일 병원의 DRG수가제에 따른 병원경영수지 개선과 의료서비스 질향상 효과에 관한 연구 : 행위별수가제와 DRG수가제의 진료비 비교 분석

박운제,홍인규 한국의료QA학회 1999 가을학술대회 Vol.1998 No.-

의무기록 완성도의 입원환자 진료적정성에 대한 예측도 평가

박운제,박일환,Park, Un Je,Park, Eal Whan 한국의료질향상학회 1997 한국의료질향상학회지 Vol.3 No.2

Background : Medical records are used to assess clinical performance of physicians and quality of care. The contents which are written in medical records are considered as the objective evidences to know what the doctors think about the patient's problems. But the problem to use medical records as the assessment tools is the incompleteness of medical recording. The purpose of this study is to know if the completeness of medical recording is correlated to quality of care for inpattients and it can predict physicians's quality of care. Method : 32 clinical physicians reviewed 200 patients' medical records who were selected randomly from the inpatients who were admitted to the university hospital during July, 1995 and June, 1996. The reviewers used the structured evaluation questionnaires which were composed of two part. One part evaluated the completeness of the medical recording and the other evaluating appropriateness of diagnosis and treatment processes. We summated the scores of each items and calculated percentile scores. Results : The mean percentile score of completeness of the medical recording was 67.9% in 1995 and 79.8% in 1996. The mean percentile score of appropriateness was 52.2% in 1995 and 69.5% in 1996. This change between 1995 and 1996 was statistically significant. In non-surgical patients, the percentile scores of the completeness and those of the appropriateness were correlated positively and this correlation was statistically significant(p<0.05). In surgical patients, the positve correlation between the completeness and the appropriateness was also statistically significant(p<0.05). Discussion : In conclusion, the completeness of medical recording is considered as the good predictor of the quality of care for inpatients.

일 대학병원 암 환자의 생존율과 예후요인에 관한 연구

박운제,이태용,이석구,김선영 한국역학회 2000 Epidemiology and Health Vol.22 No.2

일개 특수 요양병원 환자들의 특성 및 사망 위험요인

박운제(Un Je Park) 한국산학기술학회 2020 한국산학기술학회논문지 Vol.21 No.12

일 공공기관 S보훈병원과 상호 연계된 협진체제를 구축하여 운영하고 있는 V요양병원 환자들의 특성 및 사망위험요인을 파악하여, 양질의 의료서비스를 제공하는 것을 목적으로 한다. V요양병원에서 2017년 1년 동안 850명의 퇴원환자를 대상으로 2020년 3월1일부터 5월31일까지 3개월 동안 추적조사를 하였다. 조사분석 결과 V요양병원 입원환자는 최저 37세에서 최고 100세로 평균연령은 79.2세, 70세 이상이 86.4%로서 타 선행연구보다 연령 비중이 높았다. 국가유공자가 75.4%로서 유가족이나 일반인 환자보다 3배 이상 높았다. 주진단명은 치매 질환이 22.2%로 가장 많았으며, 심혈관질환, 마비증후군 순이였다. 평균재원일수는 160일이였으며, 재원일수 180일 이상이 46.4%로서 일반 요양병원의 37% 보다 높은 것으로 나타났다. 남성 사망률이 여성보다 높고, 국가유공자는 사망이 생존보다 높은 것으로 나타났다. 사망위험요인은 연령과 재원일수 이었다. S보훈병원으로 전원이 높은 것은 응급센터/재활센터/심혈관센터 등의 진료이용이 신속하고, 다양한 회복치료가 가능하기 때문이다. V요양병원 중증 만성질환자들에게 S보훈병원으로의 전원은 진료이용이 신속하고 다양한 회복치료의 효과가 높으므로 협진체계를 확대 운영하여 요양병원 만성질환자들에게 건강 회복을 통한 행복한 삶의 질을 높여야 할 것을 시사한다. The objective of this study is to provide high-quality medical service, by understanding the characteristics and death risk factors of patients at V long-term care hospital, that has established and operated the cooperative treatment system in connection with a public institution, the S veterans hospital. A follow-up survey targeting a total of 850 discharged patients was conducted for the year 2017. Average age of patients was 79.2 years, with 86.4% belonging to the 70 years or over group. The men of national merit were 75.4%, which was more than three times higher than general patients. Hospitalization for 180 days or more was 46.4%, which was higher than general long-term care hospitals (37%). The major death risk factors were age and the number of hospitalized days. Our data indicate that transfer to S veterans hospital results in providing quicker treatment and higher effectiveness of the numerous recovery therapies. We therefore propose that the cooperative treatment system should be expansively operated to increase the quality of happy life, by alleviating the health of patients with chronic diseases in a long-term care hospital.

치매환자 특성의 추이 분석

박운제(Un-Je Park) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.1

우리나라는 고령화 사회로 빠르게 진입함에 따라 치매환자가 급속히 증가하고 있다. 본 연구는 대도시에 위치한 5개 V병원의 자료를 활용하여 12년간 치매 신환자의 특성 추이를 분석하고 향후 치매환자 증가 수요에 대처하고 치매환자 관리에 기초자료를 제공하고자하는 것이 목적이다. 5개 V병원의 전체 치매 신환자수는 2003년 410명이었으나 2014년에는 5,048명으로 11.3배 증가하였으며, 5개 병원중에서는 P병원이 2003년에 비해 2014년은 30.3배로 가장 많이 증가하였고, D병원은 6.0배 증가하여 병원간에 차이가 많았으나 전반적으로 5개 V병원 치매환자 수가 크게 증가한 것으로 나타났다. 연령별에서는 75세∼84세군에서 40.4%로 가장 높았고, 85세 이상 20.2%로 65세 이상이 93.5%로 대부분을 차지하여 고령층에서도 치매환자의 비율이 높게 나타났다. 치매환자 유형별에서는 알츠하이머병이 44.4%로 가장 높게 차지하였으며, 상세불명의 치매는 33.3%, 혈관성치매가 20.4% 순이었다. 연구결과는 12년 동안 큰 폭으로 증가하였으며, 치매환자는 연령이 높을수록 발생률이 높기 때문에 앞으로 5개 V병원의 치매환자 수는 더욱 증가할 것이다. 치매환자 증가 수요에 따른 효과적인 치매관리를 위한 체계적이고 지속적인 추진방안이 요구된다. South Korea is becoming an aging society, increasing the population with dementia. This study analyzed the characteristics of the trend of dementia patients by utilizing 12 years" worth of data from five V hospitals within metropolitan cities. The results show that there has been an 11.3 times increase in the total number of new dementia patients in these five hospitals from 410 in 2003 to 5,048 in 2014; and among them, the rate of increase was highest in P hospital with a 30.3 times increase. Conversely, there has been a 6-times increase in D hospital, illustrating a noticeable gap between these hospitals. Overall, these hospitals have shown an enormous increasing ratio. In an analysis according to age, it"s been shown that those aged between 75 and 84 showed the highest prevalence, and most patients, approximately 93.5%, were 65 years or older, while 20.2% were 85 years or older, showing a high ratio of elderly among dementia patients. In an analysis by type of dementia, it"s been shown that Alzheimer"s was the most prevalent with 44.4%, followed by unspecified dementia with 33.3%, and vascular dementia with 20.4%. As evident by the outcome of the study, there"s been a drastic increase in the number of dementia patients in the past 12 years; since the prevalence of dementia was shown to be higher with older age, it is expected that the number of dementia patients will rise further in these five hospitals, where there"s a high ratio of elderly patients. More elaborate and continuous plans are necessary for the management of dementia patients following the growing number of dementia patients.

전자의무기록(EMR) 시스템하에서 의사의 만족도와 의무기록정보의 기재 충실도 향상 방안

박운제 ( Un Je Park ) 한국병원경영학회 2011 병원경영학회지 Vol.16 No.2

This study aims to present ways to enhance the stabilization of electronic medical records, ensure the commitment to filling in information of the medical record and improve the overall quality Electronic Medical Record(EMR) information. For that purpose, the present state of the incomplete record rate and the doctor`s satisfaction in Electronic Medical Record(EMR) have been surveyed by comparing and analyzing Paper-based Medical Record(PMR) and Electronic Medical Record(EMR). The survey was conducted on 31 doctors in charge of EMR system and each PMR and EMR inpatients were collected for a period of 5 months and analyzed. The results showed that the doctor`s satisfaction level was higher for EMR, and the rate of incomplete record appeared to be lower in EMR in departments of both internal and external medicine. In this context, it can be said that the higher efficiency of EMR helped accomplish the increase in commitment to completing medical record information and improve the quality of the data.

보훈의료전달체계 정립을 위한 인천권역 위탁병원 의료이용 분석 연구

박운제 ( Un Je Park ) 한국보건정보통계학회(구 한국보건통계학회) 2020 보건정보통계학회지 Vol.45 No.3

Objectives: It contributes to establishing a veteran medical delivery system through efficient operation between the consigned hospital and the veterans hospital by analyzing the actual condition of medical use of patients in the consigned hospitals in the Incheon area. Methods: The research subjects of the National Merit of Incheon area were 253,300, and 15 of the consigned hospitals were targeted at Incheon and 24 designated consigned hospitals. Results: Analyses were conducted per outpatients from each regions, clinics, consigned hospitals, 10 most common diseases and total medical expenses. From 2016 to 2018, in terms of medical use of outpatient per consigned hospitals, I hospital took first place, H hospital is the second most followed by D hospital for last 3 consecutive years. When compared and analyzed total medical expense per consigned hospitals has increased 4% annually from 2016 to 2018. Based on this study, there are gaps of cases among 24 consigned hospitals, however, chronic diseases such as hypertension and diabetes mellitus were the most common cases. That is, consigned hospitals play a significant role in primary health care. Conclusions: By improving the level of medical service centering on consigned hospitals in areas with low medical utilization rates, increasing the level of utilization and efficiently providing short-distance regional convenience and proximity medical services to national merit in Incheon area, It will contribute to establishing a veteran medical delivery system.

대전 ․ 충남지역의 암 발생률 추이와 질적 평가에 대한 연구

박운제(Park, Un-Je),남해성(Nam, Hea-Sung),김광환(Kim, Kwang-Hwan),박창수(Park, Chang-Soo),권인선(Kwon, In-Sun),김정아(Kim, Jung-A),이태용(Lee, Tae-Yong) 한국산학기술학회 2013 한국산학기술학회논문지 Vol.14 No.3

대전지역과 충남지역의 2000-2009년의 암등록 자료를 근거로 암 발생률 변화 및 지역간의 차이와 암등록 자료의 질적 수준을 평가하고자 하였다. 두 지역의 조발생률과 연령표준화 발생률을 비교하였고, 암발생 자료의 타당 도는 연령미상률(Age UNK%), 조직학적 확진(HV%)과 DCO%로 보았고, 충실도는 M/I ratio로 평가하였다. 연령표준 화 발생률의 발생률 차이는 포아송 분포로 평가하였고, 95% 신뢰구간을 계산하였다. 그리고 성별, 연령별, 지역별 차 이는 발생률 곡선으로 비교하였다. 암종별 발생분율에서 위암은 대전이 18.8%, 충남이 21.5%로 가장 높았다. 대전지 역 남성의 2000년 연령표준화 발생률은 322.1명, 2009년은 323.9명으로 10년간 0.6% 증가하였다. 여성의 경우 2000 년 203.9명에서 2009년 326.8명으로 60.3%의 증가하였다. 충남지역의 남성은 2000년 294.7명에서 2009년 336.97명으 로 14.3% 증가하였고, 여성은 2000년 156.5명, 2009년은 267.1명으로 70.7%의 증가하였다. 타당도의 연령미상률은 2000년부터 2009년까지 두 지역 모두 0.0%이었고, 조직학적 확진%는 남성은 71.8%에서 88.5%로 증가하였으며, 여 성은 78.1%에서 93.2%로 증가하였다. DCO%는 남성에서 6.4%에서 0.7%로 낮아졌고, 여성은 5.4%에서 0.8%로 낮아 졌다. 충실도의 MI%는 15.3%에서 62.1%로서 두 지역 모두 좋은 등록수준을 보였다. This study aimed to analyze the ten years cancer incidence based on diagnosis years 2000-2009, and to evaluate the quality of cancer registry in Daejeon City and Chungcheongnam-Do, Korea. Crude incidence rate and age-standardized incidence rate (ASR) in these two regions were compared, and validity of incidence data was assessed by three indicators; age unknown (Age UNK%), histological verification (HV%), and death certificate only (DCO%). Mortality/incidence ratio (M/I ratio) was used to evaluate completeness of incidence data. Incidence rate differences were assessed using Poission distribution and calculated their 95% confidence interval of ASR, and those by sex, age, and region were compared by incidence rate curve. As a result, the highest cancer site during 2000-2009 was stomach in both regions, and incidence prpportion were 18.8% in Daejeon, 21.5% in Chungnam. The overall cancer incidence was higher in males than in females, and ASR of total cancer in Daejeon increased 0.6% (from 322.1 to 323.9 per 100,000) for men and 60.3% (from 203.9 to 326.8) for women, that in Chungnam increased 14.3% (from 294.7 to 336.9) for men and 70.7% (from 156.5 to 267.1) for women. The Age UNK% during 2000-2009 were 0.0% in both regions. MV% for men was increased from 71.8% to 88.5% and that for women was increased from 78.1% to 93.2%. DCO% for men was decreased from 6.4% to 0.7% and that for women was decreased from 5.4% to 0.8%. M/I ratio was ranged from 15.3% to 62.1% and can be evaluated fairy good registration.

국가유공자 암환자의 생존율

박운제 ( Un-je Park ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1

Background: As a descriptive study targeting 2,068 cancer patients as men of national merit in 2013, this study aims to provide the basic data for systematizing the early diagnosis and treatment of cancer by comparatively analyzing the 5-year survival rate. Methods: This study researched the survival of cancer patients through Electronic Medical Record and Patriots-Veterans Qualification Program, targeting 2,068 newly-diagnosed cancer patients verified in five veterans hospitals and consigned management system. This study verified differences between general characteristics of cancer patients as men of national merit and analyzed their survival rate. Results: The cancer patients as men of national merit were super-aged as their average age was 72.5. In the analysis of general characteristics of five major prevalent cancers, there were statistically significant differences according to age, region, cancer diagnostic path, differentiation, diagnostic method, treatment method, SEER stage, and survival period, except for the types of the man of national merit (p<0.001). The whole survival rate of cancer patients as men of national merit was 50%. The 5-year survival rates of predisposing cancers were shown as prostate cancer (79%), colorectal cancer (64%), gastric cancer (57%), liver cancer (32%), and lung cancer (12%). In the cancer diagnostic path, all the predisposing cancers showed the highest survival rate in medical examination. In the treatment method, the surgery showed the highest survival rate. The cancer patients as men of national merit showed a lower survival rate than the general cancer patients of Korea. Conclusion: It would be needed to guarantee the honorable and happy life through health recovery as special treatment of contribution and sacrifice of super-aged men of national merit by increasing the cancer survival rates through regular checkup, early diagnosis, and high-quality treatment system that could have important effects on the survival rate according to the occurrence of cancers.

한국 보훈대상자의 암발생률

박운제 ( Un Je Park ),박소희 ( So Hee Park ) 한국보건정보통계학회(구 한국보건통계학회) 2018 보건정보통계학회지 Vol.43 No.2

목적: 한국의 초고령화 사회로의 진입이 가속화됨에 따라 고령자가 많은 국가 보훈대상자의 진료 및 치료를 담당하는 보훈병원 내의 암 환자 수가 더욱 증가할 것으로 예상되어 우리나라 보훈대상자의 암 발생률을 파악하고자 한다. 방법: 전국 5개의 보훈병원에서 2013년 1월 1일부터 2016년 6월 30일까지의 자료를 바탕으로 2013년도 초진 암발생 환자의 의무기록 자료를 조사하였다. 보훈대상자 암환자의 인구사회학적 특성, 임상적 특성을 규명하고 조발생률 및 연령표준화 발생률을 구하였다. 결과: 2013년 우리나라 보훈대상자 672,532명 중에서 초진 암환자는 2,070명으로 전체 보훈대상자 중 0.3%를 차지하였으며, 보훈대상자 유형별로는 베트남참전유공자가 가장 많았다. 호발 암 원발 부위별로는 전립샘암이 가장 많았고, 다음은 위암, 폐암, 대장·직장암, 간암 순으로 발생하였다. 보훈대상자의 암 발생률에서 조발생률은 307.8명이었으며, 전립샘암이 59.2명으로 가장 많았고, 위암 51.0명, 폐암 50.6명, 대장·직장암 48.2명, 간암이 22.9명으로 뒤를 이었으며, 연령표준화 발생률은 인구 10만 명당 51.1명, 위암 8.9명, 전립샘암 8.8명이었다. 결론: 2013년 보훈대상자 초진 암환자는 2,070명으로 그 중 60세 이상이 97.9%로서 우리나라 일반국민 암환자 60세 이상의 52.8%보다 암 발생률이 약 1.8배 높았다. 이와 같이 우리나라 전체 국민보다 고령 인구의 비율이 훨씬 높은 보훈대상자들의 특성을 고려했을 때 보훈대상자들의 향후 암 발생률이 지속적으로 증가할 것으로 예상한다. Objectives: The purpose of this study is to understand the rate of cancer incidence in veterans hospitals, which is in charge of care and treatment of Korean veterans, as Korea is accelerating its entry into the aging society. Methods: Cancer incidence data from January 1st 2013 to June 30th 2016 were obtained from Veterans hospitals in 5 different regions, nationwide. The incidence was defined by the number of cancer patients diagnosed in 2013. We investigated the sociodemographic and clinical characteristics of subjects. CR rates and ASR were calculated. Results: In 2013, 2,070 Korea veterans out of 672,532 were newly diagnosed with cancer which was 0.3% of the total. Vietnam War veterans showed the highest rate of cancer incidence. Prostate cancer was the most commonly diagnosed cancer and followed by stomach, lung, colorectal and liver cancer. The total CR for overall cancer incidence of veterans was 307.8 and the CR for prostate cancer was the highest (59.2) followed by stomach (51.0), lung (50.6), colorectal (48.2), and liver (22.9). Furthermore, the total ASR rates were 51.1 followed by lung (8.9), prostate cancer (8.8). Conclusions: In 2013, there were 2,070 veterans who were newly diagnosed cancer and over 97.9% of them were over the age of 60. Compared to IR for overall cancer incidence of the non-veteran Koreans (52.8%), the rate of IR of veterans (97.9%) were 1.8 times higher. Like that, at considering the characteristic of war veterans that elderly population rate is much higher comparing to the whole population in Korea, it is expected that the cancer incidence of war veterans will be continually increased.