급성심근경색증 환자를 대상으로 한 중증도 보정 방법의 평가

박형근,Park, Hyeung-Keun 한국의료질향상학회 2003 한국의료질향상학회지 Vol.10 No.2

Objectives: To evaluate the performance of models to predict AMI patients death using severity adjustment measures in Korea. Methods: Medical records of 861 patients treated by AMI in 7 general hospitals during 1996 and 1997 were reviewed by trained nurses. We measured the severity of patients by APACHE III, MedisGroups, CSI and DS. Using each severity method a predictive mortality for each patient was calculated from a logistic regression model including the severity score. The statistical performance of each severity method model was evaluated by using c-statistics and R2. For each hospital, z scores compared actual and expected mortality rates. Results: The overall in-hospital mortality was 14.5%, ranged from 10.0% to 22.2%. The distributions of severity scores for each method was significantly different by hospitals. The four severity-adjusted models to predict AMI patients death varied in their statistical performance for discrimination power of patients death. Order of Severity-adjusted mortality rates and z scores by four severity measures was different. Conclusion: Severity-adjusted mortality rates of AMI patients might be applied as an indicator for hospital performance evaluation in Korea. Because different severity methods frequently produce different impressions about relative hospital performance, more studies has to be done to use it as quality indicator and more attention should be paid to select appropriate severity measures.

관상동맥우회술 수술환자의 수술 후 사망률 예측모형의 개발

박형근,권영대,신유철,이진석,김해준,손문준,안형식,Park, Hyeung-Keun,Kwon, Young-Dae,Shin, You-Cheol,Lee, Jin-Seok,Kim, Hae-Joon,Sohn, Moon-Jun,Ahn, Hyeong-Sik 대한예방의학회 2001 예방의학회지 Vol.34 No.1

Objectives : To develop a model that will predict the mortality of patients undergoing Coronary Artery Bypass Graft (CABG) and evaluate the perfermance of hospitals. Methods : Data from 564 CABGs peformed in six general hospitals were collected through medical record abstraction by registered nurses. Variables studied involved risk factors determined by severity measures. Risk modeling was performed through logistic repression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistic, $R^2$, and Hosmer-Lemeshow statistic. Hospital performance was assessed by severity-adjusted mortalities. Results : The developed model included age, sex, BUN, EKG rhythm, Congestive Heart Failure at admission. acute mental change within 24 hours, and previous angina pectoris history. The c-statistic and $R^2$ were 0.791 and 0.001, respectively. Hosmer-Lemeshow statistic was 10.3(p value=0.2415). One hospital had a significantly higher mortality rate than the average mortality rate, while others were net significantly different. Conclusion : Comparing the quality of service by severity adjusted mortality rates, there were significant differences in hospital performance. The severity adjusted mortality rate of CABG surgery may He an indicator for evaluating hospital performance in Korea.

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.

1990년대 중반 이후 병상 공급 및 환자들의 병원이용 양상 변화에 관한 분석

박형근 ( Hyeung Keun Park ),박연서 ( Youn Seo Park ) 한국보건경제정책학회(구 한국보건경제학회) 2011 보건경제와 정책연구 Vol.17 No.1

이 연구에서는 1990년대 초에 진행된 일련의 병상 공급 규제 완화 이후 진행된 병상 공급의 변화와 환자들의 의료기관 이용 양상의 변화 추이를 평가하였다. 1996년부터 2005년까지 진행된 4차례 환자조사 자료를 이용하여, 급성기 병원에서 1개월 동안 퇴원한 환자 전수자료를 병원현황 자료와 연계해 병원 특성별 병상구성비, 병원 특성별 총 환자점유율, 개별병원별 병상회전율과 환자점유율을 산출하여 분석하였다. 서울로의 환자집중 여부를 평가하기 위해 서울소재 병원들의 입원 환자점유율 추이도 분석하였다. 병원급 기관 중심의 병상 증가와 환자점유율 비중 증가, 종합병원의 대형화 및 대형 종합병원의 환자점유율 증가, 서울병원의 지방 거주 환자점유율 증가 등이 확인되었다. 병상점유율과 병상회전율이 높은 일부 대형병원들의 병상 증축이 지속되고 있어 향후 이들 병원으로 환자집중이 보다 심화될 전망이다. 향후 보다 세밀한 평가를 위한 자료체계 구축과 이에 기초한 연구가 지속되어야 할 것이다. The aim of this study is to evaluate the trends of acute hospital beds supply and acute hospital utilization after deregulation of hospital beds in 1990s. This study calculate hospital bed proportions and hospital market shares by hospital characteristics, each hospital`s market shares and turnover rates for 1996-2005 using ``Patient Survey Data`` which has been gathered by the Ministry of Health and Welfare every three years. The concentration of patients into Seoul is examined, too. The results show the constant increase of acute hospital beds by ``hospitals``, hospital bed expansion of general hospitals and decrease of hospital bed proportions where has been in Seoul in the bed supply side. In the hospital utilization side, it appear that total ``hospitals`` market share has been continuously increased but less than it`s growth of bed composition, small-scale general hospital market share has been decreased and the market share of big4 hospitals in Seoul. It is confirmed that the growth rate of patients that turn to hospitals in Seoul to get best outcomes has been faster than on the average rate.

지역사회 거주 노인을 위한 스스로 근관절관리 프로그램의 효과

송효정,박형근,좌승훈,문수희,김세희,신주연,한지윤,이지은,장미영,현은희,Song, Hyo Jeong,Park, Hyeung-Keun,Jwa, Seung Hun,Moon, Su Hee,Kim, Se Hee,Shin, Ju Yeon,Han, Ji Yoon,Lee, Ji Eun,Jang, Mi Young,Hyun, Eun Hee 한국기초간호학회 2017 Journal of korean biological nursing science Vol.19 No.3

Purpose: The aim of this study was to determine the effectiveness of a community-based muscle and joint self-management program with muscle stretching and muscle strengthening exercises for community-dwelling older adults. Methods: The study was a pre-and-post design in a single group, which examined the effects after the intervention of muscle and joint self-management program for 6 weeks, on the 42 subjects of the elderly who registered in a Community Senior Center in J city. Data analyses were conducted with paired t-test by using a SAS (version 9.2 for Windows) program. Results: The effectiveness of muscle and joint self-management program on shoulder flexibility and right knee extension (flexibility) were significantly improved (t= 2.72, p= .010; t= -2.26, p= .029). Joint symptoms (pain, stiffness), physical functioning, depression, fatigue, and left knee extension were not significantly improved after the muscle and joint self-management program. Conclusion: The results showed the possibility of this 6-week exercise program in improving shoulder and knee flexibility for community-dwelling older adults.

갚을 수 없는 돈, 떠나는 동료, 아픈 몸: 2018 손해배상ㆍ가압류 노동자 실태조사

박주영 ( Park Jooyoung ),최보경 ( Choi Bokyoung ),김란영 ( Kim Ranyeong ),윤지선 ( Yun Jisun ),박형근 ( Park Hyeung-keun ) 한국보건사회연구원 2020 保健社會硏究 Vol.40 No.3

본 연구는 쟁의행위로 인해 손해배상청구소송 및 가압류(이하 손배가압류) 실태와 이를 경험한 노동자의 건강을 파악하고자 2018년 비영리단체 ‘손배가압류를 잡자! 손에 손을 잡고’(이하 손잡고)가 실시한 설문조사 자료(N=231)를 이용하였다. 또한 해당 자료를 근로환경조사, 한국복지패널의 동일한 연령, 성별, 제조업 노동자 건강결과와 비교하였다. 연구결과, 응답자 중 손해배상 청구금액이 10억원 이상인 이들이 75.3%(N=174)를 차지했고, ‘점거에 따른 업무방해’가 주된 청구이유였다(74.5%, N=172). 응답자가 경험한 부당노동행위는 ‘노조활동을 이유로 인사고과 등에서 불리하게 평가받았다’(51.3%, N=119), ‘손배가압류 금액을 들먹이는 회유나 협박을 당한 적있다’(29.7%, N=69) 등이 있었다. 소송과정 중 조합원이 50% 이상 감소했다는 응답은 74.1%(N=149)에 달했다. 근골격계 통증, 우울증상, 자살생각 등 모든 건강지표에서 손배가압류 노동자가 일반노동자에 비해 통계적으로 유의하게 높은 유병비를 보였다. 본 연구는 손배가압류 노동자 실태를 파악하고 건강상태를 조사한 첫번째 연구이다. Strategic lawsuit and sequestration against labor union members (SLALU) have been an emerging issue in South Korea. However, no studies on the health of workers facing SLALU have been conducted. To investigate the characteristics of SLALU and the health status of workers under SLALU, we analyzed a nationwide survey about workers sued by SLALU (N=231) carried by Sonjabgo (NGO) in South Korea, 2018. This research found that 75.3% (N=174) answered the amount of compensation in SLALU was more than a billion Korean won. The most frequent reason for SLALU was ‘interference with business from occupation.’ In terms of unfair labor practices, 51.3% (N=119) reported ‘I received an unfavorable evaluation because of my union activities’, and 29.7% (N=69) ‘They conciliate or threaten me commenting SLALU.’ The respondents took up 74.1% (N=149) that union members reduced more than half during SLALU. Considering the health status, SPRs were significantly higher among workers under SLALU in every health condition. Our findings show that SLALU may play an important role in the decline of union members and workplace injustice.

지방의료원의 지역 적합성 제고를 위한 대학병원 위탁운영 가능성 모색 : 지역사회 오피니언리더 대상 심층면접을 중심으로

박주영(Jooyoung Park),강연학(Yeon-Hak Kang),박형근(Hyeung-Keun Park) 한국보건사회학회 2021 보건과 사회과학 Vol.- No.58

2019년 A시에서 A시 소재 지방의료원 대학병원 위탁운영을 요구하는 지역주민들의 조직적인 주민운동이 발생하였다. 본 연구는 지역 주민들이 지방의료원의 대학병원 위탁운영을 요구하는 이유와 대학병원 위탁운영을 통해 기대하는 바를 체계적으로 파악하고자 지역사회 오피니언리더 23명을 대상으로 2019년 5월~6월에 심층면접을 진행하였다. 지방의료원 이용 경험, 의료원 진료 수준에 대한 평가와 문제점, 위탁운영을 통해 개선되기를 바라는 점, 의료원 경영실적과 광역자치단체의 역할 등 반구조화된 설문지를 활용하였으며, 전사된 인터뷰 녹취록을 기반으로 연구자들의 분석과 토론을 통해 연구결과를 범주화하였다. 분석 결과, 연구 참여자들은 중증응급 상황에서 완결적 진료가 이루어지지 못하고 자주 큰 병원 전원을 요구하는 것에 대한 불만과 의사 부재나 공백으로 진료받지 못하는 불편함 때문에 대학병원 위탁을 요구하게 되었음을 확인하였다. 이러한 상황에 이른 배경으로 의사와 간호사 인력 부족 등 양적인 측면과 함께 실력 있는 의사의 부족과 직원 역량 부족과 안이한 태도 등 질적인 측면 때문이라고 언급하였다. 참여자들은 대학병원의 우수한 전문의와 조직 관리 능력의 개입이 이루어진다면, 보다 실질적인 개선이 이루어질 수 있으리라는 기대에서 대학병원 위탁운영을 요구하게 되었다. 그러나, 대학병원 위탁운영 이후에 실질적인 변화 가능성에 대해서는 적지 않은 우려도 갖고 있었다. 기존 지방의료원 대학병원 위탁운영이나 진료 협력사업의 경우 전문의 구인난 개선이나 경영실적 향상을 목적으로 행정기관의 개입이나 병원 경영진 간 협의를 중심으로 한 탑다운(Top-down) 방식으로 진행되어왔다. 이 연구의 결과는 지방 소재 지방의료원 이용 경험을 토대로 지역주민들이 제기한 지방의료원의 문제점과 대학병원 위탁운영을 통해 기대하는 개선 사항을 체계적으로 파악하였다는 점에서 의미가 있다. 이러한 결과는 향후 지방의료원과 대학병원 간 다양한 연계 협력을 추진하는 데 의미 있는 기초 자료로 활용될 수 있을 것이다. The present study explored the perceptions and call for quality improvement of medical service in a local public hospital, while claiming contracting-out a local public hospital to a national university hospital close to it. We interviewed research participants from 23 community-based organizations using a semi-structured interview guide from May to June, 2019. All qualitative data were analyzed using the grounded theory methodology which is largely applied diverse socical science research. We made an iterative process from open coding, axial coding, and selective coding for conceptualization, categorization, and finally theorization on the collected data. Four major themes emerged from the data. Firstly, they complained that in emergency state patients were often asked to need to be referred to larger general hospitals because of shortage of specialist. Second, it was founded that they perceived that quality of the hospital could be improved to increase the workforce of competent specialists and nurses. Third, community leaders took the loss of fiscal bottom line for granted, resulted from strengthening of the hospital’s workforce. Finally, participants mostly supported contracting-out the local public hospital to a national university hospital closed to it, but did not look forward to be greatly changed in terms of quality of care. This study showed the demands of integrated care between a local public hospital and a national university hospital, with vivid expressions of the community leaders based on their experiences and shared words of mouth. The outcome is likely to be used to develop further recommendations and policies for quality improvement in local public hospitals to meet but community needs in terms of quality of care.

치매노인의 서비스 희망과 이용의 일치 여부에 영향을 미치는 요인

박종연 ( Chong Yon Park ),강임옥 ( Im Ok Kang ),이상이 ( Sang Yi Lee ),서수라 ( Su Ra Seo ),서남규 ( Nam Kyu Suh ),박형근 ( Hyeung Keun Park ) 한국보건행정학회 2007 보건행정학회지 Vol.17 No.2

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include soeio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

심뇌혈관질환 고위험군 대상 교육프로그램의 효과

송정국(Jung-Kook Song),박형근(Hyeung-Keun Park),홍성철(Seong Chul Hong) 한국농촌의학 지역보건학회 2015 농촌의학·지역보건 Vol.40 No.3

본 연구는 급성 심근경색과 뇌졸중의 고위험군인 노인들을 위하여 마련된 일개 권역심뇌혈관질환센터의 경로당노인 교육프로그램이 급성 심근경색과 뇌졸중 경고증상에 대한 지식수준을 높이는 데에 효과가 있었는지 교육프로그램 수행 1년이 경과시점에서 평가하였다. 2012년 제주특별자치도 제주시의 11개 경로당에서 337명을 편의표집 하였는데, 과거 2010년 해당 경로당에서 진행된 교육프로그램에 참여했었던 159명은 실험군으로 하였고, 교육에 참여하지 않은 178명은 대조군으로 하였다. 경고증상을 정확히 알고 있는지를 알아보고자 두 가지 질환 각각 3개 문항씩 총 6문항에 대하여 질환 별 증상이 맞는다고 생각하는지를 폐쇄형 질문으로 물어 명목형(정확한 인지 여부)으로 구분하였으며 빈도(백분율)로 나타내었다. 참여군과 비참여군 간에 경고증상에 대한 지식수준은 유의한 차이를 나타나지 않았고, 급성 심근경색과 뇌졸중 경고증상에 대한 지식이 최고 수준인 것(우수 인지수준, 경고증상 여섯 개 모두를 정확히 인지)과 경로당노인 교육프로그램 참여여부가 관련이 없는 것으로 나타나 교육 효과는 확인할 수 없었다. 다만 우수 인지수준이 될 오즈값은 교육수준이 초등학교 졸업 이상일 경우 초등학교 미졸업(무학 및 서당)에 대해서 3.01배 높았고(3.01; 1.72-5.26), 매일 빠지지 않고 TV뉴스를 시청할 경우 6일 이하로 시청하는 것에 대해서 2.97배 높게 나타났으며(2.97; 1.68-5.23), 이들은 통계적으로 유의하였다. 참여군에서 교육 참여 이후 높아진 지식수준이 교육 후 1년 시점까지 통계적으로 유의한 차이없이 유지되었던 것과 비참여군에서 지식수준이 참여군 만큼 높은 수준이었던 것은 교육참여와 상관없는 어떠한 교육중재적 요인을 공유하고 있음을 시사하였다. 결론적으로 심뇌혈관질환의 고위험군인 노인을 표적 선택하여 실시하는 일회적 지역사회 방문교육 대신 대중매체를 활용한 반복적 지식전달이 효과 있음을 알 수 있었다. 일회적 지역사회 방문교육의 효과는 지역사회 노인 전체를 대상으로 하는 대중매체 보건교육 캠페인이 잇달아 수반되어야만 그 효과를 장기적으로 유지할 수 있다. Objectives: This study was performed to investigate the effects of a health education program for the aged on knowledge about the warning signs and symptoms of acute myocardial infarction and stroke. Methods: Data from 337 elderly people (159 participated and 178 non-participated) at senior centers in Jeju-si were collected by 1 to 1 interview from January to March 2012, one year after the education program provided. Two stages of study were performed: Cross-sectional, case-control study on the level of knowledge about the warning signs and symptoms; and multivariate logistic regression to fine out predictors of optimal awareness. Results: No significant discrepancy of knowledge level between case and control group was found. The knowledge level as high as a surge was shown in both groups one year later. A surge of knowledge had been shown after the education provided in one month. The factors affecting the optimal level of knowledge were education (Odds ratio 3.01; Confidence Interval 1.72-5.26; P-value <0.001) and 7 days of watching TV news per week (2.97; 1.68-5.23; P<0.001). However, participation in the health education was not significant (1.60; 0.98-2.61; P=0.059). Conclusions: The effects of a targeted program in high-risk groups for cardio-cerebrovascular disease are only guaranteed in the enhancement by a population-based mass-media education campaign.

지방자치단체 보건의료 사무의 세출예산 구성과 자체재원 비율 - 제주특별자치도 사례를 중심으로

유혜영(Hyeyoung Yoo),정지운(Ji Woon Jeong),박형근(Hyeung-Keun Park) 한국농촌의학 지역보건학회 2021 농촌의학·지역보건 Vol.46 No.4

Objectives: The purpose of the study was to classify the health and medical service affairs of local governments, and to analyze the proportions of non-matching fund by local governments and central government subsidies for local government health budget. Methods: First of all, health affairs of local governments were classified to categories based on health-related laws and previous studies by review of the authors. In order to specify the scale of local government-led health affairs, we allocated 1,916 budget units into 6 main and 24 sub categories of the health and medical service affairs of local governments for the 2020 health budget of Jeju Special Self-Governing Province. For each categories, we compared the total amounts and the percentages of the "central government subsidies", "local government budget - matching fund", and "local government budget - non-matching fund". Results: The total health budget of Jeju Special Self-Governing Province accounts for 1.2% of the total budget. Of the total health budget of Jeju Special Self-Governing Province, the proportion of central government subsidies was 39.6% and the proportions of local government budget-matching fund and non-matching fund were 33.8% and 26.6%, respectively. The proportions of non-matching fund by provincial and basic local governments were 37.3% and 19.9%, respectively. Conclusion: In order for local governments to deal with the health problems of residents, it is necessary to secure and spend more local government budget(i.e., non-matching fund by local government) for health affairs in their administrative jurisdiction.