외래진료 민감질환 유질환자 중 장애인과 비장애인의 의료이용률 차이

은상준,홍지영,이진용,이진석,김용익,신영수,김윤,Eun, Sang-Jun,Hong, Jee-Young,Lee, Jin-Yong,Lee, Jin-Seok,Kim, Yong-Ik,Shin, Young-Soo,Kim, Yoon 대한예방의학회 2006 예방의학회지 Vol.39 No.5

Objectives: The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. Methods: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. Results: The numbers of physician visits per 100 patients were $0.78{\sim}0.97$ times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were $1.16{\sim}1.77$ times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: $0.44{\sim}0.70$), and the ORs of hospitalization for the disabled were significantly higher (OR: $1.16{\sim}1.89$). The lower physician visit group (number of physician visits ${\leq}$1) was more likely to be hospitalized than the higher physician visit group (number of physician visits ${\geq}$2) (OR: $1.69{\sim}19.77$). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. Conclusions: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.

병원의 급성심근경색증 진료 결과 공개의 효과

은상준,김윤,이은정,장원모,Eun, Sang Jun,Kim, Yoon,Lee, Eun Jung,Jang, Won Mo 한국의료질향상학회 2011 한국의료질향상학회지 Vol.17 No.1

Objectives : The purpose of this study was to determine whether the published AMI report card could reduce in-patient mortality, 7-day after discharge mortality, and length of stay (LOS). Methods : Interrupted time-series intervention analysis was used to evaluate the impact of the report card for AMI care quality in November 2005 in terms of risk-adjusted in-patient mortality, risk-adjusted 7-day after discharge mortality, and DRGs case-mix LOS using the claim data of Health Insurance Review and Assessment Service. Results : Public disclosure of AMI care quality decreased risk-adjusted in-patient mortality and DRGs case-mix LOS by 0.00050% per month and 0.042 days per month respectively, however there was no effect on risk-adjusted 7-day after discharge mortality. Patterns of effect of public disclosure on AMI outcomes were a fluctuating pattern on risk-adjusted mortalities and a pulse impact for 1 month on DRGs case-mix LOS. Conclusions : We found the public disclosure of AMI care quality had decreasing effects on risk-adjusted in-patient mortality and DRGs case-mix LOS, but the size of the effect was marginal.

우리나라 미생물 실험실의 생물안전현황

은상준,박기동,김종균,임정수,황유성,김용익,이진용,Eun, Sang-Jun,Park, Ki-Dong,Kim, Jong-Kyun,Im, Jeong-Soo,Hwang, Yoo-Sung,Kim, Yong-Ik,Lee, Jin-Yong 대한예방의학회 2005 Journal of Preventive Medicine and Public Health Vol.38 No.4

Objectives : The biosafety level (BSL) practiced in microbiology laboratories in Korea according to the laboratory biosafety manual published by the World Health Organization (WHO) was evaluated using the data obtained by a survey. Methods : Under the advise of Clinical Laboratory Physicians, 144 types of microorganisms were screened based on the guidelines of biosafety in microbiological and biomedical laboratories published by the US Center for Disease Control and Prevention and classified into 1-4 risk groups. A questionnaire containing 21 questions in 5 areas was developed using the biosafety manual by published WHO. Of the 1,876 different organizations sent the survey, 563 responded to the survey (response rate: 30.0%). The species of microoganisms handled by as well as the biosafety level in microbiology laboratories were analyzed. Results : There were 123 species of microorganisms handled in microbiology labs in Korea. The BSL required in 512 microbiology labs was answered by the survey responders as the first grade in 33 labs (6.4%), 2nd in 437 (85.4%), 3rd in 42 (8.2%), and 4th in none. The average number of items satisfied was 12.2, showing only a 57.9% satisfactory rate and normal distribution. Conclusions : The state of overall observance of BSL in most microbiology labs of Korea was evaluated as lagging compared with the standard set up by WHO. Therefore, the Korean government need to produce and distribute a biosafety manual in microbiology laboratories and make efforts to prevent this threat through measures such as training in biosafety in microbiology labs.

고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화

장원모,은상준,사공필용,이채은,오무경,오주환,김윤,Jang, Won-Mo,Eun, Sang-Jun,SaGong, Pil-Young,Lee, Chae-Eun,Oh, Moo-Kyung,Oh, Ju-Hwan,Kim, Yoon 대한예방의학회 2010 Journal of Preventive Medicine and Public Health Vol.43 No.6

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

우리나라 생활안전영역의 비의도적 손상 발생률 및 발생 양상

박건희,은상준,이은정,이채은,박두용,한경훈,김윤,이진석,Park, Kun-Hee,Eun, Sang-Jun,Lee, Eun-Jung,Lee, Chae-Eun,Park, Doo-Yong,Han, Kyoung-Hun,Kim, Yoon,Lee, Jin-Seok 대한예방의학회 2008 예방의학회지 Vol.41 No.4

Objectives: This study was conducted to estimate the cumulative incidence rate (CIR) of unintentional injuries in Korean daily life and to describe the pattern of unintentional injuries. Methods: The study population was the people who used the National Health Insurance because of injuries (ICD code: S00$\sim$T98) during 2006. The stratified sample according to gender, age and the severity of injury (NISS, New Injury Severity Score) was randomly selected. The questions on the questionnaire were developed as a reference for an international classification tool (ICECI, International Classification of External Causes of Injury). The questions included the locations of injury, the mechanisms of injury and the results of injury. Moreover, we used age, gender, region and income variables for analysis. Results: The CIR of unintentional injuries that occurred in daily life for 1 year per 100,000 persons was 17,606, and the CIR of severe injuries was 286. Many injuries were occurred at home (29.6%), public places (19.0%), school (13.7%) and near home (12.0%). The major mechanisms of injuries were slipping (48.8%), contact (14.0%), physical over-exertion (13.8%), and fall (6.6%). Infants and old aged people were vulnerable to injuries, and those who lived rural area and who were in a low income level were vulnerable too. Conclusions: We signified the risk groups and risk settings of unintentional injuries in Korean daily life. These results could contribute to establishing strategies for injury prevention and implementing these strategies.

패널 자료를 이용한 미충족 의료의 추세와 관련요인

김은수,은상준,Kim, Eun-Su,Eun, Sang-Jun 중소기업융합학회 2020 융합정보논문지 Vol.10 No.9

본 연구는 2009년부터 2013년까지(2010년 제외)의 한국 의료패널 자료를 활용하여 미충족 의료의 추세 및 현황을 알아보고, 미충족 의료와 관련된 요인을 분석하고자 하였다. 연구 대상자는 2009년 11,598명, 2011년 11,035명, 2012년 10,584명, 2013년 10,099명 그리고 7,144명의 패널 자료를 활용하여 빈도분석, 교차분석, 일반화 추정방정식 모형을 시행하였다. 연도별로 교차분석 결과, 여성, 중학교 졸업 이하의 학력, 의료보장 형태가 의료급여인 경우, 최저 분위의 가구소득, 주관적 건강상태 점수가 낮을 때 미충족 의료 경험률이 높은 것으로 나타났다. 일반화 추정방정식 모형을 통한 분석 결과, 여성, 40세 미만 연령대, 초등학교 졸업 이하, 최저 분위의 가구소득, 주관적 건강상태 20점 미만, 활동 제한이 있는 경우 미충족 의료를 경험할 가능성이 높은 것으로 나타났다. 이 결과를 바탕으로, 의료서비스 이용의 정책을 수립하는데 기초자료를 제공하고자 한다. The purpose of this study was to investigate the current status of unmet medical need using data from the Korea Health Panel study from 2009 to 2013 (excluding 2010), and to analyze the trends of unmet medical need and related factors. The subjects of this study were 11,598 in 2009, 11,035 in 2011, 10,584 in 2012, 10,099 in 2013, and 7,144 people in panel data, and conducted frequency analysis, chi-square test and generalized estimating equation. As a result of the analysis by year, it was found that women, under middle school graduation, medical aid, the lowest household income and low subjective health status experienced more unmet medical need. As a result of analysis using generalized estimating equation, women, under 40 years of age, under elementary school graduation, lowest quartile household income, subjective health status of less than 20 points, and activity restrictions are more likely to experience unmet medical need. Based on these results, we intend to provide basic data for establishing policies on the use of medical services.

옥천대 터널통과구간에 대한 지질리스크 극복방안

서영욱,박치면,은상준,주광수,Seo, Yeong-Uk,Park, Chi-Myeon,Eun, Sang-Jun,Ju, Gwang-Su 한국터널지하공간학회 2017 자연, 터널 그리고 지하공간 Vol.19 No.4

카타르 도하 루사일 고속도로 내 조형물(Artscape-Gateway Arch) 시공 사례

송준남(Song, Jun Nam),은상준(Eun, Sang Jun),김기창(Kim, Ki Chang) 대한토목학회 2017 대한토목학회 학술대회 Vol.2017 No.10

우리나라 주택 내에서 발생하는 비의도적 손상의 양상

이은정,이진석,김윤,박건희,은상준,서수경,김용익,Lee, Eun-Jung,Lee, Jin-Seok,Kim, Yoon,Park, Kun-Hee,Eun, Sang-Jun,Suh, Soo-Kyung,Kim, Yong-Ik 대한예방의학회 2010 예방의학회지 Vol.43 No.1

Objectives: To investigate the patterns of unintentional home injuries in Korea. Methods: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. Results: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. Conclusions: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

한국 성인의 음주, 흡연, 운동 및 영양행태에 대한 군집별 특성 및 관련요인

김꽃별(Kkot-byeol Kim),은상준(Sang Jun Eun) 한국산학기술학회 2019 한국산학기술학회논문지 Vol.20 No.5

본 연구의 목적은 한국 성인의 건강행태군집 유형을 확인하고 이와 관련된 요인들을 파악하는 것이다. 이를 위해 2014년도 국민건강영양조사 자료를 이차분석 하였다. 음주, 흡연, 운동 및 영양 변수를 이용하여 19세 이상 성인을 대상으로 군집분석하였고, 이 유형들과 인구사회학적 특성 및 건강상태의 연관성을 확인하기 위해 SPSS WIN 22 복합표본설계 모듈을 이용하여 카이제곱 검정과 다항로지스틱 분석을 실시하였다. 한국 성인의 건강행태군집 유형은 흡연군, 식습관군, 건강 관심군, 수동적 태도군 그리고 음주군의 총 6개 유형으로 분류되었고 수동적 태도군의 빈도가 26.0%로 가장 높았다. 건강행태 군집의 타당성을 검증하기 위해 분류된 군집과 건강행태변수를 이용해 판별분석한 결과 타당한 것으로 나타났다. 건강행태 군집은 성, 연령, 교육 수준, 직업, 소득 수준, 결혼 상태 및 지역 규모등 인구 사회학적 특성별로 분포가 달랐으며, 고혈압 및 당뇨와 같은 일부 만성질환의 유무별로도 다른 것으로 나타났다. 인구사회학적 특성, 지역, 고혈압 및 당뇨는 수동적 태도군 보다는 나머지 건강행태군집에 속하는 것과 유의한 연관을 보이는 변수였다. 본 연구 결과는 건강행태를 개별적으로 접근하기 보다는 군집으로 접근하는 것의 유용성에 대한 근거 자료로 활용할 수 있을 것이다. The purpose of this study was to identify the type of health behaviors in Korean adults and to identify related factors. The data used in the analysis was the Korea Health and Nutrition Examination Survey 2014., which was representative of the Korean population. Cluster analysis was used to find the pattern of clustering of smoking, drinking, exercising and nutrition. Differences in the pattern of clustering was examined, first by bivariate chi-square test, and then by multinomial logit regression. Lastly, the association between the clusters of health behaviors and other behavioral risk factors was tested by chi-square test and logistic regression. The distribution of the clusters varied not only across socioeconomic characteristics and local size, but also between individuals with certain chronic diseases and those without. The results of this study can be used as a basis for the usefulness of approaching the cluster rather than individually approaching the health behavior.