• International journal of advanced smart convergence
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• 제10권2호
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• pp.145-150
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• 2021

Patients with Pressure injuries (PIs) may have pain and discomfort, which results in poorer patient outcomes and additional cost for treatment. This study was a part of larger research project that aimed at prediction modeling using a big data. The purpose of this study were to describe the characteristics of patients with PI in critical care; and to explore comorbidity and diagnostic and interventive procedures that have been done for patients in critical care. This is a secondary data analysis. Data were retrieved from a large clinical database, MIMIC-III Clinical database. The number of unique patients with PI was 2,286 in total. Approximately 60% were male and 68.4% were White. Among the patients, 9.9% were dead. In term of discharge disposition, 56.2% (33.9% Home, 22.3% Home Health Care) where as 32.3% were transferred to another institutions. The rest of them were hospice (0.8%), left against medical advice (0.7%), and others (0.2%). The top three most frequently co-existing kinds of diseases were Hypertension, not otherwise specified (NOS), congestive heart failure NOS, and Acute kidney failure NOS. The number of patients with PI who have one or more procedures was 2,169 (94.9%). The number of unique procedures was 981. The top three most frequent procedures were 'Venous catheterization, not elsewhere classified,' and 'Enteral infusion of concentrated nutritional substances.' Patient with a greater number of comorbid conditions were likely to have longer length of ICU stay (r=.452, p<.001). In addition, patient with a greater number of procedures that were performed during the admission were strongly tend to stay longer in hospital (r=.729, p<.001). Therefore, prospective studies focusing on comorbidity; and diagnostic and preventive procedures are needed in the prediction modeling of pressure injury development in ICU patients.

• 자원ㆍ환경경제연구
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• 제22권4호
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• pp.817-841
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• 2013

본 연구의 목적은 [2013 슬로푸드국제대회(아시오 구스토)] 개최의 경제적 타당성과 파급효과를 검증하는 데 있다. 이를 위하여 기존의 연구자료 및 통계자료를 활용하였으며, 국민여행실태조사와 대국민 설문조사를 통하여 수요추정을 하였다. 엑스포 개최 타당성을 검토하기 위하여 편익 비용 비율(Benefit Cost Ratio: BCR)과 순현재가치(Net Present Value: NPV)를 통해 재무적 및 경제적 타당성을 분석하였다. 또한, 엑스포 개최에 따른 경제적 파급효과를 추정하기 위하여 지역산업연관모형을 활용하여 전국 및 경기지역에 미치는 영향(효과)을 분석하였다. 재무적 타당성 분석 결과 BC ratio는 1.02~2.27로 수익성이 있는 것으로 나타났으며, 경제성 분석에서도 무료입장 10%적용시 시나리오 3과 4에서 BC ratio가 1.04~2.15로 나타나 수익성이 도출되었다. 한편, 엑스포 개최에 따른 남양주시를 포함한 경기도 지역경제의 파급효과는 생산유발효과가 373.6~738.7억 원, 부가가치유발효과가 166.2~327.4억 원, 고용유발효과는 1,971~2,009명으로 분석되었다. 따라서 "2013 슬로푸드국제대회"의 경제적 타당성은 양호한 것으로 나타났으며, 엑스포에 대한 지역주민의 공감대가 크며 남양주시 지역경제에 대한 경제적인 파급 효과도 긍정적인 것으로 나타났다.

• 한국임상약학회지
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• 제15권2호
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• pp.75-81
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• 2005

Community acquired pneumonia (CAP) remains a prevalent and potentially life threatening illness. American Thoracic Society and Infectious Disease Society America recommend combination therapies with ${\beta}-lactam$ plus a macrolide or a fluoroquinolone monotherapy for the empirical treatment of CAP. The aim of this study was to compare moxifloxacin monotherapy with cephalosporin plus azithromycin combination therapies. From January 2004 to March 2005, 18 patients in the moxifloxacin group(MG) and 21 patients in the cefuroxime or ceftriaxone plus azithromycin group(CAG) with CAP were retrospectively reviewed with regard to clinical, laboratory and microbiological data. Each patient was stratified into mild (risk class I-II), moderate (risk class III) and severe (risk class VI, V) group according to and PSI (Pneumonia Severity Index) score. Each group was compared for microbiological eradication, clinical assessment, the length of hospital stay. As results, Total 39 patients with CAP were reviewed. The appropriateness of admission was 83.3% in MC vs. 76.2% in CAC. The mean length of the hospital day was for 8.31 days vs. 7.39 days, days switching parenteral to oral antibiotics in 5.19 days vs. 5.28 days, clinical improvement in 2.43 days vs. 2.61 days in MG vs. CAC. Radiological improvement required 3.75 days vs 3.63 days in MG vs. CAG and bacteriological eradication rate at discharge was the same in the both groups. Mortality rate was 11.1% (2 of 18) vs 14.3% (3 of 21) in MG vs. CAG (p=0.77). Drug cost of the mean 5 hospital days requiring parenteral antibiotics was the most inexpensive in moxifloxacin group for the 147,045 won, and ceftriaxone 1g-azithromycin group for the 170,285 won, cefuroxime bid-azithromycin group for the 207,800 won, ceftriaxone 2g-azithromycin group far the 220,570 won, cefuroxime tid-azithromycin group for the 251,700 won. There was no significant statistical difference in clinical, bacterial, radiological cure and hospital days, and switch to oral days. In conclusion, that i.v. moxifloxacin monotherapy was as effective as azithromycin plus cefuroxime or ceftriaxone combination therapies fur the treatment of CAP. In drug cost analysis, moxifloxacin is less expensive than CAG.

• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.531-548
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• 1991

신생아의 질적 관리를 위해 신생아실 의료인력과 의료수가의 타당성을 파악하고자 영남지역내 24개 소아과 수련병원 가운데 신설병원과 모(母)병원의 수련프로그램에 의존해 있는 병원을 제외한 20개 병원의 신생아실을 대상으로 1991년 7월 29일에서 8월 14일 사이에 각 병원을 방문하여 자료를 수집하였다. 자료는 신생아실 대장에서 1991년 6월 한달동안 입.퇴원한 정상 및 환아수를 조사하고 신생아실 수간호사와 소아과 의사를 면담하여 정상신생아 관리에 소요되는 최소한의 간호시간, 인력현황, 인력의 적정성, 그리고 인력확보의 문제점을 조사하였고 자 병원 보험심사과에서 정상 질분만시와 제왕절개분만시 산모 1인당 평균 산모 및 신생아관리분의 의료비를 조사하였다. 정상신생아 1명당 하루에 필요한 최소한의 간호시간은 평균 179.5분(${\pm}58.6$)이었고 대학병원은 202.3분(${\pm}50.7$), 종합병원은 164.2분(${\pm}60.5$)이었다. 최소한의 간호 요구시간 대 제공가능한 간호시간 비는 평균 1.42였고 환아에 대한 간호 요구량을 감안했을 때는 평균 비가 2.06으로 간호인력이 매우 부족하였다. 미국 소아과학회가 권장한 신생아실 간호인력을 기준으로 할 경우 간호사는 31%, 간호조무사는 17%가 충원된 상태였다. 신생아실 수간호사의 90%와 소아과 의사의 85%가 간호사가 부족하다고 했고 간호조무사는 각각 75%가 부족하다고 했다. 간호인력 보충이 안 되는 주된 이유는 재정사정이라고 하였다. 간호조무사의 경우는 인력구하기 힘든 것이 재정사정 다음으로 중요한 이유였다. 그러나 국립대학병원의 경우는 의사와 간호사는 T.O.의 제한이 주된 이유라고 했다. 정상 질분만으로 2박 3일만에 퇴원하는 경우 총 의료비는 평균 219,430원이었고 이 중 신생아분은 20,323원(9.3%)이었으며, 제왕절개분만으로 6박 7일만에 퇴원할 경우 평균 732,578원이었고 이 중 신생아분은 76,937원(12.0%)이었다. 원가계산방식에 의한 신생아관리에 대한 최소한의 원가는 3차진료기관의 경우 1일 16,141원, 기타 종합병원은 14,576원으로 원가가 의료보험수가의 각각 5.0배, 4.9배나 되었다. 오늘날의 의료인력의 인건비 수준과 병원시설 및 관리비를 감안할 때 현행 의료수가로 양질의 신생아관리를 기대하기 어려운 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제58권6호
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• pp.562-569
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• 2005

배 경 : 중환자에서 질환의 중증도 평가체계는 예후를 평가하는데 유용한 것으로 알려져 있다. 하지만 이들은 다소 복잡하고 비용-효과 면이 있어 보다 손쉽게 예후를 예측할 수 있는 troponin-I, lactate, CRP 등과 같은 생화적 지표에 대한 연구가 진행되어 왔다. 본 연구는 비 순환기계 중환자에서 troponin-I, lactate, CRP 수치가 예후 인자로서 유용한지를 알아보고자 하였다. 대상 및 방법 : 2003년 9월부터 2004년 6월까지 경상대학교 병원 내과계 중환자실에 비 순환기계 질환으로 입원한 환자 139명(63.3{\pm}14.7세, 남:여=88:31)을 대상으로 하였다. 중환자실 입원 24시간내 APACHE II, SAPS II와 SOFA 점수를 이용해 질환의 중증도와 다장기부전의 정도를 평가하였고 troponin-I, lactate, CRP 수치를 측정하였다. 중환자 입원 후 재원 10일째와 30일째 생존군과 비 생존군의 troponin-I, lactate, CRP 수치를 서로 비교하였고 troponin-I, lactate, CRP 수치가 정상인 군과 비정상인 군간의 재원 10일째 및 30일째 사망률을 비교하였다. 또한 각 지표와 중증도 평가체계인 SAPS II와 SOFA 점수와의 상관 관계를 조사하였다 결 과 : 재원 10일째 비생존군의 입원 당시 측정한 troponin-I와 CRP 수치는 각각 $4.208{\pm}10.23ng/ml$, $137.69 {\pm}70.18mg/L$로 생존군의 $1.018{\pm}2.58ng/ml$, $98.48{\pm}69.24mg/L$에 비해 유의하게 높았다(p<0.05). 재원 30일째 비생존군의 입원 당시 측정한 troponin-I, lactate, CRP 수치는 각각 $3.36{\pm}8.74ng/ml$, $15.42{\pm}20.57ng/dl$, $131.28{\pm}71.23mg/L$로 생존군의 $0.99{\pm}2.66ng/ml$, $8.02{\pm}9.54ng/dl$, $96.87{\pm}68.83mg/L$에 비해 유의하게 높았다(p<0.05). 입원 당시 측정한 troponin-I, lactate, CRP 수치가 비정상인 군의 재원 10일 사망률은 각각 28.1%, 31.6%, 18.9%로 정상군의 사망률 11.0%, 15.8 %, 0%에 비해 유의하게 높았다(p<0.05). 입원 당시 측정한 troponin-I, lactate, CRP 수치가 비정상인 군의 재원 30일 사망률은 각각 38.6%, 47.4%, 25.8%로 정상군의 사망률 15.9%, 21.7%, 14.3%에 비해 유의하게 높았다(p<0.05). 입원 당시 측정한 troponin-I와 lactate는 SAPS II 점수와 유의한 상관관계가 있었다($r^2=0.254$, $r^2=0.365$, (p<0.05). 결 론 : 입원 당시에 측정한 troponin-I, lactate, CRP 수치는 비 순환기계 중환자의 예후를 예측하는 데 도움이 될 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.935-939
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• 2000

Objective : Traumatic disc lesion is a lesion with tremendous controversies. The causal relationships of this lesion are not established along with pathogenesis, diagnostic criteria, methods of treatment and the outcome. However, a significant number of patients with back pain after a trauma underwent spinal operations under the diagnosis of traumatic disc lesions. Such an ill-directed operation eventually produce a person with an iatrogenic disability. We present two illustrative cases, and tried to make a preventive method. Methods : We examined the path from mild trauma after a road traffic accident into the iatrogenic disability in two illustrative cases, who requested disability assessment and medical appraisement. We evaluated the reason and background for such an unwanted outcome and tried to find a method to reduce or prevent it by a literature review. Results : These two patients were admitted to the hospital with the diagnosis of lumbar sprain after a road traffic accidents. They eventually underwent spinal surgery under another diagnosis such as traumatic disc herniation or internal disc disruption. They stayed at the hospital for more than six months and finally lost their jobs. They became the disabled at last. Although they complained back pain, they never insisted by themselves that their symptoms were due to the traumatic disc lesion. To prevent such an iatrogenic disability, the doctors should assist them to go-back to the workplace promptly instead of a reckless extension of the treatment period. It may be necessary to evaluate the certificates to extend the treatment period with an additional diagnosis by a medical expert. To reduce the unnecessary long-term admission, a new billing system such as a partial share for the high cost of the treatment by the patients may be needed. Conclusion : It is not the patient but the doctors, who has the responsibility to avoid the unnecessary operations. All treating doctors should try to reduce or prevent such an iatrogenic complication caused by ourselves before we are forced to do so.

• Journal of Preventive Medicine and Public Health
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• 제23권1호
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• pp.11-21
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• 1990

This study refers to the problem of long-term inpatient flow in a general hospital. In this study, a queueing simulation model was developed for the two departments in the hospital with a homogeneous case mix and relatively many long-term inpatients in order to increase the turnover rate and hospital charges. Before the simulation n, the model was verified by the Kolmogorov-Smirnov test. The following results were generated by three alternative models of the special bed policies. 1. Alternative I : When long term inpatients were admitted to the wards belonging to departments A and B without transfer to other departments and special beds, the average turn-over rate decreased by 2-4% and the average hospital charges decreased by 70 million won. 2. Alternative II : When long-term inpatients were transferred to department C but the transfer of wards was determined by department C in order of clinical need, the average turnover rate increased by 4-13% but the average hospital charges decreased by 30 million won. This result was not greatly different from the present state. 3. Alternative III : When long-term inpatients were transferred to the special wards and department C simultaneously, the increase in the average turnover rate and hospital charges was equivalent to the increase of two beds in the special wards. When the special wards were allocated 16 beds, the average turnover rate of departments A and B increased by about 55% and 20% respectively. Also, the hospital charges increased by about 0.44 billion won. As a result, transfer to department C and the use of 16 beds in the special wards for long-term inpatients of departments A and B is expected to maximize the hospital revenue. However, as the above special bed policy can not increase the turnover rate above 60%, there is a need for a more comprehensive policy to further increase the rate. The development of an elaborate model should include the number of long-term inpatients in all clinical departments, the special wards system or an increase of hospital beds to handle admission needs, and the resources of the hospital by department. When the alternatives are evaluated, a cost-benefit analysis in addition to the turnover rate and the hospital charges should be considered.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2523-2526
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• 2012

Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy and improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluation of granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes of prolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF in febrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANC with mortality and hospital discharge. Methods: A prospective cross sectional study was carried at an oncology ward at Aga Khan University hospital from January 2010 to June 2011. All adult patients who were admitted and treated with GCSF for chemotherapy induced febrile neutropenia were included. Multivariable regression was conducted to identify the factors related with poor outcomes. Results: A total of 131 patients with febrile neutropenia were identified with mean age of 43.2 (18-85) years, 79 (60%) being ${\leq}50$. Seventy-five (57%) had solid tumors and 56 (43%) hematological malignancies, including lymphoma. Fifty seven (43.5%) had an ANC less 100 cells/$mm^3$, 34 (26%) one between 100-300 cells/$mm^3$ and 40 (31%) an ANC greater than 300 cells/$mm^3$. Thirty (23%) patients showed ANC recovery in 1-3 days, and 74(56%) within 4-7 days. Thirteen (10%) patients showed no recovery. The overall mortality was 18 (13.7%) patients. The mean time for ANC recovery seen in hematological malignancies was 6.34 days whereas for solid tumors it was 4.88 days. Patients with ANC <100 cells/$mm^3$ were more likely to die than patients with ANC >300 cells/$mm^3$ by a factor of 4.3. Similarly patients >50 years of age were 2.7 times more likely to die than younger patients. Conclusion: Our study demonstrated that use of GCSF, in addition to intravenous antibiotics, in treatment of patients with chemotherapy induced febrile neutropenia accelerates neutrophil recovery, and shortens antibiotic therapy and hospitalization. We propose to risk classify the patients at the time of admission to evaluate the cost effectiveness of this approach in a resource constrained setup.

• 한국통신학회논문지
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• 제29권7B호
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• pp.685-696
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• 2004

많은 양의 대역폭을 사용하는 실시간 멀티미디어 응용들은 일정 수준의 서비스 품질을 보장받기 위해 필요한 자원을 사전에 예약하고 이를 사용할 수 있어야 한다. 자원의 사전 예약을 위해서는 해당 자원에 대한 사용 기간의 명시와 이를 이용해 자원을 사전에 예약하고 할당하는 자원 관리자가 필요하다. 따라서 자원의 사용 기간에 관계없이 예약 요청 발생시점에서 가용 자원의 양만을 고려하는 전통적인 자원 할당 방식과는 달리 사전 예약을 제공하는 자원 관리자는 사전에 예약된 자원과 사용 기간을 명시하지 않는 즉석 예약을 위해 할당된 자원이 서로충돌하지 않도록 예약 요청들을 처리해야 한다. 일반적으로 자원 예약의 충돌은 예약 형태에 따라 할당 자원을 분리함으로써 해결할 수 있지만 이는 자원의 낭비를 초래하게 된다. 본 논문은 즉석 예약과 사전 예약 요청을 위해 준비된 자원 공간을 변동하는 자원 경계를 이용해 효율적으로 공유하는 자원 관리 방식을 제안한다. 제안하는 자원 관리 방식은 네트워크 비용 함수를 이용해 자원 간 경계를 설정하고, 예약 자원의 충돌에 따라 비용 함수의 가중치 변수를 조정해 경계를 변화시킴으로써 공유 자원을 효과적으로 할당하고 관리한다. 또한, 사용자 효용 함수의 정의를 통해 예약된 자원을 사용하는 서비스의 품질로부터 사용자가 얻는 효용을 정량적으로 측정하며, 자원의 사전 예약이 사용자 효용 및 전체 자원 활용에 미치는 영향을 고찰한다. 네트워크 시뮬레이터(NS-2)를 이용한 실험은 제안한 자원 관리 방식이 자원 공간의 고정 분할과 같은 방식과 비교해 높은 자원 활용율과 더불어 안정적인 서비스 품질을 제공할 수 있음을 보여준다.

• 한국병원경영학회지
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• 제25권2호
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• pp.45-56
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• 2020

Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.