전문의 대상 설문조사를 이용한 보건의료 기술평가 대상 시술의 우선 순위 선정 -이비인후과와 흉부외과를 중심으로-

안형식 ( Hyeong Sik Ahn ),김선민 ( Sun Mean Kim ),신영수 ( Young Soo Shin ),김차엽 ( Chang Yup Kim ),김선미 ( Seon Mee Kim ),이순형 ( Soon Hyung Lee ) 한국보건행정학회 1997 보건행정학회지 Vol.7 No.2

입원 환자의 병원내 자원 이용에 영향을 미치는 병원, 진료과 및 의사의 특성 분석

안형식 ( Hyeong Sik Ahn ) 한국보건행정학회 1997 보건행정학회지 Vol.7 No.1

B형간염바이러스 및 C형간염바이러스의 표식자 양성율과 원발성 간세포 암의 연관성에 대한 환자-대조군 연구

안형식,김민호,김영식,김정순,Ahn, Hyeong-Sik,Kim, Min-Ho,Kim, Young-Sick,Kim, Joung-Soon 대한예방의학회 1997 예방의학회지 Vol.30 No.1

To investigate the association between hepatocellular carcinema(HCC) and infection of hepatitis B virus(HBV) and hepatitis C virus(HCV) in an HBV endemic area, a case-control study of 254 patients with HCC and of 1,270 age and sex matched health control subjects was done. Among the 254 HCC patients 166(65.4%) were positive for hepatitis B surface antigen(HBsAg), 49(19.3%) were positive for HCV antibody (anti-HCV Ab). The crude odd ratio of patients with HBsAg was 36.1(95% CI :22.4-58.2) and with anti-HCV Ab was 9.0(95% CI :5.5-14.6). In an analysis, which HBsAg(-), HBcAb(-), anti-HCV Ab(-) group was chosen as referent group, odd ratio of HBsAg(+) group was 14.4(95% CI: 7.2-28.9) and of anti- HCV Ab(+) was 10.7(95% CI: 2.9-40.0). odd ratio of anti-HCV Ab(+), HBsAg(+) group and anti-HCV Ab(+), HBsAg(-), HbcAb(+) group for HCC were elevated to 27.3(95% CI : 9.0-82.9), 15.9(95% CI:7.1-35.8) respectly, The odd ratio of anti-HCV Ab(-), HBsAg(-), HBcAb(+) group was 2.4(95% CI : 1.1-5.0). These result suggested that HBV and HCV were associated with HCC. In HBV endemic area patients with HBcAb alone should be considered risk group for HCC.

고압산소환경이 신생 및 성숙백서의 폐 superoxide dismutase 활성도에 미치는 영향에 관한 실험적 연구

안형식,조수헌,윤덕로,이동율,김용식,Ahn, Hyeong-Sik,Cho, Soo-Hun,Yun, Dork-Ro,Lee, Dong-Ryool,Kim, Yong-Sik 대한예방의학회 1989 예방의학회지 Vol.22 No.1

To investigate the effect of hyperbaric oxygenation on superoxide dismutase activity, neonatal rats (7-10 days old) and adult rats (approximately 100 days old) were continuously exposed to hyperbaric oxygen environment of 2.4ATA for 8 hours and their superoxide dismutase activity were measured. Neonatal rats, all survived through exposure, showed significant increases in the pulmonary superoxide dismutase activity at immediately and 24 hours after exposure. Adult rats, whose 8 hour survival rates were 14%, did not show any significant increase in the activity of pulmonary superoxide dismutase as compared to the control adult rats. These findings are indicating that increased tolerance to oxygen toxicity in neonatal animals during exposure may be attributed to the increase in activity of superoxide dismutase in neonatal rats.

종합병원 전자건강카드 도입에 영향을 미치는 요인

안이수,윤석준,안형식,홍석원,Ahn, Lee-Su,Yoon, Seok-Jun,Ahn, Hyeong-Sik,Hong, Seok-Won 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.2

Objective : This research is focused on understanding the current status of the Health Smart Card already in use in other advanced countries. This research will analyze the current status of the medical institutions Health Smart Card system adoption process and its effects, and provide a basis for future policy decisions for the effective adoption and diffusion of a Health Smart Card system, in the medical field, through the completed research and analysis. Method : This research surveys the domestic, and foreign, status of Health Smart Card usage. The research also presents up-to-date methodology for the evaluation of the effects of medical and health care technology. The research also conducts a survey of the domestic medical institutions that have implemented a Health Smart Card system, and then analyzes the results of the survey. Additionally, the research carried out a survey and analysis of medical institutions with no Health Smart Card system implemented, and considered the factors affecting the diffusion of Health Smart Card systems in considering an effective policy for the introduction and diffusion of such a system. Research Results : Through the study of the methodology of medical and health care information technology in advanced countries, the methodology for assessing Health Smart Card technology has been established, and focuses on 6 aspects. The study on the status of foreign implementation has shown a model for the Health Smart Card system. A survey was conducted on the current status of medical institutions with an implemented Health Smart Card system, and the survey results have been analyzed. Also, factors influencing the adoption of Health Smart Card systems have been analyzed through the survey on those medical institutions that have not implemented a Health Smart Card system. Conclusion : The government must provide institutional measures for sharing medical records by constructing an IT infrastructure at the national level to enable the adoption and diffusion of a Health Smart Card system. Such a network will make connections between medical institutions possible, thus making the diffusion of the Health Smart Card system nationwide. For the successful adoption and diffusion of a Health Smart Card system, a model system development, under a medical record sharing system, should be conducted. Additionally, a regional unit based model should be developed for the model project, as is done in advanced countries, along with the application of such results.

입원과 수술시행의 적정성 평가

김창엽,안형식,이영성,권영대,김용익,신영수,Kim, Chang-Yup,Ahn, Hyeong-Sik,Lee, Young-Seong,Kwon, Young-Dae,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1992 예방의학회지 Vol.25 No.4

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For cesarean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals and between hospital groups by size. The most freqeunt indication of C/S was repeated operation, followed by cephalopelvic disproportion (CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons fur admission were 'failure to initial treatment', 'suspected bacterial pneumonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activiteis would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studios with plentiful subjects and more representative diseases or procedures should be tried.

급성심근경색증 환자의 진료 질 평가를 위한 병원별 사망률 예측 모형 개발

박형근,안형식,Park, Hyeung-Keun,Ahn, Hyeong-Sik 한국의료질향상학회 2003 한국의료질향상학회지 Vol.10 No.2

Objectives: To develop a model that predicts a death probability of acute myocardial infarction(AMI) patient, and to evaluate a performance of hospital services using the developed model. Methods: Medical records of 861 AMI patients in 7 general hospitals during 1996 and 1997 were reviewed by two trained nurses. Variables studied were risk factors which were measured in terms of severity measures. A risk model was developed by using the logistic regression, and its performance was evaluated using cross-validation and bootstrap techniques. The statistical prediction capability of the model was assessed by using c-statistic, $R^2$ as well as Hosmer-Lemeshow statistic. The model performance was also evaluated using severity-adjusted mortalities of hospitals. Results: Variables included in the model building are age, sex, ejection fraction, systolic BP, congestive heart failure at admission, cardiac arrest, EKG ischemia, arrhythmia, left anterior descending artery occlusion, verbal response within 48 hours after admission, acute neurological change within 48 hours after admission, and 3 interaction terms. The c statistics and $R^2$ were 0.887 and 0.2676. The Hosmer-Lemeshow statistic was 6.3355 (p-value=0.6067). Among 7 hospitals evaluated by the model, two hospitals showed significantly higher mortality rates, while other two hospitals had significantly lower mortality rates, than the average mortality rate of all hospitals. The remaining hospitals did not show any significant difference. Conclusion: The comparison of the qualities of hospital service using risk-adjusted mortality rates indicated significant difference among them. We therefore conclude that risk-adjusted mortality rate of AMI patients can be used as an indicator for evaluating hospital performance in Korea.

위암 수술 환자의 건강결과 측정을 위한 동반상병 측정도구의 유용성 연구

황세민,윤석준,안형식,안형진,김상후,경민호,이은경,Hwang, Se-Min,Yoon, Seok-Jun,Ahn, Hyeong-Sik,An, Hyong-Gin,Kim, Sang-Hoo,Kyeong, Min-Ho,Lee, Eun-Kyoung 대한예방의학회 2009 예방의학회지 Vol.42 No.1

Objectives : The purpose of the current study was to evaluate the usefulness of the following four comorbidity indices in gastric cancer patients who underwent surgery: Charlson Comorbidity Index(CCI), Cumulative Illness rating scale(CIRS), Index of Co-existent Disease(ICED), and Kaplan-Feinstein Scale(KFS). Methods : The study subjects were 614 adults who underwent surgery for gastric cancer at K hospital between 2005 and 2007. We examined the test-retest and inter-rater reliability of 4 comorbidity indices for 50 patients. Reliability was evaluated with Spearman rho coefficients for CCI and CIRS, while Kappa values were used for the ICED and KFS indices. Logistic regression was used to determine how these comorbidity indices affected unplanned readmission and death. Multiple regression was used for determining if the comorbidity indices affected length of stay and hospital costs. Results : The test-retest reliability of CCI and CIRS was substantial(Spearman rho=0.746 and 0.775, respectively), while for ICED and KFS was moderate(Kappa=0.476 and 0.504, respectively). The inter-rater reliability of the CCI, CIRS, and ICED was moderate(Spearman rho=0.580 and 0.668, and Kappa=0.433, respectively), but for KFS was fair(Kappa=0.383). According to the results from logistic regression, unplanned readmissions and deaths were not significantly different between the comorbidity index scores. But, according to the results from multiple linear regression, the CIRS group showed a significantly increased length of hospital stay(p<0.01). Additionally, CCI showed a significant association with increased hospital costs (p<0.01). Conclusions : This study suggests that the CCI index may be useful in the estimation of comorbidities associated with hospital costs, while the CIRS index may be useful where estimatation of comorbiditie associated with the length of hospital stay are concerned.

6세미만 입원 법정본인부담금 면제정책이 의료이용에 미치는 영향

전경수,윤석준,안형식,신현웅,윤영혜,황세민,경민호,Jeon, Kyeong-Su,Yoon, Seok-Jun,Ahn, Hyeong-Sik,Shin, Hyun-Woong,Yoon, Young-Hye,Hwang, Se-Min,Kyung, Min-Ho 대한예방의학회 2008 예방의학회지 Vol.41 No.5

Objectives : The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. Methods : A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudo-control group. Results : The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients, with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. Conclusions : The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.

위암환자에서 의무기록과 행정자료를 활용한 Charlson Comorbidity Index의 1년 이내 사망 및 재원일수 예측력 연구

경민호,윤석준,안형식,황세민,서현주,김경훈,박형근,Kyung, Min-Ho,Yoon, Seok-Jun,Ahn, Hyeong-Sik,Hwang, Se-Min,Seo, Hyun-Ju,Kim, Kyoung-Hoon,Park, Hyeung-Keun 대한예방의학회 2009 예방의학회지 Vol.42 No.2

Objectives : We tried to evaluate the agreement of the Charlson comorbidity index values(CCI) obtained from different sources(medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay(length of stay). Methods : Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. Results : The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree(kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables($\beta$ = 0.112, 95% CI = [0.017-1.267]). Conclusions : There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.