• Journal of Preventive Medicine and Public Health
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• 제33권4호
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• pp.393-401
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• 2000

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

• Hip & pelvis
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• 제34권1호
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• pp.56-61
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• 2022

Purpose: Histopathologic analysis of femoral head specimens following total hip arthroplasty (THA) is a routine practice that represents a significant use of health care resources. However, it occasionally results in discovery of undiagnosed hematopoietic malignancy and other discrepant diagnoses such as avascular necrosis. The purpose of this study was to determine the rate of discordant and discrepant diagnoses discovered from routine histopathological evaluation of femoral heads following THA and perform a cost analysis of this practice. Materials and Methods: A review of patients undergoing primary THA between 2004-2017 was conducted. A comparison of the surgeon's preoperative and postoperative diagnosis, and the histopathologic diagnosis was performed. In cases where the clinical and histopathology differed, a review determined whether this resulted in a change in clinical management. Medicare reimbursement and previously published cost data corrected for inflation were utilized for cost calculations. Results: A review of 2,134 procedures was performed. The pathologic diagnosis matched the postoperative diagnosis in 96.0% of cases. Eighty-three cases (4.0%) had a discrepant diagnosis where treatment was not substantially altered. There was one case of discordant diagnosis where lymphoma was diagnosed and subsequently treated. The cost per discrepant diagnosis was $141,880 and per discordant diagnosis was $1,669 when using 100% Medicare reimbursement and Current Procedural Terminology (CPT) code combination 88304+88311. Conclusion: Histopathologic analysis of femoral head specimens in THAs showed an association with high costs given the rarity of discordant diagnoses. Routine use of the practice should be at the discretion of individual hospitals with consideration for cost and utility thresholds.

• 대한한방내과학회지
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• 제25권4호
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• pp.158-166
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• 2004

Background & Object : The aim of this study was to investigate the usefulness of electrogastrography in the diagnosis field of traditional medicine through a study of the relationship between gastric motility and health condition based on oriental medicine diagnostic theory in functional dyspepsia. Method : 86 patients (male 27, female 59) with functional dyspepsia and 10 healthy control subjects (male 5, female 5) were involved in the investigation. The disease information of functional dyspepsia (based on Rome criteria II) was used for dyspeptic index and scores were obtained from the comprehensive diagnosis of Qui, Xue, Shui was applied as index for health condition, those were all investigated by questionnaire. Gastric motility were recorded and analyzed using electrogastrography in fasting and postprandial period. Results : The total score of comprehensive diagnosis of Qui Xue Shui was influenced by the number of functional dyspepsia symptoms (p=0.026). In terms of electrogastrographical parameters, both postpranial normal slow waves regularity(p=0.003) and power ratio (p=0.001) in the patients had the statistical significance and they showed an incremental inverse correlation with the number of symptoms. Dominant frequency and fasting normal slow waves regularity ratio had no statistical significance. Conclusion : Results suggest that electrogastrography is useful in evaluating the health condition of patient by comprehensive diagnosis of Qui Xue Sui.

• Korean Journal of Acupuncture
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• 제40권2호
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• pp.44-53
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• 2023

Objectives : This study was conducted to reveal the relationship between multiple factors of traditional Korean Medicine diagnosis and consider the further probabilities of treating people with physical and mental problems not defined as diseases, which is called 'Mibyeong' in traditional Korean Medicine. Methods : 40 healthy participants were included in the observational clinical trial. The participants were asked to complete health questionnaires (e.g. State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Stress Response Inventory) and they went through a traditional diagnosis process, including four stages of diagnosis (looking, listening/smelling, inquiring, and pulse taking), by a Korean Medicine doctor. Both the Korean Medicine doctor and an artery tonometry device performed the pulse diagnosis. Results : Although all participants were healthy people with no history of disease, more than half of participants had a problem related with severe level of fatigue (n=19), sleep disturbance (n=26) and stress (n=27) status according to the related questionnaires. Participants diagnosed with phlegm syndrome by the Korean Medicine doctor showed significantly greater score in phlegm pattern questionnaires than participants who were not. However, there was little agreement between the doctor's pulse diagnosis and radial artery tonometry results. Conclusions : We conducted a pulse diagnosis and measured health-related information along with the traditional Korean Medicine diagnose procedure, including four stages of diagnosis, and we found a linkage between diagnosis of phlegm and the phlegm pattern questionnaire score. The results suggest that a number of healthy participants, with no disease diagnosed, have Mibyoung symptoms which need further clinical management. Thus, we suggest that Mibyoung management programs based on qualified diagnosis tools and traditional Korean medicine diagnosis procedures be developed, and that future research using various diagnostic tools be carried out on a large population.

• 대한안전경영과학회지
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• 제18권2호
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• pp.93-100
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• 2016

This study implemented the survey and analysis of the exposure to radiation by using the questionnaire targeting H Health College, located in Daejeon from September 1st, 2014 to October 15th. A total of 400 copies of the questionnaire was distributed and among them, 385 copies, excluding 15 omitted ones (total collection ratio: 96.3%), were used for the analysis. The analysis results are as follows. For the harmfulness of radiation for diagnosis, the average of the health-related was 3.15 and the average of the health-unrelated was 2.82, which the health-related students recognized the harmfulness of radiation for diagnosis higher (p<.001). The necessity of radiation for diagnosis was appeared higher from the health-related students as the average of the health-related was 3.07 and 2.52 for the average of the health-unrelated (p<.001). The recognition on the prevention of the exposure to radiation was higher from the health-related students as the average of the health-related was 3.13 and 1.84 for the average of the health-unrelated (p<.001). From this study, the necessity of using radiation from the medical field and the recognition on its harmfulness appeared to have a big difference between the health-related and health-unrelated. For such, the accurate understanding of the recognition on radiation and the education to improve recognition on radiation are considered to be required.

• 한국의료질향상학회지
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• 제3권1호
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• pp.126-143
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• 1996

Background : Little work has been carried out regarding quality assessment research in a primary care setting, comparing with that of hospitals. This study aims to evaluate the process of diagnosis and management of hypertension by public health doctors on the basis of pre-established clinical guideline, and to identify several modifying factors associated with them. Methods : Hypertension was selected as the target disease, because it is a chronic disease which is of great public health importance. Self-administered questionnaires were mailed to public health doctors practicing at health centers and health subcenters across the nation. The response rate was 20.9%. The questionnaire included the diagnosis and management process such as measuring blood pressure, history taking, physical examinations, and treatment approches and potentially modifying factors such as level of training, duration of practice as a public health doctor, and education on management of hypertension. Results : Public health doctors pay little attention in measuring BP, hypertension related history taking, performing physical examination and laboratory examination. But they devoted much effort in diagnosing hypertension exactly and giving nonpharmacological treatment. Among various antihypertensive drugs, calcium-channel blockers were the most preferred agent(50.9%). Level of training, duration of practice ad a public health doctor, and education on management of hypertension made no difference on quality of care(p>0.05). Conclusion : These public health doctors showed poor compliance with the pre-established clinical guidelines, which leaves much to be desired in diagnosing and managing hypertensive patients by public health doctors. This study might be able to contribute to develop some strategies, such as educational programs, which would be able to improve the process of care in hypertensives.

• Journal of Preventive Medicine and Public Health
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• 제46권5호
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• pp.249-260
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• 2013

Objectives: Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH). Methods: We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors. Results: Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on ${\geq}20$ days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis ${\geq}13$ years) were more likely than non-diabetics to report heavy cigarette smoking (smoking ${\geq}10$ cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30). Conclusions: The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.

• 대한간호학회지
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• 제26권1호
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• pp.177-193
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• 1996

For the purpose of integrating nursing diagnosis into the nursing curriculum, a descriptive survey research was done using the inductive method with questionnaires and a literature review. Research subjects included nurse educators, textbooks of adult nursing published in Korea, and the course outline for adult nursing used in one college of nursing. The Results show that there was common agreement on 39 nursing diagnosis which should be in cluded in the adult nursing curriculum, textbooks of adult nursing, and patient care on the medical-surgical units. The two existing nursing diagnosis classification systems(NANDA and Gordon's Human Response Patterns) show different basic frameworks and difficulties were discovered in integration of nursing diagnosis into the curriculum. To develop a conceptual framework for a nursing diagnosis classification system, diagnosis were classified into three categories ; health promotion, high risk problem, and actual problem on the basis of the framework used in adult nursing textbooks and Gordon's 11 Functional Health Patterns. Subconcepts for actual problems were classified as ; activity and rest, nutrition and elimination, perception and coordination, stress and coping. Progress in this study supports further development of a conceptual framework of nursing based on a nursing diagnosis classification system, from which improvement in nursing education and clinical practice can be expected.

• 디지털콘텐츠학회 논문지
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• 제9권1호
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• pp.27-31
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• 2008

u-Health는 유비쿼터스 IT의 대표적인 실현방식이며 우리 삶을 풍요롭게 만들 산업 영역으로 부각되고 있다. u-Health를 통하여 병원 중심의 진료라는 공간적 제약을 넘어, 생활과 진료공간을 자연스레 결합시키면서 일상 속에서 보편적 가치로 자리를 잡을 것이다. 이 논문에서 제안하는 시스템은 현제 진행 중인 u-Health 시대에 맞는 과학적이고 객관적인 지식으로 전문가의 도움을 받는 것과 동일한 효과를 얻을 수 있는 체계적이고 지능적인 휴대용 의료정보시스템을 제안하고자 한다. 휴대용 의료정보시스템은 의학적인 전문적인 지식을 요하는 문제의 해결에 필요한 경험, 지식 및 전문가의 의사결정 과정을 컴퓨터에 이식하고 이를 이용자가 이용함으로서 추론 과정을 거쳐 전문가의 견해를 제공받을 수 있다.

• 보건행정학회지
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• 제27권3호
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• pp.211-218
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• 2017

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.