• Health Policy and Management
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• v.3 no.1
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• pp.25-52
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• 1993

Variation in the utilization of medical services is a very important issue in cost containment and quality assurance of health care. Practice variation directly affects health care expenditure especially in fee-for-service system, which is the payment system of health insurance in Korea. In addition to cost issue it is generally accepted that variations in medical practice and the cost of inpatient care suggest the possibility of inappropriate quality of care. This study is to closely examine the patterne and degrees of variation in cost structure of inpatient care among types of hospital and individual hospitals in some tracer diseases, and also to inquire into the service items which contribute much to the variation of total medical care cost. Foru common diseases, i.e. Cesarean Section, appendectomy, cataract extraction and pediatric pneumonia, were selected as tracer diseases. In most tracer diseases there were statistically significant differences in total medical care cost among hospitals in same type of hospital as well as among types of hospital(p<0.01). When total medical care cost were subdivided into the types of service, cost of medication and diagnostic examination varied the most prominenly. When the cost of medication were subdivided again, cost of parenteral antibiotics showed the most prominent variation. Of total medical care cost, medication was most contributory to the variation of total medical care cost(58.1~82.3%), and cost of antibiotics was most contributory to the variation of medication cost(63.9~92.2%). The results of study implicated that reducing the variation of medication may plays a significant role in containing the cost of inpatient care. In order to sort out the factors affecting practice variations including drug prescription pattes further researches are required.

• Health Policy and Management
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• v.29 no.2
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• pp.220-227
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• 2019

Background: Potentially avoidable hospitalizations (PAH) contribute to an increased post-discharge mortality. Methods: To investigate the between-hospital variation and the relationship between all predictors and mortality after discharge among older adults with PAH, we studied 15,186 older patients with PAH in 2,200 hospitals included in the National Health Insurance Service-Senior claims database from 2002 to 2013. Multivariable multilevel logistic regression analyses were performed to analyze the variance at between-hospital for mortality after accounting for differences in patient characteristics. Results: The between-hospital variation in mortality that could be attributed to hospital practice variations were 37.6% at 1-week to 13.9% at 12-month post-discharge, after adjustment for individual patient characteristics and hospital-level factors. Hospital-level factors significantly explained mortality at 3 weeks after discharge. Clinics, compared with general hospitals, demonstrated a 2.75 times higher likelihood of deaths at 3-week post-discharge (p<0.001). Compared with private hospitals, public hospitals exhibited 1.61 times higher odds of 3-week mortality (p=0.01). Conclusion: This study demonstrates considerable between-hospital variations in PAH-related mortality that could be attributed to hospital practices. Monitoring of hospitals to identify practice variations would be warranted to improve the survival of older patients with PAH.

• Journal of Preventive Medicine and Public Health
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• v.23 no.4 s.32
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• pp.451-464
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• 1990

The variation in resource utilization for hospitalized patients who had a group of similar diseases -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utillization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs : o the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs ; o the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs : o the ratio of the maximum and the minimum among the mom LOS of hospitals was greater than 2 in 82 KDRGs ; o the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.

• Health Policy and Management
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• v.11 no.3
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• pp.121-150
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• 2001

This study was conducted to investigate provider's behavior change after releasing the information on the Cesarean section rate. Claims data filed at the National Health Insurance Corporation was used for this analysis and the focus of this study was the change of cesarean rate after the public disclosure of information. Average rates of the year 1999 and 2000 were compared, on the institutional basis, and range and coefficient of variation were estimated. For the last decade, Cesarean section rate has been increased dramatically. Clinical or demographic factors could not adequately explain the increase. Instead, nonclinical factors, such as financial incentive, physician's convenience, practice characteristics, etc., were more significant in explaining the increasing rate. Providers' behavior was significantly affected by the public release of information: after the release, average rate was decreased by 10.2%, and variations were also decreased. In particular, the extent of decrease was explained mainly by nonclinical factor rather than clinical ones. The results suggest that disseminating practice information to providers and consumers could contribute to reducing unnecessary medical service.

• Journal of Korean Society of Forest Science
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• v.104 no.4
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• pp.543-548
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• 2015

We studied the genetic impact of natural regeneration practices, such as Single seed tree, Group seed tree, Patch clear cutting and Alternate strip clear cutting systems, by comparing the nuclear microsatellite(nSSR) variation of post-practice natural regeneration one-year old seedlings of Pinus densiflora to that of pre-practice mature trees. The levels of genetic diversity of seedlings (A=13.6, $A_e$=4.3, $H_o$=0.571, $H_e$=0.597) were similar to those of mature trees (A=13.4, $A_e$=4.3, $H_o$=0.596, $H_e$=0.598) and the differences in the level of genetic diversity between seedlings and mature trees for each of the practices were not statistically significant. The degree of genetic differentiation between seedlings and mature trees was very low ($F_{ST}$=0.002) and the pairwise $F_{ST}$ values between seedlings and mature trees for all practices were less than 0.01. Overall, the natural regeneration practices appeared to have only minor impacts on the genetic diversity and the genetic composition in the studied P. densiflora stands. For a better understanding of the genetic effects of natural regeneration practices, subsequent studies such as temporal genetic variation of seedlings formed by crossing among post-practice mature trees should be considered.

• Health Policy and Management
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• v.14 no.2
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• pp.138-162
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• 2004

This study was performed to investigate small area variation in rates of three common surgeries in general surgery department across 156 small areas. Three surgery rates were analyzed; Anal and/or stomal procedures, inguinal and/or femoral hernia procedures, appendectomy. Methods: We used health insurance claims data and the number of patients were 13,845, 2,154 and 7,151 persons respectively. Surgery rates were directly standardized with age and sex and logistic regression was used to analyze surgery rates. Results: Mapping of the surgery rates, there was small area variation in anal and/or stomal procedures. The clinic which was located in more competitive market and chose DRG payment system tends to do more anal and/or stomal procedures. There was no factor except DRG bed rates had effect on rate of inguinal and/or femoral hernia procedures. Conclusions: Findings of this study will contribute to developing investigation method on small area variation and policy to reduce the variation such as developing evidence based medical practice guideline.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.15 no.4
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• pp.418-427
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• 2008

Purpose: This study was done to investigate the relationship of knowledge related to disease, awareness and practice of inhaler use in asthmatic patients. Method: The participants in this research were 124 patients with asthma who used inhalers, and were admitted to hospital or attended outpatient asthmatic clinics. Data were collected using a self-administered questionnaire which consisted of demographic characteristics, illness-related characteristics, and tools to measure knowledge of disease, awareness and practice related to inhaler use. Results: Knowledge related to disease was statistically significantly different for age (p<.001) and marital status (p=.017). The mean score for awareness of inhaler use was significantly higher than the mean score for practice in inhaler use (p<.001). There were significant correlations between awareness and practice of inhaler use (p<.001), knowledge related to disease and awareness of inhaler use (p<.001), and knowledge related to disease and practice of inhaler use (p<.001). Conclusion: Results indicate that due to the variation in degree of illness in patients with asthma, there is a need to develop appropriate education programs for people of different ages and also precise ${\alpha}$ II content for use of inhalers method of checking capacity washing and storing as well as directions about different kinds of the inhalers.

• 대한예방의학회:학술대회논문집
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• 2002.10a
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• pp.386-387
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• 2002

• Smart Structures and Systems
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• v.19 no.2
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• pp.137-149
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• 2017

Under the interference of the temperature effect, the alternation of cable force due to damages of a cable-stayed bridge could be difficult to distinguish. Considering the convenience and applicability in engineering practice, simple air or cable temperature measurements are adopted in the current study for the exclusion of temperature effect from the variation of cable force. Using the data collected from Ai-Lan Bridge located in central Taiwan, this work applies the ensemble empirical mode decomposition to process the time histories of cable force, air temperature, and cable temperature. It is evidently observed that the cable force and both types of temperature can all be categorized as the daily variation, long-term variation, and high-frequency noise in the order of decreasing weight. Moreover, the correlation analysis conducted for the decomposed variations of all these three quantities undoubtedly indicates that the daily and long-term variations with different time shifts have to be distinguished for accurately evaluating the temperature effect on the variation of cable force. Finally, consistent results in reducing the range of cable force variation after the elimination of temperature effect confirm the validity and stability of the developed method.

• Proceedings of the Korean Society of Soil and Groundwater Environment Conference
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• 2000.11a
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• pp.302-306
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• 2000

In case of applying electrokinetic remediation, magnitude of electric current is one of major factors for estimation of contaminant transport. In practice, electric current provide determination of electric conductivity based on specimen resistance. Electric current variation is produced during Electrokinetic remediation test. Electric current is decreased by expotential function according to time in condition of constant voltage. This can be interpreted as precipitation effect by OH$^{-10}$ generation in a cathode.