입원 환자의 병원내 자원 이용에 영향을 미치는 병원, 진료과 및 의사의 특성 분석

안형식 ( Hyeong Sik Ahn ) 한국보건행정학회 1997 보건행정학회지 Vol.7 No.1

전문의 대상 설문조사를 이용한 보건의료 기술평가 대상 시술의 우선 순위 선정 -이비인후과와 흉부외과를 중심으로-

안형식 ( Hyeong Sik Ahn ),김선민 ( Sun Mean Kim ),신영수 ( Young Soo Shin ),김차엽 ( Chang Yup Kim ),김선미 ( Seon Mee Kim ),이순형 ( Soon Hyung Lee ) 한국보건행정학회 1997 보건행정학회지 Vol.7 No.2

고압산소환경이 신생 및 성숙백서의 폐 superoxide dismutase 활성도에 미치는 영향에 관한 실험적 연구

안형식,조수헌,윤덕로,이동율,김용식,Ahn, Hyeong-Sik,Cho, Soo-Hun,Yun, Dork-Ro,Lee, Dong-Ryool,Kim, Yong-Sik 대한예방의학회 1989 예방의학회지 Vol.22 No.1

To investigate the effect of hyperbaric oxygenation on superoxide dismutase activity, neonatal rats (7-10 days old) and adult rats (approximately 100 days old) were continuously exposed to hyperbaric oxygen environment of 2.4ATA for 8 hours and their superoxide dismutase activity were measured. Neonatal rats, all survived through exposure, showed significant increases in the pulmonary superoxide dismutase activity at immediately and 24 hours after exposure. Adult rats, whose 8 hour survival rates were 14%, did not show any significant increase in the activity of pulmonary superoxide dismutase as compared to the control adult rats. These findings are indicating that increased tolerance to oxygen toxicity in neonatal animals during exposure may be attributed to the increase in activity of superoxide dismutase in neonatal rats.

종합병원 전자건강카드 도입에 영향을 미치는 요인

안이수,윤석준,안형식,홍석원,Ahn, Lee-Su,Yoon, Seok-Jun,Ahn, Hyeong-Sik,Hong, Seok-Won 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.2

Objective : This research is focused on understanding the current status of the Health Smart Card already in use in other advanced countries. This research will analyze the current status of the medical institutions Health Smart Card system adoption process and its effects, and provide a basis for future policy decisions for the effective adoption and diffusion of a Health Smart Card system, in the medical field, through the completed research and analysis. Method : This research surveys the domestic, and foreign, status of Health Smart Card usage. The research also presents up-to-date methodology for the evaluation of the effects of medical and health care technology. The research also conducts a survey of the domestic medical institutions that have implemented a Health Smart Card system, and then analyzes the results of the survey. Additionally, the research carried out a survey and analysis of medical institutions with no Health Smart Card system implemented, and considered the factors affecting the diffusion of Health Smart Card systems in considering an effective policy for the introduction and diffusion of such a system. Research Results : Through the study of the methodology of medical and health care information technology in advanced countries, the methodology for assessing Health Smart Card technology has been established, and focuses on 6 aspects. The study on the status of foreign implementation has shown a model for the Health Smart Card system. A survey was conducted on the current status of medical institutions with an implemented Health Smart Card system, and the survey results have been analyzed. Also, factors influencing the adoption of Health Smart Card systems have been analyzed through the survey on those medical institutions that have not implemented a Health Smart Card system. Conclusion : The government must provide institutional measures for sharing medical records by constructing an IT infrastructure at the national level to enable the adoption and diffusion of a Health Smart Card system. Such a network will make connections between medical institutions possible, thus making the diffusion of the Health Smart Card system nationwide. For the successful adoption and diffusion of a Health Smart Card system, a model system development, under a medical record sharing system, should be conducted. Additionally, a regional unit based model should be developed for the model project, as is done in advanced countries, along with the application of such results.

B형간염바이러스 및 C형간염바이러스의 표식자 양성율과 원발성 간세포 암의 연관성에 대한 환자-대조군 연구

안형식,김민호,김영식,김정순,Ahn, Hyeong-Sik,Kim, Min-Ho,Kim, Young-Sick,Kim, Joung-Soon 대한예방의학회 1997 예방의학회지 Vol.30 No.1

To investigate the association between hepatocellular carcinema(HCC) and infection of hepatitis B virus(HBV) and hepatitis C virus(HCV) in an HBV endemic area, a case-control study of 254 patients with HCC and of 1,270 age and sex matched health control subjects was done. Among the 254 HCC patients 166(65.4%) were positive for hepatitis B surface antigen(HBsAg), 49(19.3%) were positive for HCV antibody (anti-HCV Ab). The crude odd ratio of patients with HBsAg was 36.1(95% CI :22.4-58.2) and with anti-HCV Ab was 9.0(95% CI :5.5-14.6). In an analysis, which HBsAg(-), HBcAb(-), anti-HCV Ab(-) group was chosen as referent group, odd ratio of HBsAg(+) group was 14.4(95% CI: 7.2-28.9) and of anti- HCV Ab(+) was 10.7(95% CI: 2.9-40.0). odd ratio of anti-HCV Ab(+), HBsAg(+) group and anti-HCV Ab(+), HBsAg(-), HbcAb(+) group for HCC were elevated to 27.3(95% CI : 9.0-82.9), 15.9(95% CI:7.1-35.8) respectly, The odd ratio of anti-HCV Ab(-), HBsAg(-), HBcAb(+) group was 2.4(95% CI : 1.1-5.0). These result suggested that HBV and HCV were associated with HCC. In HBV endemic area patients with HBcAb alone should be considered risk group for HCC.

입원과 수술시행의 적정성 평가

김창엽,안형식,이영성,권영대,김용익,신영수,Kim, Chang-Yup,Ahn, Hyeong-Sik,Lee, Young-Seong,Kwon, Young-Dae,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1992 예방의학회지 Vol.25 No.4

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For cesarean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals and between hospital groups by size. The most freqeunt indication of C/S was repeated operation, followed by cephalopelvic disproportion (CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons fur admission were 'failure to initial treatment', 'suspected bacterial pneumonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activiteis would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studios with plentiful subjects and more representative diseases or procedures should be tried.

급성심근경색증 환자의 진료 질 평가를 위한 병원별 사망률 예측 모형 개발

박형근,안형식,Park, Hyeung-Keun,Ahn, Hyeong-Sik 한국의료질향상학회 2003 한국의료질향상학회지 Vol.10 No.2

Objectives: To develop a model that predicts a death probability of acute myocardial infarction(AMI) patient, and to evaluate a performance of hospital services using the developed model. Methods: Medical records of 861 AMI patients in 7 general hospitals during 1996 and 1997 were reviewed by two trained nurses. Variables studied were risk factors which were measured in terms of severity measures. A risk model was developed by using the logistic regression, and its performance was evaluated using cross-validation and bootstrap techniques. The statistical prediction capability of the model was assessed by using c-statistic, $R^2$ as well as Hosmer-Lemeshow statistic. The model performance was also evaluated using severity-adjusted mortalities of hospitals. Results: Variables included in the model building are age, sex, ejection fraction, systolic BP, congestive heart failure at admission, cardiac arrest, EKG ischemia, arrhythmia, left anterior descending artery occlusion, verbal response within 48 hours after admission, acute neurological change within 48 hours after admission, and 3 interaction terms. The c statistics and $R^2$ were 0.887 and 0.2676. The Hosmer-Lemeshow statistic was 6.3355 (p-value=0.6067). Among 7 hospitals evaluated by the model, two hospitals showed significantly higher mortality rates, while other two hospitals had significantly lower mortality rates, than the average mortality rate of all hospitals. The remaining hospitals did not show any significant difference. Conclusion: The comparison of the qualities of hospital service using risk-adjusted mortality rates indicated significant difference among them. We therefore conclude that risk-adjusted mortality rate of AMI patients can be used as an indicator for evaluating hospital performance in Korea.

산소과다가 임신에 미치는 영향에 관한 실험적 연구

이승철,조수헌,안형식,윤덕로,Lee, Seung-Chul,Cho, Soo-Hun,Ahn, Hyeong-Sik,Yun, Dork-Ro 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.1

The adverse effect of diving on the fetus may extend beyond n gestational process and outcome. Primiparous Sprague-Dawley rats were assigned to one of ten exposure schedules during gestatred $PO_2$ level, the following question about the effect of exposing a pregnant female to high partial pressure of inspired oxygen has been raised. 'What effect does an increased maternal $PIO_2$ have on fetal arterial $PO_2$ and therefore on possible fetal oxygen poisoning?' This study was carried out to observe the effects of maternal hyperoxia on gestational process and outcome. Primiparous Sprague-Dawley rats were assigned to one of ten exposure schedules during gestation. The treatment groups were subjected to either the high concentration of oxygen, or the high atmospheric pressure. On day 21 of gestation, laparotomy was performed to examine for number and distribution of implantations and live and resorbing embryos. Fetuses were weighed, and examined for gross malformations. Subsequently, they were fixed, measured in physical parameters, and examined for visceral anomalies. Minor visceral anomalies and anatomical variation was not found. Similarily, there were no significant differences when number of resorptions, mean fetal weights, pregnancy interruption rate were compared by analysis of variance. These results indicate that exposing rats to oxygen at increased atmospheric pressure doese not affect fetal health or survival.

한국인에서 Helicobacter pylori 감염의 진단에 있어 Genedia™ H . pylori ELISA 검사의 진단 정확도

정인식(In Sik Chung),김상우(Sang Woo Kim),고재성(Jae Sung Go),김나영(Na Young Kim),김재규(Jae Gyu Kim),김진호(Jin Ho Kim),김학양(Hak Yang Kim),김재준(Jae Jun Kim),노임환(Im Hwan Roe),심재건(Jae Geon Sim),안형식(Hyeong Sik Ahn),윤병철(By 대한내과학회 2001 대한내과학회지 Vol.61 No.1

N/A Background: Genedia™ H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of Genedia™ H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. Methods Genedia : H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with Genedia™ H. pylori ELISA. H, pylori infection was determined by rapid urease test, histology, culture or (13)C-urea breath test in adults. In children, the subject was considered to he H. pylori positive if (13)C-urea breath test was positive. Results: In adults, the sensitivity and specificity of Genedia™ H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of Genedia™ H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of Genedia™ H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%, p<0.005 and 92.5% vs 71.4%, p<0.005, respectively). Conclusion : Genedia™ H pylori ELISA is a relatively accurate method for the serodiagnosis of H pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of Genedia™ H. pylori ELISA for epidemiological studies of H. pylori infection in Korea. (Korean J Med 61:17-23, 2001)

1개 군지역 의료보험제도에서의 보험료 부담수준별 병.의원 의료이용에 관한 연구

이상일,최현림,안형식,김용익,신영수,Lee, Sang-Il,Choi, Hyun-Rim,Ahn, Hyeong-Sik,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.4

1988년부터 전국적으로 실시된 농어촌 지역의료보험제도의 형평성을 검토하기 위하여 1개군 지역의료보험 대상자 중 1년간 계속하여 자격을 보유하고 있었던 피보험자를 대상으로 세대당 총보험료와 능력비례 보험료에 따라 10등급으로 구분하여 1) 등급별 보험료 구성, 2) 등급별 의료이용도, 3) 등급별 보험급여액, 4) 등급별 의료이용의 진료권별 분포를 분석하여 다음과 같은 결과를 얻었다. 총보험료중 능력비례 보험료가 차지하는 비율은 39.2%이었으며 등급이 증가할수록 총보험료중 능력비례 보험료가 차지하는 비율이 증가하고 있었다. 보험료 부담수준이 증가할수록 병의원 외래, 입원 및 치과 의료이용율이 증가하여 소득이 낮은 계층에서 상대적으로 큰 미충족 의료필요가 존재함을 시사하고 있었다. 총보험료 및 능력비례 보험료 등급이 증가할수록 보험료의 누적백분율이 보험급여액의 누적백분율보다 커서 상위 등급에서 하위 등급으로 보험료의 이전이 발생하고 있으나, 보험료 등급에 따른 피보험자수의 누적백분율이 보험급여액의 누적백분율보다 크게 나타나고 있어 의료보험제도 내에서도 소득수준에 따른 의료이용의 차이가 있어 매우 제한된 범위내에서 소득재분배 효과가 있는 것으로 생각되었다. 총보험료 및 능력비례 보험료 등급별 의료이용 중 군내 및 군외 1차기관이 차지하는 비율은 등급의 상승에 따라 감소하고 2차기관의 이용 비율은 증가하는 경향을 보이고 있어 의료전달체계의 실시가 병의원 이용에 있어 보험료 부담수준 또는 의료비 지불 능력에 따라 차별적인 영향을 미치는 것으로 나타났으며 이는 주로 간접의료비에 기인한 것으로 생각되었다.자에게 1-2종의 항생제를 평균 1주일 정도 투여하였다. 또 어떤 의원에서는 제왕절개 분만시 모든 환자에게 전혈을 수혈하는 곳도 있었다. 이 외에도 의료기관에 따라 비타민제제, 지혈제, 자궁수축제, 진통제, 해열제, 소염제, 진정진경제, 소화제, 변비완화제, 항히스타민제, 이뇨제 등을 투여하는 빈도와 약품종류가 다양하였다. 입원기간에 있어서는 정상분만의 경우 평균 입원기간이 초산은 2.6일, 경산은 2.4일로 초산이 경산보다 약간 길었으며 어떤 병원에서는 3.5일로서 약간 긴 경우도 있었으나 대체로 비슷한 양상이었다. 제왕절개 분만에 있어서는 평균 입원기간이 초산 7.5일, 경산 7.6일로 별다른 차이는 없었다. 그러나 의료기관에 따라 가장 짧은 것은 6.5일에서 가장 긴 것이 9.4일로 차이가 났다. 평균 입원비는 일반환자인 경우 정상분만의 초산 비용은 182,100원이었고, 경산은 167,300원이었다. 의료보험인 경우 본인 부담액이 초산은 82,400원, 경산은 75,600원이었으며 제왕절개분만은 일반환자 초산인 경우 946,500원, 경산은 753,800원이었고, 의료보험인 경우 초산은 256,200원, 경산은 253,700원이었다. 대학병원간에도 정상분만 비용이 268,000원과 350,000원으로 큰 차이를 보이며 제왕절개 분만의 경우에도 각 의료기관별로 차이를 나타내고 있다. 이와 같이 의료기관에 따라 정상분만과 제왕절개분만시 임상병리검사, 투약 등에 큰 차이를 나타내고 입원기간에도 차이가 있어 결과적으로 의료비에도 큰 차이를 나타내고 있으며 어떤 기관에서는 포괄수가제를 적용하고 있는 곳도 있었다. This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows : 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.