장애가중치 산출 연구에서의 쟁점 검토

옥민수 ( Minsu Ock ),고슬기 ( Seulki Ko ),이현정 ( Hyeon-jeong Lee ),조민우 ( Min-woo Jo ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.4

Summary measures of population health (SMPHs) have been used to estimate the burden of diseases. Among various type of SMPHs, disability adjusted life year (DALY) and healthy life expectancy (HALE) have been calculated in the global and national burden of disease studies. In order to calculate DALY and HALE, disability weight is an essential element. Disability weights quantify the level of disability for health states or diseases and have values between 0 (full health) to 1 (being dead). In this study, we reviewed the main disability weights studies and determined their meaning and limitations. Furthermore, we provided the whole process of typical disability weight study and reviewed key issues as follows: health state or disease description development, panel composition, valuation method, validation of disability weight, cross-cultural variability in health state or disease, and so on. The results from this study will be helpful to conduct future disability weight studies for adapting disability weights and developing new methodologies.

송변전 지리정보 시스템을 이용한 고압 송전선과 거주지 간 이격거리에 대한 인식 평가

옥민수(Minsu Ock),이무송(Moo-Song Lee),전보민(Bomin Jeon),김화정(Hwa Jung Kim),류현미(Hyun Mi Ryu),명성호(Sung-Ho Myung),민석원(Suk Won Min) 한국전자파학회 2015 한국전자파학회논문지 Vol.26 No.7

이번 연구에서는 송변전 지리정보 시스템(Transmission and substation Geographic Information System: TGIS)을 이용하여 일반인들이 판단한 고압 송전탑 및 송전선, 변전소와 거주지 간 거리 인식이 실측 거리와 일치하는지 확인해 보았다. 총 725명의 응답자 중 136명이 고압 송전탑 및 송전선, 변전소가 눈에 보이는 거리에 있다고 응답하였고, 이 중 114명이 TGIS로 분석할 수 있는 유효한 주소를 제공하였다. 114명 중 42명(36.8 %)은 실측 거리보다 인식 거리가 짧았으며, 15명 (13.2 %)은 인식 거리보다 실측 거리가 짧았다. 일반인들의 고압 송전탑 및 송전선, 변전소와 거주지 간 거리 예측의 타당도가 높지 않은 점을 바탕으로 했을 때, 이를 극저주파 전자기장 노출량의 대용물로 사용하는 것은 부적절할 것으로 보인다. The purpose of this study was to evaluate the perceived distance from home to high-voltage power lines using a transmission and substation geographic information system(TGIS). Of the 725, 136 respondents reported that high voltage power transmission tower, power lines or substation was within visual field range from home. Among them, 114 respondents reported valid address, which could be used in the analysis of TGIS. Forty two respondents(36.8 %) estimated that the power lines were closer and 15 respondents(13.2 %) estimated that they were farther than they actually were. Our current findings suggest that the reported distance from home to high-voltage power transmission towers, power lines, and substations cannot be used as a proxy for exposure to electromagnetic fields due to the low validity.

환자중심성의 개념적 구성 요소: 환자와 가족구성원의 관점

김은나,옥민수,신유경,조민우,이진용,도영경,Kim, Un-Na,Ock, Minsu,Shin, Yukyung,Jo, Min-Woo,Lee, Jin Yong,Do, Young Kyung 한국의료질향상학회 2019 한국의료질향상학회지 Vol.25 No.2

Purpose:The objective of this study was to identify the conceptual constructs of patient centeredness from the perspective of patients and family members in Korea, and to compare them with those included in the Picker Institute framework. Methods: Two focus group discussions were conducted. Each focus group consisted of six participants who had experienced being either a patient or a caregiver. We carried out a thematic analysis, and then compared the contents of our focus group discussions with the components of patient-centered care outlined by the Picker Institute. Results: Six conceptual constructs of patient centeredness emerged from the focus group discussions. Five of these overlapped with those outlined by the Picker Institute: 1)respect for patients' values, preferences, and needs, 2) coordination and integration of care, 3) information, communication, and education, 4) physical comfort, and 5) emotional support and alleviation for fear and anxiety. A new component that was not mentioned in the Picker Institute framework emerged from this study: "ease of making a complaint." Currently, "involvement of family and friends" and "continuity and transition" were not prominent components of patient centeredness according to our focus group discussions. Conclusions: This study presents the conceptual constructs of patient centeredness, five of which overlap with those outlined by the Picker Institute, and provides a qualitative basis of the patient experience survey currently being implemented by the Health Insurance Review & Assessment Service in Korea.

환자안전 담당자의 근본원인분석 수행 경험에 대한 조사

최은영 ( Eun Young Choi ),옥민수 ( Minsu Ock ),이상일 ( Sang-il Lee ) 대한보건협회 2020 대한보건연구 Vol.46 No.3

연구목적 : 이 연구의 목적은 환자안전 담당자들의 근본원인분석 수행 경험을 조사하는 것이다. 연구방법 : 근본원인분석 수행 현황, 수행 중에 겪는 어려움, 근본원인분석 수행 및 효과에 대한 태도를 확인하기 위하여 온라인 설문조사를 시행하였다. 총 236명의 근본원인분석 수행 경험이 있는 환자안전 담당자가 조사에 참여하였다. 수집된 자료는 기술 통계, 일원배치분산분석, 교차분석의 방법으로 분석하였다. 연구결과 : 근본원인분석 수행 현황은 의료기관별로 다양하였다. 대부분의 환자안전 담당자들이 방법론에 대한 지식 부족, 사건에 대한 불충분한 정보, 팀 활동의 어려움, 분석 결과에 대한 확신 부족 등 근본원인분석과 관련된 기술적인 어려움을 겪고 있었다. 또한, 의료진의 방어적인 태도, 시간과 자원의 부족, 경영진의 지원 부족 등의 조직 문화와 관련된 어려움도 겪고 있었다. 이러한 어려움에도 불구하고, 대부분의 참여자들은 근본원인분석의 효과에 대해 동의하였다. 결론 : 의료기관에서 성공적인 근본원인분석 수행을 위해서는 근본원인분석 수행 중에 겪는 어려움을 개선해야 할 뿐만 아니라 근본원인분석을 위한 의료기관 차원의 지원도 고려해야 할 필요가 있다. Purpose : This study aimed to explore the experiences of patient safety managers who conducted root cause analysis (RCA). Methods : An on-line questionnaire survey was done to investigate the current state of RCA, barriers, and benefits in conducting RCA. A total of 236 patient safety managers participated in the survey. Data was analyzed using descriptive statistics, one-way analysis of variance, and chi-square test. Results : The current state of RCA activities varied between hospitals. Most participants had difficulties in their technical skills during RCA process, such as lack of knowledge of RCA methodology, insufficient information about incidents, difficulty in team activities, and lack of confidence in the RCA. There were also challenges related to organizational culture, including the defensive attitude of medical staff, the lack of time and resources, and the weak support of the hospital management. Nevertheless, most participants agreed on the benefits of RCA. Conclusion : In order to promote successful RCA in hospital, it is necessary not only to improve the difficulties encountered during conducting RCA but also to consider organizational support for RCA.

진료정보교류 인센티브사업에 대한 이해관계자 조사연구

박하영(Hayoung Park),옥민수(Minsu Ock),박정선(Jong Son Park),이혜린(Hye Rin Lee),김수민(Soomin Kim),이상일(Sang-il Lee) 한국IT서비스학회 2017 한국IT서비스학회지 Vol.16 No.3

Health Information Exchange (HIE) is expected to improve the quality and efficiency of care by allowing providers online access to healthcare information generated by other providers at the point of care. However, the adoption of the technology in Korea has been slow since its pilot program in 2007~2010 at Seoul National University Bundang Hospital. The objective of this study was to survey stakeholders on the incentive program for the facilitation of HIE adoption. We surveyed 39 experts representing 6 categories of stakeholders-provider, insurer, government, information service firms, customers, and medical informatics experts for the interviews. Interview questions included program objectives, program participation requirements, incentive payment method, and administrative burden for program participation. Experts indicated that the quality of care was the most important value the program should aim to achieve through the HIE adoption. They suggested that the requirements and administrative burden for participation should be kept at minimum to recruit a large number of providers to the program, which is an indicator of program success. Experts were divided on the payment method whether the incentive should be paid as a part of the fee payment scheme operated by the National Health Insurance (NHI) or should be a payment made independent of the NHI. The source of the divide was conflict of interest among stakeholders as to who pays for the program, and the insurer and consumer groups were against the NHI taking the financial burden. It appeared to be the most significant factor for the successful program launching to resolve the gap in perceptions about benefits of the technology among stakeholders and to win the willingness to pay for the program.

환자안전사건으로 인한 제1의 피해자 심리사회적 지원 프로그램 개발을 위한 유사 프로그램 검토

표지희,최은영,이원,장승경,옥민수,Pyo, Jeehee,Choi, Eun Young,Lee, Won,Jang, Seung Gyeong,Ock, Minsu 한국의료질향상학회 2021 한국의료질향상학회지 Vol.27 No.1

Purpose:In this study, we reviewed existing victim support programs implemented in Korea to aid in the development of psychosocial support programs for patients and guardians who have experienced patient safety incidents. Methods: We reviewed similar programs: a support program for suicide survivors operated by the Korea Psychological Autopsy Center (Korea Foundation for Suicide Prevention), a family harmony program for workers in industrial accidents operated by the National Center for Forest Therapy, and the support services for crime victims provided by the Korean Crime Victims Support Association. We reviewed the contents of each website and conducted interviews with key personnel from each institution. Results: The support program for families who have experienced suicide was developed based on the suicide prevention project at the Central Psychological Autopsy Center. The family harmony program for workers who suffered industrial accidents is operated by the National Center for Forest Therapy at the behest of the Korean Workers' Compensation and Welfare Service. The Korean Crime Victims Support Association was established by the Ministry of Justice in accordance with the Crime Victim Protection Act and provides support to victims of crime. Each program was designed and implemented considering the objectives and goals, defining their recruitment plans as well as the selection criteria for their participants, and creating quality content that adequately addressed the struggles of their participants. Conclusion: The summarization of the various types of victim support programs in this study can be helpful in the future development of psychosocial support programs for victims of patient safety incidents.

일반 질 지표로서의 병원 표준화 사망비에 대한 고찰

김선하 ( Seon-ha Kim ),최은영 ( Eun Young Choi ),이현정 ( Hyeon-jeong Lee ),옥민수 ( Minsu Ock ),조민우 ( Min-woo Jo ),이상일 ( Sang-il Lee ) 한국보건행정학회 2017 보건행정학회지 Vol.27 No.2

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.

필수의료 영역별 지역친화도 분석: 울산광역시를 대상으로 한 예비 연구

박영권 ( Young-kwon Park ),표지희 ( Jeehee Pyo ),김영은 ( Young-eun Kim ),옥민수 ( Minsu Ock ),윤석준 ( Seok-jun Yoon ) 대한보건협회 2021 대한보건연구 Vol.47 No.2

연구목적 : 이번 연구에서는 2007년부터 2016년까지 울산시의 필수보건의료 영역별 지역친화도(relevance index) 분석하였다. 국내 질병부담 연구에서 산출 및 분류하고 있는 260개 질병을 총 8가지 필수보건의료 영역별로 재분류하였다. 연구방법 : 특정 지역 거주 입원 환자의 총 의료이용량 중에서 의료기관 소재지별 의료이용량(입원)을 백분율로 나타낸 값인 지역친화도를 계산하여 진료권 분석 결과를 제시하였다. 연구결과 : 2016년 환자 수 기준으로 볼 때, 입원 환자 중 울산시 지역에서 의료이용을 한 비중은 암 영역(70.6%)에서 가장 낮았고, 정신(73.3%), 노인 및 재활(82.6%) 순으로 비중이 낮았다. 본인부담금 기준으로 볼 때, 입원 환자 중 울산시 지역에서 지출된 본인부담금의 비중이 가장 낮은 영역은 정신(63.3%)이었고, 암(63.8%), 노인 및 재활(76.8%) 순으로 비중이 낮았다. 외상 영역 외 다른 영역의 경우 모두 울주군 주민의 타 지역 입원 비중이 다른 지역에 비해 가장 높은 것으로 드러났다. 결론 : 울산시의 지역친화도는 개선되고 있지 않음을 알 수 있었고, 필수보건의료 영역들 중에서는 암, 정신, 노인 및 재활, 모성 영역의 지역친화도 개선이 우선적으로 필요하며, 울주군의 지역친화도 개선이 시급함을 알 수 있었다. Purpose : In this study, the relevance index analysis by field of essential medical service in Ulsan Metropolitan City (hereinafter Ulsan city) from 2007 to 2016 was performed in terms of the number of admission patients and out-of-pocket expenses total amount. For this purpose, the 260 diseases calculated and classified in the National Disease Burden Study using the Korea National Health Insurance Service data and the Korean National Hospital Discharge IN-depth Injury Survey data were reclassified into a total of eight essential medical services fields. Methods : The medical service region was analyzed by calculating the relevance index, which is a percentage of the medical care utilization (admission) by medical institution location among the total medical care utilization of inpatients in a specific region. Results : In 2016, the proportion of number of inpatients by medical services field in the Ulsan city region was the lowest in the cancer field (70.6%), followed by mental field (73.3%), elderly & rehabilitation field (82.6%). The proportion of out-of-pocket expenses of inpatients by medical services field in the Ulsan city region was the lowest in the mental field (63.3%), followed by cancer field (63.8%), elderly & rehabilitation field (76.8%). In all fields except the trauma field, the proportion of residents of Ulju-gun who were admitted to other regions was the highest compared to other locations. Conclusions : As a result, the relevance index in Ulsan City has not improved, and among the essential medical service fields, the relevance index in the cancer, mental, elderly & rehabilitation and maternal & neonatal fields needs to be improved first, and the relevance index of Ulju-gun must be improved urgently. Based on the results of this study, it is necessary to prepare a strategy for improving the relevance index of essential medical service fields in Ulsan City.

병원 성과 비교를 위한 급성기 뇌졸중 사망률 위험보정모형의 타당도 평가

최은영 ( Eun Young Choi ),김선하 ( Seon-ha Kim ),옥민수 ( Minsu Ock ),이현정 ( Hyeon-jeong Lee ),손우승 ( Woo-seung Son ),조민우 ( Min-woo Jo ),이상일 ( Sang-il Lee ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.4

Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, R² values, and Hos-mer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.

일반인 대상 환자안전 교육을 통한 환자안전 및 환자 참여에 대한 인식 증진: 예비 연구

표지희 ( Jeehee Pyo ),이원 ( Won Lee ),최은영 ( Eun Young Choi ),장승경 ( Seung Gyeong Jang ),옥민수 ( Minsu Ock ),이상일 ( Sang-il Lee ) 대한보건협회 2018 대한보건연구 Vol.44 No.3

연구목적: 이 연구의 목적은 환자의 자기 보호 행동에 대한 인식과 환자 안전에 대한 의사 결정 참여를 확인하고 환자 안전 교육의 효과를 평가하는 것이다. 연구방법: 울산지역 퇴직자 지원센터 내 일반인을 대상으로 환자안전 교육을 진행하였다. 참가자들을 대상으로 교육 전후 환자 참여에 대한 인식을 알아보기 위해 자가기입 설문지를 실시하였다. 환자안전 교육의 효과를 평가하기 위하여 교육 전후 설문 응답에 대하여 Wilcoxon signed-rank test를 수행하였다. 연구결과: 총 25명의 일반인을 대상으로 교육한 결과, 통계적으로 유의하지 않은 결과도 있었지만 환자안전 교육은 전반적으로 환자안전 및 환자 참여에 대한 인식을 높일 수 있는 것으로 나타났다. 특히, 의료기관 인증 여부에 따른 의료기관 선택 의향, 의료기관 방문 시 보호자 동반 의향, 검사나 치료에 대한 환자 의견 반영 의향, 감염 및 낙상 관련 예방 활동에 대한 참여 의향에 있어 교육 전후 통계적으로 유의한 변화가 나타났다. 결론: 이 연구는 우리나라에서 처음으로 일반인 대상으로 환자안전 교육을 시행하였다는 측면에서 큰 의의가 있다. 더불어 이번 연구에서 개발된 환자안전 교육안을 참고로 하여 우리나라에서도 특정 유형의 환자안전사건들을 예방하기 위한 좀 더 자세한 교육안도 개발할 수 있을 것이다. 하지만 이 연구는 여러 선행 연구들에서 활용하고 있는 환자 참여 촉진 중재들이 낮은 수준의 단계에 머물러 있다는 제한점이 있기 때문에 후속 연구에서는 실제 임상 현장에서 적용해야 하는, 더 높은 수준의 환자 참여 중재 개발하고 활용해보는 것이 필요할 것이다. Objective: The purpose of this study was to identify the perception of patient’s self-protection behaviors and patient engagement in decision making for patient safety and to evaluate the effectiveness of patient safety education. Methods: Patient safety education was conducted in the Ulsan retirement support center. Participants completed a questionnaire to evaluate the perception of patient safety before and after the education. The Wilcoxon signed rank test was performed on the patient safety questionnaire response to compare the perceptions before and after the education. Results: A total of 25 people participated in this study. Although there were some statistically insignificant results, it was found that overall patient awareness of safety and patient engagement could be improved. Particularly, patient safety education led to statistically significant difference in pre and post educating in the tendency to choose medical institutions according to whether they are certified by medical institutions, intention to accompany guardians when visiting medical institutions, intention to reflect patient's opinion on test or treatment, intention to participate in preventive activities related to infections, and to participate in fall prevention activities. Conclusion: In the future, the researchers should develop and utilize higher level patient engagement intervention in the actual clinical field.