http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
주영준 ( Yeong Jun Ju ),장성인 ( Sung-in Jang ) 한국보건행정학회 2017 보건행정학회지 Vol.27 No.1
Suicide is becoming a public health issue in many countries, and even more so in Korea. Korea has the highest suicide rate in the Organization for Economic Cooperation and Development countries. To address these issues, we investigated the recent trends in suicidal ideation and suicide attempts among the adult population. We used data from four sources: Korean National Health and Nutrition Examination Survey (KNHANES, `2007-2012, `2013, `2015), Korean Community Health Survey (KCHS, `2008-2009, `2013), Korean Wealth Panel Study (KOWEPS, `2012-2015), and Korea Health Panel Survey (KHP, `2010-2013). Weighted frequencies and trend tests were used. The rate of suicidal ideation as recent year was 5.10% (KNHANES, `2015), 8.95% (KCHS, `2013), 2.34% (KOWEPS, `2015), or 5.39% (KHP, `2013). Regarding the suicide attempts, the rate of suicide attempts as recent year was 0.61% (KNHANES, `2015), 0.41% (KCHS, `2013), or 0.04% (KOWEPS, `2015). Average percent change of suicidal ideation during survey year was -2.80% (KNHANES, `2007-2012), 5.78% (KNHANES, `2013-2015), 0.62% (KCHS, `2008-2013), -5.63% (KOWEPS, `2012-2015), and -10.94% (KHP, `2010-2013). Average percent change of suicide attempts during survey year was -3.84% (KNHANES, `2007-2012), 4.55% (KNHANES, `2013-2015), -2.54% (KCHS, `2008-2013), and -18.96% (KOWEPS, `2012-2015). Those who had lower income level were more likely to have self-reported suicidal ideation and suicide attempts. Our results suggest that further efforts are needed for more effective intervention to identify and manage low income strata with suicide problem.
말기 암환자에서의 호스피스 완화의료 비용효과 분석: 병원 기반 호스피스 완화의료 치료와 일반 병동 치료의 비교
주영준 ( Yeong Jun Ju ),김우림 ( Woorim Kim ),최윤수 ( Yoon Soo Choy ),이주은 ( Joo Eun Lee ),이상아 ( Sang Ah Lee ),장지은 ( Jieun Jang ),박은철 ( Eun-cheol Park ) 대한내과학회 2019 대한내과학회지 Vol.94 No.3
목적: 호스피스 완화의료는 중요한 공중보건학적 과제로써 관심이 높아지고 있지만, 호스피스 완화의료의 효과에 대한 연구는 국내에서는 부족한 실정이기 때문에 이에 대한 연구는 중요한 정보와 함의를 제공해줄 수 있을 것이다. 이 연구는 말기 암환자들을 대상으로 호스피스 완화의료의 비용효과 분석을 시행하였다. 방법: 결정수형(decision tree)과 함께 마콥모형(Markov model)을 이용하여 비용효과 분석을 시행하였으며, 병원내 일반 병동 대비 호스피스 완화의료 병동에서 치료받았을 때의 비용, 삶의 질 그리고 비용효과성을 비교하였다. 비용과 삶의 질은 국내에서 출판된 국내 연구에서 활용된 값을 이용하여 추정하였으며 비용효과성은 ICER을 통하여 산출하였다. 추가적으로 비용 상승을 가정하여 일요인(one-way) 민감도 분석을 시행하였다. 결과: 일반 병동 대비 호스피스 완화의료 병동에서 치료받는 대안이 가장 비용효과적이었다. 점증비용(incremental cost)은 290,401원이었으며, 점증효과(incremental effect)는 -0.25였다. 점증적 비용효과비는 -1,174,045원이었다. 민감도 분석 결과 비슷한 경향성이 관찰되었다. 결론: 일반 병동 대비 호스피스 완화의료 병동에서 치료받는 대안이 비용은 더 낮고 효과는 더 좋은 것으로 관찰되었다. 따라서 이 연구 결과를 통하여 일반 병동 대비 호스피스 완화의료 병동에서 치료받는 대안이 비용효과적인 관점에서 선택할 수 있는 대안임을 제안한다. Background/Aims: Although there is growing interest in hospice-palliative care, little information is available on the effects of such care in South Korea. Addressing this research gap, i.e., determining the cost-effectiveness of hospice-palliative care in South Korea, will help guide policy. Thus, the aim of this study was to evaluate the cost-effectiveness analysis of hospice-palliative care in adults diagnosed with terminal cancer. Methods: We used a Markov model to construct a decision tree, for an analysis comparing the general ward with the hospice- palliative ward in terms of patient quality of life and cost-effectiveness. Cost and quality of life were estimated based on published Korean studies. Cost-effectiveness was calculated as the incremental cost relative to the incremental effect. Additionally, a one-way sensitivity analysis was performed to test the robustness of the results. Results: Hospice-palliative ward care was more cost-effective than general ward care. The incremental cost was 290,401 Korean won (KRW) and the incremental effect was -0.25. The incremental cost-effectiveness ratio was -1,174,045 KRW. A similar pattern of results was obtained in the sensitivity analysis. Conclusions: Our results suggest that hospice-palliative ward care is more cost-effective than general ward care. (Korean J Med 2019;94:273-280)
이상아,주영준,신재용,박은철,이후연,Lee, Sang-Ah,Ju, Yeong-Jun,Shin, Jae-Yong,Park, Eun-Cheol,Lee, Hoo-Yeon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1
Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.
장지은 ( Jieun Jang ),주영준 ( Yeong Jun Ju ),이두웅 ( Doo Woong Lee ),이상아 ( Sang Ah Lee ),오소연 ( Sarah Soyeon Oh ),최동우 ( Dong-woo Choi ),이현지 ( Hyeon Ji Lee ),신재용 ( Jaeyong Shin ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1
Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: ‘high in advantaged,’ ‘high in disadvantaged,’ ‘middle in advantaged,’ ‘middle in disadvantaged,’ ‘low in advantaged,’ and ‘low in disadvantaged.’ We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the ‘low in disadvantaged’ group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the ‘high in advantaged’ group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the ‘low in advantaged’ and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.