암환자에서 암발생부위와 생존기간에 따른 사망전 1년간의 의료비용

이지전,유원곤,김소윤,김광기,이상욱,Yi, Jee-Jeon,Yoo, Won-Kon,Kim, So-Yoon,Kim, Kwang-Ki,Yi, Sang-Wook 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objectives : To analyze medical expenses by cancer site and survival time among cancer patients in their last year of life. Method : The study subjects were 45,394 people that had died of cancers in 2002, were registered by the Korea Central Cancer Registry and received National Health Insurance benefit in the last year (360 days) of life. Personal identification data, general characteristics, dates of death and cancer incidence, and site of cancer were collected from the National Statistical Office and the Korea Central Cancer Registry, and merged with the data of the individual medical expenses of the Health Insurance Review Agency. Results : Average monthly cost curves were U-shaped with high costs near the time of diagnosis and death, and lower costs in between. Medical expenses in the last year of life were around 30.3, 16.7, 13.0, and 12.1 million won among leukemia, lymphoma, ovarian cancer, and breast cancer patients, respectively. Digestive organ cancers including stomach, esophagus, liver, pancreas, and colorectal cancers had relatively low medical expenses. Medical expenses in the last year of life were inverse U-shaped with high expenses near one year of survival. Average monthly cost in the 12 months before death among the patients who had survived $10{\sim}15$ years were more than two-fold greater than the cost before diagnosis among those who had survived for less than one year. Conclusions : Leukemia was the most expensive cancer. It is possible that once diagnosed as cancer, medical expenses do not return to the level before diagnosis. Further research will be needed to understand the magnitude and change of the medical expenses among cancer patients with long term follow up data.

남녀별 음주율 현황과 음주와 관련된 요인분석

이지전,이상욱,송재석,박웅섭 關東大學校 醫科大學 醫科學硏究所 2003 關東醫大學術誌 Vol.7 No.1

In this study, drinking prevalence and the factors associated with drinking by gender were investigated. A cross-sectional study was conducted from 22 April to 3 May in 2002. 1000 subjects(301 females and 699 males) aged 13 to 59 were personally interviewed by trained interviewers. Data on socio-demographic characteristics, drinking related behaviors and health behaviors of subjects were collected. Among females, 191(63.5%) subjects were drinkers and preferred beverage was beer. Drinkers were likely to be 30-39 year-old, employed, religionless, smokers and metropolitan city residents. Among males, 579(82.8%) subjects were drinkers and preferred beverage was Soju. Drinkers were likely to be 19-29 year-old, religionless, jobless, smokers and county residents. After adjusting for various confounders, age, religion and smoking were statistically significantly related to drinking. Smoker(Odds ratio=2.68 females, 2.77 males) and catholic-buddhist(OR=1.51 female, 3.83 males) had higher drinking risk than non-smoker and protestant. County residents had borderline significantly lower drinking risks(OR=0.50) than metropolitan city residents among females.

노인의 사망 전 1년간 의료이용 수준과 추이분석

이지전,박기순,유승흠,김정인,박재용,유왕근,이상욱,Yi, Jee-Jeon,Park, Ki-Soon,Yu, Seung-Hum,Kim, Jeoug-In,Park, Jae-Yong,Yoo, Wang-Kun,Yi, Sang-Wook 대한예방의학회 2003 예방의학회지 Vol.36 No.4

Objectives : To analyze medical service utilization and trends among the elderly in the last year of life. Method : The subjects of this study were People that had died at the age sixty-five and above between January $1^{st}$ and June $30^{th}$ 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. Results : In the first half of 2000, 84.2% of the funeral-expenses-receivers (53,063) utilized medical services during the year prior to their death; 51.0% (27,042) were female and 49.0% (26,021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3,107,935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. Conclusions : This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.

사망전 노인의 전체보건의료비용에서 보완대체요법 비용과 비용분율에 관한 연구

이지전,오희철,이상욱,Yi, Jee-Jeon,Ohrr, Hee-Choul,Yi, Sang-Wook 대한예방의학회 2004 예방의학회지 Vol.37 No.2

Objectives : To evaluate the cost and proportion of complementary and alternative medicines (CAM) in the total healthcare costs among the elderly in the last 6 months of life. Methods : The care-giving families of 301 persons older than 65 years, who died between July 1st and December 31st of 2001, and were also registered in Self-Employed Health Insurance Programs in Seoul, were interviewed. Results : The cost of CAM was 1.09 million Won, which as a proportion of the total healthcare cost was 38.1%. The elderly aged between 65 and 69 year-old, male, living with their spouse, Buddhist and having cancers had higher CAM costs in an ANOVA and simple regression analysis. After controlling of various factors, age was the only significant factor associated with the cost of CAM. The elderly above 80 years old, female, bereaved and Buddhist had higher proportional CAM costs, and the elderly having cancers or cardiovascular diseases had lower proportional CAM costs in an ANOVA and simple regression analysis. After adjusting for various factors, the elderly above 85 years old, female and Buddhist had higher proportional CAM costs, and the elderly having cancers had lower proportional CAM costs. Conclusion : The very old and Buddhist, and/or the ill with no clear diagnosis, may depend more on CAM. Further research will be needed on the meaning and impact of CAM and their costs to public health and the total healthcare system.

노인의 사망 전 6개월간 의료이용수준과 간병가족의 가족부담과의 관련성

이지전,이희나,오희철,정혜영,이상욱,Yi, Jee-Jeon,Lee, Hee-Na,Ohrr, Hee-Choul,Jung, Hye-Young,Yi, Sang-Wook 대한예방의학회 2003 예방의학회지 Vol.36 No.4

Objective : To investigate the relationship between medical expenses and the burden of families caring for the elderly in the last 6 months of life, and to evaluate the factors relating to the burden of family caregivers. Methods : The families of 301 persons older than 65 years, who died between 1 July and 31 December 2001, and were registered in Resident-based- Health Insurance Programs in Seoul, were interviewed. The medical expenses and length of stay among the elderly were collected from Korean Health Insurance Corporations. Results : 31 percents of the elderly had no medical expenses in the last 6 months of life. On average, the objective burden (4.92) was higher than the subjective burden (3.35). Families caring for male elderly had a higher burden. With increasing age af death, the objective burden was significantly increased. The burden on a family seemed to be influenced more by the family income than the property of the elderly. With increasing total health care costs, the objective burden on the family caregivers was significantly increased, but with increasing medical expenses, the subjective burden was significantly decreased. Conclusion : An association between healthcare utilization and burden on families was observed. The reason for the decreasing subjective burden when medical expenses were decreased was unclear. Further research will be needed.

장기요양환자에서 환자 특징 및 기능상태와 환자돌봄 시간과의 관련성

이지전,김정인,유승흠,유형식,이상욱,Yi, Jee-Jeon,Kim, Jeong-In,Yu, Seung-Hm,Yoo, Hyeong-Sik,Yi, Sang-Wook 대한예방의학회 2004 예방의학회지 Vol.37 No.3

Objectives : The aim of this study was to investigate the functional status variables related to the care time of health professionals for patients in long-term care facilities. Methods : The functional stati of 1001 patients in 8 long-term care hospitals were examined by the Resident Assessment Instrument for Long-term Care Facility Version 2.0. The care time of health professionals for patients was calculated using data from a self-reported task survey by nurses, auxiliary nurses, private aides, doctors, physiotherapists and social workers. Results : The average care time per diem was 240.6 minutes. The care time by doctors, nurses and private aides were 11.0, 71.0 and 139.5 minutes, respectively. The lower the function of activities of daily living (ADL) and the greater the symptoms of extensive services, special care and clinical complexity, the more care time was served. On the contrary, the greater the symptoms of nursing rehabilitation, depression, cognitive disorder, behavior problem and psychiatry/mood disorder, the less care time was served. Age and gender were not significantly related to the care time. Conclusions : Developing a case mix classification system for elderly long term care patients may be helpful for both of patients and health care providers. The ADL, extensive services, special care and clinical complexity of variables should be considered in the development of a case mix system for the long term care of patients in Korea.

즐겨 마시는 술의 종류와 음주 및 건강특성의 관련성

이지전,오희철,정우진,이상욱,Yi, Jee-Jeon,Ohrr, Hee-Choul,Chung, Woo-Jin,Yi, Sang-Wook 대한예방의학회 2004 예방의학회지 Vol.37 No.2

Purpose : To investigate the association between the type of preferred alcoholic beverage and drinking pattern and health characteristics. Methods : A Cross-sectional study was conducted from 22 April to 3 May in 2002. 301 females and 699 males aged 13 to 59 were personally interviewed. Data on sociodemographic characteristics, drinking pattern and health characteristics were collected. 735 drinkers who were 19 year-old or over were included in analysis. Beverage preference was classified 3 categories: Beer drinker, wine drinker(including wine, makguly, chungju and yakju) and soju drinker (including soju and spirits). Results : Beer drinkers were likely to be females. Compared to wine or soju drinkers, beer drinkers were less frequently drank, and consumed less total alcohol per week and less alcohol per 1 drinking among both male and female. Controlling for various confounders, beer drinker had significantly less total alcohol consumption per week, and alcohol consumption per 1 drinking than wine and soju drinker. Conclusion : Beer drinking were associated with less smoking in males and healthy drinking pattern in both gender than soju drinking.

장기요양시설 노인의 환자구성에 관한 연구

이지전,김석일,유승흠,이상욱,Jeon, Yi-Jee,Kim, Suck-Il,Hum, Yu-Seung,Yi, Sang-Wook 한국병원경영학회 2001 병원경영학회지 Vol.25 No.3

This study is about major symptoms of elderly and medical services for elderly in long-tenn care facilities. The subject of this study was 298 patients over 00 years old staying in two geriatric hospitals and two nursing homes. The symptoms and medical services were level of patient classification from RUG(Resource Utilization Group)-III which is applied for both Medicare and Medicaid for skilled nursing facilities reimbursement system in US and designed for measuring patient characteristics and medical staff time. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). In this study, the symptoms and services were compared by facility type and they were categorized by level and compared by CMI. Major findings are as follows; 1. There were more elderly who have cognitive function problems in nursing homes than patients in geriatric hospitals. There were more patients with behavioral problems in geriatric hospitals than residents in nursing homes. These results were both statistically significant. 2. The patients in geriatric hospitals received significantly more nursing rehabilitation services, rehabilitation services and extensive services than residents in nursing homes. Other hands, special care services were provided significantly more to residents in nursing homes than elderly in geriatric hospitals. 3. ADL and depression variables had higher CMI when the symptoms were heavier condition. The CMI were not matched with levels of cognitive function problems and behavioral problems. 4. The CMI matched well significantly with levels of nursing rehabilitation services, special care services, and clinically complex services provided for the patient in geriatric hospitals and only nursing rehabilitation services in nursing homes. The CMI for rehabilitation services level and extensive services had regular trends. From the result of this study, the resource utilization level and services provided for elderly in each long-term care facilities were figured out. For the further study, it needs to have more concern about RUG-ill which classification variables were just analyzed.

RUG-III를 이용한 노인환자군분류의 타당성검증

이지전,유승흠,오희철,남정모,박은철,이윤환,Yi, Jee-Jeon,Yu, Seung-Hum,Ohrr, Hee-Chul,Nam, Chung-Mo,Park, Eun-Chul,Lee, Yoon-Whan 한국병원경영학회 2001 병원경영학회지 Vol.25 No.3

The purpose of this study is to classify elderly patient in long-term care facilities using RUG(Resource Utilization Group)-III. It is designed by measuring patient medical characteristics and medical staff time. Elderly patients are classified into 7 categories by clinical(medical and behavioral) hierarchical typology of patients. Through the tertiary split, all 44 groups are formulated. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). Major findings are as follows; 1. The objects in this study were classified into 35 groups out of 44 groups. The most frequent category is clinical complex category(CCC; 38.9%). And extensive service category(ESC; 18.8%), reduced physical function category(RPC; 13.1%), special rehabilitation category(SRC; 12.8%), and impaired cognitive category(ICC; 0.00%) are followed. 2. The mean of total CMI was $1.02{\pm}0.36$, ranging from 0.68 to 1.44(1 vs 2.12). The mean of CMI of SRC is only 1.17 which should be the highest. The means of ESC and see are equally 1.20. The means of CMI of CCI, ICC, BPC, and RPC were 0.90, 0.75, 0.83 and 0.96, respectively. 3. The validity of this classification was tested. Trend-test using Regression Analysis was done in the secondary split level. SCC, CCC, ICC, and RPC which covered 68.4% of this research objects showed linear trend of CMI in interim classification. This results were statistically significant. 4. In clinical hierarchy, the trend were showed linearity. But the multiple comparison of categories using Scheffe-test showed that SRC, ESC and see had same level of CMI means and CCC and ICC, too. This results were statistically significant. Classifying elderly patients with RUG-III, the results showed partly linear trend in clinical hierarchy and in interim classification in conclusion. But, in clinical hierarchy, it was failed to show the consistent order of CMI. It can be explained by two reasons. One is that this research subjects were overlapped in each clinical hierarchy group. And the other is that the some of the characteristics for clinical hierarchy is not appropriate for them. For the further study, it needs to have proper sample size and to modify RUG-III to K-RUG to consider our.. medical environment.

장기요양시설 노인의 환자구성에 관한 연구

이지전 ( Jee Jeon Yi ),김석일 ( Suck Il Kim ),유승흠 ( Seung Hum Yu ),이상옥 ( Sang Wook Yi ) 한국병원경영학회 2001 병원경영학회지 Vol.6 No.3

This study is about major symptoms of elderly and medical services for elderly in long-term care facilities. The subject of this study was 298 patients over 60 years old staying two geriatric hospitals and two nursing homes. The symptoms and medical services were level of patient classification from RUG(Resouce Utilization Group)-Ⅲ which is applied for both Medicare and Medicaid for skilled nursing facilities reimbursement system in US and designed for measuring patient characteristics and medical staff time. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). In this study, the symptoms and services were compared by facility type and they were categorized by level and compared by CMI. Major findings are as follows; 1. There were more elderly who have cognitive function problems in nursing homes than patients in geriatric hospitals. There were more patients with behavioral problems in geriatric hospitals than residents in nursing homes. These results were both statistically significant. 2. The patients in geriatric hospitals received significantly more nursing rehabilitation services, rehabilitation services and extensive services than residents in nursing homes. Other hands, special care services were provided significantly more to residents in nursing homes than elderly in geriatric hospitals. 3. ADL and depression variables had higher CMI when the syptoms were heavier condition. The CMI were not matched with levels of cognitive function problems and behavioral problems. 4. The CMI matched well significantly with levels of nursing rehabilitation services, special care services, and clinically complex services provided for the patient in geriatric hospitals and only nursing rehabilitation services in nursing homes. The CMI for rehabilitation services level and extensive services had regular trends. From the result of this study, the resource utilization level and services provided for elderly in each long-term care facilities were figured out. For the further study, it needs to have more concern about RUG-Ⅲ which classification variables were just analyzed.