의과대학 학생들의 환자안전에 대한 인식

이후연,이상규,Lee, Hoo-Yeon,Lee, Sang-Gyu 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.1

Background: The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships. Methods: Cross-sectional and self-administered questionnaire survey was conducted on 34 students from one medical school using a modified version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS). We assessed $4^{rd}-year$ medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. The overall response rate was 66.4%. Results: Among safety domains, "teamwork culture" was rated highest. "Error disclosure culture" received the lowest ratings. Regarding the error disclosure domain, only 10% of respondents reported that they have received education or training on how to disclose medical error to patients. Independent of survey domains, when students were asked "Overall, do you think your hospital is safe based on your clinical rotation?", 61.8% reported that the hospital was safe. Conclusions: Assessing students' perceptions of safety culture can provide clerkship directors and educators with information that enhances the educational environment and promotes patient safety. Discussions of medical errors, patient safety, and how best to incorporate an analysis of these issues into the existing curriculum are needed.

관상동맥질환 치료를 위한 시롤리무스 방출 스텐트 ($CYPHER^{TM}$)의 경제성 분석

이후연,박은철,박기동,박지은,김영,이상수,강혜영,Lee, Hoo-Yeon,Park, Eun-Cheol,Park, Ki-Dong,Park, Ji-Eun,Kim, Young,Lee, Sang-Soo,Kang, Hye-Young 대한예방의학회 2003 Journal of Preventive Medicine and Public Health Vol.36 No.4

Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

인공와우 이식의 비용효용 분석

이후연,김희남,김한중,최재영,박은철,Lee, Hoo-Yeon,Kim, Hee-Nam,Kim, Han-Joong,Choi, Jae-Young,Park, Eun-Cheol 대한예방의학회 2004 예방의학회지 Vol.37 No.4

Objective : To determine the quality of life and cost consequences for deaf adults who received a cochlear implant. Methods : The data from 11 patients, post-lingual deaf adults who received cochlear implants from 1990 to 2002, underwent cost-utility analysis. The average age of the participants was 49.6 years. The main outcomes were direct cost per quality-adjusted life-year (QALY) using the visual analog scale (VAS), health utility index (HUI), EuroQol (EQ-5D), and quality well-being (QWB), with costs and utilities being discounted 3% annually. Results : Recipients had an average of 5.6 years of implant use. Mean VAS scores increased by 0.33, from 0.27 before implantation to 0.60 at survey. HUI scores increased by 0.36, from 0.29 to 0.65, EQ-5D scores increased by 0.26, from 0.52 to 0.78, and QWB scores increased by 0.16, from 0.45 to 0.61. Discounted direct costs were $22,320, yielding $19,223/QALY using VAS, $17,387/QALY using HUI, $24,604/QALY using EQ-5D, and $40,474/QALY using QWB. Cost-utility ratios using VAS, HUI, and EQ-5D were all below $25,000 per QALY, except using QWB. Conclusion : Cochlear implants in post-lingual deaf adult have a positive effect on quality of life at reasonable direct costs and appear to produce a net saving to society.

경기도 S시 노인의 신체적 및 도구적 일상생활수행능력에 근거한 장기요양시설 보호대상자 추계

이후연(Hoo-Yeon Lee),김성아(Sung-A Kim),이혜진(Hye-Jean Lee),정상혁(Sang-Hyuk Jung) 한국농촌의학 지역보건학회 2004 농촌의학·지역보건 Vol.29 No.2

대학생에서의 담배 가격과 금연의지와의 관계

이욱진(Lee Wook-Jin),이승준(Lee Seung-Jun),이재랑(Lee Jae-rang),이정명(Lee Jung-myung),이주형(Lee Joo-hyoung),박은철(Park Eun-choel),이후연(Lee Hoo-yeon) 한국역학회 2003 Epidemiology and Health Vol.25 No.2

Background: The smoking rate of adult male is 68.2% in Korea and that of adolescent and women has risen recentlyMinistry of Health and Welfare plans to raise the price of cigarettes by 1,000 Won per pack this year in hopes of securing funds to aid the underprivileged and discourage excessive smoking. . In this study, we tried to find the relationship between tobacco price increase and willingness to quit smoking among university students, and the factors associated with willingness to quit smoking. Method: The data were collected by questionnaire survey from 225 university students living in Seoul. The questionnaire contained items on age, sex, smoking history, economical status and the intention to quit smoking when the tobacco price be raised. Result: The proportion of smokers who has the intention to quit smoking if the price of tobacco be raised by 3,000 Won was 46.2%. The factors associated with willingness to quit smoking were age of initiating smoking, opinion for price of cigarette, self efficacy scores, current plans to quit smoking, and viewpoint of changes in the rate of smokers. Conclusion: The results showed that tobacco price rises will increase willingness to quit smoking among university students.

전문가와 비전문가의 환경 및 과학기술 위험에 대한 위해도 인식 차이

함명일,권호장,이후연,박화규,이상규,Hahm, Myung-Il,Kwon, Ho-Jang,Lee, Hoo-Yeon,Park, Hwa-Gyoo,Lee, Sang-Gyu 한국환경보건학회 2009 한국환경보건학회지 Vol.35 No.4

Objective : The objective of this study was to examine how experts and the public perceived various environmental and technological hazards based on psychometric paradigm. Methods : We conducted a survey that included 30 hazards and 10 risk attributes. Subjects of this study were 214 people with three groups; (1) experts (55 people), (2) graduates( 78 people), (3) under graduates (81 people). Factor analysis was used to confirm the common risk attribute from 8 risk attributes. Also, multiple regression analysis was used to identify factors influencing on perceived risk and benefit of hazards. Results : This study revealed that experts tend to be more tolerant than graduates and under graduate students for the 30 hazards. Using factor analysis, two main factors were identified: factor 1, commonly called "Dread Risk", and factors 2, commonly called, "Unknown Risk" in the literature. We identified that environmental hormone concentration and global warming ranked high in both dread risk and unknown risk. Multiple regression models were used to test the association of perceived social risk and perceived social benefit with two main factors. Dread risk had significant explanatory power on perceived social risk and benefit. We identified that the experts were less likely to perceived dread risk and know more information about the hazards. Conclusions : There were differences of risk perception between experts and lay people. Especially, experts' perception of risk was commonly lower than other people's perception.

미국, 캐나다, 영국의 재입원율 활용 현황

이상아,주영준,신재용,박은철,이후연,Lee, Sang-Ah,Ju, Yeong-Jun,Shin, Jae-Yong,Park, Eun-Cheol,Lee, Hoo-Yeon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

국가산업단지 인근 지역 주민의 인식 및 태도

한설(Xue Han),이후연(Hoo-Yeon Lee),임지애(Ji-ae Lim),권호장(Ho-Jang Kwon) 환경독성보건학회 2017 한국독성학회 심포지움 및 학술발표회 Vol.2017 No.10

의과대학생에 있어서 성별에 따른 자아존중감의 차이

유정선(Jeong-seon Yoo),양원선(Wonsun Yang),이경은(Kyong-eun Lee),이상은(Sang-eun Lee),이승규(Christopher Seongkyu Lee),이후연(Hoo-Yeon Lee),박은철(Eun-Cheol Park) 한국의학교육학회 2003 Korean journal of medical education Vol.15 No.3

Purpose: Many studies from the past have indicated that women tend to have lower selfesteem than men. This cross-sectional study looks for this tendency in a medical school in Korea, where men are still thought to comprise much of a dominating force despite the current growth in number of female students in student body. Along with the cross-examination of possible gender difference in self-esteem, the significant and relevant factors will also be sought and discussed. Methods: Questionnaires were obtained from 202 junior and senior students (125 male and 77 female students) in a medical school in Korea. Self-esteem was determined using the Rosenberg self-esteem scale (reliability = 86% in our study). Multiple regression analysis was used to determine gender difference in self-esteem and statistical relevance in each covariate. Results: There was no statistically significant difference in self-esteem between male and female medical students. Significant factors related to self-esteem include school rank, physical attractiveness, and depression, among which of them, depression was the strongest. Conclusion: Innate limitation of cross-sectional studies and evaluation of selected junior and senior students of a single medical school could possibly explain for the absence of gender difference in self-esteem in this study. Academic achievement and physical attractiveness are shown to be positive factors for self-esteem, while depression puts negative force in one s self-esteem.

국가암조기검진 수검자 만족도에 영향을 미치는 요인

윤난희 ( Nan He Yoon ),권순만 ( Soon Man Kwon ),이후연 ( Hoo Yeon Lee ),박은철 ( Eun Cheol Park ),최귀선 ( Kui Son Choi ),곽민선 ( Min Son Kwak ) 한국보건행정학회 2009 보건행정학회지 Vol.19 No.1

The objectives of this study were to evaluate the satisfaction of participants in the National Cancer Screening Program(NCSP) and to identify factors affecting the satisfaction. The telephone survey was conducted in July 2007 for the participants who were screened by the NCSP from January through May 2007. Student`s t-tests and analysis of variance were performed first to determine if the mean satisfaction score differed by the characteristics of study objects, followed by multiple linear regression analyses to examine the factors affecting satisfaction. Dependent variable was general satisfaction for the screening service, and three dimensions of independent variables - ``sociodemographic characteristics``, ``screening characteristics``, and ``perceived service quality`` - were used for the empirical analyses. Female, old-aged, less educated, Medicaid recipients, rural residents and the participants with normal results were more likely to be satisfied with the NCSP. The results of multiple regression analyses show that gender, age, location of residence, type of screening units, and perceived quality of screening services were significantly related to satisfaction. This study is meaningful as the first attempt to measure participant satisfaction with the NCSP, and to identify factors affecting the satisfaction. Among the identified factors, the NCSP needs to pay attention to perceived quality of service, in particular, to improve the satisfaction. This study is expected to contribute to raising the compliance rate and to improve the quality of the NCSP.