우리나라 병원의 환자안전 향상을 위한 활동 현황

황수희,김명화,박춘선,Hwang, Soo-Hee,Kim, Myung-Hwa,Park, Choon-Seon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.2

Purpose: The aims of this study were to assess the presence of core patient safety practices in Korean hospitals and assess the differences in reporting and learning systems of patient safety, infrastructure, and safe practices by hospital characteristics. Methods: The authors developed a questionnaire including 39 items of patient safety staffing, health information system, reporting system, and event-specific prevention practices. The survey was conducted online or e-mail with 407 tertiary, general and specialty hospitals. Results: About 90% of hospitals answered the self-reporting system of patient safety related events is established. More than 90% of hospitals applied incidence monitoring or root cause analysis on healthcare-associated infection, in-facility pressure ulcers and falls, but only 60% did on surgery/procedure related events. More than 50% of the hospitals did not adopted present on admission (POA) indicators. One hundred (80.0%) hospitals had a department of patient safety and/or quality and only 52.8% of hospitals had a patient safety officer (PSO). While 82.4% of hospitals used electronic medical records (EMRs), only 53% of these hospitals adopted clinical decision support function. Infrastructure for patient safety except EMRs was well established in training, high-level and large hospitals. Most hospitals implemented prevention practices of adverse drug events, in-facility pressure ulcers and falls (94.4-100.0%). But prevention practices of surgery/procedure related events had relatively low adoption rate (59.2-92.8%). Majority of prevention practices for patient safety events were also implemented with a relatively modest increase in resources allocated. Conclusion: The hospital-based reporting and learning system, EMRs, and core evidence-based prevention practices were implemented well in high-level and large hospitals. But POA indicator and PSO were not adopted in more than half of surveyed hospitals and implementation of prevention practices for specific event had low. To support and monitor progress in hospital's patient safety effort, national-level safety practices set is needed.

다제내성결핵 환자에서 표준 1차 항결핵제 치료 중 발생한 획득 내성

전두수 ( Doo Soo Jeon ),김도형 ( Do Hyung Kim ),강형석 ( Hyung Seok Kang ),민진홍 ( Jin Hong Min ),성낙문 ( Nack Moon Sung ),황수희 ( Soo Hee Hwang ),박승규 ( Seung Kew Park ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.3

OECD 병원 성과 프로젝트의 동향과 국내 시사점

박춘선,최효정,황수희,임지혜,김경훈,김선민,Park, Choon-Seon,Choi, HyoJung,Hwang, Soo-Hee,Im, JeeHye,Kim, Kyoung-Hoon,Kim, Sun-Min 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1

The Organization for Economic Cooperation and Development, which has continuously evaluated the performance of healthcare systems, has recently invested much effort into hospital performance measurement. The purpose of this paper is to introduce the hospital performance measurement programs operated by international organizations or at the national level based on the OECD's hospital performance project. Health Insurance Review & Assessment service (HIRA)'s quality assessment was analyzed based on the analytical framework of the OECD's hospital performance project. The hospital performance measurement programs of WHO, Canada, Australia, United States and United Kingdom are briefly explored, in view of the conceptual framework, key performance dimensions and indicators that are currently in use. The OECD suggested seven key dimensions of hospital performance: timeliness, efficiency, continuity, effectiveness and appropriateness, staff orientation, patient orientation and safety. The analysis of the quality assessment program of HIRA, which operates 36 diseases and procedures and 347 indicators, shows that the numbers of indicators are relatively small in the areas of safety, patient centeredness and efficiency. Continuity of care and staff orientation are not fully developed also, but the situations are similar in other countries. In conclusion, hospital performance measurement using stable and comprehensive data should be developed to improve overall system performance, and discussions on a conceptual framework that can lay out directions and key performance domains need to take into place.

다제 내성 폐결핵환자의 폐절제술에 관한 연구

권은수 ( Eun Soo Kwon ),하현철 ( Hyun Cheol Ha ),황수희 ( Su Hee Hwang ),이홍렬 ( Hung Yol Lee ),박승규 ( Seung Kyu Park ),송선대 ( Sun Dae Song ) 대한결핵 및 호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.6

자폐성장애인의 상해 및 질병이환 현황 분석

심보람(Boram Sim),황수희(Soo-Hee Hwang),이혜진(Hyejin Lee),윤지은(Jieun Yun),이진용(Jin Yong Lee) 한국자폐학회 2023 자폐성 장애연구 Vol.23 No.1

2010년부터 2019년까지의 국민건강보험공단 자료를 이용하여 자폐성장애인들에서 발생하는 상해의 유형은 무엇인지, 어떤 질환에 주로 이환되고 있는지 등에 대한 실태를 파악하기 위해 이 연구를 시행하였다. 연구 결과, 자폐성장애인의 상해 발생율은 전체 인구집단과 비교했을 때 높은 수준은 아니었으나, 지난 10년 간 꾸준히 증가하고 있음을 확인하였다. 또한 자폐성장애인의 질병이환은 정신 및 행동 장애가 가장 많았다. 특히 자폐성장애의 고유 특성에 기인한 질병이환외에도 조현병과 같은 정신 질환 관련 질병이환이 많았다. 입원진료에서 치과질환의 이환이 높은 것도 일반 인구집단에 비해 높은 것도 큰 특징이었다. 이러한 결과는 자폐성장애인의 상해를 줄이기 위한 예방 전략과 자폐성 장애인의 복합적인 의료 요구도를 고려한 의료서비스 전달체계 필요성에 대한 근거가 될 수 있다. 이 연구는 기존에 전국 단위로 산출되지 못하였던 국내 자폐성장애인의 상해 및 질병이환 현황을 파악한 최초의 연구라는 점에서 의의가 있다. 향후에도 이러한 역학 자료를 주기적으로 측정하고 추이 변화를 확인하는 과정이 지속적으로 이루어져야 한다. This study is an initial study providing nationwide statistics regarding the prevalence of injuries and comorbidities in people with Autism Spectrum Disorder (ASD). The prevalence of injuries and comorbidities in pleple with ASD was examined in the National Health Insurance Service (NHIS) data spanning from 2010 to 2019. We found that the prevalence of injuries in people with ASD was not higher than in the general population. However, this had increased steadily over 10 years. The most common comorbidities with ASD were found to be mental and behavioral disorders. Outpatient visits for mental diseases such as schizophrenia and hospitalization for dental treatment were more prevalent than in the general population.

폐결핵 재치료에서 이차항결핵제 복합처방의 효과에 관한 비교 연구

하현철 ( Hyun Cheol Ha ),권은수 ( Eun Soo Kwon ),최인환 ( In Hwan Chio ),황수희 ( Su Hee Hwang ),박승규 ( Seung Kyu Pakk ),송선대 ( Sun Dae Song ) 대한결핵 및 호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.6

다제내성 폐결핵의 화학치료

박승규 ( Seung Kyu Park ),권은수 ( Eun Soo Kwon ),하현철 ( Hyun Cheol Ha ),황수희 ( Su Hee Hwang ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.1

건강보험 청구자료를 이용한 일반 질 지표로서의 위험도 표준화 재입원율 산출: 방법론적 탐색과 시사점

김명화 ( Myung Hwa Kim ),김홍수 ( Hong Soo Kim ),황수희 ( Soo Hee Hwang ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.3

Background: The purpose of this study was to propose a method for developing a measure of hospital-wide all-cause risk-standardized readmissions using administrative claims data in Korea and to discuss further considerations in the refinement and implementation of the readmission measure. Methods: By adapting the methodology of the United States Center for Medicare & Medicaid Services for creating a 30-day readmission measure, we developed a 6-step approach for generating a comparable measure using Korean datasets. Using the 2010 Korean National Health Insurance (NHI) claims data as the development dataset, hierarchical regression models were fitted to calculate a hospital-wide all-cause risk-standardized readmission measure. Six regression models were fitted to calculate the readmission rates of six clinical condition groups, respectively and a single, weighted, overall readmission rate was calculated from the readmission rates of these subgroups. Lastly, the case mix differences among hospitals were risk-adjusted using patient-level comorbidity variables. The model was validated using the 2009 NHI claims data as the validation dataset. Results: The unadjusted, hospital-wide all-cause readmission rate was 13.37%, and the adjusted risk-standardized rate was 10.90%, varying by hospital type. The highest risk-standardized readmission rate was in hospitals (11.43%), followed by general hospitals (9.40%) and tertiary hospitals (7.04%). Conclusion: The newly developed, hospital-wide all-cause readmission measure can be used in quality and performance evaluations of hospitals in Korea. Needed are further methodological refinements of the readmission measures and also strategies to implement the measure as a hospital performance indicator.

다제내성결핵 균주에서 Reverse Hybridization Assay를 이용한 Fluoroquinolone, Kanamycin 신속 내성 검사의 유용성

박진수 ( Chin Su Park ),성낙문 ( Nack Moon Sung ),황수희 ( Soo Hee Hwang ),전재현 ( Jae Hyun Jeon ),원영섭 ( Young Sub Won ),민진홍 ( Jin Hong Min ),김천태 ( Cheon Tae Kim ),강형석 ( Hyung Seok Kang ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1

Multidrug-resistant tuberculosis (MDR-TB) is an increasing public health problem and poses a serious threat to global TB control. Fluoroquinolone (FQ) and aminoglycoside (AG) are essential anti-TB drugs for MDR-TB treatment. REBA MTB-FQ? and REBA MTB-KM? (M&D, Wonju, Korea) were evaluated for rapid detection of FQ and kanamycin (KM) resistance in MDR-TB clinical isolates. M. tuberculosis (n=67) were isolated and cultured from the sputum samples of MDR-TB patients for extracting DNA of the bacilli. Mutations in genes, gyrA and rrs, that have been known to be associated with resistance to FQ and KM were analyzed using both REBA MTB-FQ? and REBA MTB-KM?, respectively. The isolates were also utilized for a conventional phenotypic drug susceptibility test (DST) as the gold standard of FQ and KM resistance. The molecular and phenotypic DST results were compared. Sensitivity and specificity of REBA MTB-FQ? were 77 and 100%, respectively. Positive predictive value and negative predictive value of the assay were 100 and 95%, respectively, for FQ resistance. Sensitivity, specificity, positive predictive value and negative predictive value of REBA MTB-KM? for detecting KM resistance were 66%, 94%, 70%, and 95%, respectively. REBA MTB-FQ? and REBA MTB-KM? evaluated in this study showed excellent specificities as 100 and 94%, respectively. However, sensitivities of the assays were low. It is essential to increase sensitivity of the rapid drug resistance assays for appropriate MDR-TB treatment, suggesting further investigation to detect new or other mutation sites of the associated genes in M. tuberculosis is required.

객담 전처리 방법에 따른 객담 항산균 도말 및 배양 양성률 비교연구

강형석 ( Hyung Seok Kang ),성낙문 ( Nack Moon Sung ),이선숙 ( Sun Sook Lee ),김도형 ( Do Hyung Kim ),전두수 ( Doo Soo Jeon ),황수희 ( Soo Hee Hwang ),민진홍 ( Jin Hong Min ),김진희 ( Jin Hee Kim ),원영섭 ( Young Sub Won ),박승규 ( 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5

연구배경: NaOH (sodium hydroxide) 기법을 이용한 전처리 객담과 NALC-NaOH (N-acetyl-L-cysteine-sodium hydroxide) 기법을 이용한 객담의 항산균 도말 및 결핵균 배양 양성률 그리고 배지 오염률을 비교하여 실험실 검사과정 중의 일부분을 개선함으로써 검사 결과의 개선이 가능한 지 확인하고자 하였다. 방법: 2007년 6월부터 2008년 6월까지 국립마산병원에서 객담 검사가 시행된 환자를 대상으로 환자에게서 객담배출 요령을 충분히 교육한 후 두개의 객담 검체를 채취하여 통상적인 NaOH 기법과 NALC-NaOH 기법을 각각 적용한 후 도말 및 배양 결과 그리고 배지 오염률을 비교하였다(n=436). 결과: 항산균 도말 검사에서는 NaOH 기법에 비하여 NALC-NaOH 기법이 다소 높은 양성률(33.0% vs. 39.0%)을 보였으나 통계적인 유의성은 없었다(p=0.078). 결핵균 배양 검사에서는 배지 오염률(culture contamination)은 각각 3.2%와 3.0%로 유의한 차이는 보이지 않았다. 배양 양성률은 NALC-NaOH 기법이 통계적으로 유의하게 높은 배양 양성률(39.7% vs. 28.0%, p=0.0003)을 보였으며, 배양 결과를 도말 검사 결과와 연관 지어 분석하였을 때 도말 검사상 음성인 경우 NaOH 기법과 NALC-NaOH 기법은 각각 7.2%와 15.8% (p=0.0017), scanty를 보인 객담의 경우 각각 42.9%와 60.8% (p=0.036)의 배양 양성률을 보여 통계적으로 의미 있는 차이를 보였다. 결론: 도말 검사에서 음성이나 scanty를 보여 상대적으로 결핵균의 수가 적은 객담의 경우 NALC-NaOH를 이용함으로써 배양 양성률을 개선 시킬 수 있었으며 이는 임상적으로 폐결핵의 진단과 치료 경과 관찰에 직접적인 도움을 줄 수 있음을 보여주었다. Background: Sputum decontamination with NALC-NaOH (N-acetyl-L-cysteine-sodium hydroxide) is known to better detect Mycobacterium tuberculosis (M. tb) by culture than that with using NaOH, which is widely used in Korean hospitals. In this report, sputum samples collected from pulmonary tuberculosis (TB) patients were treated with either NaOH or NALC-NaOH, and we compared the results of smear and culture positivity to determine whether the NALC-NaOH treatment method improves culture positivity in the sputum samples, and especially for those sputum samples that are smear negative and scanty. Methods: For each decontamination method, 436 sputum samples from pulmonary TB patients in the National Masan Tuberculosis Hospital were collected for this study. Sputum from a patient was collected two times for the first and second day of sampling time, and these samples were employed for the decontamination process by performing the 4% NaOH and NALC-2% NaOH treatment methods, respectively, for detecting M. tb by an AFB (Acid Fast Bacilli) smear and also by culture in solid Ogawa medium. Results: The NaOH and NALC-NaOH treatment methods did not significantly affect the AFB smear positivity of the sputum samples (33.0% vs 39.0%, respectively, p=0.078). However, the culture positive percents of M. tb in the Ogawa medium treated with NALC-NaOH and NaOH were 39.7% and 28.0%, respectively, which was a significantly different (p=0.0003). This difference in culture was more prominent in the sputum samples that were smear negative (the positive percents with NALC-NaOH and NaOH were 15.8% and 7.2%, respectively, p=0.0017) and scanty (NALC-NaOH and NaOH were 60.8% and 42.9%, respectively, p=0.036), but not for a smear that was 1+ or higher (p>0.05). Conclusion: NALC-NaOH treatment is better than NaOH treatment for the detection of M. tb by culture, but not by smear, and especially when the AFB smear is negative and scanty. (Tuberc Respir Dis 2008;65:379-384)