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      • 응급실에서의 질 향상 기법 적용

        황지인,황정해,김창엽,신희영,오병희 한국의료QA학회 1999 한국의료질향상학회지 Vol.6 No.1-2

        Background : Although a number of studies are related to QA improvement, there are few studies applied various method of QA tools. This study reviewed the availability of general quality assurance(QA) tools according to ten steps in performing quality improvement activities at emergency room of a tertiary teaching hospital which has more than 1,000 beds. Methods : All patients in emergency room from 15th Oct. 1997 to 5th Sep. 1998 were surveyed. The survey .data based on the patient's records of emergency room were evaluated according to length of stay, and we tried to identify problems with management of emergency room. To solve the problems, our team applied general QA tools(brainstorming, flow chart, nominal group technique, benchmarking, cause-and-effect diagram, run chart, control chart) to quality improvement activities and discussed the availability of the tools. Results : After the activities such as changes of staffing, the establishment of local area network and chest pain clinic, application of triage and so on, the percentage of patient who had stayed more than six hours was reduced from 56.0% to 46.8%. The mean number of patients per day in emergency room was increased from 49 to 62. But the reporting time for laboratory test was not changed after these activities. Conclusion : Each QA tool has unique benefit and limitation, but we can implement and evaluate the quality improvement activities more scientifically and systematically by applying these tools to practice according to QA ten steps.

      • 환자안전과 관련된 정부의 정책방향

        권준욱 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.1

        의료환경안전관리란 병원 내 감염뿐만 아니라, 혈액, 약품, 의료기기 등 전반적 안전관리 및 그 대상에 있어서도 환자 뿐 아니라 의료인까지 포함하고 있는 확대된 개념이며 이를 위해서는 의료기관 내에서의 감염관리 - 의료진, 다른 환자, 오염된 의료기기, 병원 내의 주위 환경 등 - 가 내성관리, 전파 차단의 핵심으로 볼 수 있다. 최근 선진국을 중심으로 의료 환경 개선과 질 향상을 위한 감시체계 가동 및 감시 자료를 바탕으로 분석된 근거에 따라 각종 지침, 권고를 통해서 의료 환경개선을 위한 노력이 활발하게 전개되고 있다. 병원감염은 궁극적으로 유병율의 증가, 치료 지연 및 심한 경우 환자 사망까지 발생시키고 있으며 나아가 주요 원인균들이 항생제 내성을 획득하여 다른 환자의 치료에도 지장을 초래하게 된다. 국내에서도 병원감염은 보건 의료의 질을 떨어뜨려 국민 건강을 위협하는 공중 보건문제이며 보건의료 비용 증가로 건강보험 재정에 악영향을 미치며 또한 입원기간의 연장으로 의료비용이 증가하여 경제적 손실이 크다. 이에 질병관리본부는 의료환경안전관리를 위해 2004년부터 전국병원감염감시체계를 구축 운영하고 있으며, 관계 전문학회 등과의 파트너쉽을 통해 의료기관에서 필요로 하는 감염관리 지침개발, 예방홍보물 지원 등으로 병원감염으로 인해 발생하는 국민건강 위해를 줄이고자 적극적인 사업을 추진하고 있다.

      • 한국의 병원 구조에서 QA 팀을 어떻게 구성하고 운영 할 것인가?

        양웅석 한국의료QA학회 1997 한국의료질향상학회지 Vol.4 No.2

        Since the start of the Korean Society of Quality Assurance in Health Care in 1994, QA has improved, but it is time to develop our own policies that are more appropriate for Korean hospitals. American Quality Assurance policies are difficult to apply to the Korean medical community due to the differences in health insurance policies, and hospital structure between the two countries. Methods : I would like to propose more efficient organization and management of Quality Assurance according to the specific structures of hospitals in Korea. All of the hospital departments and committees should report to the Quality Assurance office, which in turn should report to the director. I would like to suggest that the current insurance review staff be used for the Quality Assurance office. A nurse should be in charge of the Quality Assurance department. The Quality Assurance department should have three sections : Medical Inssurance Review, QA records for the different Medical Departments, and QA records for the Ancillary Departments. A staff physician should be the chairman of the hospital QA committee, which should serve as the advising body to the QA Department. The QA Committee should be organized into eight subcommittees so that all departments throught the hoapital are represented. The current Medical Insurance Review offices in Korea have similar responsibilities to the QA Department : therefore I would like to recommend that the Medical Insurance Review office be changed the the QA office. If there are presently two separate Medical Insurance and QA offices, these should be combined into one office. Conclusion : These changes would surely benefit hospitals and strengthen the efficiency of both Insurance Review and Quality Assurance.

      • 의료서비스의 질향상 진화와 현안 : 미국의 동향

        한휘종 한국의료QA학회 2008 한국의료질향상학회지 Vol.14 No.2

        흔히 관리의료 (Managed Care)라 불려지는 미국의 의료체계는 과거 약 30여년간 미국내 의료비용증가의 억제, 의료서비스 접근성 개선, 의료의 질향상이라는 세가지 목표를 이루기위해 시행되어 왔다. 이 관리의료체계는 지속적으로 증가하는 의료비용을 어느정도 억제하는데는 성공하였으나, 몇년전부터 의료정책전문가들은 관리의료체계의 의료비용증가 억제 역할은 이미 한계에 다다렀다고 판단하고 있으며, 의료서비스 접근성 개선이나 의료의 질향상에는 큰 성과를 이루지 못했다고 평가하고 있다. 그럼에도 불구하고 미국의 의료서비스 질향상을 위한 노력은 지속적이면서도 체계적으로 진행되어왔다고 자부하고 있다. 최근 미국내 의료서비스 질향상을 위한 형태를 살펴보면 자주 거론되는 것이 Prevention activity, Physician Profiling, Pay-for-Performance (P4P), Clinical Practice Guideline, Health Information Technology (Health IT)등임을 알 수있다. 미국의 이러한 노력들이 최근 1-2년사이 한국내에도 널리 알려지고 이미 일부는 시범사업형태로 실시되고 있는점을 감안하면 별반 다를것이 없다고 여겨질 수 있으나, 여기서 주목할 것은 이러한 노력들이 미국내에서 시도되게된 계기와 목적, 그리고 그 과정들을 눈여겨 볼 필요가 있다는 점이다. 하지만 민간보험 주도 형태의 미국 의료시장에서 탄생한 이런 일련의 노력들이 정부주도하의 전국민건강보험체계로 운영되는 국내 의료시장에 도입되어 실효를 거두기 위해서는 모방형 도입이 아닌 국내 의료체계와 실정에 적합하도록 수정 혹은 개선된 형태로 선별, 도입되어야 함을 암시하고 있음도 주지해야 한다.

      • 3개 대학병원의 주 진단 코딩사례 평가

        서순원,김광환,부유경,서진숙,서정돈,윤석준,이영성,이무식,정희웅 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

        Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators(MRAs) of 3 university hospitals participated in coding principal Dx. From August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three(A,B,C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses ; how they decide and code the principal diagnosis when day see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician’s opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in coding among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.

      • 일개 대학병원 신경외과중환자실에서 Clostridium difficile 관련 설사 감소를 위한 CQI활동

        박은숙,장경희,윤영옥,이정신,김태곤,여한승,김선호,신정원,이경원,김준명 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.1

        Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea(CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C.difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C.difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program(8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C.difficlie from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C.difficile may have affected the incidence of vancomycin resistant enterococci(VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C.difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients’ risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

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