의료 질 향상 사업의 성공요인과 실패요인

최귀선,이선희,조우현,강혜영,채유미 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : To propose effective strategies for successful implementation of QI in health care institutions, by identifying facilitating factors and barriers to conducting QI programs. Methods : In order to examine empirical evidence on the success factors or barriers to QI implementation in hospitals, a literature study was performed on the basis of MEDLINE search. Among the identified literature. 13 provided reliable findings and basis comprehensive discussion on this issue and thus were selected for in-depth analysis. A mailed questionnaire survey was conducted for hospital CEOs and QI directors of hospitals with 400 beds or greater to investigate what attributes of their organizations they perceived as success factors or obstacles to QI implementation. Result : The analysis of selected literature and survey results presented that the primary factors considered to be most important as successful implementation of QI were: strong support from hospital CEOs, setting higher priority for QI activities, continuous and persistent efforts in QI activities, and active participation of clinical staffs. The barriers identified in this study were : the lack of orientation and understanding of QI concepts, low level of interest and participation of physician in QI programs, the lack of evaluation and rewarding system for QI activities. Conclusion : By identifying factors that affect facilitation of QI, the study results will be of great use for either institutions being in the early stage of evolving QI or those looking for better strategies to achieve more active and persistent QI implementation in their institutions.

환자만족도 조사설문지의 설문문항 배열에 따른 신뢰도 분석

최귀선,조우현,홍재석,이선희,강명근 한국의료QA학회 2000 한국의료질향상학회지 Vol.7 No.2

Objectives : The purpose of this study was to evaluate the reliability of questionnaire according to item arrangement on patient satisfaction questionnaire. Methods : We developed the two types of questionnaire with different item arrangement. In the first type (A), questions were arranged according to medical service dimensions. Questions in the second type (B) were arranged according to medical process. Both questionnaires were composed of six dimensions: physical environments, process, competence, courtesy, information giving, understanding patients. Measurements were performed on a 5-score Likert scale. In an outpatients and inpatient survey, total 777 patients answered the type A (outpatients: 257, inpatients: 128) or Type B (outpatients: 257, inpatients: 135). In order to compare the internal consistency of two types. Cronbach's α were calculated. Multiple regression analysis was also performed to know which type of questionnaire explain more of the overall satisfaction. Results : In outpatient survey, type A questionnaire showed higher internal consistency than B except physical environments dimension. Also in inpatient survey, type A had higer internal consistency than B in four dimensions(process, competence, courtesy, understanding patients). In the results of multiple regression analysis, type A questionnaire (R² =0.53) explained more of the variation in overall satisfaction then B questionnaire (R2=0.43) in outpatient survey. In inpatient survey, type B questionnaire (R²=0.40) explained, more of the variation in overall satisfaction than type A questionnaire (R² =0.33).But the.difference of R was not significant in inpatient survey. Conclusion : The results of this study support that type A questionnaire has higer reliability in assessment of consumer satisfaction than type B.

국내 의료기관의 질 향상 사업주제

채유미,이선희,최귀선 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : the hospitals in Korea are in a situation of a severe competition than the past. This situation was resulted from the increase in the number of hospitals and also from the government policy controlling the medical insurance fee. Moreover, consumer’s desire for the high quality medical service g\has been significantly increased. Many programs to improve the quality of medical services are being performed in hospitals since the middle of 1990’s. Studies up to now reported that more than 10 programs are being performed per hospital in Korea. So far studies have been performed to measure only the number of such programs in a hospital. The purposes of this study are to examine a specific area involved in the programs designed to improve the medical service quality and to suggest a future direction of the such programs. In addition, we hope that the results from this study could assist the programs for the medical service quality. Methods : A mailed questionnaire survey of the QI staffs at hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for inclusion in our study, 69 participated, yielding a response rate of 63.9%. Excluding 7 hospital which are not responsed about activities of hospital then 62 hospitals were used for the analysis. Result : The total number of programs was 1,081 from the 62 hospitals participated in the survey. The highest number(24.8 programs) was found in the hospital having more than 800 beds and performing the programs more than 5 years. The 1,081 programs were consisted of 445 from the medical examination area, 343 from the medical examination support area, and 296 from the management area. Conclusion : This study showed the present situation of hospitals in Korea regarding to the quality improvement programs. The results from this study suggest that the pattern of the program for the medical service improvement is being changed to service process and result-centered programs from the structural area.

국내 의료기관의 질 향상 활동 현황

이선희,채유미,지영건,최귀선 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : This study was carried out to assess the quality improvement(QI)activities in Korean hospitals. Methods : A mailed questionnaire survey was conducted between September 15 and October 30, 2000. The staffs being charge of QI each of the hospitals with 400 beds or more responded to the questionnaire. Of the 108 hospitals eligible for inclusion in our study, 69 participated, yielding a response rate of 63.9%. Results : Based on these survey, 87.3 percent of the responding hospitals were performing QI projects and 54 percent of the hospitals had a separate department for QI activity. About 62 percent of hospitals performing QI activity(QI hospitals)had a QI manager and 58 percent had a separate budget for QI activities. Among the QI hospitals, 85 percent had cross-functional or cross-departmental teams as the major mechanisms for doing QI projects, 94 percent had one or more educational programs on QI. The level of physician’s participation level for QI projects was lower than other staff(CEO, nurses and other administrators). Conclusion : The majority of the hospitals have undertaken activities in QI. For the successful implemented QI, the involvement of and education for employees(including physicians and other health professionals)are needed as well as management strategy and leadership. Understanding of other hospitals experience would be helpful for health care managers to plan and initiate QI activities.

Job loss and reemployment after a cancer diagnosis in Koreans—a prospective cohort study

Choi, Kui Son,Kim, Eun-Jung,Lim, Jin-Hwa,Kim, Sung-Gyeong,Lim, Min Kyung,Park, Jae-Gahb,Park, Eun-Cheol JOHN WILEY & SONS LTD, JOURNALS 2007 PSYCHOONCOLOGY Vol.16 No.3

<P>Patients undergoing treatment for cancer have reported a variety of work-related problems. The aim of this study was to investigate the impact of a cancer diagnosis on employment status, and to identify relevant associated factors. This prospective cohort study was conducted at the National Cancer Center in Korea. Male patients newly diagnosed with stomach, liver, or colorectal cancers were recruited. Patients were interviewed and asked to complete an employment questionnaire every 3 months for 24 months. Clinical, sociodemographic and work-related factors were assessed. There were 305 male patients who had a primary diagnosis of cancer and underwent appropriate treatment. Of the 305 male patients who were employed at the time of diagnosis, 53% lost their job, and of these 23% later reemployed. In a multivariate Cox regression analysis, job loss was significantly associated with years of education, job characteristics and disease stage. Reemployment was significantly associated with disease stage and cancer site. Change of employment was common among cancer patients in Korea. With an understanding of the factors involved, it should be possible to reduce unnecessary work cessation, and increase the rate of employment of cancer survivors. Copyright © 2006 John Wiley & Sons, Ltd.</P>

Screening for gastric cancer in Korea: population-based preferences for endoscopy versus upper gastrointestinal series.

Choi, Kui Son,Kwak, Min-Son,Lee, Hoo-Yeon,Jun, Jae Kwan,Hahm, Myung-Il,Park, Eun-Cheol American Association for Cancer Research 2009 Cancer epidemiology, biomarkers & prevention Vol.18 No.5

<P>This study assessed the screening rates for gastric cancer by two different screening methods, upper gastrointestinal (UGI) series and endoscopy; intentions to undergo future gastric cancer screening; and the preferred method of screening. The study population was derived from the 2006 Korean National Cancer Screening Survey. The Korean National Cancer Screening Survey is an annual cross-sectional survey that uses nationally representative random sampling to investigate cancer screening rates. A total of 1,625 Koreans over 40 years of age participated in this study. Logistic regression was used to identify the factors associated with undergoing gastric cancer screening, having an intention to be screened, and preferring one of the two screening tests. Among the 1,625 subjects, 15.1% had received a UGI, 33.2% had received an endoscopy, and 43.1% had undergone either or both of the tests in the previous 2 years. About 52% of people reported the intention to be screened within the next 2 years. The odds ratio for intending to be screened was 11.8 and 6.2 higher among those who had undergone a prior UGI test and an endoscopy test within the previous 2 years, respectively, than for those who had never been screened. Among the 1,625 individuals, 67% chose endoscopy and 33% UGI for their preferred future screening method. Collectively, our results highlight the preference for endoscopy testing as a gastric cancer screening method. Providers' assessments of individuals' screening preferences in combination with intervention strategies to promote performance of the preferred test may increase patient compliance with gastric cancer screening recommendations.</P>

Comparison of Breast Cancer Screening Rates Between Korean Women in America Versus Korea

Choi, Kui Son,Lee, Sunmin,Park, Eun-Cheol,Kwak, Min-Son,Spring, Bonnie J.,Juon, Hee-Soon Mary Ann Liebert 2010 Journal of women's health Vol.19 No.6

<P>Breast cancer is the most commonly diagnosed cancer among Korean American women and among Korean women in Korea. However, many Asian women are not aware of the importance of screening mammography. This study compares breast cancer screening in Korean women in California and in Korea.</P>

Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in the Patients with Severe Alopecia Areata; A Retrospective Study with a Self-Controlled Design

( Kui Young Park ),( Woo Sun Jang ),( In Pyeong Son ),( Sun Young Choi ),( Moo Yeol Lee ),( Beom Joon Kim ),( Myeung Nam Kim ),( Byung In Ro ) 대한피부과학회 2013 Annals of Dermatology Vol.25 No.1

Background: Alopecia areata (AA) is believed to be an organ-specific autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no definitive therapy for AA. Objective: We sought to determine whether the combination therapy of cyclosporine and psoralen plus ultraviolet A (PUVA) could be an effective treatment for severe AA. Methods: A total of 41 patients with severe AA were treated with oral cyclosporine and topical PUVA. Cyclosporine was given at an initial daily dose of 200 mg for adult and 100 mg for children for periods of up to 16 weeks. Eight-methoxypsoralen (Methoxsalen) was applied topically 20 minutes prior to ultraviolet A (UVA) exposure, and the patients were irradiated with UVA twice a week for 16 weeks. Results: Of the total 41 patients, 2 (7.3%) patients were lost to follow-up, and 1 (2.4%) patient discontinued the treatment due to abdominal discomfort. Six (14.6%) patients were treated for less than 12 weeks. Of remaining 32 patients, 3 (9.4%) showed excellent response, 3 (9.4%) showed good response, 12 (37.5%) showed fair response, and 14 (43.7%) showed poor response. Conclusion: Although limited by its uncontrolled character, this study shows that the combination therapy with cyclosporine and PUVA may be an additional choice for severe and recalcitrant AA. (Ann Dermatol 25(1) 12∼16, 2013)

의료 질 향상 활동에 대한 병원장의 인식 및 태도

최귀선,지영건,이선희,채유미 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : The purpose of this study was to investigate the understanding and the attitude of Korean hospital CEOs toward the healthcare quality improvement. Methods : A mailed questionnaire survey to the CEOs of hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for the study, 58 participated, yielding a response rate of 54 percent. Result : The hospital CEOs have expressed that their hospital management was arduous job, and they had been pressured by increasing competitions among healthcare providers. They indicated that the low fees of health insurance made their hospital management difficult. The results also indicated that there was general consensus that the improvement of service quality was important in encouraging their organizations, but the investment of manpower and equipment ranked higher than the improvement of service quality. The majority of the CEOs have good understanding about quality improvement activities. However the facts that in general QI must be focused at the process of services and customer satisfaction, meanwhile quality improvement activities are helpful for the organizational productivity embarrassed them. The hospital CEOs responded that there were successful changes in terms of quality of care, patient satisfaction, and process efficiency after QI activities, but no increase in patient number and profit. Lack of understanding to QI activities and limited budget seem to attribute unsatisfactory outcomes. Conclusion : The majority of Korean hospital CEOs have a good understanding and attitude about QI activities. As mentioned in the result, despite of several limitations, several facts regarding the CEOs of hospital in Korean can be elucidated. (1)The general cognition of the QI project is relatively high, and it is accepted with positive concern, (2) the priority of the QI project, however, is not set higher than other projects and (3) the specific concepts of the actual QI project such as customer(patient)-focused work driving, the recognition of the work accomplishment, and the importance of rewards have not sufficiently understood.

Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries

Eunji Choi,Sangeun Lee,Bui Cam Nhung,Mina Su,Boyoung Park,Jae Kwan Jun,Kui Son Choi 한국역학회 2017 Epidemiology and Health Vol.39 No.-

OBJECTIVES: Assessing long-term success and efficiency is an essential part of evaluating cancer control programs. The mortality-to-incidence ratio (MIR) can serve as an insightful indicator of cancer management outcomes for individual nations. By calculating MIRs for the top five cancers in Organization for Economic Cooperation and Development (OECD) countries, the current study attempted to characterize the outcomes of national cancer management policies according to the health system ranking of each country. METHODS: The MIRs for the five most burdensome cancers globally (lung, colorectal, prostate, stomach, and breast) were calculated for all 34 OECD countries using 2012 GLOBOCAN incidence and mortality statistics. Health system rankings reported by the World Health Organization in 2000 were updated with relevant information when possible. A linear regression model was created, using MIRs as the dependent variable and health system rankings as the independent variable. RESULTS: The linear relationships between MIRs and health system rankings for the five cancers were significant, with coefficients of determination ranging from 49 to 75% when outliers were excluded. A clear outlier, Korea reported lower-than-predicted MIRs for stomach and colorectal cancer, reflecting its strong national cancer control policies, especially cancer screening. CONCLUSIONS: The MIR was found to be a practical measure for evaluating the long-term success of cancer surveillance and the efficacy of cancer control programs, especially cancer screening. Extending the use of MIRs to evaluate other cancers may also prove useful.