처방전달체계에 대한 사용자 만족도에 영향을 미치는 요인

김창엽,하범만,강길원,김병익,김용익,이진석,Kim, Chang-Yup,Ha, Bum-Man,Kang, Gil-Won,Kim, Byoung-Yik,Kim, Yong-Ik,Lee, Jin-Seok 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. Methods : A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was peformed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience, OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. Results : There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. Conclusions : There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.

일부 다빈도 입원 및 수술례의 진단과 치료과정에 대한 연구

김창엽,김윤,권영대,김용익,신영수,안형식,Kim, Chang-Yup,Kim, Yoon,Kwon, Young-Dae,Kim, Yong-Ik,Shin, Young-Soo,Ahn, Hyeong-Sik 대한예방의학회 1993 예방의학회지 Vol.26 No.3

The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.

DRG 지불제도 도입에 따른 의료보험청구 행태 변화

강길원,박형근,김창엽,김용익,하범만,Kang, Gil-Won,Park, Hyoung-Keun,Kim, Chang-Yup,Kim, Yong-Ik,Ha, Beom-Man 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

Archer의 형태발생론을 활용한 2007년 의료급여정책변동 사례연구

정성식(Jeong, Seong-Sik),김창엽(Kim, Chang-Yup) 비판과 대안을 위한 사회복지학회 2016 비판사회정책 Vol.- No.53

본 연구는 2007년 의료급여정책 변동에 대한 사례연구로서, 당시 정부가 기존의 보장성 확대 정책기조에서 벗어나 재정안정화를 위하여 본인부담제와 선택병의원제와 같은 수급권자의 의료이용을 규제하는 정책들을 도입하게 된 원인과 기전을 규명하는 것을 목표로 하였다. 이를 위하여 Archer의 형태발생론을 연구모형으로 활용하여 정치ㆍ경제ㆍ사회문화의 구조적 요인과 정부체계적 요인 및 정책행위자 간의 상호작용 요인을 분석하였다. 분석 결과, 당시 복지예산 확대에 부정적인 정치권의 상황과 효율적 복지를 지향하는 참여정부의 질서자유주의적 경제정책이념 및 그에 따른 정책기조의 전환과 보건복지부 장관의 정책적 신념 등이 정책변동에 중요한 영향을 미쳤다. 정책행위자 간 상호작용 과정에서 정부는 시종일관 밀어붙이는 전략과 함께 수급권자 전체를 ‘도덕적 해이’ 집단으로 낙인찍는 언론프레이밍 전략을 활용하였고, 이에 맞서는 시민사회단체연합은 사회적 이슈화 전략과 도덕적 우위 전략을 통해 비판여론을 확산시켜 정부를 압박하고자 하였으나 결국 정책도입을 저지하는 데 실패하였다. As a case study of the Korea medical aid policy change in 2007, this study aimed to analyze the cause and mechanism that the government at that time introduced policies which restrict the medical use of the medical aid recipients like ‘co-payment system’ and ‘designated doctor system’ for out-patient services in order to stabilize the finances deviated from previous policy stance of the expansion of the medical aid coverage. For this, this study analyzed the political · economicㆍsociocultural structural conditions, government system · policy-decision maker factors and the interaction factors between policy actors using Archer’s morphogenetic social theory as a analysis model. The analysis results were as follows. The political conditions being negative about expanding the welfare budget, the government’s economic policy ideology of ‘Ordo-liberalism’ aiming efficient welfare, a change of the policy stance accordingly and the political belief of the Minister of Health and Welfare at that time had an effect on the policy change. While in the interactive process between policy actors, the government used ‘media framing strategy’ stigmatizing whole recipients as ‘moral hazard’ group with ‘pushing strategy’ consistently, whereas the civil society groups tried to put pressure on the government by spreading the critical opinions through ‘making social issue & moral superiority strategy’, but failed to stop the introduction of the policies eventually.

병원표준화심사의 질 향상 관련 항목에 대한 평가와 개선방안

김창엽,이상일,이건세,신영수,Kim, Chang-Yup,Lee, Sang-Il,Lee, Kun-Sei,Shin, Young-Soo 한국의료질향상학회 1995 한국의료질향상학회지 Vol.2 No.1

Background: Korean Hospital Standardization Program(KHSP), as a hospital accreditation program initiated and promoted by Korean Hospital Association since 1981, has played a key role in the hospital quality improvement in structural aspect particularly. Recently, however, KHSP has been critisized by hospitals and health personnels in that it is unpractical to be utilized as an initiative to improve hospital quality. In particular, the section of quality assurance in KHSP, strongly influenced by old version of Hospital Accreditation of Joint Commission in U.S.A., has been required to be fundamentally revised. For design of new criteria in quality assurance section, a survey for evaluation of existing program and collection of opinions for ideal one was conducted. Methods: For a month in 1994, structured questionnaires were administered by mailing to 470 hospital staffs from 200 hospitals, participated in the survey for the 1994 KHSP in each hospital. The total number of respondents was 116. Results: Less than half of the respondents(34.5%) value positively on the impact of current KHSP in general on the quality improvement of their hospitals. Moreover, most responses indicated that KHSP should be reorganized towards more practical and applicable one. Current KHSP criteria for quality activities in hospitals were regarded as a unpractical one which should be basically renewed. For new criteria and standards, most respondents emphasized the importance of applicability of those in real situations. Conclusion: For the KHSP to be effective, new evaluation criteria for quality activities should be more practical and fully accommodated to hospital situations in reality.

1990년부터 1996년까지 국내 일부 의학연구 학술지에 발표된 암 관련 논문 초록의 분석

김창엽,이영성,강철환,유근영,강길원,하범만,강영호,Kim, Chang-Yup,Lee, Young-Sung,Kang, Chul-Whan,Yoo, Keun-Young,Kang, Gil-Won,Ha, Beom-Man,Khang, Young-Ho 대한예방의학회 2001 Journal of Preventive Medicine and Public Health Vol.34 No.3

Objective : To explore the status of cancer research in the Republic of Korea. Methods : Thirty-eight medical journals, published in Korea between 1990 and 1996, were reviewed for abstracts relating to cancer research. Of the 5,899 eligible abstracts related to cancer, 4,732 were collected and evaluated. Results : Including first author and first two co-authors, a total of 7,427 authors were identified. Those who published an average of one or more article per one year were defined as cancer researchers for this study. This group, however, accounted for a small proportion of the total (3.1%). Analysis of the selected abstracts showed that the study goals in more than half focused on pathophysiologic mechanisms. Studies that were designed to use causal relationships such as cohort studies and randomized controlled trials were rare. A greater number of analytic and experimental studies were found in abstracts published by the cancer researcher group. More advanced study designs that explored causal relationships and analytic procedures were found in abstracts published later than those abstracts published from 1990 to 1992. Conclusion : Our findings show that researchers who published more articles adopted more advanced study designs. This study provides primary data that can be used to compare the status of cancer research in future studies.

한의대생의 전문직 사회화과정 연구

김창엽,김광호,임병묵,Kim Chang-Yup,Kim Kwang-Ho,Lim Byung-Mook 대한예방한의학회 2002 대한예방한의학회지 Vol.6 No.2

The study aims to investigate the process of professional socialization of oriental medical students, to analyze influencing factors on it, and to compare the results with those of western medical students. Professional socialization, in the context of this study, means the process through which a layperson becomes a profession equipped with professional identity and values. A survey using specially designed questionnaire was carried out in 1999. The data were collected from 11 oriental medical colleges for 2,656 students. A total of 2,597 cases was finally included in the statistical analysis. Analysis of factors related to professional value found that oriental medical students thought highly of human-oriented factors, followed by science and status, and this trend remained unchanged as they moved on to qualification. Among professionalism related items, those involved in professional regulation and dominance factors showed high scores, while showing low scores on items related to bio-ethics and autonomy factors. Unlike items of professional value, those of professionalism showed a notable difference in attitude statistically by schooling level. The average scores of factors for professionalism increased with increasing schooling years. This trend proved that oriental medical students acquired professional norms and attitudes through their educational period. Multiple regression analysis with the factors related to professional value and professionalism as dependent variables found that independent variables had some impact on science, status, and clinical autonomy, but no impact on human, policy autonomy, and professional regulation factors. In conclusion, with increasing schooling years, professional norms and attitudes of oriental medical students were also strengthened. And, in spite of the differences in general propensity, they have a base consciousness in common with western medical students. The difference of mind-set and attitudes related to professionalism in the two groups, however, considering the necessity of future cooperative relations, indicated that a common curriculum between both schools is needed, and the education of social medicine should be strengthened in oriental medical colleges.

북한의 동.서의 결합

김창엽,이상구,임병묵,Kim Chang-Yup,Lee Sang-Gu,Lim Byung-Mook 대한예방한의학회 2000 대한예방한의학회지 Vol.4 No.2

According to the North Korean documents , North Korean government have emphasized the development of the Koryo medicine (traditional korean medicine) and encouraged the combination of the Koryo and the modern medicine. It is regarded that this attitude arose from the ruler's will toward independency in the medical field and at the same time the lack of modern medical resources . Combinations of the Koryo medicine and the modern medicine in the clinical textbooks are classified as follows: first, mixed medication of the Koryo and the modern medicine. Second, combination of the traditional acupuncture(or moxibustion) and the medication of modern medicines. Third, injection of modern medicines at acupoints. Forth, an intramuscular or an intravenous injection of the Koryo medicine. Fifth, anesthesia using Koryo medicine. Sixth, simple surgery at the acupoints. Lastly, combination of injection and the traditional therapy(eg. acupuncture, moxibustion and cupping) Despite of many achievements in the field of combined medical treatment, recent economic failure and severe famine for several years caused collapse of the health care delivery system in North Korea, and it is hard to find combined practices actually.

우리 나라 농어촌지역 성인의 고혈압 관련 행태

김창엽,이건세,임준,최용준,이해국,이경호,김용익,강영호,Kim, Chang-Yup,Lee, Kun-Sei,Yim, Jun,Choi, Yong-Jun,Lee, Hae-Kook,Lee, Kyung-Ho,Kim, Yong-Ik,Khang, Young-Ho 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.1

Objectives : To describe health behaviors related to hypertension in rural population of Korea and focused to identify inappropriate awareness, treatment, and control of hypertension. Methods : We surveyed 5,517 adults (2,288 males, 3,229 females) older than 30 years in 58 rural areas, purposely sampled nationwide from December 1996 to February 1997. Blood Pressure was checked twice af the time of the first visit. For those who showed high blood pressure using the JNC-6 criteria at their initial visit, we followed up their blood pressure one week later. Also information on the health behavior related to hypertension was collected through the person-to-person interview using structured questionnaire at the first visit. Results : For the past one year, females had more experiences of checking their blood pressure than males (77.3% versus 69.5%, p=0.001). Through the results of consecutively checked blood pressure, only 51.7% of the hypertensives were aware of their condition. Of the hypertensives who aware of their condition, 44.4% did not receive any medication and/or recommendation. And 50.4% of the hypertensives who had anti-hypertensive medication were classified as still having hypertensive blood pressure by 160/95 mmHg criteria. Of the medicated, 54.8% were found to take medication regularly for the past six months. Among the medicated, only 11.4% knew the name of anti-hypertensive drug they had. Conclusions : 'Rule of halves', which works in the situation of no special efforts for hypertension control, was identified. This study showed that much efforts to control hypertension would be required in the rural population of Korea.

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.