• Title/Summary/Keyword: health care costs

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Validation of initial nutrition screening tool for hospitalized patients (입원 환자용 초기 영양검색도구의 타당도 검증)

  • Kim, Hye-Suk;Lee, Seonheui;Kim, Hyesook;Kwon, Oran
    • Journal of Nutrition and Health
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    • v.52 no.4
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    • pp.332-341
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    • 2019
  • Purpose: Poor nutrition in hospitalized patients is closely linked to an increased risk of infection, which can result in complications affecting mortality, as well as increased length of hospital stay and hospital costs. Therefore, adequate nutritional support is essential to manage the nutritional risk status of patients. Nutritional support needs to be preceded by nutrition screening, in which accuracy is crucial, particularly for the initial screening. To perform initial nutrition screening of hospitalized patients, we used the Catholic Kwandong University (CKU) Nutritional Risk Screening (CKUNRS) tool, originally developed at CKU Hospital. To validate CKUNRS against the Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is considered the gold standard for nutritional risk screening, results from both tools were compared. Methods: Nutritional status was evaluated in 686 adult patients admitted to CKU Hospital from May 1 to July 31, 2018 using both CKUNRS and PG-SGA. Collected data were analyzed, and the results compared, to validate CKUNRS as a nutrition screening tool. Results: The comparison of CKUNRS and PG-SGA revealed that the prevalence of nutritional risk on admission was 15.6% (n = 107) with CKUNRS and 44.6% (n = 306) with PG-SGA. The sensitivity and specificity of CKUNRS to evaluate nutritional risk status were 98.7% (96.8 ~ 99.5) and 33.3% (28.1 ~ 39.0), respectively. Thus, the sensitivity was higher, but the specificity lower compared with PG-SGA. Cohen's kappa coefficient was 0.34, indicating valid agreement between the two tools. Conclusion: This study found concordance between CKUNRS and PG-SGA. However, the prevalence of nutritional risk in hospitalized patients was higher when determined by CKUNRS, compared with that by PG-SGA. Accordingly, CKUNRS needs further modification and improvement in terms of screening criteria to promote more effective nutritional support for patients who have been admitted for inpatient care.

Review of 2016 Major Medical Decisions (2016년 주요 의료판결 분석)

  • Park, Tae Shin;Yoo, Hyun Jung;Jeong, Hye Seung;Lee, Dong Pil;Lee, Jung Sun
    • The Korean Society of Law and Medicine
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    • v.18 no.1
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    • pp.297-341
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    • 2017
  • We searched out court rulings on medical affairs through court library search sites and specialized articles on medically relevant judgments sentenced in 2016. And we selected and analyzed the judgements of the court we considered important as follows. In relation to the medical civil judgements, (1) In the case of applying surgery for female infertility during cesarean section operation but it has not been done, we expressed the regret for the lack of judgment in the process of entering the medical contract, introducing the rights infringed and the scope of compensation, (2) We pointed out that the ruling on the medical malpractice estimation goes out of limit of negligence estimation doctrine, and that the court asked very high degree duty of the traditional Korean medicine doctors to cooperate with Western medicine doctors. (3) In the case of admitting hospital's 100% responsibility, we pointed out the court overlooked the uncertainty and good intention of the medical practice. (4) Additionally, We introduced the cases admitted the hospital's responsibility in the accident related to the psychiatric patients in closed ward. Relating to a medical criminal ruling, we analyzed the supreme court decision about whether the dentist's Botox injection on the patient's face is a medical practice within the scope of the license from the viewpoint whether it is within the possible range of the word. And, concerning decisions on healthcare administration, (1) we analyzed the case about when medical personnel operate multiple medical institutions, whether it is possible to get back medical care costs under the National Health Insurance Law, (2) We commented on the ruling regarding explanation obligation in terms of object, degree, subject of explanation as a prerequisite for permissible arbitrary uninsured benefits. Finally, we reviewed the decision of the Constitutional Court about the Article 24 of the Mental Health Law, which it had allowed for a mental patient to be hospitalized forcibly by the consent of two guardians and a diagnosis of a psychiatrist. Also we indicated the problems of the revised Mental Health Law.

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The Clinical and Cost Effectiveness of Medical Nutrition Therapy for Patients with Type 2 Diabetes Mellitus (제2형 당뇨병환자에서 임상영앙치료의 임상적 효과와 비용효과 연구)

  • Cho, Youn-Yun;Lee, Moon-Kyu;Jang, Hak-Chul;Rha, Mi-Yong;Kim, Ji-Young;Park, Young-Mi;Sohn, Cheong-Min
    • Journal of Nutrition and Health
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    • v.41 no.2
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    • pp.147-155
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    • 2008
  • Medical nutrition therapy (MNT) is considered a keystone of medical treatment of chronic diseases. However, only few studies have evaluated medical and economical outcome of MNT. The study was performed on the patient with type 2 diabetes mellitus to evaluate the effect of clinical and cost-effective outcomes of MNT. Subjects from two general hospitals were randomly assigned to two different groups; One receiving basic nutritional education (BE) (n = 35), and the other receiving intensive nutritional education (IE) (n = 32) for a 6-month clinical trial. The group which received BE had a single visit with a dietitian, while the other group which received IE had an initial visit with a dietitian addition to two visits during the first 4 weeks of the study periods. Anthropometric parameters, blood components, and dietary intake were measures at the beginning of study period and after 6 month. Cost-effective analysis included direct labor costs, educational materials and medication cost difference during 6 months. After 6 month, subjects from IE group showed significant reduction of body weight (p <0.05) and systolic blood pressure (p <0.05), whereas BE group did not show any significant changes. Result from biochemical indices showed glycated hemoglobin concentration was significantly reduced by 0.7% (p <0.05) only in the IE group. The ratio of energy intake to prescribed energy intake decreased significantly in both groups (p <0.05). Mean time taken for a dietitian to educate the subject was 67.9 ${\pm}$ 9.3 min/person for BE group, while 96.4 ${\pm}$ 12.2 min/person for IE group. Mean number of educational materials was 1.9 ${\pm}$ 0.7/person for BE group and 2.5 ${\pm}$ 0.7/person for IE group. Change in glycated hemoglobin level along the 6 month period of study can be achieved with an investment of \88,510/% by implementing BE and \53,691/% by implementing IE. Considering the net cost-effect of blood glucose control and HbA Ic, IE which provides MNT by dietitian had a cost efficiency advantage than that of BE. According to this study, MNT provided by dietitian had a significant improvements in medical and clinical outcomes compared to that of BE intervention. Therefore, MNT protocol should be performed by systemic intensive nutrition care by dietitian in clinical setting to achieve good therapeutic results of DM with lower cost.

Database for Hospice Nursing in Electronic Medical Record (호스피스 전자기록을 위한 데이터베이스 개발)

  • Kim, Young-Soon;Lee, Chang-Geol;Lee, Kyoung-Ok;Kim, Ok-Kyum;Kim, In-Hye;Kim, Mi-Jeong;Hwang, Ae-Ran;Lee, Won-Hee
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.200-213
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    • 2004
  • Purpose: The purpose of this study was to create an electronic nursing record form to build a hospice nursing process database to be used in the u-hospital EMR system. Specific aims of the study were: 1. To generate a complete, accurate, and simple electronic nursing record form. 2. To verify its appropriateness following documentation with the standardized hospice protocol. 3. To verify its validity and finalize the hospice nursing process database through discussion among hospice professionals. Methods: Nursing records from three independent hospice organizations were collected and analyzed by five expert hospice nurses with more than 10 years of experience, and a nursing record database was developed. This database was applied to 81 hospice patients at three hospice organizations to verify its completeness. Results: 1. An electronic nursing record form with completeness, accuracy, and simplicity was developed. 2. The completeness of the standardized home hospice service protocol was 95.86 percent. 3. The hospice nursing process database contains 18 items on health problems, 79 items on related causes and major symptoms, and 229 items on nursing interventions. Conclusion: The new nursing record form and database will reduce documentation time and articulate and streamline the working process among team members. They can also improve the quality of hospice services, and ultimately enable us to estimate hospice service costs.

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Clinical Use and Complications of Percutaneous Central Venous Catheterization in Very Low Birth Weight Infants (극소 저출생 체중아에서 경피 중심정맥 도관의 유용성과 합병증)

  • Kim, Hyang;Kim, Sun Hui;Byun, Hyung Suck;Choi, Young Youn
    • Clinical and Experimental Pediatrics
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    • v.48 no.9
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    • pp.953-959
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    • 2005
  • Purpose : The administration of total parenteral nutrition(TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization(PCVC) in very low birth weight infants. Methods : A total of 56 very low birth weight infants below 1,500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group(n=32) included the babies who had undergone PCVC and a control group(n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. Results : There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2,000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1,000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1,000 to 1,500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2,000 g. Conclusion : Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.

Seeking a Better Place: Sustainability in the CPG Industry (추심경호적지방(追寻更好的地方): 유포장적소비품적산업적가지속발전(有包装的消费品的产业的可持续发展))

  • Rapert, Molly Inhofe;Newman, Christopher;Park, Seong-Yeon;Lee, Eun-Mi
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.2
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    • pp.199-207
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    • 2010
  • For us, there is virtually no distinction between being a responsible citizen and a successful business... they are one and the same for Wal-Mart today." ~ Lee Scott, al-Mart CEO after the 2005 Katrina disaster; cited in Green to Gold (Esty and Winston 2006). Lee Scott's statement signaled a new era in sustainability as manufacturers and retailers around the globe watched the world's largest mass merchandiser confirm its intentions with respect to sustainability. For decades, the environmental movement has grown, slowly bleeding over into the corporate world. Companies have been born, products have been created, academic journals have been launched, and government initiatives have been undertaken - all in the pursuit of sustainability (Peattie and Crane 2005). While progress has been admittedly slower than some may desire, the emergence and entrance of environmentally concerned mass merchandisers has done much to help with sustainable efforts. To better understand this movement, we incorporate the perspectives of both executives and consumers involved in the consumer packaged goods (CPG) industry. This research relies on three underlying themes: (1) Conceptual and anecdotal evidence suggests that companies undertake sustainability initiatives for a plethora of reasons, (2) The number of sustainability initiatives continues to increase in the consumer packaged goods industries, and (3) That it is, therefore, necessary to explore the role that sustainability plays in the minds of consumers. In light of these themes, surveys were administered to and completed by 143 college students and 101 business executives to assess a number of variables in regards to sustainability including willingness-to-pay, behavioral intentions, attitudes, willingness-to-pay, and preferences. Survey results indicate that the top three reasons why executives believe sustainability to be important include (1) the opportunity for profitability, (2) the fulfillment of an obligation to the environment, and (3) a responsibility to customers and shareholders. College students identified the top three reasons as (1) a responsibility to the environment, (2) an indebtedness to future generations, and (3) an effective management of resources. While the rationale for supporting sustainability efforts differed between college students and executives, the executives and consumers reported similar responses for the majority of the remaining sustainability issues. Furthermore, when we asked consumers to assess the importance of six key issues (healthcare, economy, education, crime, government spending, and environment) previously identified as important to consumers by Gallup Poll, protecting the environment only ranked fourth out of the six (Carlson 2005). While all six of these issues were identified as important, the top three that emerged as most important were (1) improvements in education, (2) the economy, and (3) health care. As the pursuit and incorporation of sustainability continues to evolve, so too will the expected outcomes. New definitions of performance that reflect the social/business benefits as well as the lengthened implementation period are relevant and warranted (Ehrenfeld 2005; Hitchcock and Willard 2006). We identified three primary categories of outcomes based on a literature review of both anecdotal and conceptual expectations of sustainability: (1) improvements in constituent satisfaction, (2) differentiation opportunities, and (3) financial rewards. Within each of these categories, several specific outcomes were identified resulting in eleven different outcomes arising from sustainability initiatives. Our survey results indicate that the top five most likely outcomes for companies that pursue sustainability are: (1) green consumers will be more satisfied, (2) company image will be better, (3) corporate responsibility will be enhanced, (4) energy costs will be reduced, and (5) products will be more innovative. Additionally, to better understand the interesting intersection between the environmental "identity" of a consumer and the willingness to manifest that identity with marketplace purchases, we extended prior research developed by Experian Research (2008). Accordingly, respondents were categorized as one of four types of green consumers (Behavioral Greens, Think Greens, Potential Greens, or True Browns) to garner a better understanding of the green consumer in addition to assisting with a more effective interpretation of results. We assessed these consumers' willingness to engage in eco-friendly behavior by evaluating three options: (1) shopping at retailers that support environmental initiatives, (2) paying more for products that protect the environment, and (3) paying higher taxes so the government can support environmental initiatives. Think Greens expressed the greatest willingness to change, followed by Behavioral Greens, Potential Greens, and True Browns. These differences were all significant at p<.01. Further Conclusions and Implications We have undertaken a descriptive study which seeks to enhance our understanding of the strategic domain of sustainability. Specifically, this research fills a gap in the literature by comparing and contrasting the sustainability views of business executives and consumers with specific regard to preferences, intentions, willingness-to-pay, behavior, and attitudes. For practitioners, much can be gained from a strategic standpoint. In addition to the many results already reported, respondents also reported than willing to pay more for products that protect the environment. Other specific results indicate that female respondents consistently communicate a stronger willingness than males to pay more for these products and to shop at eco-friendly retailers. Knowing this additional information, practitioners can now have a more specific market in which to target and communicate their sustainability efforts. While this research is only an initial step towards understanding similarities and differences among practitioners and consumers regarding sustainability, it presents original findings that contribute to both practice and research. Future research should be directed toward examining other variables affecting this relationship, as well as other specific industries.