• 한국의료질향상학회지
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• 제7권2호
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• KDI Journal of Economic Policy
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• 제29권3호
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• pp.29-73
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• 2007

보육보조금은 일반적으로 여성의 노동시장참여를 용이하게 해주려는 것과 아동이 양질의 보육 및 교육 환경에서 돌보아지는 것을 돕는 목표로 지급된다. 본 연구는 보육시설을 이용하는 영아가구에 보육료를 지원하는 영아기본보조금의 효과를 살펴봄으로써 영아기본보조금이 그 정책목표를 달성하고 있는지 검토한다. 기본보조금이 2006년 민간보육시설에만 도입되었고 유아는 제외하고 영아에게만 지급된다는 준실험적(Quasi-Experiment) 설정을 이용하여 시설 측면과 가구 측면의 효과를 분석한다. 분석 결과, 보조금으로 인해 영아의 이용비중이 높은 보육시설에서는 교사의 처우 및 시설환경이 개선되는 등의 효과가 나타났으나 여성의 노동공급에는 거의 영향을 미치지 않았고, 수요자의 보육만족도에도 부정적 영향을 미친 것으로 나타났다.

• 지역사회간호학회지
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• 제13권4호
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• pp.679-688
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• 2002

Purpose: The purpose of this study was to examine the relationships among self-care, self-care agency, self-efficacy, and quality of life in type II diabetic patients registered at a public health center. Method: The study subjects were 128 type II diabetic patients who were living in G city. The data were collected from March 2001 to February 2002. The instruments used for this study were the self-care scale developed by Jeung(1997) and designed by Park (1984) based on the original scale, the self-care agency scale developed by So (1992), the self-efficacy scale developed by a Jeung (1997) and designed by Paek (1996) based on the original scale, and the quality of life scale developed by Ro (1988). The data were analyzed using descriptive statistics, pearson correlation coefficient, and stepwise multiple regression. Results: 1. The relationships among self-care, self-care agency, self-efficacy, and quality of life were significant. Self-care was significantly related to self-care agency (r=.609. p<.01), self-efficacy (r=.763. p<.01), and quality of life (r=.493. p<.01). 2. The stepwise multiple regression analysis was performed to identify factors influencing quality of life of the subjects. The most powerful predictor was self-care agency (48.4%). The combination of self-care, complication status, age, education level, and self-efficacy accounted for 88.7% of the variance of quality of life in type II diabetic patients. Conclusion: The results suggest that self-care, self-care agency, self-efficacy, and quality of life are important variables for development of nursing intervention programs for patients with diabetes.

• 지역사회간호학회지
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• 제20권2호
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• pp.243-250
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• 2009

Purpose: This is a qualitative study to identify dimensions of long-term care hospital care quality that provide high-level medical services for long-term care patients in Korea. Methods: Service consumers and providers were interviewed, and collected data were analyzed into thesis, type and dimension. The focus group method was applied to two provider groups and individual interview was applied to two persons who had experienced a long-term care hospital. Results: The results of analyzing the consumers and providers was integrated into 8 dimensions: physical environment, staff, clinical care and nursing, multiplicity of activity program, atmosphere, interaction with family, nutrition, and quality improvement system. Conclusion: The dimensions of long-term care hospital care quality from this study can be used as a basis of quality indicators. Quantitative studies to test these dimensions are required for establishing quality management systems.

• 간호행정학회지
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• 제18권1호
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• pp.106-117
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• 2012

Purpose: This study was designed to develop quality outcome indicators for nursing homes and community-based home care that would contribute to an appropriate evaluation and improvement of quality of long term care in Korea. Methods: The preliminary quality indicators of long term care were developed from a literature review and clinical expert panel. A content validity testing was done using a panel of experts who were selected from academic and clinical field of long-term care. The final quality indicators were confirmed after application in four nursing homes and four home care agencies to test clinical validity. Results: The preliminary quality indicators consisted of 3 domains and 19 indicators. The final quality indicators were composed of 4 domains and 17 indicators. Conclusion: This study demonstrated the feasibility of outcome quality indicators in long term care. These quality indicators can be effectively used to evaluate the quality of nursing home and home care and to improve the quality of care in the Korean long-term care system.

• 한국의료질향상학회지
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• 제3권1호
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• pp.104-124
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• 1996

Background : In these days, the health care organizations have concerned about customer-centered care in order to empower the competitiveness on the health care markets. The departments working for quality management of the hospitals have used health care quality indicators in terms of medical areas as well as service areas of the hospitals. However, there were insufficient efforts to develop the credible measurement to seek the customers' needs, their expectations and their satisfaction levels related to health care services because various kinds of challenges were in the process of scale development to measure customers' satisfaction in health care. The purpose of this study was to develop the satisfaction scale to health care services in a Korea health care organization and to test its tool with validity and reliability. Method : The concept of this tool was acceptability that one of the components of health care quality defined by Donabedian. Acceptability has the five dimensions of concept: Accessibility; Patient-Practitioner Relations; Amenities; Patient Preferences as to the effects of care; and Patient Preferences as to the costs of care. The Satisfaction Tool to Health Care Services was reviewed by expert panel with five researchers, including hospital managers and a professor related to quality management of the hospitals. As a result, the content validity index was .84 in the outpatient satisfaction tool. The inpatient satisfaction tool had .87 of the content validity index. The Satisfaction Tools to Health Care Services finally consisted of 44 items for outpatients/their families and of 60 items for inpatients/their families. Study subjects of the construct validity test were 479 outpatients/their families and 561 inpatients/their families who visited or admitted at a University hospital from July 1, 1996 through August 10, 1996. The data were examined by Factor Analysis with SPSS. Result : The items of Satisfaction tools for outpatients/their families were categorized by eleven factors with eigenvalue greater than 1.0 accounting for 64.2 percent of the variation in item scores. Also, the items of inpatient tool had eleven factors with eigenvalue greater than 1.0 accounting for 60.3 percent of the variation in item scores. The reliability of overall scale were .95 and .96 for the outpatients/their families satisfaction scores and inpatient/their families satisfaction scores. The internal consistency reliability with eleven factors was ranged from .30 to .94 for inpatients/their families. The Satisfaction Tool with eleven factors for inpatients/their families had internal consistency reliability ranged from .53 to .89. Conclusion : The Satisfaction Tools to Health Care Services focused on outpatients/their families and inpatients/their families developed in this study had a high reliability and the strong evidence of content validity and construct validity based on quality concept. Therefore, this tool would be utilized as a credible quality indicator of health care services to assess the quality problems and to monitor the quality improvement activities in Korean Health Care Organizations.

• 아동학회지
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• 제17권2호
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• pp.181-193
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• 1996

The purpose of this study was: (1) to examine relationships between social development and day care quality, child-care experience and family characteristics, and (2) to investigate the explainability of those related variables for social development. Subjects for this study were 252 4-year-old children and their mothers from 32 day care centers in Seoul. Harms & Clifford's Early Childhood Environment Rating Scale was used to measure the quality of day care. The main results were as follows: (1) Day care quality, child-care experience and family characteristics were significantly related to social development. (2) Child's gender, months of age, mother's child rearing attitude, the length of child-care experience, overall quality of day care, and group size significantly predicted social development. 33％ of the variance of social development was explained by these variables. The relative influence of these variables to the prediction of social development was about the same.

• 대한간호학회지
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• 제49권6호
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• pp.783-794
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• 2019

Purpose: This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes. Methods: A Delphi questionnaire was developed based on a review of the literature using the keywords "nursing homes," "workforce," and "quality of care." A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged. Results: A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea. Conclusion: To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.

• 한국보건간호학회지
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• 제31권1호
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• pp.19-33
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• 2017

Purpose: This study was conducted to explore the meaning and contents of high-quality aged care facilities and provide basic data for evaluation of service quality in such facilities. Methods: The focus group interviews and participants consisted of two user groups, for a total of 16 family caregivers of the elderly living in facilities and four service provider groups, for a total of 26 chief managers and caregivers working in aged care facilities. All interviews were recorded and transcribed as they occurred. Content analysis was used and debriefing notes were referred to in order to analyze the data. Results: Four themes of a high-quality aged care facility emerged from the analysis; 1) a place to rest for comfortable later years; 2) systematic value-based management; 3) providing professional care; 4) comprehensive service provision in response to diverse needs. Conclusion: The findings of the study showed the importance of client centered care and ethical mindset of providers, which had not been included in the existing quality evaluation programs. Based on these results, medical treatments, end-of-life care and more comprehensive and extended services including family care need to be provided in facilities to ensure good quality aged care.

• Child Health Nursing Research
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• 제24권4호
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• pp.373-382
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• 2018

Purpose: This study aimed to compare the quality of nursing care as perceived by registered nurses and mothers of hospitalized children in South Korea. Methods: This was a descriptive study that recruited 70 mothers of hospitalized children and 70 nurses in pediatric units in university hospitals as participants. The quality of pediatric nursing care was measured using importance and performance scores for 19 items describing various elements of nursing care. The collected data were analyzed using descriptive statistics and the independent t-test. Results: The hospitalized children mothers'mean importance scores were significantly higher than those of the nurses (t=2.94, p=.004). However, there were no significant differences in the mean performance scores of nurses and mothers (t=0.91, p=.363) or between nurses'and mothers'perceptions of quality of nursing care, with the exception of a significant difference for the quality of explanations (t=2.78, p=.006). The quality of explanations was assessed more positively by nurses than by mothers. Conclusion: This study suggests that when developing strategies to improve the quality of nursing care in pediatric wards, ensuring that pediatric nurses provide detailed explanations should be considered as a way to improve the quality of nursing care in pediatric units.