의료보험환자 진료비 명세서에 기록된 상병명 통계의 신뢰도 조사

신종연 서울保健大學 1988 論文集 Vol.8 No.1

종합병원 응급실 의무기록에 관한 조사 : 서울에 위치한 병원표준화심사 대상 병원을 중심으로

신종연 중앙의학사 1989 中央醫學 Vol.54 No.2

This study was intended to analyze emergency room record (ERR) forms & their items. Samples were 47 general hospitals in Seoul which were participated in Korean Hospital Standardization Program (KHSP) in 1988. The results were as follows; 1. 3.6% of OPD pt. were the emergency OPD pt., and the ratio of OPD pt. vs emergency OPD pt. was not showed marked trend according to scale of hospital beds. 2. 44 hospitals used specially designed ERR form from KHSP data but 31 hospitals used from actually gathering ERR form by mail from sample hospitals. 3. 10 kinds of name were titled in ERR forms. Among these, 응급실 임상기록 by Korean and Emergency Room Record by English were the most popularly used. 4. KISP emergency department question whether the certain items were involved in ERR form were answered that all items were involved, so this data was marked 100%, but the analysis of above mentioned items in actually gathering ERR from was marked 59.9%. 5. 216 items were contained in 24 kinds of ERR forms these were actually gathered from 47 sample hospitals by mail. But the only 3 items (pt. name, hospital number, and ER arrival time) were commonly included.

의무행정과 교과과정 개발을 위한 선행연구

신종연,윤병준,김영훈 서울保健大學 1993 論文集 Vol.13 No.1

This study was carried out to develope the educational program of medical administration department, Seoul Health Junior College. For this study, educational subjects were derived from the job division analysis of a hospital(1200 beds teaching hospital). Questionaires were sent to the 150 numbers of graduates who finished the course of the above department from 1983 to 1992, and who are now employed in hospitals. Also other questionairs were sent to the chiefs of medical record, medical insurance, and hospital affairs departments in 120 numbers of teaching hospitals accredited by Ministry of Health & Social Affairs. The answers from 109 graduates and 86 department chiefs have been actually surveyded. 1. General characteristics It was found that female respondents were 77%, the respondents under 30 years of age were 81.6%, and 67.9% of the 109 respondents were employed in hospitals with over 300 bed capacity. The largest number of respondent(34.9%) were employed in the hospitals run by educational foundations, the smallest numbers(10.1%) were in national & public hospitals. The classification by the working period showed that the workers under two years of period had the higest rate(40.4%) and the workers over 6 years of period had the second rate(27.5%) Their major working fields in the hospitals were the departments of medical record(32.1%), hospital affairs(27.5%), and medical insurance (21.1%), respectively. 2. Degree of job difficulty When the difficulties of the job performed by the respondents were categorized into difficulty, moderate, easy, the proportion of the moderate job in which more respondents were actually working was found to be much larger that of moderate job classified by job analysis. Job difficulties classified by working fields were not statistically significant. 3. The utilization of professional knowledge 68.8% of respondents think that their professional knowledge is practically utilized. The utilization of professional knowledge classified by difficulty of job, the more difficulty the job is, the more utilized the professional knowledge is. The utilization of professional knowledge by working period, it is statistically significant for the respondents of over 5 years of period compared with those of under 5 years of period. 4. The satisfaction with professional knowledge When the utilization of and the satisfaction with their professional knowledge were compared, their patterns(the percentage of respondent) appeared to be almost the same in bed capacity, working-fields, degree of job difficulty, the duration of work period, but the satisfaction was considered to be lower than utilization in all above variables. 5. Subjects of study needed in fields Professional knowledge in medical terminology, practicum of medical insurance, and ICD coding were necessary in carrying out their works. Also graduates wanted to study more about practicum of medical insurance, computer science, and clinical pharmacology respectively. The graduates in hospitals wanted to study more about the subjects such as hospital planning, hospital marketing, employer & labor relations, purchasing management, but these subjects are excluded from the curriculum of medical administration department as a single subject. 6. Training & QJT after graduation 60.6% of respondents had the intensive training to make themselves familiar with the professional work after graduation. Computer fields commomly required more training(40.9%) and the training period was usually 2~3 months(46.9%). 36.7% of the surveyed graduates were job-trained and the larger the bed capacity was, the more OJT was given. The subjects most frequently studied in OJT were firstly the reimbursement of medical insurance and secondly computer science. The effect of OJT is positive in recognition of facts and rules, in behavior changes, in cost reduction and improving job practice. 7. Continuing education Korea air and correspondence university was preferred in order to continue education but this educational experience was not much useful for their professional jobs in general. So the need of continuing education in connection with their practical jobs was very high(74.8%) and 76.2% of surveyed graduates intend to participate in program if the above continuing education program is provided in the junior college. 8. Evaluation of hospital practicum The effect of hospital practicum in college according to the graduates' opinion was moderate degree and the first negative reason against hospital practicum was the unfaithful behavior of the hospital personnels toward the students. 44.2% of department chiefs in hospitals think that practicum period(3~4weeks) was not adequate. 23.2% of chiefs think that the practicum season(summer vacation) was not adequate, because they are very busy due to the summer vacation of hospital personnels and the increase of hospital patients. So they don't have enough time to teach students in that season. 82.6% of chiefs gave job orientation to students and 71% of them trained the students according to systemic teaching schedule including all the aspects of works of departments and only 58.1% checked the reports submitted by students at the end of their practicum. 9. Extending of hospital practicum period The opinion about extension of hospital practicum period to 2∼3 months was recognized positively by 47.7% of departments chiefs. The reasons for the extension were that hospitals should have enough time for their educational responsibility and through their adequately long training course can choose the capable personnel. The preliminary requirement for the extension of hospital practicum period are the development of practicum programs and evaluation devices, the consideration of hospital top manager about the educational function of practicum, and the question of practicum fee. 10. The systems of promoting the efficiency of hospital practicum suggested by department chiefs were: 1) to change the 2 year course of the medical administration department into the 3 year course, and make the hospital practicum of the last term an obligation. 2) to give the credits of hospital practicum in current educational system. 3) to extend the current practicum period. 4) to consider the internship in the certain hospitals after graduation. As a result of the study, the educational program of medical administation department should be devised to promote the followings: 1. In order to meet the satisfaction of professional knowledge, quantitative & qualitative chance for studying the subjects necessary for practical job should be strengthened. 2. In the revision of the curriculum, the inclusion of the subjects the respondents want to study as a single subject should be considered. 3. In order to promote the efficient continuing education for the graduates, the chance of education program for further study should be provided in junior college. 4. The actual problems arising in the current hospital practicum should be recognized, the alternative improvement should be sought. 5. In stead of depending upon the partial changes of curriculum, the total educational program should be reformed to get rid of current problems and forecast the future need.

韓國綜合病院의 病床管理에 關한 調査硏究(1986) : "炳床利用率,病床回轉數,平均在院日數를 중심으로"

신종연 중앙의학사 1987 中央醫學 Vol.52 No.2

1986년 대한병원협회에서 실시한 병원표준화 심사를 받은 종합병원을 대상으로 하여 地域別, 經營主體別, 病床規模別로 病床利用率, 病床回轉數, 在院日數를 조사한 결과 다음과 같은 결론을 얻었다. 1. 서울특별시, 경기도, 부산직할시 병원수의 50.6%. 병상數의 56.3%가 분포되어 있으나, 병상 이용율, 병상회전수, 재원일수는 지역별로 특이한 양상을 나타내지는 않았다. 2. 각종 法人이 운영하는 병원이 78개(46.4%)로 가장 많고, 국공립 25개 (14.9%), 개인병원 25개(14.9%) 가장 적으며 병상數는 대학병원(41.7%)이 가장 많다. 병상규모별로는 D군병원이 89개(53%)로 가장 많고, 병상數는 A군(38.2%)이 가장 많다. 3. 병상이용율은 79.2%로 경영주체별로는 대학병원(81.1%)이 가장 높고, 개인병원(72.8%)이 가장 낮으며, 병상규모가 커질수록 병상이용율이 높아진다. 4. 병상회전수는 25.1회로 경영주체별로는 개인병원(27.3회)이 가장 많고, 국?공립(22.2회)이 가장 적으며, 병상규모별로는 C군(27.6회)이 가장 많고 A군(23.1회)이 가장 적었으나 병상규모에 따른 一定한 傾向을 보이지는 않는다. 5. 재원일수는 11.4日로 경영주체별로는 국공립병원(13.1日)이 가장 길고 개인병원(10日)이 가장 짧으며, 병상규모가 커질수록 재원일수가 길어진다. This study was conducted to investigate the bed management of 168 hospitals which participated in Korea hospital standardization program (1986). The bed management was focused on bed occupancy rate, bed turn over, and average length of stay. Selected dependent variables were hospital location, administrative body, and scale of hospital beds. The results were as follows; 1) The distribution of hospitals according to cities & provinces showed that 50.6% of hospitals and 50.6% of hospitals beds were located in Seoul, Kyunggi and Pusan. But there wasn't showed specific tendency in bed occupancy rate, bed turn over and average length of stay. 2) The analysis of hospitals by administrative body were revealed that the coperative 78 hospitals (46.4%) were the most in number of hospital and national & public 25 hospitals (14.9%) and private 25 hospitals (14.9%) were the fewest in number of hospital. The most number of beds (41.7%) were included in teaching hospitals. The analysis by scale of beds (group A, B, C, D) showed that group "D" hospital (89 hospitals, 53%) were the most in number of hospital. But group "A" hospital (30 hospitals, 17.9%) taked the first place in number of hospital beds (38.2%). 3) The average bed occupancy rate was 79.2%. The teaching hospital was the higest (81.1%) and the private hospital was the lowest (72.8%). The more increased in scale of hospital beds, the more increased in average length of stay. 4) The average number of bed turn over by annual was 25.1. Private hospital showed the most rapid frequency (27.3) and national & public hospital showed the slowest frequency (22.2). But there wast showed specific tendency. The average length of stay was 11.4 days. National & public hospital showed the longest length of stay (13.1 days) and private hospital showed the shortest (10 days). The more increased in scale of beds, the more longer in average length of stay.

한국병원 협동조합 활성화 방안

신종연 大韓病院協會 2000 대한병원협회지 Vol.29 No.1

의무기록 서식의 표준화를 위한 조사 : "퇴원환자 요약자료,입퇴원기록지.퇴원요약지를 중심으로"

신종연,김양담 중앙의학사 1986 中央醫學 Vol.50 No.2

Hospital discharge abstract data, admission & discharge record, and discharge summary in the medical record are known as the most useful sourec of clinical information for hospital statistics. This study was designed to investigate the contents of discharge abstract data, admission & discharge record, and discharge summary being currently used, and to find out some basic data items that could be used in common for efficient health information. This study dealt with 39 general hospitals in Seoul. The major results were as follows; 1. The tittle of the medical record was being used differently discharge abstract data is the six different tittle, 16 different tittle in admission & discharge record, 8 different tittles in discharge summary. 2. The 30.8% (12 hospitals among 39) was being used either only admission and discharge record, or discharge summary or no forms. They are all less than 300 bed counts. 3. This study identified 83 different items and 14 same items in 6 discharge abstract data, 56 different items and 2 same items in 26 admission & discharge record, 33 different items and same a single item in discharge summary. 4. The following 20 items as a basic data in discharge abstract data: ① Hospital unit number. ② security identification number. ③ Address ④ Admission & discharge date ⑤ Attending physicians ⑥ Department & hospital days of transfer ⑦ No. of consult ⑧ discharge result ⑨ final diagnosis and code No. ⑩ operation procedures, and code no. ⑪ Type of patient ⑫ No. of biopsy ⑬ Type of anesthesia ⑭ department of consult ⑮ Death classification (16) Infertility (17) Postoperation infection (18) Cesarean section (19) Signature of medical record technician (20) Therapeutic abortion.

서울보건전문대학 의무행정과 졸업생중 보건분야 종사자들의 사회활동에 관한 조사 연구

신종연 서울保健大學 1987 論文集 Vol.7 No.1

보건소 질병통계 산출을 위한 질병정보체계에 관한 연구

신종연 서울保健大學 1990 論文集 Vol.10 No.1

정상아 분만과 비정상아 분만 산모의 특성에 관한 비교연구

신종연,윤병준,김영훈 서울保健大學 1992 論文集 Vol.12 No.1

This study was carried out to find the characteristics of the women who delivered abnormal newborn infant. For this study, medical records of 511 abnormal cases along with those of 438 normal controls of the same ages who delivered from Jan. 1988 to Dec, 1990. at 6 general hospitals in Seoul were surveyed. The results obtained were as fallows : 1. Maternal age was most largely between the ages of 25 and 29 years. 2. The gestional period of under 36 weeks was found in 2.1% of the control group, and that of 37 to 42 weeks in 97.9%, while in the case group 22.7% had the period of under 36 weeks and 77.1 % the period of 37 to 42 weeks. The difference was statistically significant. 3. Of the types of delivery in the control group, NSVD was 93.6%, cesarean section 5.0%. In the case group, cesarean section was 41.9%, NSVD 40.5%, vacuum extraction 13.7%. breech extraction 0.8%. The difference was statistically significant. 4. As for medical history, 96.1% of the control group had their medical history, but in the case group only 88.8% had theirs. The difference was statistically significant. 5. The obstetric problems found during prenatal care in the case group were more frequent than in the control group. The problems were antepartum haemorrhage, abruptio placenta and placenta praevia, hyper tension complication pregnancy, childbirth and the puerperium, early or threatened labour, prolonged pregnancy, twin pregnancy. 6. Delivery complications were found in 10.5% of the control group, but they were found in 76.7% of the case group. The difference was statistically significant. 7. The body weight of 14.7% of the infants delivered by the control group was found to be less than or equal to 2.9kg and that of 59.0% was 30~34kg. Of the infants of the case group, 43.7% was less than or equal to 2.9kg and 37.5% were 3.0 to 3.4kg. The difference was statistically significant. 8. The congenital anomaly was the highest incidence in the musculoskeletal system. The musculoskeletal anomaly was found in 14.7%, bulbus cordis anomalies and anomalies of cardiac septal closure in 12.1%, other congenital anomaly of heart in 12.1%, the congenital anomalies of limbs in 9.0%.

臨床診斷과 手術診斷의 比較 調査

신종연,남송현 서울保健大學 1985 論文集 Vol.5 No.1

1979년 1월부터 1984년 12월까지 5년동안 서울시내에 위치한 한 종합병원(200병상) 내과로 입원하여 외과로 전과된 例(n=75)를 대상으로 하여 내과에서 전과전에 내려진 임상진단명과 수술후 확진된 진단명을 비교 조사하여 다음과 같은 결론을 얻었다. 1. 年度別 전과율은 평균 2.8%로 75列이며 오진율은 전과例의 32%인 24例이었다. 年度別오진율의 감소현상은 없었으며 남녀간에도 오진율의 차이는 없었다. 2. 오진예의 계절별 분포는 여름중에서도 7월이 가장 높았으며, 가을이 가장 낮았다. 3. 오진예의 연령군별 분포는 50代에서 가장 많았으나 오진율에 있어서는 연령군간에 특이한 경향이 없었다. 4. 내과에서의 입원기간이 2日~3日사이에 오진율의 50%가 나타났으나, 正診率과 誤診率과의 관계에서 입원기간은 통계적으로 有意한 상관관계를 나타내지 않았다. 5. 의료비 지불방법이 의료보험인 환자의 37.8%, 일반환자의 26.3%가 오진으로 나타나 보험환자의 경우가 다소 높았으나 통계적으로 有意하지 않았다. 6. 오진의 정도를 분류하면 오진24例(32%)중 수술이 필요치 않았던 경우는 8例(10.6%)이며, 나머지는 어차피 수술을 했어야 한 경우이나, 5例(6.7%)는 질환장기가 정확히 진단되지 못했던 경우이고, 11例(14.7%)는 질환장기는 맞았으나 그 장기의 질병명이 다소 다르게 진단되었던 경우이다. 7. 계통별 오진예는 소화기질병(62.5%), 신생물(16.6%) 順이었으며, 장기별 오진율은 간(66.6%), 담낭(38.9%), 장(33.3%), 위장(15.8%) 順으로 간질환은 전과예가 적은데 비하여 오진율이 높았고, 위장질환은 전과예가 많은데 비해 오진율이 낮았다. 8. 오진의 원인을 살펴보면 담당의사의 판단 오류로 인한 오진이 51.2%로 가장 높다. 이중환자의 증세를 정확히 판단하지 못한 경우가 28%, 검사결과의 판단오류가 20.5%이었다. 오진의 개념과 범위를 정의함에 따라 오진율의 비율은 많은 변이를 나타낸다. 본 조사에서 대상이 되었던 전과수술예란 수술을 위하여 외과로 전과했던 경우로서 오진의 개념을 수술이 과연 필요했는가에 촛점을 맞춘다면, 본 조사결과에서는 총 전과예 75例중 10.6%에 속하는 8例만이 해당되므로 그 수준은 소규모 종합병원에서는 만족할만한다 하겠다. This study was conducted to: 1) determine the consistency of post-operative, pathological diagnosis as conpared to clinical diagnosis: 2) indentify the characteristics of patients and diagnosis subject to diagnostic discrepancy: and 3) analyze the apparent reasons on such discrepancies. The date was obtained from a review of one hospital medical records of surgical patients transferred from medical department (n=75) during 5 years-period (1979.1-1984.12) The results were as follows. 1. Misdiagnosis was observed in 24 cases (male 13, female 11) out of 75 transferred cases, with diagnostic error of 32 %. 2. Seasonal variance is noteworthy that the highest incidence of misdiagnosed cases occurred during June particulary in Summer. 3. Misdiagnosed cases were highest in the group aged 56 to 59, but there were no marked trend in diagnostic error rate according to age group of patients. 4. Misdiagnosis were occurred freguently in the patient group transferred after short termed hospitalization in internal medical department but no relationship was found between the diagnostic error rate and length of stay in internal medical department. (P>0.05). 5. There was a tendency that insurred patients seemed to have higher rate of misdiagnosis than non-insurred patients had. But this result was not statistically significant (P>0.05). 6. Misdiagnosis which led to carry out unnecessary operation were 8 cases (10.6%). 7. Diagnostic error seemed to be due not so much the lack of medical knowledge as to deficiencies of medical judgement, alterness and throughness.