복지시설 이용 노인을 위한 보건교육 효과분석

하귀염(Gwi-Yoem Ha),임희진(Hee-Jin Lim),김초강(Cho-Gang Kim) 한국보건교육건강증진학회 2005 보건교육건강증진학회지 Vol.22 No.1

체계적 고찰 방법을 이용한 임상진료지침 정책효과 평가

이선희,하귀염,김주혜,서주현,김현미 한국병원경영학회 2009 병원경영학회지 Vol.14 No.1

A systematic review of the literatures was conducted to evaluate the effect of clinical practice guideline. The 77 studies were identified from a computerized search of published research on MEDLINE, Science-Direct and Blackwell synergy from January, 1997 to October, 2007. The main search terms were “clinical practice guideline" and “effectiveness", “clinical practice guideline" and “impact", “clinical practice guideline" and “evaluation". These studies were assessed the quality twice by one qualified expert and converted into weighted scale. The 63 studies were eligible inclusion criteria and subdivided into type of effect. Final indicator using for policy effect of clinical practice guidelines were classified as 4 categories; "improvement of outcomes" in 81 studies, "betterment in practice patterns" in 68 studies, "rationalization in resource utilization" in 84 studies and "cost containment" in 31 studies. The vote-counting method, one of meta-analysis method, was applied to summarized the effect of clinical practice guidelines and test statistically. From results of meta analysis, all indices were statistically significant. In conclusion, this meta-analysis showed that introduction of clinical practice guidelines were resulted positive outcomes in health policy.

1주기 의료기관 평가에 대한 평가대상 기관 실무자들의 인식과 태도 조사

이선희,김현미,하귀염,조희숙,채유미 한국의료QA학회 2008 한국의료질향상학회지 Vol.14 No.1

Objectives: The purpose of this study was to survey the opinion and attitude of hospital managers toward the hospital evaluation program. Method : Managers of 157 hospitals which had participated in the hospital evaluation program were requested to respond to structured self-administered questionnaire. The questionnaire was composed with five categories: the preparation for the hospital evaluation program, the expertise levels of surveyors, the process and contents of the hospital evaluation program, the applying strategies for the result of the hospital evaluation to manager's work at their hospitals, and the main points to improve the hospital evaluation program. Result : 135 out of the 157 subjects completed the questionnaire, and the overall response rate was 86%. The hospital managers answered that they didn't have enough information such as the scoring rule of the standards, the process of the evaluation, and how to ask and get an answer to prepare the hospital evaluation. Furthermore, they estimated that the surveyors weren't specialized enough and didn't give a chance of checking over the result of the evaluation. In addition, they experienced that the result and feedback of the evaluation weren't enough information to be used as a guideline to improve in hospital management. Managers of the hospitals responded that the standards and method of survey in the hospital evaluation system should be reformed. Conclusion: Most of the responded managers seemed to have negative opinion on the hospital evaluation system, even though they were pushed up for interest in quality: Further studies and extensive evaluation of the hospital evaluation program are needed to bring up various information such as receptiveness and effectiveness.

의료소비자, 서비스 및 시장 특성요인과 고객충성도와의 관계 분석 -1개 중소도시의 의료이용 경험자를 대상으로-

이선희,김현미,김주혜,하귀염,Lee, Sun-Hee,Kim, Hyun-Mi,Kim, Ju-Hye,Ha, Gwi-Yeom 대한예방의학회 2008 예방의학회지 Vol.41 No.5

Objectives : This study was performed to explore customer royalty and the related factors. Methods : 900 households(a 1% sample) were randomly selected from the total population of K city located in Kangwon province. An interview survey was performed with using a structured questionnaire for the subjects(923 persons) who had used medical service during the year before the survey, and the survey was done September, 2002. Results : When comparing the relating factors related with customer royalty according to the sociodemographic characteristics, the older group showed a significantly higher level of recognition for service quality, service reputation, internal customers' attitudes and switching cost. The lower income group showed a higher level of recognition for service quality, service image and switching cost. The lower educated group showed a higher level of recognition for service reputation, service image and internal customers' attitudes. The higher educated group showed a higher level of recognition for perceived risk, and seeking variety. In addition, the expert group or the service and manufacturing workers group showed a higher level of recognition for service involvement. On multiple regression analysis, internal customers' attitudes, service image, service reputation, service quality, switching cost, and substitutability showed significant relations with customer loyalty. Conclusions : This study showed that customer loyalty was significantly influenced by service factors like internal customers' attitudes, service image, service reputation, and service quality, and by market factors like switching cost, and substitutability. The results of this study can be used as a baseline for developing strategies to create and keep customers with high loyalty.

전공에 따른 대학생들의 질병 원인 및 의료에 대한 태도 비교 분석

이선희,김주혜,서주현,이정아,하귀염 한국의학교육학회 2009 Korean journal of medical education Vol.21 No.3

Purpose: This study aims to compare and investigate the differences in beliefs with regard to the cause of illnesses, medial skepticism, and attitudes toward medical care between medical, Oriental medical, and nonmedical students. Methods: To this end, we used a structured questionnaire and collected self-reported data from a sample of 667 respondents. Results: First, their beliefs on the causes of illness were markedly different, depending on their specialty. Compared with students from other specialties, Oriental medical students ranked host factors, environmental factors, and natural factors as the highest causes of illness. —the former group regarded supernatural factors as a more influential cause of illnesses compared with the latter. Among Oriental medical students and nonmedical students —who were also subdivided into the aforementioned groups —the upper-grade group regarded host factors as a higher cause of illness than the lower-grade group. Second, Medical skepticism also differed depending on specialty. Compared with the medical students, Oriental medical students were more likely to have high confidence in “overcoming illnesses”, “home remedies”, “self-decision in treatments”, and “understanding their own health”. In subdividing medical and Oriental medical students according to grade we observed that the senior group had more confidence in home remedies than the junior group. Third, In an analysis of the students attitudes toward medical care, we found that nonmedical students had the highest score in the “care-oriented” and “cure-oriented” attitude categories. In the overall results, the care-oriented category ranked highest for the nonmedical students, followed by Oriental medical students and medical students; the cure-oriented category ranked highest for nonmedical students, followed by medical students and then Oriental medical students. Conclusion: Based on our results, we conclude that these differences between specialties should be reflected in medical curricula to bridge the gap between patients and doctors in medical education with regard to the causes of illness and attitudes toward medical care.

국내외 임상 질 지표 개발과정 및 내용 비교분석

김현미,이선희,김주혜,하귀염 한국의료QA학회 2007 가을학술대회 Vol.2007 No.3

소방공무원에서 탄력성이 외상후스트레스 증상과 해리에 미치는 영향 : 우울의 매개 효과

권태훈,현소연,정영기,임기영,노재성,강대용,하귀염,김남희,Kwon, Tae Hoon,Hyun, So Yeon,Chung, Young Ki,Lim, Ki Young,Noh, Jae Sung,Kang, Dae Ryong,Ha, Gwiyeom,Kim, Nam Hee 한국정신신체의학회 2016 정신신체의학 Vol.24 No.1

연구목적 본 연구는 소방공무원에서 탄력성이 외상후스트레스 증상 및 해리에 미치는 영향과 함께, 탄력성과 각 외상후스트레스 증상 및 해리의 관계에서 우울의 매개효과에 대해서 알아보고자 하였다. 방 법 총 115명의 소방공무원을 대상으로, 생활사건 체크리스트, 사건충격척도-개정판, 해리경험척도, 벡 우울척도, 코너-데이비슨 탄력성 척도를 시행하였다. 탄력성이 외상후스트레스 증상과 해리에 미치는 영향 및 우울의 매개효과를 확인하기 위해 구조방정식모형(Structural equation modeling)과 경로분석(path analysis)을 실시하였다. 결 과 탄력성이 높을수록 낮은 외상후스트레스 증상과 낮은 해리를 보였으며, 각 탄력성과 외상후스트레스 증상 및 해리의 관계는 우울이 완전 매개를 하는 것으로 나타났다. 즉, 탄력성이 외상후스트레스 증상 및 해리에 대해 직접적인 영향이 아닌 우울을 통해 간접적으로 각 증상을 감소시킴을 보여주었다. 결 론 본 연구는 소방공무원에서 외상후스트레스 증상 및 해리의 예방과 치료에 있어 탄력성 강화와 우울 증상 감소를 목표로 한 임상적 개입이 중요함을 시사한다. Objectives : This study aimed to investigate the effects of resilience on posttraumatic stress symptoms and dissociation and whether depression mediates the relationships between resilience and posttraumatic stress symptoms and dissociation. Methods : A total of 115 firefighters participated in the study. Data were collected via the Life Events Checklist, Impact of Event Scale-Revised, Dissociative Experience Scale, Beck Depression Inventory, and Connor-Davidson Resilience Scale. Structural equation modeling and path analysis were applied to estimate the relationships between resilience, depression, posttraumatic stress symptoms, and dissociation. Results : Greater resilience was associated with lower posttraumatic stress symptoms and dissociation, and the relationship between them was fully mediated by depression. Conclusions : Specific aspects of depression may help explain the relationships between resilience and posttraumatic stress symptoms and dissociation. Tailored prevention programs and treatments based on resilience and depression may prevent posttraumatic stress symptoms and dissociation in firefighters and improve treatments outcomes among firefighters with posttraumatic stress symptoms and/or dissociation.

개방병원제도 운영실태 분석

이선희 ( Sun Hee Lee ),채유미 ( Yoo Mi Chae ),김현미 ( Hyun Mi Kim ),하귀염 ( Gwi Yeom Ha ),김주혜 ( Ju Hye Kim ) 한국병원경영학회 2008 병원경영학회지 Vol.13 No.2

Though the attending system was first implemented in 2003 to facilitate the efficient utilization of medical resources and specialties, only a few hospitals and physicians are participated in that system. The purpose of this study was to investigate the actual facts which related to operation of attending system and propose a basic information to revitalized of the attending system in Korea. The data were collected between August 1 and October 30, 2005 from 25 hospitals and 42 attending physicians who were in part of the attending system. Medical institutions were unwilling to participate despite the advantages of the attending system with respect to the utilization of medical resources and improvement in the quality of medical services. The primary reason for this was the lack of understanding among physicians about the attending system and the difficulty(lack of time) encountered by the attending physicians in administering care to patients hospitalized in the attending hospitals. Moreover insufficient reimbursement for rendered medical services constituted another important reason. In conclusion, we can state that the establishment of a committee is required to discuss the issues surrounding the attending system and to control the growing disparity between the viewpoints of hospitals and physicians. Regardless, there is a need to develop economical incentives for medical institutes. The attending system served as a useful policy in promoting the medical service system and bringing about an improvement in the management of medical institutes.