• 한국산학기술학회논문지
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• 제14권7호
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• pp.3390-3399
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• 2013

본 연구는 2009년 한 해 동안 건강보험심사평가원의 요양급여 전체 청구자료를 통계적으로 표본 추출 한 환자표본자료를 이용하여 의료기관 종류 별 욕창 발생현황과 이중 요양병원 환자의 욕창 발생에 영향을 주는 요인을 규명하기 위해 시도되었다. 전체 의료기관 입원환자의 3.2%(n=25,339)에서 욕창이 발생하였다. 의료기관 종별로는 요양병원 입원환자의 8.2%(n=11,895)에서 욕창이 발생하여 종합병원(2.7%, n=8,052), 일반병원(1.7%, n=5,059) 보다 상대적으로 높은 비율을 보였다. 요양병원 입원환자(n=144,523)의 욕창발생에 영향을 주는 요인을 분석한 결과 의학적 진단 중 요실금을 가진 환자 군이 가지지 않은 군에 비해 욕창 발생이 2.46배 유의하게 높게 나타났다(Odds ratio(OR)=2.462, 95% confidence interval(CI)=2.038-2.974). 더하여, 고혈압질환(OR=1.456, CI=1.400-1.515), 말초혈관 질환(OR=1.357, CI=1.200-1.534)군 순으로 욕창 발생에 영향을 미쳤다. 진단 수(OR=1.193, CI=1.187-1.199)와 나이(OR=1.011, CI=1.009-1.012) 및 100침상 당 의사 수(OR=1.063, CI=1.035-1.091)가 증가할수록, 의료기관의 전체 침상수(OR=.889, CI =.869-.909)가 적을수록 욕창발생은 유의하게 높은 것으로 나타났다.

• 간호행정학회지
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• 제5권1호
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• pp.39-61
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• 1999

This thesis is attempted to ananlyze the relationship between the empowerment in the nursing work environment, the job-related personal charateristics and the nursing job performance according to the individual variables of hospital, age, experience, education, position, practice area, number of nurses in the practice area, number of beds. 'Opportunity', 'support', 'informantion', ,resource' are used as structural factors of empowerment suggested by Kanter's theory of structural power in organization, and 'self-efficacy', 'burnout', 'motivation', 'organizational commitment' are defined as four job-related personal charateristics. The ultimate goal of this study is to find out the work effectiveness of the structural factors of empowerment and the job-related personal charateristics. The basic data consists of two sets of questionaires. One is the self-reporting quetionaires for the staff nurses and the other one is questionaires answered by nursing managers. The latter is designed to objectively measure the job performance. A total of 523 items of data are collected randomly from nursing population of 7 different university teaching hospitals in Seoul metropolitan area. The data were analyzed mainly using descriptive statistics, correlation analysis. ANOVA, and Duncan test according to the various purposes of the analysis. The main results of this study are as follows : 1. The mean score of four structural empowerment factors are ranked by support, opportunity, resource, and information. And among the four job-related personal charateristics self-efficacy factor shows especially high score. 2. The results of the correlation analysis between the empowerment factors and the job-related personal charateristics are as follow: 1) The 'opportunity' factor is correlated with organizational commitment' (r=.37), 'motivation' (r=.36), 'burnout' (r=-.17), and (r=.09). 2) The 'information' factor is correlated with 'organizational commitment' (r=.44), 'motivation' (r=.39), 'burnout' (r=-.24), and 'self-efficacy' (r=.17), 3) The 'support' factor is correlated with 'organizational commitment' (r=.47). 'motivation' (r=.42), 'burnout' (r=-.24), and 'self-efficacy (r=.20), 4) The 'resource' factor is correlated with 'burnout' (r=-.28), 'organizational commitment' (r=.26), and 'motivation' (r=.26), 3. The job performance are correlated with 'motivation' (r=.24) , 'self-efficacy' (r=.16), 'burnout' (r=-.16) and 'organizational commitment' (r=.12), 4. The job performance are correlated with' support' (r=.17), 'information' (r=.12) 'opportunity' (r=.10), 5. The result of ANOVA for analysing the relationship between the structural factors of empowerment and individual variables shows that the level of empowerment are significantly different by the variables such as 'hospital' and 'the number of beds in the practice area'. In summary, there were several findings in this study, First, the structural factors of empowerment defined as opportunity, support, information are significantly correalted with the job-related personal charateristics that are supposed to relate to the level of job performance. These results support the basic hypothesis suggested by Kanter's theory and implies that for improving the job performance of nurses, hospital has to have more concern about the structural factors of nursing environment.

• 대한기계학회논문집
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• 제16권2호
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• pp.325-335
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• 1992

In this work, direct contact 4-stage fluidized bed heat exchanger is experimentally studied to develop a new type of heat exchanger which recovers the energy contained in the high temperature waste gas exhausted from the industrial furnaces. A sand is used as a heat transfer medium in this experiment. To determine the optimum operating condition, 11 different perforated plates which have a different free area ratio with different hole diameter are used in the experiment. From the room temperature experiment, the pressure drop which is caused by fluidized bed formation is observed. The high temperature experiment is carried out to seek the optimum operating condition of high heat efficiency at low heat exchanger operation cost. The results of experiment are as following. The pressure drop in the high temperature condition can be predicted from the results of the room temperature experiment. And Nusselt number becomes smaller due to the increased interference between sand particles as Reynolds number increases when the dilute phase fluidized beds are formed in nigh temperature condition. But heat transfer amount through the total sand surface area become larger due to the large resident amount of sand. Considering the heat transfer amount and the heat exchanger operation cost, perforated plates which have either a 30% or 35% of free area ratio with 15mm of hole diameter are best fitted for our goal of this work. The values of .phi. which is a dimensionless number representing the absorption heat amount per unit sand rate are in the range from 0.4 to 0.5, when Reynolds number of waste gas ranges from 25-30 with these perforated plates.

• 한국병원경영학회지
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• 제22권4호
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• pp.61-73
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• 2017

In the Health Insurance System of South Korea, patients must pay high out-of-pocket expenditures for the medical service by uninsured medical benefits. So, the government implemented a policy to relieve the burdens of patients by lowering the uninsured selective-medical treatment costs in August, 2014. This study investigate the policy effects of selective-medical treatment(SMT) on the medical service's usage and cost with severe lung cancer patients. The patients are selected in one university hospital(with 1,000 beds), between one year before and after policy implementation. The study find that the usages of outpatient(visit number) and inpatient (length of stay) are not changed by statistically significant. It means that there are no effect in medical service behavior between before and after the policy. In medical expenses, outpatients decreased in their out-of-pocket payments by policy, but total medical expenses and insured medical benefits is not changed, because of the increased another medical insurance fees. For inpatient, although the SMT costs are statistically significant decrease, the total out-of-pocket payments and insured medical expenses are not changed statistically significant. Those findings show that the political decision making about SMT made lowing the selective-medical expenses, but total insured cost and patient's out-of pocket money were not changed by the new increased medical insurance fees. It means that the policy about SMT gave no particular benefit for patients. So, it need another benefit plans to lower the medical expenses of severe lung cancer patients with a high medical service usage and much total medical expense.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8749-8752
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• 2014

Purpose: This study aimed to determine the patterns of follow-up visits for cervix cancer in a national cancer center in Mexico. Materials and Methods: The National Cancer Institute of Mexico is cancer center with 119 beds that mostly cares for an underserved and socially disadvantaged population. The medical records of cases of cervical cancer that had at least one year of clinical follow-up after being in complete response at the end of primary treatment were analyzed. We recorded the numbers of total and yearly follow-up visits and these were compared with the number of follow-up visits recommended by the National Comprehensive Cancer Network 2013, version 2 for cervical cancer. Results: Between March and June 2007, the medical records of 96 consecutive patients were reviewed. Twenty (21%) of these met inclusion criteria and were selected. In the first year the median number of visits was 11 (4-20). In the ensuing years, $2^{nd}$, $3^{rd}$, $4^{th}$ and $5^{th}$, the number of analyzed patients remaining in follow-up decreased to 17, 14, 13 and 9 respectively. There were 462 follow-up visits to primary treating services (Gynecology Oncology, Radiation Oncology and Medical Oncology) as compared to 220 suggested by the NCCN guidelines ($X^2$ test p<0.0001). There were 150 additional visits to other services. Conclusions: Our results suggest that in our institution there is an overuse of oncological services by cervical cancer patients once treatment is completed.

• 보건행정학회지
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• 제26권3호
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• pp.233-241
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• 2016

Background: This study purposed to analyze and understand how spatial accessibility of patients influenced the number of outpatient visits for the internal medicine of a hospital. Methods: A hospital with 100 beds in Seoul, South Korea provided data from 2013 January 1 to 2013 June 30. Euclidean distance and road ares were used to represent the spatial accessibility. Patient level data and dong level data were collected and used in spatial analysis. Dong level data was converted into grid level ($500{\times}500m$) for the multivariate analysis. Hot-spot analysis and generalized linear model were applied to the data collected. Results: Hot-spots of outpatient visits were found around the study hospital, and cold-spots were not found. Number of outpatient visits was varied by the distance between patient resident and hospitals, and about 80% of total outpatient visits was occurred in within the 5 km from study hospital, and 50% was occurred in within 1.6 km. Spatial accessibility had significant influences on the outpatient visits. Conclusion: Findings provide evidences that spatial accessibility had influences on the patients' behaviors in utilizing the outpatient care of internal medicine in a hospital. Results can provide useful information to health policy makers as well as hospital managers for their decision making.

• 한국안전학회지
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• 제33권4호
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• pp.105-110
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• 2018

Korea has entered to 'aged society', which the elderly people over 65 years old is over 14% of total population. This paper aims to analyze the traffic accident by aging level. In pursuing the above, this paper focuses on modeling the traffic accident severity based on three aging levels. The main results are as follows. First, the ratio of fatal and serious injured persons (FSI) is judged to increase according to increasing aging level. Second, the null hypothesis that there is no difference in FSI among three aging levels (aging, aged, and super-aged) is rejected. Four accident severity generalized linear models which are all statistically significant have been developed. Third, the common variables are analyzed to be median age, the number of hospital beds per persons, and turn signal usage ratio. Fourth, the differentiated traffic safety policies fitted to aging levels are required. The enforcement of traffic law violation and safety enhancement of motorcycle in the region of 'aging society', improvement of traffic facilities in the region of 'aged society', and expansion of transportation facilities in the region of 'super-aged society' are evaluated to be indispensable.

• Journal of Preventive Medicine and Public Health
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• 제54권5호
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• pp.352-359
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• 2021

Objectives: The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality. Methods: Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis. Results: The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile. Conclusions: Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.

• 보건행정학회지
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• 제6권1호
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• pp.191-210
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• 1996

This study purported to acquire information necessary to improve the operational efficiency of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospital which affect the major financial indices. 201 hospitals which were subject to standardization audit by the Korean Hospital Association were investigated and 80 hospitals were finally chosen for this study. Their financial and managerial data during the period between January 1991 and December 1991 were collected. Considering financial indices in this study were the ration of net income to total asset, income growth rate, and quick ration. The results of study are summarized as followings. First. The ration of net income to total assets and quick ration were highly related to managerial characteristics of general hospitals. Therefore, the standardization of three financial indices should be needed to systematically check the operational efficiency of general hospitals. Second, the sample hospitals can be classified as four groups on the basis of their financial indices' level. 4 of those hospitals(5.0%) showed high level of performance in terms of three financial indices and 27 of them(33.7%) showed that they are highly related to only two financial indices. 34 hospitals(42.5%) showed they have high level of relationship with only one indices and 15 hospitals(18.8%) showed very weak performance level with three indices. In addition, there is no hospitals to show mid-range level of managerial performance in relation to all three financial indices. Third, there is no significant relationship between three financial indices and the managerial characteristics of hospitals such as the number of beds, type of operation, location of hospitals, and etc. However, in the case of hospitals which have high level of managerial performance, they have more specialists and medical support personnel in comparison to low performance hospitals. They also have high level of bed occupancy rate and average length of stay(ALOS). In conclusion, the study showed the standardization of 3 financial indices are necessary to systematically evaluate the managerial performance of general hospitals and provide more accurate operational information for each hospital. To do so, it is necessary to focus on management side of hospital such as the effective human resource management and quality enhancement of medical treatment.

• 보건행정학회지
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• 제19권2호
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• pp.71-84
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• 2009

Objectives : The purpose of this study is to analyze the proportion of admission via the emergency room(the rest is ER) in an emergency medical center and to examine the factors related to admission. Methods : This study used 2005 National Health Insurance claims data for admitted patients of 112 hospitals having emergency medical centers in Korea. The study sample had 2,335,610 patients. The data was classified into emergency admission and non-emergency admission. To investigate the factors affecting the type of admission, the following were included as independent variables: type of health assurance_(national health insurance beneficiaries or medical aid beneficiaries), demographic characteristics_ (sex, age), cause of admission_ (disease or injury), whether an operation was performed or not, DRG severity level, the number of beds, and the location of the hospital. Data were analyzed using the Chi-square test for the differences in emergency admission rates for each variables, and multiple logistic regression analysis was used for identifying the factors affecting admission type. Results : The proportion of admission via the ER accounted for 40.6% of the total admission among hospitals having emergency medical centers. The risk of admission via ER was relatively high for patients who were male, the aged, the injured, the surgical patients, the patients having more severe symptoms, and the patients admitted the hospitals located in metropolitan areas, and the patients admitted the hospitals having 300-699 beds. Medical aid patients were more likely admitted through the emergency room than health insurance patients after other variables ware adjusted. Conclusions and Discussion : We analyzed the proportion of admission via the ER for the total admission rate of hospitals having an emergency medical center in Korea. And we explored the factors related to admission via the ER. This proportion may be used as an indicator of the adequacy of medical utilization or low accessibility to hospitals of patients with low socioeconomic status.