EMTP 시뮬레이션과 축소모형 실험에 의한 SSSC의 성능 해석

姜中九(Jung-Gu Kang),韓炳文(Byung-Moon Han) 대한전기학회 1999 전기학회논문지A Vol.48 No.5

신포괄수가 시범사업 모형 개선 이후의 지불정확도 변화

최정규,김선희,신동교,강중구,Choi, Jung-Kyu,Kim, Seon-Hee,Shin, Dong-Gyo,Kang, Jung-Gu 한국보건행정학회 2017 보건행정학회지 Vol.27 No.3

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.

입원환자의 낙상 실태 및 위험요인 조사연구

윤수진,이천균,진인선,강중구,Yoon, Soo-Jin,Lee, Chun-Kyon,Jin, In-Sun,Kang, Jung-Gu 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.2

Purpose: The objective of this study was to report the incidence of falls in hospitals and analyze the risk factors for falls. Methods: This study used data on 1,216 patients who experienced falls from 2015 to 2017 during their hospitalization. The data was collected from the falls incident reports and patient' electronic medical record of hospital. Data were analyzed with descriptive statistics using Chi-square test, Fisher's exact test and multiple Poisson regression analysis with the SAS 9.4 Results: The incidence of falls was 1.38 per 1,000 patients days (2015), 1.81 per 1,000patients days (2016) and 1.99 per 1,000patients days (2017). The incidence of injury caused by falls (level III~V) was 0.05 per 1,000patients days (2015), 0.04 per 1,000patients days (2016) and 0.06 per 1,000patients days (2017). The largest number of falls occurred during night shift (42.5%), specifically in the patients' room (70.8%), and medical unit (66.0%). Average age of fallers was 69.1 years and 61.7% of them were older than 71 years. CCI and the patient's department have statistically significant differences in injury or injury levels from falls, but the integrated nursing care services had no significant difference in injury or injury levels from falls. Conclusion: The result of this study can be used as a reference for establishing a fall prevention strategy for hospitalized patients by presenting index values such as the fall rate.

직장암에서 전층절편 조직 검사를 통한 직장간막 미세종양 결절과 측방 절제연에 관한 임상연구

김서전(Seo-Jeon Kim),최윤정(Yoon-Jung Choi),강중구(Jung-Gu Kang) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.5

Purpose: Total mesorectal excision (TME) has been widely accepted as the principal method in rectal cancer surgery and demonstrates good oncologic and functional outcome. The recurrence rate of mid-low rectal cancer surgery with TME is reported as 5∼6%. Concerning local recurrence, remaining microscopic nodules in mesorectum are a major issue. In this study, we investigated mesorectal spread of tumors and exact lateral resection margin using whole mount section (WMS) to obtain correlations with other clinico-pathological variables. Methods: 63 rectal cancer patients underwent surgery with TME and WMS at National Health Insurance Corporation Ilsan Hospital between December 2005 and October 2008. Preoperative study was made by computed tomography (CT), magnetic resonance imaging (MRI). We measured the distance from the largest cut section of the primary tumor to the nearest circumferential margin using MRI and compared them to lateral resection margins in WMS. Results: Among 63 patients, the sex ratio was 1:1.17 and the median age was 62.7 years. There were 34 patients in TNM stage Ⅲ (54.0%), 21 patients in stage Ⅱ (33.3%) and 8 patients in stage Ⅰ (12.7%). Lateral margin involvement was predicted in 4 cases pre-operatively and confirmed in 3 cases with WMS. Micrometastasis in mesorectum was detected in 6 patients (9.5%) and all were in stage Ⅲ. N stage was statistically correlated with micrometastasis (P=0.016). Conclusion: WMS offers precise lateral resection margin and mesorectal spread of microscopic tumor nodules. WMS is best considered in stage Ⅲ cancer to evaluate mesorectal micrometastasis. The mid-low rectal cancer cases with predicted lateral margin involvements using MRI should be operated on with great care.

대장암의 근치적 절제 후 재발의 발견에 대한 양전자방출 단층촬영의 진단적 가치

홍영기(Young Ki Hong),김우람(Woo ram Kim),최윤정(Yoon Jung Choi),강중구(Jung Gu Kang) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.2

Introduction : Accurate detection of recurrent colorectal cancer remains a diagnostic challenge. The purposes of this study were to evaluate the diagnostic value of Positron Emission Tomography-Computed Tomography (PET/CT) using flour-18-deoxyglucose (FDG) in Detection of Recurrence after Curative resection for Colorectal Cancer. Material and Methods : We performed a retrospective review of 248 patients who underwent PET/CT for surveillance of colorectal cancer after curative resection between June 2008 and April 2011. Recurrence of colorectal cancer was validated by histopathologic examination or serial imaging study follow-up. Results : Of the 248 patients (149 males) included in the study, thirty-six patients (14.5%) were confirmed as recurrence. Liver was the most common site of recurrence (n=13). A total 472 PET/CT were conducted in 248 patients during follow-up period. The sensitivity and specificity of PET/CT were 0.921(95% Cl 0.908-0.934) and 0.981(95% Cl 0.975-0.987) for detecting tumor recurrence. The sensitivity and specificity of contrast enhanced computed tomography (CECT) were 0.902(95% Cl 0.888-0.916) and 0.952(95% Cl 0.942-0.952). CEA elevation was shown in only 13 cases (36.1%) of patients with recurrence. The treatment plans of 26 cases (10.5%) were altered by PET/CT findings. The curative surgical tumor resection procedure was performed in 15 out of 36 patients. In 3 cases which CECT showed negative findings, PET/CT had detected unexpected metachronous cancer (one colon, two bladders). Conclusions : Additional PET/CT on CECT seems to provide high detection rate of tumor recurrence after curative resection for colorectal cancer and other critical information such as unexpected secondary malignancy.

국소 진행성 대장암에 대한 병합절제의 안전성에 대한 연구

임대로 ( Dae Ro Lim ),홍영기 ( Young Ki Hong ),허호 ( Ho Huh ),임치영 ( Chi Young Lim ),강중구 ( Jung Gu Kang ),최윤정 ( Yoon Jung Choi ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.2

Purpose: About 10% of colorectal cancers are known to have already invaded contiguous organs or had inflammatory adhesion to adjacent structures. Under such circumstances, combined resections of involved structures may be considered. The aims of this study were to investigate true incidence of cancer invasion and surgical outcomes in patients where a multivisceral resection was performed for locally advanced colorectal cancer. Methods: Nine hundreds two patients with colorectal cancer submitted to surgical treatment between March 2000 and December 2007 were reviewed retrospectively, and multivisceral resection was performed in 68 patients. We reviewed the clinicopathologic characteristics of multivisceral resections for locally advanced colorectal cancer Results: The incidence of multivisceral resection was 7.5%. The positive predictive values of cancer invasion were 60.0% in CT and 57.1% in MRI. The rate of true cancer invasion in multivisceral resection was 46.4%. In TMN stage, stage IIIB was the most common (27.9%) and followed by stage IIIC (20.6%). Rectal cancer was 29 cases (42.6%), sigmoid colon cancer was 18 cases (26.4%). In combined resection, female reproductive organ were the most commonly involved organ (27.2%) and followed by small bowel (16.3%) and bladder (9.8%). In number of organs, one organ in the combined resection was 41 cases (60.3%) and there was 1 case in which 6 neighboring structure involved in combined resection. There was no postoperative death and complications in postoperative period occurred in 23.5% including wound infection, intestinal obstruction, and pneumonia. Conclusions: When adhesion to neighboring organ by primary colorectal cancer was found intraoperatively, multivisceral resection would be mandatory regardless of the preoperative assessment. Every effort to reduce postoperative complication may be necessary to justify multivisceral resection.

일개 종합병원 4인실과 5/6인실 사용자의 만족도 비교

이찬희 ( Chan Hee Lee ),임현선 ( Hyun Sun Lim ),윤수진 ( Soo Jin Yoon ),박은철 ( Eun Cheol Park ),강중구 ( Jung Gu Kang ) 한국병원경영학회 2016 병원경영학회지 Vol.21 No.2

Purpose: The purpose of this study is to compare the user satisfaction between 4-bedrooms and 5/6-bedrooms in a single general hospital. Methodology: To measure and compare multiple-bed ward user satisfaction between 4-bedrooms and 5/6-bedrooms, questionnaires were collected from 916 inpatients and 129 nurses in a single general hospital. The patient satisfaction questionnaire categories included environmental conditions, protection of privacy, and medical services. The nurse satisfaction questionnaire categories included space, infection control, patient safety, work load and psychologic view point. Findings: Satisfaction of patient who admitted in 4-bedroom to the environmental conditions and protection of privacy was higher than that of 5/6-bedroom group (3.91 vs. 3.25, p<0.001). Satisfaction of nurse who worked in 4-bedroom was higher than that of 5/6-bedroom (3.05 vs. 1.92, p<0.001). By the multiple linear regression analysis, patient satisfaction to the environmental conditions and protection of privacy was related with multi-bedroom type and location of beds; 4-bedrooms were higher than 5/6-bedrooms(p<0.001), window side bed were higher than hallway side bed(p=0.001). There was no satisfaction difference in comparing medical services between the two groups. By the multiple linear mixed regression analysis, nurse satisfaction who were assigned for 4-bedrooms were higher than that of 5/6-bedrooms in all categories(p<0.001). Practical Implications: Even though no difference has shown in medical services satisfaction between the two patient groups, multi-bedroom type may affect patient satisfaction in environmental condition, protection of privacy and may also affect overall nurse satisfaction. This result suggests that to improve multi-bedroom user satisfaction, 4-bedroom is recommended over 5/6-bedroom.

외래 초진환자의 만족진료시간과 관련 추가 비용 지불 의사

이찬희 ( Chan Hee Lee ),임현선 ( Hyunsun Lim ),김영남 ( Youngnam Kim ),윤수진 ( Soojin Yoon ),박양숙 ( Yang Sook Park ),김선애 ( Sun Ae Kim ),박은철 ( Eun-cheol Park ),강중구 ( Jung-gu Kang ) 한국보건행정학회 2017 보건행정학회지 Vol.27 No.1

Background: We evaluated new patient`s satisfactory consultation time (SCT) and their willingness to pay additional costs (WPAC) for their SCT. Methods: We surveyed medical service satisfaction, SCT, WPAC for their SCT, and payable amount to 612 new patients of single general hospital and measured their real consultation time (RCT). To compare WPAC and payable amount, we divided RCT into 4 groups (≤3 minutes, 3-5 minutes, 5-10 minutes, and >10 minutes), and SCT into 3 groups (≤5 minutes, 5-10 minutes, and >10 minutes). On the basis of WPAC, we estimated new patient`s SCT. Results: RCT was 6.2 minutes, SCT was 8.9 minutes, and medical service satisfaction score was 4.3 (out of 5). The number of patients having WPAC (payable group) was 381 (62.3%) and the amount was 5,853 Korean won. Their RCT and SCT were longer than non-payable group (6.4 minutes vs. 5.7 minutes, 9.3 minutes vs. 8.2 minutes). From multiple logistic regression analysis, WPAC of RCT 5-10 minutes was higher than that RCT ≤3 minutes (odds ratio=1.78). Payable amount was highest in RCT >10 minutes (6,950 Korea won) and SCT >10 minutes (7,458 Korean won). Intuitively we suggest 10 minutes as SCT, based on payable group`s SCT (9.3 minutes) and cut-off time differentiating payable group with non-payable group (10 minutes). Conclusion: We found that new patient had WPAC for their SCT and the longer the SCT, the greater the amount. From this, we hope that current simplified new patient consultation fee calculating system should be modified combining the consultation time factor.

다량의 복수로 발현된 사르코이드증 1예

이수진 ( Su Jin Lee ),김은혜 ( Eun Hye Kim ),김영숙 ( Young Sook Kim ),송제은 ( Je Eun Song ),정수진 ( Soo Jin Chung ),이천균 ( Chun Kyun Lee ),장명희 ( Myung Hee Chang ),강중구 ( Jung Gu Kang ),최윤정 ( Yoon Jung Choi ),박수미 ( 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.6

진료과별 적정 외래 진료시간에 관한 연구

이찬희 ( Chan Hee Lee ),임현선 ( Hyun Sun Lim ),김영남 ( Young Nam Kim ),박애희 ( Ai Hee Park ),박은철 ( Eun Cheol Park ),강중구 ( Jung Gu Kang ) 한국보건행정학회 2014 보건행정학회지 Vol.24 No.3

Background: The purpose of this study is to assume appropriate outpatient consultation time for each clinical department on the basis of measured outpatient consultation time and satisfaction of outpatient. Methods: We surveyed the feeling and satisfactory outpatient consultation time, satisfaction, revisiting intention and recommendation to others to 1,105 patients of single general hospital in Gyeonggi-do and measured their real outpatient consultation time from October 28 to November 25 in 2013. On the basis of satisfaction, we estimated appropriate outpatient consultation time through area under the receiver operating characteristic curve in logistic regression model. Results: Feeling outpatient consultation time was 5.1 minutess, satisfactory outpatient consultation time which was suggested by patient was 6.3 minutes, and real outpatient consultation time was 4.2 minutes. Department which had longest real outpatient consultation time was infection (7 minutes) and department which had longest satisfactory outpatient consultation time was neurology (9.4 minutes). From the univariate and the multiple linear regression analysis, real outpatient consultation time was longer in pulmonology patient, new patient and afternoon patient, satisfactory outpatient consultation time was longer in infection, neurology, neuropsychiatry, neurosurgery, and rehabilitation patient. Appropriate real outpatient consultation time was suggested as 5.6 minutes which differentiated high and low satisfied patient group. However, we could not assume appropriate OCT for each clinical department because the number of patient who had bad satisfaction was too low. Conclusion: To improve patient`s satisfaction, we hope outpatient reservation system is operated as each patient`s outpatient consultation time is at least 5.6 minutes.