• Journal of information and communication convergence engineering
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• 제10권4호
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• pp.337-342
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• 2012

The medical industries are integrated with information technology with mobile devices and wireless communication. The advent of mobile healthcare systems can benefit patients and hospitals, by not only providing better quality of patient care, but also by reducing administrative and medical costs for both patients and hospitals. Security issues present an interesting research topic in wireless and pervasive healthcare networks. As information technology is developed, many organizations such as government agencies, public institutions, and corporations have employed an information system to enhance the efficiency of their work processes. For the past few years, healthcare organizations throughout the world have been adopting health information systems (HIS) based on the wireless network infrastructure. As a part of the wireless network, a mobile agent has been employed at a large scale in hospitals due to its outstanding mobility. Several vulnerabilities and security requirements related to mobile devices should be considered in implementing mobile services in the hospital environment. Secure authentication and protocols with a mobile agent for applying ubiquitous sensor networks in a healthcare system environment is proposed and analyzed in this paper.

• 보건행정학회지
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• 제28권2호
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• pp.138-144
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• 2018

Background: Diagnostic imaging fee had been reduced in May 2011, but it was recovered after 6 months because of strong opposition of medical providers. This study aimed to analyze the behavior of medical providers according to fee changes. Methods: The National Health Insurance claims data between November 2010 and December 2012 were used. The number of exams per computed tomography was analyzed to verify that the fee changes increased or decreased the number of exams. Multivariate regression model were applied. Results: The monthly number of exams increased by 92.5% after fee reduction, so the diagnostic imaging spending were remained before it. But medical provider decreased the number of exams after fee return. After adjusting characteristic of hospitals, fee reduction increased the monthly number of exams by 48.0% in a regression model. Regardless type of hospitals and severity of disease, the monthly number of exams increased during period of fee reduction. The number of exams in large-scaled hospitals (tertiary and general hospital) were increased more than those of small-scaled hospitals. Conclusion: Fee-reduction increased unnecessary diagnostic exams under the fee-for-service system. It is needed to define appropriate exam and change reimbursement system on the basis of guideline.

• 한국병원경영학회지
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• 제16권4호
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• pp.35-66
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• 2011

This study analyzed efficiency by utilizing DEA analytical technique centering on materials for 2009 of 20 major university hospitals in capital area. Input variables were utilized professor & full-time doctor, resident, nurse & number of bed hospitals. Output variables were analyzed by dividing number of annual outpatients & number of annual inpatients, and annually total outpatient profit & inpatient profit into a model of the standard for number of patients and the standard for medical profit. DEA analysis was elicited efficiency score by applying CCR, BCC, BFG, scale profit, and SE model. Through t-test after eliciting efficiency score, the implications were suggested by comparing efficiency between DMU in Seoul and DMU in capital area, by comparing between high-class general hospitals and general hospitals, and by comparing between high-class general hospitals in Seoul and 5 big hospitals. As a result of analysis, the major university hospitals in capital area showed high efficiency as a whole close to "1," but indicated low efficiency relatively in CCR field. Thus, the expansion in scale within capital area was indicated to reach the limit. Second, in a model of analyzing the standard for number of patients, the medical institutions, which are being operated efficiently, were indicated to be 10 DMUs. In the standard for medical profit, 12 DMUs were analyzed to be operated efficiently. Third, the efficiency in general hospital was higher than high-class general hospital. Thus, the efficiency of operation was indicated to be more important than scale. Also, large high-class hospitals(big 5) where are located in downtown Seoul showed the higher efficiency than other general high-class general hospitals, but were indicating very low efficiency in some DMUs. Fourth, as a result of generalizing and evaluating the number of patients and the medical profit, the efficient DMU was indicated to be more when analyzing on the basis of medical profit than the standard for number of patients. Thus, major university hospitals in capital area were indicated to make more effort for section in medical profit. Based on the analytical results of efficiency, a strategy for reinforcing efficiency in inefficient DMU was indicated to be needed a strategy of creating customers for promoting number of patients and a strategy for making operation efficient for increasing profitability.

• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.206-215
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• 2014

Objectives: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. Methods: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. Results: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. Conclusions: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

• 한국의류학회지
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• 제26권1호
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• pp.168-178
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• 2002

This study is aimed at investigating and comparing the differences in the uniform of nurses according to regions and hospital size in Korea. This study takes two large regions as its survey area; one is Seoul, Incheon and Gyeonggi Province, and the other is Daejon and Chungcheong Province. The hospital size is divided into general hospitals and neighborhood hospitals. The survey was conducted among the nurses working in 12 randomly-selected hospitals and its statistical results are analysed firm 818 respondents'questionnaires. The results are divided into 3 categories as follows; 1) Results of analysis of survey on the uniform of nurses : Nurses usually wear two-piece suits and more than half of the hospitals choose a white-color pattern. And the nurse's uniform with color varying according to their position and ward is considered to be desirable; 2) Analysis on regional differences : In the case of Daejon and Chungcheong Province, there is a relatively high ratio of respondents who answered questions with 'high percentage of young nurses', 'position differentiation by means of different design and fabric according to ward'. In case of Seoul, Incheon and Gyeonggi Province, questions with 'use of a patterned textile in nurses'uniform', 'ready-made size system'are higher; 3) Analysis of the differences in accordance with hospital size : In the case of general hospitals, there is relatively a high ratio of respondents who answered questions with 'use of different design and fabric according to a nurse's position', 'use of patterns in nurses'uniform'. In the case of neighborhood hospitals, there is a high ratio of respondents with'use of classical one-piece or two-piece type wear', 'ready-made type size system', 'obligatory use off nurse's cap'.

• 보건행정학회지
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• 제28권2호
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• pp.168-177
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• 2018

Background: This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample. Methods: We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis. Results: After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively. Conclusion: Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.

• 한국병원경영학회지
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• 제6권2호
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• pp.115-137
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• 2001

The purpose of this study is to find out the successful way of the hospital management focusing on the OCS. More than 40 educational hospitals have OCS. However, only five of them were chosen for the research. Questionnaires are collected from more than 750 persons working in five educational hospitals and some of them were interviewed. The major conclusions of the study can be summarized as follows: o The OCS has simplified the treatment procedure for outpatients, and the outpatients' waiting time has been shortened. o Higher rate of satisfaction was found among the personnel in general. o The number of patients who visited outpatients clinics has increased, so as the hospital profits: the personnel are rescheduled or sent to other departments the number of employees in hospitals have decreased. o The system has the positive effect on large hospitals with over 1000 beds, highly invested hospitals, well computerized hospitals and where the personnel are much interested in the system. o The managers' and the doctors' intention to utilize the OCS is the most important factor influencing the patients' convenience, the simplification of the work and the rate of the employees' satisfaction about their duties. The suggestions for more efficient hospital management through the OCS are as follows ; o The managers and the doctors are need to decide to make active use of the OCS. o The hospital can be run more effective under the clear management purpose. o The work in the hospital must be standardized based on patients' needs. o The OCS must be built and developed mainly for the users' utility. o The education of the personnel and the inspection of the program are necessary before the OCS is introduced. o The hardware should be thoroughly benchmarked before the purchase.

• 대한임상독성학회지
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• 제5권2호
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• pp.106-111
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• 2007

Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{\pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.322-327
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• 2023

Situs inversus totalis (SIT) is a rare condition in which cardiac and abdominal organs are inverted from their normal left-sided orientation. Mirizzi syndrome, characterized by the obstruction of the common hepatic duct or the common bile duct by gallstone, is a rare condition. Mirizzi syndrome co-occurrence in SIT patients is rare. Gallbladder in sinistroposition is extremely uncommon in SIT patients. We report a known case of diabetes, ventricular septal defect with transposition of the great arteries in a 32-year-old female who presented with jaundice, cholangitis, chills, and fever that had lasted for 10 days. She was confirmed to have SIT with type III Mirizzi syndrome following a series of diagnostic procedures. Primarily, endoscopic retrograde cholangiopancreatography along with common bile duct stenting was performed to initially reduce cholangitis. After an eight-week follow-up after the reduction of cholangitis, surgery was conducted. Mirror-imaged ports were used for the laparoscopic procedure, and the surgeon was on the patient's right side rather than the usual left side. The patient was discharged from the hospital following two days of uneventful healing.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.30-39
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• 2022

Objective : There are different types of cerebral vascular malformations. Pial arteriovenous fistulas (PAVFs) and dural arteriovenous fistulas (DAVFs) are two entities; they consist of one or more arterial connections to a single venous outlet without a true intervening nidus. The high turbulent flow of PAVFs and aggressive DAVFs with cortical venous reflux can result in venous outflow varix and aneurysmal dilatation. They pose a significant challenge to transvenous embolization (TVE), stereotactic radiosurgery, and surgical treatment. We aim to share our centers' experience with the transarterial embolization (TAE) for arteriovenous fistulas (AVFs) with large venous pouches and to report the outcome. Methods : The authors' two institutions' databases were retrospectively reviewed from February 2017 to February 2021. All patients with intracranial high flow PAVFs and aggressive DAVFs with venous outlet ectasia and large venous varix and were treated by TAE were included. Results : Fifteen patients harboring 11 DAVFs and four PAVFs met our inclusion criteria. All patients underwent TAE in 17 sessions. Complete angiographic obliteration was achieved after 14 sessions in 12 patients (80%). Four patients (25%) had residual after one TAE session. Technical failure was documented in one patient (6.7%). Fourteen patients (93.3%) had favorable functional outcome (modified Rankin score 0-2). Conclusions : TAE for high flow or aggressive intracranial AVFs is a safe and considerable treatment option, especially for those associated with large venous pouches that are challenging and relatively high-risk for TVE.