지리적 접근성을 이용한 도시지역 보건지소의 입지선정

이건세,김창엽,김용익,신영수,Lee, Kun-Sei,Kim, Chang-Yup,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1996 예방의학회지 Vol.29 No.2

Decentralization to local governments and amending of Health Center Law are to promote the efforts of health planning at the level of local agencies. In the health facility planning, it is important to take into account that what to be built, where to be located, how far should be service area and so forth, because health facilities are immovable, and require capital as well as personnel and consumable supplies. The aim of our study, answering to the question of 'where to be located?', is to determine the best location of urban health sub-center. At the local level, planning is the matter of finding the best location of specific facilitiy, in relation to population needs. We confine the accessibility, which is basic to location planning, to geographic one. Location-Allocation Model is used to solve the problem where the location is to maximize geographic accessibility. To minimize the weighted travel distance, objective function, $R_k=\sum{\sum}a_{ij}w_{i}d_{ij}$ is used. Distances are measured indirectly by map measure-meter with 1:25,000 Suwon map, and each potential sites, 10 administrative Dongs in Kwonson Gu, Suwon, are weighted by each number of households, total population, maternal age group, child age group, old age group, Relief for the livelihood, and population/primary health clinics. We find that Kuwoon-Dong, Seodun-Dong, Seryu3-Dong, according the descending orders, are best sites which can minimize the weighted distance, and conclude that it is reasonable to determine the location of urban health sub-center among those sites.

한국 호스피스.완화의료 기관 현황 및 과제

이건세,주지수,김정회,김건엽,Lee, Kun-Sei,Joo, Ji-Soo,Kim, Jung-Hoe,Kim, Keon-Yeop 한국호스피스완화의료학회 2008 한국호스피스.완화의료학회지 Vol.11 No.4

목적: 본 연구는 현재 호스피스완화의료 기관의 인력 및 시설, 제공서비스 등이 말기 암환자 전문의료기관 지정 기준에 부합하는 정도를 조사하고 분석하여 향후 정책수립을 위한 기초자료를 제공하고자 실시되었다. 방법: 자료는 2007년 10월부터 12월까지 수집되었으며 설문내용으로는 호스피스 완화의료 기관의 일반현황, 인력현황, 시설현황, 장비현황, 호스피스 서비스 운영현황 등을 포함하였다. 총 62개 의료기관이 응답하였다. 결과: 전체 62개 기관 가운데 42개 기관이 종합병원 이상인데 비하여 의원의 경우 9개 기관에서 호스피스를 제공하고 있었다. 호스피스 의료기관은 수도권 지역 위주로 분포하고 있어 지역적인 불균형 공급을 보이고 있다. 의사의 경우 환자 10명당 1인의 의사를 갖추고 있는 기관은 종합병원 이상(80.0%)인데 비하여 의원의 경우 이 기준을 충족하는 비율은 낮았다(42.9%). 간호사의 경우 호스피스 간호를 위해 필요한 조건인 환자 1.5 명당 1인의 기준에 충족하는 기관은 의원급(71.4%)이 종합병원 이상의 기관(65.0%), 병원(50.0%)에 비해 높게 나타났다. 호스피스 지원기관의 기준에 해당하는 1병실 4인 기준을 충족하는 기관은 전체 62개 기관에서 14개 기관으로 22.6%를 차지하고 있었다. 호스피스 환자들을 위한 특수요법의 경우는 의원급(66.7%), 병동 및 독립형(64.9%), 지원 사업 기관(73.9%)일수록 2개 이상의 특수요법을 실시하고 있는 것으로 나타났다. 임종 및 사별관리 프로그램에 해당하는 임종관리, 장례준비, 유가족지지모임, 사별가족 관리 프로그램을 실시하는 기관의 비율이 높았으며, 의원급, 병동 및 독립형, 지원 사업 수록 실시율이 높게 나타났다. 팀 인력에 대한 교육은 의원급(55.6%), 병동형 및 독립형(55.8%), 지원기관(65.2%) 이 상대적으로 높은 비율로 시행하고 있었다. 현재 가정 호스피스 서비스를 운영하고 있는 곳은 절반 수준인 32개(51.6%) 기관으로 나타났다. 결론: 본 연구를 통해 확인한 것은 호스피스 기관을 양적으로 확대하는 것과 함께 지역적인 분포를 동시에 고려하는 것이 필요하다는 점과 아직도 호스피스 지원 기관의 인력, 시설 수준을 충족하지 못하는 비율이 높다는 것을 확인하였다. 또한 호스피스 기관의 종별 특성에 따라 인력 및 시설 확보 수준, 프로그램 운영에 차이가 있으므로 시설의 특성을 고려한 개선 방안을 고려하여야 할 것이다. Purpose: The purpose of this study was to evaluate the current status of hospice palliative care facilities, and to identify problems and improve hospice palliative care in Korea. Methods: The questionnaire survey was implemented from October to December, 2007. It was consisted of general characteristics of organization, health manpower, facilities & equipments, service programs, and so on. Sixty two (79.5%) out of 78 hospice palliative care facilities returned the questionnaires. Results: They were 42 hospital-based hospice palliative care hospitals and 9 clinics, and most of them are located at central metropolitan areas (Seoul and Gyeonggi Province). more than 80% of hospitals met with the requirements (one doctor per 10 patients and one nurse per 1.5 patients), whereas 42.9% of clinics met the requirements. Approximately 22% of them met the requirement of sick room (4 patients for 1 room). Most of them provided various hospice palliative care programs. The proportion of giving regular education programs to hospice palliative care personnels were about half (41.9%). Thirty two (51.6%) facilities provided home visiting hospice palliative care service. Conclusion: There were lack of enough health manpower, rooms, and programmes and they varied among facilities. It is necessary to increase the number of hospice palliative care facilities with consideration of regional fair distribution and standardization of programmes.

보건의료 경제성 평가 방법론 고찰 -연구 설계와 비용 추정을 중심으로-

이건세 ( Kun Sei Lee ),( Brouwer Wbf ),이상일 ( Sang Il Lee ),구혜원 ( Hye Won Koo ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.2

Cost containment has become high political issues since financial crisis of the Korean Health Insurance fund in 2000. Korean Government has developed and implemented several measures to reduce the pharmaceutical expenditures. Pharmaceutical economic evaluation can be a tool in decision to allocate scare resource efficiently. In order to increase the quality of economic evaluation for pharmaceuticals, the Korean Health Insurance Review Agency(HIRA) is considering the development of a guideline for economic evaluation. It mandates that pharmaceutical companies could submit the result of an economic evaluation when demanding reimbursement of new pharmaceutical drugs. The purpose of this study is to provide a critical review of the economic evaluations of health care technologies published in the Korean context whether they have been performed according to current guidelines and therefore whether their results are directly useful for decision making. We found there exist important problems and deviation from ``good practice`` both in the general features of the studies, like the study design and perspective, and in terms of cost measurement and valuation. There are needs to develop clear guidelines and to educate and train researchers in performing economic evaluations.

Rand Social Health Battery를 이용한 일부 농촌지역 주민의 사회적 기능 평가

이건세(Kun-Sei Lee),김형수(Hyeong-Su Kim),장성훈(Soung-Hoon Chang),박수경(Suekyung Park),최희정(Hee Jeong Choi),함은미(Eun Mi Ham) 한국보건교육건강증진학회 2004 보건교육건강증진학회지 Vol.21 No.2

농촌지역의 방문보건서비스에 대한 요구조사

이건세(Kun Sei Lee),김창엽(Chang-Yup Kim),김용익(Yong-Ik Kim),신영수(Young Soo Shin) 한국농촌의학 지역보건학회 1994 농촌의학·지역보건 Vol.19 No.1

건국대학교 의과대학 학생의 자원봉사활동에 대한 인식 조사

이건세(Kun-Sei Lee),새날을 여는 우리(New Horizon) 한국의학교육학회 2001 Korean journal of medical education Vol.13 No.1

Purpose: The aim of this study is to evaluate the medical students consciousness on volunteer activities. What kinds of volunteer activities they had done, what kinds of volunteer activities they want to participate in, how they think about making volunteer program as school regular curriculum, and how they feel about volunteer activity. Materials and Methods: Study subjects are first, second grade premedical students and first, second grade medical students. Self-administered questionnaire was conducted at October, 1999. Finally, 119 questionnaire is collected, which is 74% of all students except 3rd, 4th grade students. Results: Study subjects had participated in several volunteer activities. 44.5% of them had participated in some volunteer activities since they had become to college student, 30.8% of them participated in summer rural volunteer activity, and 39.3% of them had donated their blood. Many students (79.66%) agreed that volunteer activities are required as college students, and if they might have some opportunities to participate in volunteer activities, they would like to (54.17%). However, Only 22.50% of subjects agreed to make volunteer activities as regular medical curriculum. Even though the percentage showed low, they intended to apply to the curriculum (40.83%). Most of them agreed there were in need of participating in hospital volunteer activities (82.50%) and community volunteer activities (78.33%). Among hospital volunteer activities, they wanted to participate in volunteer activities at supporting department (26.05%), emergency room (22.69%), out-patient department (21.01%), and in-patient department (21.01%). They wanted to have volunteer activities at institution (66.39%) rather than to individual person (33.61%). They wanted to participate in friendly supports (40.34%), out-going supports (28.57%), house work supports (22.69%). Factor analysis showed that recognition of volunteer activities had 5 latent dimensions: ‘self-achievement (16.15%), ‘social exchange and the pursue of experience (13.93%) , ‘social responsibility of college (13.03%) , ‘leisure of worth and expert activity (12.40%)’, ‘passive and meeting other s expectation (9.03%) Conclusion: From above results, We found premedical and medical students had participated in various volunteer activities and they had much more intention to participate in. Before developing and designing volunteer programmes, One should consider they have various aspects on the programmes. The programmes should not be emphasized on altruistic aspect and social responsibility extremely, but rather it should be considered how the programmes could give the opportunities for the social exchange, social relationship, sense of solidarity, and usefulness of acquired medical knowledge and skill.

보건소 예방접종 전산프로그램의 운영 현황 분석

이건세 ( Kun Sei Lee ),이석구 ( Seok Goo Lee ),이무식 ( Moo Sik Lee ),신의철 ( Eui Chul Shin ),김영택 ( Young Taek Kim ),이연경 ( Yeon Kyeng Lee ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.2

Background: Immunization has been one of the most effective measures preventing from infectious diseases. However, children routine vaccination rate of Korea was 68.2% and it was not higher than expected. Korean government revised the School Health Law for every primary school children to submit the vaccination certificate record from 2005. It is quite important national infectious disease prevention policy to keep the immunizations rate high and monitor the immunizations rate continuously. To do this, National Institute of Health introduced the National Immunization Registry(NIR) Program at 2000. Objective: The aims of this study was to evaluate the Immunization Registry program which has been implementing since 2000 at the Public Health Centers(PHC). Methods: The mail survey was done from November 2001 to January 2002. 169 (69%) Public Health Centers among 244 PHC were responded. Results: The respondents of PHC said the Immunization Registry(IR) program had reduced the workload (18.5%). 69.2% said they inputted the immunization data into the IR program after the shots were given. 86.5% said they hadn`t checked or retrieved the children lists who had missed the scheduled immunization. Only 17.2% said the speed of internet for the IR program was good. It showed that 20% of respondents hadn`t written down documents, records on immunization any more. Even there were a lot of negative results, the respondents of PHC thought that the IR program was effective. They especially agreed that the IR program could make the job accurate (81.5%), convenient (71.3%), and reduced the chances of making mistakes (71.3%), increase the service quality (78.5%). And they were well adapting the job process of the IR (79.63%). Bivariate analysis showed that the software program was the important determinants of IR success. The only Bit Computer software program has been evaluated to be less satisfactory than the Integrated (Posdata operating system + Bit software) program. Other variables, such as age, duration of present job, and location of PHC (metropolitan, small city, rural area) were not significantly related. Conclusion: It seemed that the success of NIR might depend on the software program. Because Integrated program, which has been developed from 1994, include not only the general operating and management program for PHC but also IR program. It was natural to prefer Integrated program to Bit software program. So we can suggest that it is essential for the NIR to be successful that not only the immunization software program but also hardware equipments and public health information system should be further improved.

농촌지역 주민의 암 경고증상에 대한 지식수준 평가

이건세(Kun-Sei Lee),이원진(Won-Jin Lee),장성훈(Soung-Hoon Chang) 한국농촌의학 지역보건학회 1998 농촌의학·지역보건 Vol.23 No.1

권역심뇌혈관질환센터의 공익성 측정도구 개발

이건세 ( Kun Sei Lee ),신은영 ( Eun Young Shin ),정효선 ( Hyoseon Jeong ),이정현 ( Jung Hyun Lee ),김희숙 ( Hee Sook Kim ),임영실 ( Young Sil Lim ),김영택 ( Young Taek Kim ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Background: Regional Cardiocerebrovascular Centers (RCC) were established for the prevention and treatment of cardiocerebrovascular disease and funded by the Ministry of Health and Welfare. The purpose of this study was to develop and validate the measurement tool of public benefits in RCC. Methods: Through the intensive literature review, experts surveys and their repetitive feedback, we selected the 46 items about the public benefits in RCC. Development of measurement tool involved content validity test using Content Validity Index (CVI), construct validity test through factor analysis and reliability test. Results: Thirty-five items were selected by content validity test, which CVI was 0.08 or higher. Through the construct validity test, 32 items in 7 factors were derived. And Cronbach`s alpha was 0.951. Finally, public benefits measurement tool is composed of 32 items in 7 factors which are comprehensiveness of health care services, market complement, emergency care, cost, governance, quality improvement, and government control. Conclusion: Though we developed the measurement tool of public benefits in RCC, it would be utilized to measure the public benefits of various health agencies.

부적절 재원의 이유

김윤,이건세,김창엽,김용익,신영수,이상일,Kim, Yoon,Lee, Kun-Sei,Kim, Chang-Yup,Kim, Yong-Ik,Shin, Young-Soo,Lee, Sang-Il 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.4

This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into slx major categories : delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol (AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services ($4.7{\sim}9.2%$), and delay related to surgery in surgical services ($7.3{\sim}15.0%$). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay ($2.9{\sim}6.4%$). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical charateristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.