의과대학 학생들의 환자안전에 대한 인식

이후연,이상규,Lee, Hoo-Yeon,Lee, Sang-Gyu 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.1

Background: The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships. Methods: Cross-sectional and self-administered questionnaire survey was conducted on 34 students from one medical school using a modified version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS). We assessed $4^{rd}-year$ medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. The overall response rate was 66.4%. Results: Among safety domains, "teamwork culture" was rated highest. "Error disclosure culture" received the lowest ratings. Regarding the error disclosure domain, only 10% of respondents reported that they have received education or training on how to disclose medical error to patients. Independent of survey domains, when students were asked "Overall, do you think your hospital is safe based on your clinical rotation?", 61.8% reported that the hospital was safe. Conclusions: Assessing students' perceptions of safety culture can provide clerkship directors and educators with information that enhances the educational environment and promotes patient safety. Discussions of medical errors, patient safety, and how best to incorporate an analysis of these issues into the existing curriculum are needed.

인공와우 이식의 비용효용 분석

이후연,김희남,김한중,최재영,박은철,Lee, Hoo-Yeon,Kim, Hee-Nam,Kim, Han-Joong,Choi, Jae-Young,Park, Eun-Cheol 대한예방의학회 2004 예방의학회지 Vol.37 No.4

Objective : To determine the quality of life and cost consequences for deaf adults who received a cochlear implant. Methods : The data from 11 patients, post-lingual deaf adults who received cochlear implants from 1990 to 2002, underwent cost-utility analysis. The average age of the participants was 49.6 years. The main outcomes were direct cost per quality-adjusted life-year (QALY) using the visual analog scale (VAS), health utility index (HUI), EuroQol (EQ-5D), and quality well-being (QWB), with costs and utilities being discounted 3% annually. Results : Recipients had an average of 5.6 years of implant use. Mean VAS scores increased by 0.33, from 0.27 before implantation to 0.60 at survey. HUI scores increased by 0.36, from 0.29 to 0.65, EQ-5D scores increased by 0.26, from 0.52 to 0.78, and QWB scores increased by 0.16, from 0.45 to 0.61. Discounted direct costs were $22,320, yielding $19,223/QALY using VAS, $17,387/QALY using HUI, $24,604/QALY using EQ-5D, and $40,474/QALY using QWB. Cost-utility ratios using VAS, HUI, and EQ-5D were all below $25,000 per QALY, except using QWB. Conclusion : Cochlear implants in post-lingual deaf adult have a positive effect on quality of life at reasonable direct costs and appear to produce a net saving to society.

우리나라 재입원율 평가모형 개발과 활용

이후연 한국보건행정학회 2016 한국보건행정학회 학술대회 논문집 Vol.2016 No.2

관상동맥질환 치료를 위한 시롤리무스 방출 스텐트 ($CYPHER^{TM}$)의 경제성 분석

이후연,박은철,박기동,박지은,김영,이상수,강혜영,Lee, Hoo-Yeon,Park, Eun-Cheol,Park, Ki-Dong,Park, Ji-Eun,Kim, Young,Lee, Sang-Soo,Kang, Hye-Young 대한예방의학회 2003 Journal of Preventive Medicine and Public Health Vol.36 No.4

Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

노인의 사회 경제적 수준과 주관적 건강수준과의 관계

이후연,김성아,이혜진,정상혁 한국보건행정학회 2005 보건행정학회지 Vol.15 No.2

The purpose of this paper is to examine the relationship between socio-economic factors and self-rated health among older people living in the community. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic factors, chronic diseases, and functional status. We surveyed to investigate the self-rated health of 397 study samples which had been selected by stratified randomized sampling, 2.7% by each Dong(district) of S-city in Gyeonggi-do. Our study found that the socioeconomic factors such as income, occupation, and insurance were significantly associated with self-rated health. The level of social economic status was positively associated with the level of self-rated health. Two-staged multivariate analysis demonstrated that this relationship was still significant even after adjustment for demographic factors, chronic diseases, and functional status. In conclusion, there are wide socio-economic disparities in self-rated health of older people in this community. It is important that government should know not only health status but also the health-associated factors in order to prepare for the aged society and improve the health status of the elderly. Further researches should uncover causality and mechanism by which SES affects changes in functional health among the elderly.

JCI 평가와 환자안전

이후연 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.1

plenary session : 인구집단 기반의 책임의료: 도전과 과제 : 책임의료, 어떻게 운영할 것인가?

이후연 한국보건행정학회 2014 한국보건행정학회 학술대회 논문집 Vol.2014 No.2

취재현장의 여기자와 남기자

이후연 관훈클럽 2017 관훈저널 Vol.- No.145

Socioeconomic Disparities in the Prevalence, Diagnosis, and Control of Hypertension in the Context of a Universal Health Insurance System

이후연 대한의학회 2017 Journal of Korean medical science Vol.32 No.4

A lower use of preventive intervention in low socioeconomic populations has been described in countries with universal coverage health care systems, but little is known about the possible socioeconomic inequalities in secondary prevention in a universal health insurance system. Data from the 2010-2013 Korea National Health and Nutrition Examination Survey, a nationwide survey, were analyzed. A total of 20,044 subjects older than 30 years of age were included after excluding subjects with missing data. Prevalence ratios were calculated using Poisson regression models with robust variance to explore factors associated with the prevalence, unawareness, and inappropriate control of hypertension. Hypertension prevalence decreased with increasing education and income level. We observed an inverse association between education level and undiagnosed hypertension among women, but not men. Socioeconomic level was not associated with inadequate control of hypertension among men or women. Future interventions should include primary prevention efforts targeted at lower socioeconomic populations to reduce disparities. There is substantial room for improvement in secondary prevention efforts. Monitoring strategies may highlight gaps in the preventive and care services offered to the most vulnerable individuals and encourage governments and practitioners to address these gaps.

제1형 당뇨병 청소년의 자기관리 영향요인: 정보-동기-행동기술 모델을 기반으로

이후연,최은경,김희정,김호성,김희순 한국아동간호학회 2019 Child Health Nursing Research Vol.25 No.2

Purpose: The purpose of this study was to investigate associations between self-management and diabetes knowledge, diabetesrelated attitudes, family support, and self-efficacy in adolescents with type 1 diabetes mellitus based on the information-motivation-behavior skills model. Methods: Data collection was conducted between March 18 and September 30, 2018. Patients (N=87) aged 12 to 19 years were recruited from the outpatient clinic of S children’s hospital and an online community for patient with type 1 diabetes mellitus. Data were analyzed using descriptive statistics, the independent t-test, one-way ANOVA, Pearsons correlation, and hierarchical multiple linear regression with SPSS IBM 23.0, with the two-tailed level of significance set at 0.05. Results: The mean score of self-management in adolescents with type 1 diabetes mellitus was 61.23±10.00 out of 80. The regression analysis showed that self-efficacy and family support significantly explained 56.9% of the variance in self-management (F=21.38, p<.001). Self-efficacy (β=.504, p<.001) and family support (β=.188, p<.001) were significant predictors of self-management. Conclusion: It is necessary to develop individual interventions to improve self-efficacy and family support for adolescents with type 1 diabetes mellitus to help them enhance their self-management.