한국 호스피스.완화의료 기관 현황 및 과제

이건세,주지수,김정회,김건엽,Lee, Kun-Sei,Joo, Ji-Soo,Kim, Jung-Hoe,Kim, Keon-Yeop 한국호스피스완화의료학회 2008 한국호스피스.완화의료학회지 Vol.11 No.4

목적: 본 연구는 현재 호스피스완화의료 기관의 인력 및 시설, 제공서비스 등이 말기 암환자 전문의료기관 지정 기준에 부합하는 정도를 조사하고 분석하여 향후 정책수립을 위한 기초자료를 제공하고자 실시되었다. 방법: 자료는 2007년 10월부터 12월까지 수집되었으며 설문내용으로는 호스피스 완화의료 기관의 일반현황, 인력현황, 시설현황, 장비현황, 호스피스 서비스 운영현황 등을 포함하였다. 총 62개 의료기관이 응답하였다. 결과: 전체 62개 기관 가운데 42개 기관이 종합병원 이상인데 비하여 의원의 경우 9개 기관에서 호스피스를 제공하고 있었다. 호스피스 의료기관은 수도권 지역 위주로 분포하고 있어 지역적인 불균형 공급을 보이고 있다. 의사의 경우 환자 10명당 1인의 의사를 갖추고 있는 기관은 종합병원 이상(80.0%)인데 비하여 의원의 경우 이 기준을 충족하는 비율은 낮았다(42.9%). 간호사의 경우 호스피스 간호를 위해 필요한 조건인 환자 1.5 명당 1인의 기준에 충족하는 기관은 의원급(71.4%)이 종합병원 이상의 기관(65.0%), 병원(50.0%)에 비해 높게 나타났다. 호스피스 지원기관의 기준에 해당하는 1병실 4인 기준을 충족하는 기관은 전체 62개 기관에서 14개 기관으로 22.6%를 차지하고 있었다. 호스피스 환자들을 위한 특수요법의 경우는 의원급(66.7%), 병동 및 독립형(64.9%), 지원 사업 기관(73.9%)일수록 2개 이상의 특수요법을 실시하고 있는 것으로 나타났다. 임종 및 사별관리 프로그램에 해당하는 임종관리, 장례준비, 유가족지지모임, 사별가족 관리 프로그램을 실시하는 기관의 비율이 높았으며, 의원급, 병동 및 독립형, 지원 사업 수록 실시율이 높게 나타났다. 팀 인력에 대한 교육은 의원급(55.6%), 병동형 및 독립형(55.8%), 지원기관(65.2%) 이 상대적으로 높은 비율로 시행하고 있었다. 현재 가정 호스피스 서비스를 운영하고 있는 곳은 절반 수준인 32개(51.6%) 기관으로 나타났다. 결론: 본 연구를 통해 확인한 것은 호스피스 기관을 양적으로 확대하는 것과 함께 지역적인 분포를 동시에 고려하는 것이 필요하다는 점과 아직도 호스피스 지원 기관의 인력, 시설 수준을 충족하지 못하는 비율이 높다는 것을 확인하였다. 또한 호스피스 기관의 종별 특성에 따라 인력 및 시설 확보 수준, 프로그램 운영에 차이가 있으므로 시설의 특성을 고려한 개선 방안을 고려하여야 할 것이다. Purpose: The purpose of this study was to evaluate the current status of hospice palliative care facilities, and to identify problems and improve hospice palliative care in Korea. Methods: The questionnaire survey was implemented from October to December, 2007. It was consisted of general characteristics of organization, health manpower, facilities & equipments, service programs, and so on. Sixty two (79.5%) out of 78 hospice palliative care facilities returned the questionnaires. Results: They were 42 hospital-based hospice palliative care hospitals and 9 clinics, and most of them are located at central metropolitan areas (Seoul and Gyeonggi Province). more than 80% of hospitals met with the requirements (one doctor per 10 patients and one nurse per 1.5 patients), whereas 42.9% of clinics met the requirements. Approximately 22% of them met the requirement of sick room (4 patients for 1 room). Most of them provided various hospice palliative care programs. The proportion of giving regular education programs to hospice palliative care personnels were about half (41.9%). Thirty two (51.6%) facilities provided home visiting hospice palliative care service. Conclusion: There were lack of enough health manpower, rooms, and programmes and they varied among facilities. It is necessary to increase the number of hospice palliative care facilities with consideration of regional fair distribution and standardization of programmes.

호스피스 보험수가 개발

이건세,Lee, Geon-Se 한국호스피스협회 2007 호스피스 학술지 Vol.7 No.2

지리적 접근성을 이용한 도시지역 보건지소의 입지선정

이건세,김창엽,김용익,신영수,Lee, Kun-Sei,Kim, Chang-Yup,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1996 예방의학회지 Vol.29 No.2

Decentralization to local governments and amending of Health Center Law are to promote the efforts of health planning at the level of local agencies. In the health facility planning, it is important to take into account that what to be built, where to be located, how far should be service area and so forth, because health facilities are immovable, and require capital as well as personnel and consumable supplies. The aim of our study, answering to the question of 'where to be located?', is to determine the best location of urban health sub-center. At the local level, planning is the matter of finding the best location of specific facilitiy, in relation to population needs. We confine the accessibility, which is basic to location planning, to geographic one. Location-Allocation Model is used to solve the problem where the location is to maximize geographic accessibility. To minimize the weighted travel distance, objective function, $R_k=\sum{\sum}a_{ij}w_{i}d_{ij}$ is used. Distances are measured indirectly by map measure-meter with 1:25,000 Suwon map, and each potential sites, 10 administrative Dongs in Kwonson Gu, Suwon, are weighted by each number of households, total population, maternal age group, child age group, old age group, Relief for the livelihood, and population/primary health clinics. We find that Kuwoon-Dong, Seodun-Dong, Seryu3-Dong, according the descending orders, are best sites which can minimize the weighted distance, and conclude that it is reasonable to determine the location of urban health sub-center among those sites.

보건소 예방접종 전산프로그램의 운영 현황 분석

이건세 ( Kun Sei Lee ),이석구 ( Seok Goo Lee ),이무식 ( Moo Sik Lee ),신의철 ( Eui Chul Shin ),김영택 ( Young Taek Kim ),이연경 ( Yeon Kyeng Lee ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.2

Background: Immunization has been one of the most effective measures preventing from infectious diseases. However, children routine vaccination rate of Korea was 68.2% and it was not higher than expected. Korean government revised the School Health Law for every primary school children to submit the vaccination certificate record from 2005. It is quite important national infectious disease prevention policy to keep the immunizations rate high and monitor the immunizations rate continuously. To do this, National Institute of Health introduced the National Immunization Registry(NIR) Program at 2000. Objective: The aims of this study was to evaluate the Immunization Registry program which has been implementing since 2000 at the Public Health Centers(PHC). Methods: The mail survey was done from November 2001 to January 2002. 169 (69%) Public Health Centers among 244 PHC were responded. Results: The respondents of PHC said the Immunization Registry(IR) program had reduced the workload (18.5%). 69.2% said they inputted the immunization data into the IR program after the shots were given. 86.5% said they hadn`t checked or retrieved the children lists who had missed the scheduled immunization. Only 17.2% said the speed of internet for the IR program was good. It showed that 20% of respondents hadn`t written down documents, records on immunization any more. Even there were a lot of negative results, the respondents of PHC thought that the IR program was effective. They especially agreed that the IR program could make the job accurate (81.5%), convenient (71.3%), and reduced the chances of making mistakes (71.3%), increase the service quality (78.5%). And they were well adapting the job process of the IR (79.63%). Bivariate analysis showed that the software program was the important determinants of IR success. The only Bit Computer software program has been evaluated to be less satisfactory than the Integrated (Posdata operating system + Bit software) program. Other variables, such as age, duration of present job, and location of PHC (metropolitan, small city, rural area) were not significantly related. Conclusion: It seemed that the success of NIR might depend on the software program. Because Integrated program, which has been developed from 1994, include not only the general operating and management program for PHC but also IR program. It was natural to prefer Integrated program to Bit software program. So we can suggest that it is essential for the NIR to be successful that not only the immunization software program but also hardware equipments and public health information system should be further improved.

권역심뇌혈관질환센터의 공익성 측정도구 개발

이건세 ( Kun Sei Lee ),신은영 ( Eun Young Shin ),정효선 ( Hyoseon Jeong ),이정현 ( Jung Hyun Lee ),김희숙 ( Hee Sook Kim ),임영실 ( Young Sil Lim ),김영택 ( Young Taek Kim ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Background: Regional Cardiocerebrovascular Centers (RCC) were established for the prevention and treatment of cardiocerebrovascular disease and funded by the Ministry of Health and Welfare. The purpose of this study was to develop and validate the measurement tool of public benefits in RCC. Methods: Through the intensive literature review, experts surveys and their repetitive feedback, we selected the 46 items about the public benefits in RCC. Development of measurement tool involved content validity test using Content Validity Index (CVI), construct validity test through factor analysis and reliability test. Results: Thirty-five items were selected by content validity test, which CVI was 0.08 or higher. Through the construct validity test, 32 items in 7 factors were derived. And Cronbach`s alpha was 0.951. Finally, public benefits measurement tool is composed of 32 items in 7 factors which are comprehensiveness of health care services, market complement, emergency care, cost, governance, quality improvement, and government control. Conclusion: Though we developed the measurement tool of public benefits in RCC, it would be utilized to measure the public benefits of various health agencies.

딥러닝을 이용한 외해 해양기상자료로부터의 항내파고 예측

이건세(Geun Se Lee),정동현(Dong Hyeon Jeong),문용호(Yong Ho Moon),박원경(Won Kyung Park),채장원(Jang Won Chae) 한국해안해양공학회 2021 한국해안해양공학회 논문집 Vol.33 No.6

본 연구에서는 항내 파고를 신속하고 비교적 정확하게 예측할 수 있는 딥러닝 모델을 구축하였다.다양한 머신러닝 기법들을 외해파랑의 항내로 전파 변형 특성을 감안하여 모델에 적용하였으며 스웰로 인해 하역중단 문제가 심각했던 포항신항을 모델적용 대상지로 선정하였다. 모델의 입력 자료는 외해의 파고, 주기, 파향 그리고 출력 및 예측 자료로는 항내 파고자료로 하여 모델을 학습시켰다. 이때 자료의 전처리 과정으로 항내·외 파랑 시계열자료의 상관성을 감안하여 파향 자료를 분리하는 방법을 적용하고 딥러닝 기법을 이용하여 모델을 학습하였다. 결과적으로 모델을 통해 예측한 값이 항내관측치의 파고 시계열자료를 잘 재현하였으며 모델의 안정성을 크게 향상시켰다. In this study, deep learning model was set up to predict the wave heights inside a harbour. Various machine learning techniques were applied to the model in consideration of the transformation characteristics of offshore waves while propagating into the harbour. Pohang New Port was selected for model application, which had a serious problem of unloading due to swell and has lots of available wave data. Wave height, wave period, and wave direction at offshore sites and wave heights inside the harbour were used for the model input and output, respectively, and then the model was trained using deep learning method. By considering the correlation between the time series wave data of offshore and inside the harbour, the data set was separated into prevailing wave directions as a pre-processing method. As a result, It was confirmed that accuracy and stability of the model prediction are considerably increased.

정상가격과 최유효사용에 관한 연구

이건세(Lee, Kon Sae) 한국부동산연구원 1996 부동산연구 Vol.6 No.1

부동산가격의 중심개념인 정상가격은 감정평가사가 추구하는 시장가치의 기본이념형으로 합리적인 시장조건과 합리적인 수요자·공급자의 행위를 전제로 하고 있다. 마찬가지로 정상가격의 성립요건인 최유효사용의 원칙도 소유자 또는 사용자의 능력을 전농으로 가정한 이상적인 조건을 전제로 하고 있다. 그러나 이와같이 이상적인 가격모형을 파악하는 것이 지나치게 추상적이며 셜득력이 없다는 비판을 받게 되었고, 이에 대한 대안으로 「최빈매매가능가격」과 「최빈사용가능방법」이라는 실증적·구체적인 접근방법이 새로이 제시되기에 이르렀다. 지가공시법과 함께 듣장한 적정가격의 개념도 정상가격의 범주에서 벗어나는 것이 아니며 오히려 최빈매매가능가격과 유사한 특성을 지니고 있다. 앞으로 정상가격과 적정가격의 본질에 대한 심층적인 연구가 계속되어 보다 명확한 정의가 내려지길 기대한다.

보건의료 경제성 평가 방법론 고찰 -연구 설계와 비용 추정을 중심으로-

이건세 ( Kun Sei Lee ),( Brouwer Wbf ),이상일 ( Sang Il Lee ),구혜원 ( Hye Won Koo ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.2

Cost containment has become high political issues since financial crisis of the Korean Health Insurance fund in 2000. Korean Government has developed and implemented several measures to reduce the pharmaceutical expenditures. Pharmaceutical economic evaluation can be a tool in decision to allocate scare resource efficiently. In order to increase the quality of economic evaluation for pharmaceuticals, the Korean Health Insurance Review Agency(HIRA) is considering the development of a guideline for economic evaluation. It mandates that pharmaceutical companies could submit the result of an economic evaluation when demanding reimbursement of new pharmaceutical drugs. The purpose of this study is to provide a critical review of the economic evaluations of health care technologies published in the Korean context whether they have been performed according to current guidelines and therefore whether their results are directly useful for decision making. We found there exist important problems and deviation from ``good practice`` both in the general features of the studies, like the study design and perspective, and in terms of cost measurement and valuation. There are needs to develop clear guidelines and to educate and train researchers in performing economic evaluations.

캔버라의 土地賃貸保有制에 관한 硏究

李建世(Lee. Kon-Sae) 한국부동산학회 1985 不動産學報 Vol.6 No.-

Rand Social Health Battery를 이용한 일부 농촌지역 주민의 사회적 기능 평가

이건세(Kun-Sei Lee),김형수(Hyeong-Su Kim),장성훈(Soung-Hoon Chang),박수경(Suekyung Park),최희정(Hee Jeong Choi),함은미(Eun Mi Ham) 한국보건교육건강증진학회 2004 보건교육건강증진학회지 Vol.21 No.2