• Title/Summary/Keyword: medical statistics

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A Study on the Classification and Research Trends of Articles in The Korean Journal of Rural Medicine (한국농촌의학회지(韓國農村醫學會誌)에 게재된 연구논문의 분류 및 연구동향)

  • Wee, You-Mee;Kim, Suk-Il;Park, Hyang;Ryu, So-Yeon;Park, Jong;Kim, Ki-Soon
    • Journal of agricultural medicine and community health
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    • v.25 no.2
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    • pp.231-244
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    • 2000
  • Classification and research trends were studied to analyze a total of 240 original articles that have been published in 34 volumes of The Korean Journal of Rural Medicine from 1976 to 1999. The results were as follows: 1. A total of 337 articles were published. Among them, 240(71.2%) articles were classified as original articles. This number has been increasing significantly over the years as the number of the articles was 13 in the 1970s, 73 in the 1980s, and 154 in the 1990s. 2. There were 10 authors in the original articles and 55(22.9%) of them were written by 3 of them. There were five research institutions involved in the articles, and 106(44.2%) of the articles were done by one research group. 3. In the original articles. 24(10.0%) were noted to be done using research funds, and only 6(2.5%) were written in English. 4. In the view of the research styles of the original articles, 115(47.9%) used analytical study, 92(38.3%) used technical study, 21(9.2%) used experimental study, and 6(2.5%) used case reports. In the 1970s, 13(100.0%) articles used technical study, and in the 1980s, 47(64.4%) used technical studies and 19(26.0%) used analytical studies. However, in the 1990s, 96(62.8%) articles used analytical studies and 32(20.9%) used technical studies. The statistical methods most commonly used in the articles were technical statistics, the ${\chi}^2$-test, and the t-test respectively. 5. On the classification into three different research fields, 105(43.8%) articles were classified as health management, 96(40.0%) as disease epidemiology, and 39(16.3%) as rural environment and rural occupational disorders. In the 1970s, 12 (92.3 %) of the articles were on disease epidemiology and 1(7.7%) on health management were published. In the 1980s, 33(45.2%) articles on disease epidemiology, 29(39.7%) on health control, and 11(15.1%) on rural environment and rural occupational disorders were recorded. In the 1990s, however, 75(48.7%) articles were on health control, 51(33.1%) on disease control, and 28(18.2%) on the rural environment and rural occupational disorders. 6. According to the research subjects in each research field, the 39 articles in rural environment and rural occupational disorders were composed of 8(20.5%) articles on pesticide intoxication, 7(17,9%) on farmer's diseases, 7(17.9%) on vinyl-house diseases, and 6(15.4%) on accidents. From a total of 96 articles in disease epidemiology 56(58.3%) articles were on parasites, 16(16.7%) on non-infectious diseases, 12(12.5) on infectious diseases. From 105 articles in health control 25(23.8%) articles were on medical care utilization patterns, 18(17.1%) on the health care delivery system, and 13(12.4%) on maternal and child health. In the analysis of the 10 most prevalent subjects dealt in the above articles, 6(46.2%) articles were on parasites and 4(30.8%) on non-infectious diseases were recorded in the 1970s. In the 1980s, 28(38.4%) were on parasites. 9(12.3%) on the health care system, 7(9.6%) on medical care utilization patterns, 5(6.8%) on maternal and child health, and 4(5.5%) were on pesticide intoxication. In the 1990s, 22(14.3%) articles were on parasites. 18(11.7%) on medical care utilization patterns, 16(10.4%) on senile health, 14(9.1%) on the health care system, 10(6.5%) on infectious diseases, arid 10(6.5%) were on non-infectious diseases. In conclusion, the research activity on rural health has been strengthened in this country because the original articles in The Korean Journal of Rural Medicine have significantly increased in the past 24 years. In the 1970s and 1980s, research on disease epidemiology was most prevalent, but in the 1990s papers on health care were most popular. In addition, the articles on parasites were most frequently published in the 1970s, 1980s, and 1990s, showing that parasitic problem was the main theme in those eras. However, in the 1990s, it was evident that the articles on parasites were decreasing and articles on the subject of medical care utilization patterns and senile health increased. Hereafter it was expected that research on health care would be more common in rural health in Korea.

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CQI Action Team Approach to Prevent Pressure Sores in Intensive Care Unit of an Acute Hospital Korea (중환자의 욕창 예방 연구 : 욕창 예방 QI팀을 중심으로)

  • Kang, So Young;Choi, Eun-Kyung;Kim, Jin-Ju;Ju, Mi-Jung
    • Quality Improvement in Health Care
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    • v.4 no.1
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    • pp.50-63
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    • 1997
  • Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

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Analyzing Contextual Polarity of Unstructured Data for Measuring Subjective Well-Being (주관적 웰빙 상태 측정을 위한 비정형 데이터의 상황기반 긍부정성 분석 방법)

  • Choi, Sukjae;Song, Yeongeun;Kwon, Ohbyung
    • Journal of Intelligence and Information Systems
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    • v.22 no.1
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    • pp.83-105
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    • 2016
  • Measuring an individual's subjective wellbeing in an accurate, unobtrusive, and cost-effective manner is a core success factor of the wellbeing support system, which is a type of medical IT service. However, measurements with a self-report questionnaire and wearable sensors are cost-intensive and obtrusive when the wellbeing support system should be running in real-time, despite being very accurate. Recently, reasoning the state of subjective wellbeing with conventional sentiment analysis and unstructured data has been proposed as an alternative to resolve the drawbacks of the self-report questionnaire and wearable sensors. However, this approach does not consider contextual polarity, which results in lower measurement accuracy. Moreover, there is no sentimental word net or ontology for the subjective wellbeing area. Hence, this paper proposes a method to extract keywords and their contextual polarity representing the subjective wellbeing state from the unstructured text in online websites in order to improve the reasoning accuracy of the sentiment analysis. The proposed method is as follows. First, a set of general sentimental words is proposed. SentiWordNet was adopted; this is the most widely used dictionary and contains about 100,000 words such as nouns, verbs, adjectives, and adverbs with polarities from -1.0 (extremely negative) to 1.0 (extremely positive). Second, corpora on subjective wellbeing (SWB corpora) were obtained by crawling online text. A survey was conducted to prepare a learning dataset that includes an individual's opinion and the level of self-report wellness, such as stress and depression. The participants were asked to respond with their feelings about online news on two topics. Next, three data sources were extracted from the SWB corpora: demographic information, psychographic information, and the structural characteristics of the text (e.g., the number of words used in the text, simple statistics on the special characters used). These were considered to adjust the level of a specific SWB. Finally, a set of reasoning rules was generated for each wellbeing factor to estimate the SWB of an individual based on the text written by the individual. The experimental results suggested that using contextual polarity for each SWB factor (e.g., stress, depression) significantly improved the estimation accuracy compared to conventional sentiment analysis methods incorporating SentiWordNet. Even though literature is available on Korean sentiment analysis, such studies only used only a limited set of sentimental words. Due to the small number of words, many sentences are overlooked and ignored when estimating the level of sentiment. However, the proposed method can identify multiple sentiment-neutral words as sentiment words in the context of a specific SWB factor. The results also suggest that a specific type of senti-word dictionary containing contextual polarity needs to be constructed along with a dictionary based on common sense such as SenticNet. These efforts will enrich and enlarge the application area of sentic computing. The study is helpful to practitioners and managers of wellness services in that a couple of characteristics of unstructured text have been identified for improving SWB. Consistent with the literature, the results showed that the gender and age affect the SWB state when the individual is exposed to an identical queue from the online text. In addition, the length of the textual response and usage pattern of special characters were found to indicate the individual's SWB. These imply that better SWB measurement should involve collecting the textual structure and the individual's demographic conditions. In the future, the proposed method should be improved by automated identification of the contextual polarity in order to enlarge the vocabulary in a cost-effective manner.

Effect of Work Improvement for Promotion of Outpatient Satisfaction on CT scan (CT 외래환자의 만족도 향상을 위한 업무개선 연구)

  • Han, Man-Seok;Lee, Seung-Youl;Lee, Myeong-Goo;Jeon, Min-Cheol;Cho, Jae-Hwan;Kim, Tae-Hyung
    • Journal of radiological science and technology
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    • v.35 no.1
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    • pp.45-50
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    • 2012
  • Nowadays, most of the hospital serves "one stop service" for CT scan. The patients could be taken the CT scan in the day they register for scan. On the contrary to the time convenience, patients are not satisfied with long waiting time and unkindness of staff. The objective of this study is to improve the patient's satisfaction for the CT scan, by analyzing inconvenience factors and improving the service qualities. From April 1 to August 30 in 2011, we investigated the satisfaction of patients who did examined abdomen CT scan with contrast media. We analyzed the 89 questionnaires before and after the service improvements from them. The worker's kindness, the environment of CT room and understanding about CT scan were answered by questionnaire and the waiting time of a day CT scan was drawn by medical information statistics. Also, the period before improvement was from April to June and the period after improvement was from July to September. And these questionnaire was analyzed through SPSS V. 15.0. In this study, kindness of staff, environment of CT room, intelligibility for CT scan and waiting time was explored and analyzed by SPSS V.15.0. The score of kindness was improved by 32%, satisfaction level of the environment was improved by 52.54%. The understanding level about CT scan was improved by 52.36% and the wating time of a day CT was shortened by 21% through our service enhancement programs. Consequentially, it is considered that these efforts would contribute to increase the revenue of hospital.

The Survey of Dentists: Updated Knowledge about Basic Life support and Experiences of Dental Emergency in Korea

  • Cho, Kyoung-Ah;Kim, Hyuk;Lee, Brian Seonghwa;Kwon, Woon-Yong;Kim, Mi-Seon;Seo, Kwang-Suk;Kim, Hyun-Jeong
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.14 no.1
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    • pp.17-27
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    • 2014
  • Background: Various medical emergency situations can occur during dental practices. Cardiac arrest is known to comprise approximately 1% of emergency situation. Thus, it is necessary for dentists to be able to perform cardiopulmonary resuscitation (CPR) to increase the chance of saving patient's life in emergency situation. In this paper, we conducted a survey study to evaluate to what extent dentists actually understood CPR practice and if they had experience in handling emergency situations in practice. Method: The survey was done for members of the Korean Dental Society of Anesthesiology (KDSA), who had great interest in CPR and for whom survey-by-mail was convenient. We had selected 472 members of the KDSA with a dental license and whose office address and contact information were appropriate, and sent them a survey questionnaire by mail asking about the degree of their CPR understanding and if they had experience of handling emergency questions before. Statistical analyses -frequency analysis, chi-square test, ANOVA, and so on- were performed by use of IBM SPSS Statistics 19 for each question. Result: Among 472 people, 181 responded (38.4% response rate). Among the respondents were 134 male and 47 female dentists. Their average age was $40.4{\pm}8.4$. In terms of practice type, there were 123 private practitioners (68.0%), 20 professors (11.0%), 16 dentists-in-service (8.8%), 13 residents (specialist training) (7.2%) and 9 military doctors (5%). There were 125 dentists (69.1%) who were specialists or receiving training to be specialist, most of whom were oral surgeon (57, 31.5%) and pediatric dentists (56, 30.9%). There were 153 people (85.0%) who received CPR training before, and 65 of them (35.9%) were receiving regular training. When asked about the ratio of chest pressure vs mouth-to-mouth respiration when conducting CPR, 107 people (59.1%) answered 30:2. However, only 27.1% of them answered correctly for a question regarding CPR stages, C(Circulation)- A(Airway)- B(Breathing)- D(Defibrillation), which was defined in revised 2010 CPR practice guideline. Dentists who had experience of handling emergency situations in their practice were 119 (65.6%). The kinds of emergency situations they experienced were syncope (68, 37.6%), allergic reactions to local anesthetic (44, 24.3%), hyperventilation (43, 23.8%), seizure (25, 13.8%), hypoglycemia (15, 8.3%), breathing difficulty (14, 7.8%), cardiac arrest (11, 6.1%), airway obstruction (6, 3.3%), intake of foreign material and angina pectoris (4, 2.2%), in order of frequency. Most respondents answered that they handled the situation appropriately under the given emergency situation. In terms of emergency equipment they had blood pressure device (70.2%), pulse oximetry (69.6%), Bag-Valve-Mask (56.9%), emergency medicine (41.4%), intubation kit (29.8%), automated external defibrillator (23.2%), suction kit (19.3%) and 12 people (6.6%) did not have any equipment. In terms of confidence in handling emergency situation, with 1-10 point scale, their response was $4.86{\pm}2.41$ points. The average point of those who received regular training was $5.92{\pm}2.20$, while those who did not was $4.29{\pm}2.29$ points (P<0.001) Conclusion: The result showed they had good knowledge of CPR but the information they had was not up-to-date. Also, they were frequently exposed to the risk of emergency situation during their dental practice but the level of confidence in handling the emergency situation was intermediate. Therefore, regular training of CPR to prepare them for handling emergency situation is deemed necessary.

A Study of a Pattern of the Stress Perceived by Stroke Patients through the Rehabilitative Process (뇌졸중 환자의 재활과정에 따른 스트레스 변화 양상)

  • Lee, Jung-Min
    • Journal of East-West Nursing Research
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    • v.1 no.1
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    • pp.82-98
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    • 1997
  • The purpose of this study was to determine pattern of the stress perceived by stroke patients over time. The ultimate goal of the research is to provide data to help nurses to design the plan of nursing care of the stroke patients both in the hospital and at home. A total of 57 admitted stroke patients were collected from one general hospital in Seoul from June, 12 to September, la, 1993. The data were collected for three phases(within one week after leaving the hospital). The tools for this study, three scales were used ; Stress scale developed by the investigator. Constitution classifing scale designed by Kho(1984), and Self-care measuring scale by Kang(1984). Data were analyzed in four steps using statistical analysis. First, demographic data were determined by descriptive statistics. Second. the pattern of stress perceived by stroke patients across three phases was measured using repeated measures ANOVA. Third, stress of stroke patients classified by constitution, paralyzed area. and attack frequency were measured using ANOVA or t-test, and the pattern of stress by group over time was determined using paired t-test in post hoc test. Fourth. Pearson correlation coefficients were calculated to determine the relationship between the stress and self-care activities. The results of this study are ; 1. The pattern of stress across three phases ; There was a decrease of the stress across three phases. In general. psychological stress as the highest among three phases(F=36.92. P=.000). There was a statistically significant difference of the physical stress(F=34.55, p=.000), the psychological stress (F=15.49, p=.0005) and the social stress (F=24.71. p=.000) among three phases. There was a statistically significant difference of the stress between the first phase (on admission) and the second phase(before leaving the hospital) and was a decrease of the stress (t =6.36. p=.000). 2. The pattern of stress of stroke patients classified by constitution across three phases ; Stroke patients classified as So-Eum perceived the highest stress among three groups(Tae-Eum, So-Eum. So-Yang). There was no statistically significant difference of stress according to the constitution of stroke patients among three phases. Hence. stress was not influenced by the constitution of stroke patients, but there was a statistically significant difference of stress over time. 3. The pattern of stress of stroke patients classified by the paralyzed area across three phases ; Right paralyzed stroke patients perceived higher stress than left paralyzed stroke patients. There was, however, no statistically significant difference of stress between two groups except 2nd phase. There was no statistically significant difference of the perception of stress bet ween the right and left paralyzed stroke patients. 4. The pattern of stress of stroke patients classified by the frequency of the relapse of the disease across three phases ; Stress was higher in stroke patients who had the relapse of the disease twice more than the first time. There was, however, no statistically significant difference of stress between two groups. There was no statistically significant difference of stress of stroke patients according to the relapse of the disease among three phases. Hence, stress was no influenced by the relapse of the disease. 5. The relationship between the stress and self-care activities ; There was a negative relationship between the stress and self-care activities each phase(on admission, r= -.1563 ; before leaving the hospital, r= -.4030 ; after leaving the hospital, r= -.5291). Hence, the higher the self-care activities, the lower the stress. This study has three important findings. First finding was that psychological stress perceived by stroke patients was the highest among three phases. The second finding was that factors such as the constitution, the paralyzed area, and the relapse of the disease did not have an influence on the stress perceived by stroke patients across three phases(on admission, before leaving the hospital, after leaving the hospital). There was a statistically significant decrease of the stress perceived by stroke patients across three phases. The third finding was that there was a negative relationship between the self-care ability and stress. In this study, these findings have implications for nursing care for the rehabilitation of stroke patients and suggest the need of nursing intervention to promote the self-care ability and to support the psychological self-esteem of stroke patients.

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Job Analysis for Role Identification of General Hospice Palliative Nurse (호스피스 완화 간호사 역할규명을 위한 직무분석)

  • Kim, Boon-Han;Choe, Sang-Ok;Chung, Bok-Yae;Yoo, Yang-Sook;Kim, Hyun-Sook;Kang, Kyung-Ah;Yu, Su-Jeong;Jung, Yun
    • Journal of Hospice and Palliative Care
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    • v.13 no.1
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    • pp.13-23
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    • 2010
  • Purpose: This study was to identify the role of general hospice palliative nurse through job analysis (duties, task, and task elements). Methods: The sample consisted of 136 nurses or professors who were performing duties related to hospice care areas in Korea. A survey method was used, and the questionnaire included frequencies, criticality, and difficulties of task elements in job description by the DACUM method. Descriptive statistics were performed by using SPSS WIN 17.0. Results: The job description of general hospice palliative nurse was identified 8 duties, 36 tasks, and 137 task elements. As for the 8 duties, the average scores of frequency, criticality, and difficulty were 2.94, 3.66, and 2.80, respectively. The role of ‘pain assessment’ was the most important task element among frequency and criticality. The lowest score at the frequency and criticality were ‘manage public finance’ and ‘collect datum through diagnostic test & lab', respectively. Furthermore, the role of 'identify spiritual needs of patients and family' was the most difficult task, whereas the role of 'manage documents and information' was the least. Conclusion: In this study, we could recognize the reality of general hospice palliative nurse's performances. For general hospice palliative nurse, therefore, concrete practice guide lines of psychosocial and spiritual care, communication skills, and bereavement care with qualifying system are critically needed.

Study for Diagnostic Correspondent Rates between DSOM and Oriental Medical Doctors (한방진단시스템과 진단의 간의 진단일치도 연구)

  • Lee, In-Seon;Lee, Yong-Tae;Chi, Gyoo-Yong;Kim, Jong-Won;Kim, Kyu-Kon
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.22 no.6
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    • pp.1359-1367
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    • 2008
  • DSOM(Diagnosis System of Oriental Medicine) was made as a computerized assistant program for oriental medicine doctors to be able to diagnose with statistical basis. Then DSOM uses questionnaires filled out by subjects without enough explanatory guide. If the subject misunderstand the meaning of the passages, we might not rely on that result. So I designed this study to investigate the diagnostic correspondent rates between DSOM and practitioners. First, let the respondents answer to DSOM(DSOM-Ⅰ for the rest). After that, three doctors diagnosed the respondents and marked how much they had symptoms about 16 pathogenic factors in the score range 0${\sim}$5('0' means they didn't have that symptom, '1' means they had that symptom but mild, '3' means they had that symptom moderately, '5' means they had that symptom severely. And let the respondents answer to DSOM(DSOM-Ⅱ for the rest) again. Finally, we investigated the correspondent rates of diagnosis between DSOM-Ⅰ,Ⅱ and doctors'. We obtained conclusions as following. In the comparison of output frequency rate of the pathogenic factors, the difference between DSOM-Ⅰ and Ⅱ was 1%. In the correspondent rates of diagnosis between DSOM-Ⅰ,Ⅱ and doctors', In DSOM-Ⅰ and Ⅱ answered by subjects two times respectively, the correspondent rate was highest in insufficiency of Yang(陽虛) and liver(肝) as 93.2%, lowest in damp(濕) as 69.5% and showed 81.9% in all 16 pathogenic factors mean. In DSOM-Ⅰ and Ⅱ, and Doctors' diagnose, they showed the complete correspondent rates of 15.3${\sim}$61.0%, 15.3${\sim}$59.3% in individual pathogenic factor, 36.5%, 37.3% in all 16 pathogenic factors mean each, and within ${\pm}$1 errorrange, they showed the correspondent rates of 32.2${\sim}$93.2%, 35.6${\sim}$89.8% in individual pathogenic factor, 67.6%, 67.3% in all 16 pathogenic factors mean each, and within ${\pm}$2 error range, they showed the correspondent rates of 62.7${\sim}$98.3%, 71.2${\sim}$100% in individual pathogenic factor, 85.1 87.6%% in all 16 pathogenic factors mean each. In the correspondent rates of the severe case, In the cases that the Doctors' diagnostic score mean was over 3(the severity of disease is middle), there were deficiency of qi(氣虛), stagnation of qi(氣滯), blood stasis(血瘀), damp(濕), liver(肝), heart(心), spleen(脾) and they all showed the correspondent rates of over 60 except blood stasis(血瘀). In the cases that the weighed pathogenic factor was above 9, the correspondent rates were 50${\sim}$100%. deficiency of qi(氣虛), blood-deficiency(血虛), stagnation of qi(氣滯), blood stasis(血瘀), insufficiency of Yin(陽虛), insufficiency of Yang(陽虛), coldness(寒), heat (熱), damp(濕), dryness(燥), liver(肝), heart(心), spleen(脾), kidney(腎), phlegm(痰).

Analyses of the Efficiency in Hospital Management (병원 단위비용 결정요인에 관한 연구)

  • Ro, Kong-Kyun;Lee, Seon
    • Korea Journal of Hospital Management
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    • v.9 no.1
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    • pp.66-94
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    • 2004
  • The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

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Application of Patient Safety Indicators using Korean National Hospital Discharge In-depth Injury Survey (퇴원손상심층자료를 이용한 환자안전지표의 적용)

  • Kim, Yoo-Mi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.5
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    • pp.2293-2303
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    • 2013
  • Objective: This study aims to determine whether national patient safety indicators (PSIs) can be calculated. Methods: Using PSI criteria from Organization for Economic Co-Operation and Development (OECD) Health Technical Papers 19 based on the Agency for Healthcare Research and Quality (AHRQ), PSIs were identified in the Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) database for 875,622 inpatient admissions between 2004 and 2008. Logistic regression was used to estimate factors of variations for PSIs. Results: From 2004 to 2008, 3,084 PSI events of 8 PSIs occurred for over 80 thousands discharges. Rates per 1,000 events for decubitus ulcer (PSI3, 4.88), foreign body left during procedure (PSI5, 0.05), postoperative sepsis (PSI13, 1.32), birth trauma-injury to neonate (PSI17, 7.92) and obstetric trauma-vaginal delivery (PSI18, 32.81) are all identified between ranges from maximum to minimum of OECD rates, respectively. However, rates per 1,000 events for selected infections due to medical care (PSI7, 0.22), postoperative pulmonary embolism or deep vein thrombosis (PSI12, 0.90) and accidental puncture or laceration (PSI15, 0.71) are below the minimum of OECD range. 7 PSIs except PSI 18 showed statistically significant relationship with number of secondary diagnoses. When adjusting patient characteristics, there are statistically significant different rates according to bed size or location of hospitals. Conclusion: This is the first empirical study to identify nationally number of adverse events and PSIs using administrative database. While many factors influencing these results such as quality of data, clinical data and so on are remain, the results indicate opportunities for estimate national statistics for patient safety. Furthermore outcome research such as mortality related to adverse events is needed based on results of this study.