 일반 혈액 검사실의 전산화를 구축할 수 있어 향후에 추진될 임상병리과 전체의 정보관리시스템을 구축하는데 일부분이 되고 다른 병원에서 임상병리과 전산화를 구축할 때에 모델이 될 것으로 사료된다.