• 한국의료질향상학회지
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• 제11권1호
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• pp.46-60
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• 2004

Background : Recently, we have experienced various changes in the healthcare environment. Healthcare organizations are facing a financial crisis due to more competitive relationships among themselves as well with low health insurance fees. The purposes of the current study were: (1) to develop a data warehouse-based system for evaluating and monitoring the case management activities, and (2) to measure and analyze its effects. Methods : In order to collect the data for the study, the database on discharged patients was utilized at a university hospital located in Seoul from June 1, 2002 through December 31, 2002. Initially, a data warehouse was built for the case management system. The case management activities were analyzed using structured methodology to establish the case management system. Results : The findings of this study were as follows: (1) A case management system was developed to make it possible to monitor of healthcare quality and resource utilization. The Case management System included monitoring functions regarding utilization reviews, critical pathways, and clinical indicators. (2) Utilizing the case management system, unplanned readmissions were documented among total discharged patients during two months from November 1, 2002 through December 31, 2002. The unplanned readmission rate was 2.3%(276 patients) in total of 11,960 discharged patients. Among them 81 patients(0.7% of total discharges, 29.3% of unplanned readmission) were readmitted to the same physician in charge under the same diagnosis. No significant differences were found in the demographic variables such as gender and age among the patients. (3) After implementing the case management system, 2.9% of average length of stay reduced. Applying cost-benefit analysis, the 2.9% reduction of length of stay represents net profit of ${\backslash}$ 279,592,000 in the year of 2004. In addition, applying value acceleration analysis, cumulative net benefit of ${\backslash}$ 1,481,000,000 was expected by the year of 2007. Also we were able to expect ${\backslash}$ 247,800,000 of cumulative benefit for the prospective 5 years in value linkage analysis. It represents average ${\backslash}$ 787,700,000 of pure net benefit a year. Conclusion : The value of present study would be not only implementing the knowledge management system into the existing case management activities, but also evaluating its effects and estimating its financial benefits. This study suggested that the case management system would be a supportive tool for monitoring and improving the quality of healthcare, and a cost-effective tool for increment of healthcare organization's financial benefit.

• 의학교육논단
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• 제16권3호
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• pp.119-125
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• 2014

Much of the behavior of doctors reflects the influences from the social, cultural, historical, and economic environment of the time. Therefore, it is very important for future doctors to understand the practice environment in an ever changing world. Traditionally, doctors' competence has been based on the doctor-patient relationship. However, the social practice of medicine in the contemporary era asks future doctors to have social competencies, which often are defined as non-clinical competencies. As a global project, the World Federation for Medical Education has urged every country to define the future role of doctors to encompass global roles based on the duty toward and value of clinical as well as non-clinical competencies. In the past four years, Korean medical professional societies have coordinated to set forth the global role of Korean doctors. Five domains of clinical competence, professionalism, social accountability, communication and collaboration, and education and research have been chosen. The current version of the "global role of Korean doctors" can be used not only for the common objectives of medical education, but also for translating into the competencies of doctors that can be achieved through life-long learning. If we all want to improve medical education in order to produce more qualified and competent doctors as the public desires, then it may be the most urgent task to produce doctors who are equipped with social competencies to persuade, negotiate, and engage in constructive dialogues with society for better health care for a better society.

• 한국결정성장학회지
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• 제27권4호
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• pp.196-205
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• 2017

오늘날 의료분야의 서비스 디자인은 유 무형의 서비스 요소를 통합적으로 가시화하고 혁신적 해결책을 도출, 고객이 해당 서비스를 더 중요한 가치로 느낄 수 있도록 지원하는 실용적 서비스 연구개발로 발전하고 있는 상황이다. 개인의 소득수준이 향상되면서 의료복지와 웰빙에 대한 관심이 날로 높아지고 있어, 의료분야의 초점도 과거의 질병 질환에 대한 치료의 개념에서 예방 의료로 구심점이 이동하고 있다. 이런 추세에 맞추어 최근 의료복지에 유비쿼터스 개념을 접목하여 건강진단 및 건강관리의 시간과 공간 제약을 대폭 줄인 홈헬스케어 시스템의 연구개발이 활발히 진행되고 있고 헬스케어3.0 시대에 따른 사용자 중심의 의료 서비스와 사용자 니즈를 기반으로 한 제품 및 의료 환경 개선 요구가 증대하고 있어 그에 따라 사용자 중심 니즈와 요구가 반영된 현장 의료진단 제품 개발이 필요하다. 본 연구는 현장 의료진단 제품 중 하나인 '무선 X-ray 디텍터'를 연구 개발함에 있어 현장진단 제품에 적합한 소재와 외형을 적용하여 사용자의 요구가 충분히 반영된 제품을 개발 연구하는 것을 목표로 두고 있다.

• 임상간호연구
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• 제17권1호
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• pp.101-112
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• 2011

Purpose: The purpose of this study is to develop a detailed clinical model for recording initial nursing assessment items, and to test the applicability of the model to facilitate semantic interoperability for sharing and exchanging nursing information. Methods: First, the researchers extracted items by analyzing initial nursing assessment records. Second, defining characteristics were identified by analyzing nursing records and reviewing the literature. Third, value sets for defining characteristics were identified and types and cardinalities of defining characteristics were defined based on the value sets. Finally, the detailed clinical model was tested through evaluation by experts and comparison with the initial nursing assessment in a clinical setting. Results: Sixty-one detailed clinical models were developed with 178 defining characteristics and value sets. The experts evaluation and comparison with the initial nursing assessment in a clinical setting showed that the detailed clinical model developed in this study was valid. Conclusion: Use of this detailed clinical model can ensure that the Electronic Health Record contains meaningful and valid information and supports semantic interoperability of nursing information. This use will promote quality in the nursing records and eventually quality of nursing care.

• 한국안광학회지
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• 제6권2호
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• pp.161-164
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• 2001

건안은 콘택트렌즈를 착용하는 대부분의 환자에게서 쉽게 나타날 수 있으며 방치해 두면 누액의 안정성이 줄어들고 누액의 찌꺼기, 점액이 점점 증가하면서 각막 얼룩이 형성되어 눈에 충혈, 건조감 등을 동반할 수 있다. 본 연구에서는 51명의 성인 남녀를 대상으로 건성안을 판단하기 위해 Schirmer test, TBUT, 순목 횟수 등을 조사하였다. 건성안 검사 방법 중 순목 횟수는 1분에 평균 19회였고 Schirmer test의 평균은 5분에 25mm이였으며, TBUT는 평균 7.1초로 나타났다. 이런 결과로 TBUT 검사치가 낮으면 순목 횟수가 증가하는 것으로 나타났다.

• 대한지역사회영양학회지
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• 제20권3호
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• pp.165-177
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• 2015

Objectives: Based on individual and environmental characteristics of low-income children, we developed a nutrition education program for school-aged children from low-income families according to effective use in social welfare centers. Methods: We conducted in-depth group interviews to assess program needs in 28 participants, 10 low-income school-aged children and 9 of their care givers, 9 social workers and 9 care-givers. Theoretical backgrounds of our program were heath belief model and social cognitive theory considering motivation, action and environment characteristics. Results: Based on the findings of this qualitative study, we developed major program themes and contents. Five selected key themes were 'balanced diet', 'processed food', 'food hygiene and safety', 'Korean healthy traditional diet', and 'family cooking' to induce changes in dietary behaviors. Main findings of in-depth group interviews included 'child's active participation', 'simple and easy to understand messages', and 'environmental constraints' such as a lack of child care at home, limited budget of social welfare centers, and less qualified educators for nutrition and health. Each lesson was constructed as a 1-hour program particularly emphasizing activity-based programs, including cooking and teamwork exercises. Program contents in each session consisted of activities that could induce outcome and value expectations, self-efficacy, perceived benefits, and barriers and cues to actions regarding diet behavior. Conclusions: We developed a nutrition education programthat is rarely available for low-income children in Korea, considering theoretical bases. Further studies are needed to validate our program.

• 한국임상약학회지
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• 제25권4호
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• pp.273-279
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• 2015

Objective: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. Method: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were subclassified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. Results: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). Conclusion: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제11권9호
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• pp.4461-4475
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• 2017

Recently, introduction of the hospital information system has remarkably improved the efficiency of health care services within hospitals. Due to improvement of the hospital information system, the issue of integration of medical information has emerged, and attempts to achieve it have been made. However, as a preceding step for integration of medical information, the problem of searching the same patient should be solved first, and studies on patient identification algorithm are required. As a typical case, similarity can be calculated through MPI (Master Patient Index) module, by comparing various fields such as patient's basic information and treatment information, etc. but it has many problems including the language system not suitable to Korean, estimation of an optimal weight by field, etc. This paper proposes a method searching the same patient using MRI information besides patient's field information as a supplementary method to increase the accuracy of matching algorithm such as MPI, etc. Unlike existing methods only using image information, upon identifying a patient, a highest weight was given to physical information of medical image and set as an unchangeable unique value, and as a result a high accuracy was detected. We aim to use the similarity measurement result as secondary measures in identifying a patient in the future.

• Tuberculosis and Respiratory Diseases
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• 제86권2호
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• pp.133-141
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• 2023

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Conclusion: Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.

• 대한간호학회지
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• 제20권3호
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• pp.430-458
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• 1990

Care is a central concept of nursing. Nursing would not exist without caring. Care and quality of life are closely related. Human behavior is a manifestation of culture. We can say that caring and nursing care are expression of culture. The nurse must understand the relationship of culture with care for ensure quality nursing care. But knowledge of cultural factors in nursing is not well developed. Time and in - depth study are needed to find meaningful relationships between culture and care. Nurses recognized the importance of culturally appropriate nursing There are two care systems in culturally based nursing. The folk care system and the professional nursing care system. The folk care system existed long before the professional nursing care system was introduced into this culture. If the discrepancy between these two care systems is great, the client may receive inappropriate nursing care. Culture and subcaltures are diverse and dynamic in nature. Nurses need to know the caring behaviors, patterns, and their meaning in their own culture. In Korea we have taken some first step to study cultural nursing phenomena. It is not our intent necessarily to return to the past and develop a nationalistic of nursing, but to identify the core of traditional caring and relate that to professional nursing care. Our Assumptions are as follows : 1) Care is essential for human growth, well being and survial. 2) 7here are diverse and universal forma, expressions, patterns, and processes of human care that exist transcul - turally. 3) The behaviors and functions of caring differ according to the social structure of each culture. 4) Cultures have folk and professional care values, beliefs, and practices. To promote the quality of nursing care we must understand the folk care value, beliefs, and practices. We undertook this study to understand caring in our traditional culture. The Goals of this study were as follows : 1) To identify patterns in caring behavior, 2) To identify the structural components of caring, and 3) To understand the meaning and some principles of caring. We faised several questions in this study. Who is the care-giver? Who is the care-receipient? Was the woman the major care -giver at any time? What are the patterns in caring behavior? What art the priciples underlying the caring process? We used an interdisciplinary team approach, composed of representatives from nursing and anthropology, to contribute in -depth understanding of caring through a socicaltural perspeetive. A Field study was conducted in Ro-Bong, a small agricultural kinship village. The subjects were nine women and one man aged be or more years of age. Data were collected from january 15 to 21, 1990 through opem-ended in-depth interviews and observations. The interview focused on caring behaviors sorrounding birth, aging, death and child rearing. We analysed these data for meaning, pattern and priciples of caring. In this report we describe caring behaviors surrounding childbirth. The care-givers were primarily mothers- in -low, other women in the family older than the mother - to- be, older neighbor woman, husbands, and mothers of the mother-to- be. The care receivers were the mother-to-be the baby, and the immediate family as a component of kinship. Emerging caring behavior included praying, helping proscribing, giving moral advice(Deug - Dam), showing concern, instructing, protecting, making preparations, showing consideration, touching, trusting, encouraging, giving emotional comfort, being with, worrying about, being patient, preventing problems, showing by an example, looking after bringing up, taking care of postnatal health, streng thening the health condition, entering into another's feelings(empathizing), and sharing food, joy and sorrow The emerging caring component were affection, touching, nurtuing, teaching, praying, comforting, encouraging, sharing. empathizing, self - discipline, protecting, preparing, helping and compassion. Emerging principles of. caring were solidarity, heir- archzeal relationships, sex - role distinction. Caring during birth expresses the valve of life and reflects the valued traditional beliefs that human birth is given by god and a unique unifying family event reaching back to include the ancestors and foreward to later generations. In addition, We found positive and rational foundations for traditionl caring behaviors surrounding birth, these should not be stigmatized as inational or superstitious. The nurse appropriately adopts the rational and positive nature of traditional caring behaviors to promote the quality of nursing care.