• 한국의료질향상학회지
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• 제3권2호
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• pp.52-59
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• 1997

Background : In many Nursing Delivery System, Nursing Department at D Hospital had used to traditional nursing practice model what is called functional activities based system. It has a lot of merit that carried out specialized and rapid works but tend to ignore indivisual professional responsibility and task-based work assignments. In addition this system showed high turnover rates due to heavy workload, timesum of handing over duties, lack of support from peers and interstaff communication. So we performed conversion of Nursing Delivery System to My Patients Nursing Care System for providing comprehensive nursing to patient and reducing turnover rates and increasing job satisfaction to nurse. Method : 1. 1st step(96.4.9): Detected the problem of Nursing delivery System and estabilished improving planning 2. 2nd step(96.4.26): Visited other hospital on job training 3. 3th step(96.4.29): Discussed to premonitoring problem after conversion Nursing Delivery System and prepared structure 4. 4th step(96.5.6): My Patients Nursing Care System practical application 5. 5th step(96.7.20): Held complementary meeting 6. 6th step(96. 7): The other ward application 7. 7th step(96. 10): Extended application to whole wards Results: 1. Workload: (1) reduction(55.6%) (2) addition(44.4%) 2. Strong points after conversion: (1) decreased timesum of handing overduties (35.2%) (2) increased responsibility(33%) (3) broaden nurse's outlook to duties(14.8%) 3. Shortcoming after conversion: (1) understanding difficulties except my patient(57.8%) (2) weak teamwork(23.3%) (3) intensive stress to low grade nurse(12.2%) 4. Effective complemental way: (1) manpower(76.7%) (2) conversion of though (8.9%) (3) education(14.4%) 5. Patient's satisfaction: (1) satisfaction(64%) (2) no effect(36%) 6. Physician and peer's satisfaction: (1) satisfaction(12.5%) (2) dissatisfaction(21.6%) (3) no interest(44.3%) 7. Nurse's satisfaction: (1) satisfaction(74.7%) (2) dissatisfaction(5.5%) (3) unknown(20.5%) 8. Want to continued: (1) want(76.4%) (2) try to any other system(18%) Conclusion : Even though Nursing Delivery System conversion still has many problem, we gained more merits than traditional nursing delivery system. So we suggest that My Patients Nursing Care System should be encouraged for comprehensive nursing care and satisfaction to nurses.

• 한국보건간호학회지
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• 제9권1호
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• pp.83-102
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• 1995

As the society is being industrialized, the fast-paced economic development that has caused substantial increase in cerebrovascular and coronary artery diseases and the industrial development and increased use of means of transportation have resulted in the rapid rise of incidents in external injuries as well. So the pubic has become acutely aware of the need for fast and effective emergency care delivery system. The goal of emergency care delivery system is to meet the emergency care needs of patients. The emergency care delivery system is seeking to efficiently satisfy the care needs of people. Therefore the purpose of this study is designed to develop an effective programs for emergency care delivery system in Korea. The following specific objectives were investigated. This emergency care delivery system must have the necessary man power, for transfering the patients, communication net work, and emergency care facilities. 1) Man power Emergency care requires n0t only specialized traning in the emergency treatment but also knowledge and experience i11 other related area, so emergency care personnel traning program should be designed in order to adapt to the specific need of emergency patients. It will be necessary to ensure professional personnel who aquires the sufficient traning and experience for emergency care and to look for legal basis. We have to develop re-educational programs for emergency nurse specialist. They should be received speciality of emergency nursing care so that they will work actively and positively in emergency part. Emergency medical doctor and nurse specialist should be given an education which is related in emergency and critical care. Emergency care personnel will continue to provide both acute and continuing care as partner with other medical team. 2) Transfering the patients. Successful management of pre-hospital care requires adequate traning for the emergency medical technician. Traning program should be required to participate in a actual first aids activites in order to have apportunities to acquire practical skills as well as theoretical knowledge. The system of emergency medical technician should be remarkablly successful with first responder firefighters. Establishing this system must add necessary ambulances operating at any given time. It will be necessary to standardize the ambulance size and equipment. Ambulance should be arranged with each and every fire station. 3) Communication net work. The head office of emergency commumication network should be arranged with the head office of fire station in community. It is proposed that Hot-line system for emergency care should be introduce. High controlled ambulance and thirtial emergency center should simultaneously equip critical-line in order to communication with each other. Ordinary ambulance and secondary emergency facility should also simultaneously equip emergency-line in order to communication with each other. 4) Emergency care facilities. Primary emergency care facilities should be covered with the ambulatory emergency patients-minor illness and injuires. Secondary emergency care facilities should be covered with the emergency admission patients. Third emergency care center should be covered with the critical patients who need special treatments and operation. Secondary and third emergency care facilities should employ emergency medical doctor and emergency nurse specialist to treat in-patients with severe and acute illness and multiple injuires. It should be fashioned for a system of emergency facilities that meets emergency patients needs. Provide incentives for increased number of emergency care facilities with traning in personal/clinical emergency care. 5) Finance It is recommended to put the finance of a emergency care on a firm basis. The emergency care delivery system should be managed by the government or accreditted organizations. In order to facilitate this relevant program the fund is needed for more efficient and effective emergency researchs, service, programs, and policy. 6) Gaining understanding and co-operation of pubic It is also important to undertake pubic education to improve understanding of first aids and C. P. R of individuals, communities and business. It is proposed that teachers and health officers be certified in C. P. R. The C. P. R education can be powerful influence save lives. Lastly appropriate emergency care information must be provided to the pubic for assisting them in choosing emergency care.

• 보건행정학회지
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• 제27권2호
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• pp.128-138
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• 2017

Background: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. Methods: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. Results: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. Conclusion: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.

• 보건의료기술평가
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• 제6권2호
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• pp.88-94
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• 2018

This review aims to provide implications for relevant domestic policies and researches from Patient-Centered Medical Home (PCMH), a reinforcement model for primary care and its evaluations in the United States. As chronic diseases became dominant, changes in the health care delivery system in which primary care is central was required. The United States initiated primary care-reinforcing policies based on the PCMH following the increased demand for evidence-based health care policies. The current activities of the United States such as sharing research tools used to evaluate primary care interventions and circulating evaluation findings provide examples to Korea. Systematic evaluations for primary care interventions are required and appropriate methods using various types of data to reflect the real-world settings should be prepared. It is necessary to conduct policy assessment studies of public interests considering regional context. Support for the researches to make and advance from the existing environment must be examined.

• 한국직업건강간호학회지
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• 제9권2호
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• pp.155-165
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• 2000

This study is to grope for a plan to increase nurse's autonomy by grasping autonomy degree according to nursing delivery system. The subject of this study are 265 nurses who work for 4 general hospitals in Seoul, and 73 of them work in primary nursing delivery system, 99 of them in team nursing delivery system and 93 of them in functional nursing delivery system. Data collection was done through questionaires from Sep. 1, 1997 to Sep. 30, 1997, and autonomy was measured by Professional Nursing Autonomy Scale developed by Schutzonhofer. Data analysis as inspected with $X^2$ test, ANOVA, and t-test, using SPSS program. The results are as follows : 1. When it comes to the autonomy of all the nurses, mean score was 161.99. Which is medium level, and autonomy degree according to nursing delivery system had no significant differences. 2. There was a significant difference in autonomy degree according to inservice education among the subject's work-related characteristics, and there was no significant difference in autonomy distribution in each grade according to general characteristics although older group, married group, and junior college graduates group showed rather higher trends. 3. Considering each item, questions related to direct nursing such as "Vital sign monitoring", "Nursing rounding", "Withhold contraindicated drug", showed high score in autonomy scores, and long-term and indirect nursing behaviors such as "Nursing administration", "Nursing research", "Follow-up care" and "Educational planning".

• 보건행정학회지
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• 제29권3호
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• pp.342-356
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• 2019

Background: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. Methods: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. Results: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. Conclusion: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.

• 의료법학
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• 제20권3호
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• pp.235-262
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• 2019

전통적으로 인류를 위협해 오던 감염성 질환이 줄어드는 반면, 심뇌혈관 질환을 포함하여 암, 당뇨와 같은 만성질환이 빠른 속도로 퍼져나가고 있다. 오랜 시간에 걸쳐 발병하며 증세가 장기간 지속되지만 치료가 어려운 만성질환의 특성을 반영, 그 위험요인의 관리와 이에 대응하는 건강증진정책의 마련은 세계 각국의 중요 관심사로 부상하게 되었다. 일차 의료 시스템이 점점 더 복잡한 형태로 변화하는 현대사회의 건강요구에 부합, 건강증진 및 질병 예방 정책, 지역사회에 대응 솔루션 등 이른바 환자 중심의 다 부문 접근방식을 제공하면서 변화된 의료 환경에서 일차 의료의 가치는 다시 한 번 부각 되고 있다. 기존의 의료전달체계로는 급속한 고령화 및 질병 패러다임의 변화, 삶의 질 향상을 향한 민중의 욕구를 감당하기 어려워지면서 유럽연합국가들은 지속적이며 포괄적이고 조정된 관리를 제공하는 일차 의료 시스템을 구축, 그 품질 향상을 위하여 다각적인 노력을 기울이고 있다. 본 논문은 우리나라 보건의료 전달체계의 현황 및 문제점 등을 검토하고, 일차 의료 강화와 관련된 유럽연합의 예를 중심으로 그 시사점을 도출, 환자 중심의 미래형 의료전달체계 구축 방안에 관하여 논의하고자 한다.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제17권2호
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• pp.27-34
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• 2011

It is very important to justify the reasonable role of healthcare facilities in the law in order to provide considerable medical services to the patient. Defining the right role of healthcare facilities makes it possible to build adequate Health Care Delivery System which might be helpful for the patient. However, the information of healthcare facilities in Korean law is so unclear that people are able to hardly understand what sort of proper medical service is for them. Furthermore, there is not enough regulation to differentiate each type of hospitals in the law. The result of this study is summarized into three points. Firstly, the current medical law does not reflect differences of function which each medical facility has. Secondly, the method of classification of healthcare facilities in the law disagrees with the Health Care Delivery System. Finally, there is no information on the type of sickbed in the law. Therefore, this study intend to analyze cause of problems which the law contains in order to be used for the fundamental resource for the healthcare facility planning.

• 보건행정학회지
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• 제24권4호
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• pp.301-303
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• 2014

• 한국보건간호학회지
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• 제8권2호
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• pp.71-82
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• 1994

The article reviewed the elderly health care management problems in policy development issue of the nation. Policy of Korean government on elderly health care has still not yet developed. The main stream of policy which is effective on elderly welfare policy is 'Elderly care are responsible by their families'. Now only those aged whose family members are not able to take care of their parents are receive custodial care at the non-profit nursing homes. This article examined the main stream policy in pro and cons aspects in relation to social changes such as: demographic changes. family structure changes. attitude changes. health care delivery system. and political settlement view points in connection with medical insurance program. Finally. a model for the elderly health care management was proposed which will provide chronic care services at the community level. such as nursing homes. day care centers. day hospitals, respite care units, and special care institute for dementia.