혈액투석 의료서비스의 질평가 지표 개발

김동숙 ( Dong Sook Kim ),정진희 ( Jin Hee Jung ),진동찬 ( Dong Chan Jin ),김미경 ( Mi Kyoung Kim ),이규덕 ( Kyoo Duck Lee ),김선민 ( Seon Min Kim ),이병란 ( Byoung Lan Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5

Purpose: This study was a pilot study to develop structure, clinical performance and outcome measurement and criteria for increasing number of dialysis facilities and patients to provide quality of care. Methods: The six components of developing quality indicators for hemodialysis were as follows: 1) Organizing expert panel members. 2) Selecting the area: to reflect stakeholders` opinion, structured interviews were done. And literature reviews were performed to investigate guidelines and quality measurements of foreign countries. 3) Selecting clinical performance indicators: From experts` opinions and literature review. 4) Developing candidate indicators. 5) Performing demonstration survey: Systemic sampling was performed and 43 facilities were participated in self-answered medical record survey. 6) Based on preliminary evaluation model, final indicators were selected from expert panel reviews. Results: Eleven measures of structure, thirteen performance measures of process and nine monitoring measures of outcome were developed based on literature review and clinical practice guideline. As for criterion-related validity, those of process and outcome were most high and in case of face validity, those of structure and process were most high. The most valid quality indicators were the rate of internal medicine specialist, dialysis frequency per doctor, whether or not keeping emergency equipment, examination of water quality, hemodialysis adequacy (Kt/V), monitoring arterial venous graft for stenosis maintenance of iron storage, and administration of supplemental iron. Conclusion: By developing quality indicators of hemodialysis and performing demonstration evaluation, quality of care for hemodialysis patients is expected to be improved, so as to promote hemodialysis patients` health and improve on quality of life.

Improving Quality of Care in Nursing Homes

이향열,김은만 사단법인 대한보건협회 2018 대한보건연구 Vol.44 No.1

Objective: Ensuring the quality of care in nursing homes is a persistent concern in many countries. This study aimed (a) to clarify the most important quality-of-care problems and priorities to improve the quality of nursing home care, and (b) to identify some of the best measures of quality-of-care and quality-of-life. Methods: This explanatory descriptive study entailed conducting a nursing home director questionnaire; 43 directors participated. Results: Directors answered that quality of care means providing “timely care” for patients with symptoms or diseases. Pressure ulcer rate (74%) and activities-of-daily-living (ADL) function (67%), direct-care hours (67%), and the number of nursing staff (56%) were the best measures chosen as quality-of-care indicators. The directors defined the quality of life as helping residents be healthy and dignified, and the best set of quality-of-life indicators, included by more than 70% of participants, were physical comfort (84%), ADL level (81%), respect for individual dignity (79%), and satisfaction in level of protection and safety (74%). Conclusion: These results provide clear direction for policy-makers in changing policies and regulations for the best care of nursing home residents. More research is needed to improve the quality of care and quality of life in nursing homes using the best measures identified in this study.

폐렴 입원환자 진료과정의 질적 수준과 이에 영향을 미치는 요인: 임상질지표를 중심으로

문상준 ( Sang Jun Moon ),이진석 ( Jin Seok Lee ),김윤 ( Yoon Kim ),유선주 ( Sun Ju You ),최윤경 ( Yun Kyoung Choi ),서수경 ( Soo Kyung Suh ),김용익 ( Yong Ik Kim ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.4

연구배경: 감염성 질환 중 가장 흔한 질환인 폐렴의 질병부담을 줄이기 위해서 폐렴환자의 진료 과정 개선과 이에 영향을 미치는 요인에 대한 분석이 필요하다. 본 연구에서는 국내 폐렴환자의 진료 과정의 질적 수준을 평가하고, 질적 수준에 영향을 미치는 환자 및 병원 요인을 분석하고자 한다. 방법: 500병상 이상 병원 21곳의 1989년 12월 31일 이전 출생 입원 환자로 청구코드 주진단 기준 폐렴인 환자 중 2006년 8월부터 10월 사이 퇴원 환자 중 무작위 표본추출 방식으로 1,001건을 표본으로 추출하였다. 환자 및 병원 요인과 과정 지표의 상관관계를 다중 로지스틱 회귀분석을 통하여 분석하였다. 결과: 병원 도착 후 24시간 이내 혈중산소포화도 검사 시행률은 69.4%, 24시간 이내 혈액배양검사 시행률은 79.1%, 8시간 이내 항생제 투여율은 82.5%, 항생제 투약 전 배양검사 시행률은 60.5%로 대부분의 지표가 높은 충족도를 보였다. 환자 요인 중에서는 연령이 24시간 이내 혈중산소포화도 검사 시행률에 영향을 미쳤고, 병원 요인 중에는 병상수, 병상당 간호사수, 연간 응급실 내원자수, 병상가동률, 지역, 입원 시각 및 경로 등이 과정 지표 시행률에 영향을 미쳤다. 결론: 본 연구에서 드러난 진료 과정상의 질적 수준이 취약한 부분에 대하여 질 개선 활동의 역량을 강화하여 보완할 필요가 있다. 또한, 과정 지표들의 병원 간 변이를 줄이기 위하여 지표 시행률이 낮은 의료기관에서는 진료 프로토콜 개선 등의 활동을 통하여 진료 과정을 개선해 나가는 노력이 필요하다. Background: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. Methods: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months` August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. Results: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. Conclusion: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.

Quality of Early Depression Management and Long-Term Medical Use: Aspect of Quality Indicators for Outpatients with Depression

Lim Hyun Ho,Lee Jae Kwang,Park Sunyoung,Chang Jhin Goo,Oh Jooyoung,Park Jaesub,Song Jungeun 대한우울조울병학회 2023 우울조울병 Vol.21 No.3

Background: Depression is a global mental health concern that negatively affects individuals’ health and increases medical costs. This study aimed to assess whether early depression management is cost-beneficial and effective from the perspective of quality indicators. Methods: Data of patients newly diagnosed with depressive disorder between 2012 and 2014 as well as follow-up data until 2020 were extracted from the National Health Insurance Service database. Hospitalization, emergency room visits, and annual medical expenses were set as dependent variables to estimate the effect of depression and information on medical expenditures. Six quality indicators developed by the Health Insurance Review and Assessment Service comprised independent variables. Results: In total, 465,766 patients were included in this study. Patients who met the quality indicators were more likely to be hospitalized with a psychiatric diagnosis. Furthermore, patients who met the quality indicator of revisiting within 3 weeks of their first visit had greater psychiatric and overall expenses during the early treatment phase; however, the overall expenses gradually decreased over time. Conclusion: High-quality initial treatment for depression can be cost-effective in the long term; however, further studies are needed to discern its immediate clinical effects.

노인요양시설의 질 지표 결정요인에 관한 연구

이승희 대한간호학회 간호행정학회 2006 간호행정학회지 Vol.12 No.3

Purpose: The Purpose of this study was to examine the factors on the nursing home quality indicators. Methods: The subjects of this study were 377 residents living in the nursing home more than 30 bed. The subject's minimum length of residence is 3 months and age of the subject is year of 65 over. The data were analyzed using descriptive statistics, Pearson correlation and multilevel analysis. Results: The main result of the study were in following. First, the quality gap among nursing homes resulted from both institutional and person level factors. Second, the person level factors affecting the quality of nursing home included ALD. However institution level factors had no direct effect on dependent valuable. Third, the interaction effect between the institution and person level factors was found. The ADL have less effect on the quality of nursing homes doing more quality management than of nursing homes doing less. Forth, The effect of ADL was different according to the level of care planing and satisfaction survey. Conclusion: These results suggest that the determinants of nursing home quality indicators were ADL & quality management. This study will contribute to apply nursing home quality indicators in Korea.

일반 질 지표로서의 위험도 표준화 재입원율의 적절성

최은영 ( Eun Young Choi ),옥민수 ( Min Su Ock ),이상일 ( Sang-il Lee ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.2

The hospital readmission rate has been widely used as an indicator of the quality of hospital care in many countries. However, the transferrability of this indicator that has been developed in a different health care system can be questioned. We reviewed what should be considered when using the risk-standardized readmission rate (RSRR) as a generic quality indicator in the Korean setting. We addressed the relationship between RSRR and the quality of hospital care, methodological aspects of RSRR, and use of RSRR for external purposes. These issues can influence the validity of the readmission rate as a generic quality indicator. Therefore RSRR should be used with care and further studies are needed to enhance the validity of the readmission rate indicator.

새로운 의료관련감염 감시지표

박선희,조선영,최수한,최지연,손희정,김홍빈,이미숙 대한의료관련감염관리학회 2022 의료관련감염관리 Vol.27 No.2

The Korean National Healthcare-associated Infections Surveillance System (KONIS) started surveilling healthcare-associated infections (HAIs) in intensive care units in 2006. Since then, the KONIS modules have expanded, and the participating hospitals have diversified. To allow for these changes, surveillance indicators need to be improved to represent national data and provide useful benchmarks. Herein, we reviewed the national HAI surveillance systems in 11 countries and the European Union, which were searched online during October–December 2019, and compared the target healthcare facilities, indicators, and surveillance methods. Twelve experts independently evaluated the priorities in terms of disease burden, relevance, intervenability, urgency, applicability, acceptability, barriers and facilitators of implementation on a scale of 0-10 in each category, and the highest score had the highest priority. This review identified five areas of improvement. First, new surveillance nfl indicators that require web-based automated systems can be introduced. These would include laboratory-based surveillance, such as Clostridioides difficile infection and multi-drug resistant organisms, and surveillance of antimicrobial resistance and use. Second, surveillance areas can be expanded to general or specialized wards, according to the needs of the participating hospitals. Third, healthcare facilities, such as outpatient dialysis clinics or outpatient surgical centers, can be included in the KONIS. Fourth, standardized infection ratios (SIRs) and standardized utilization ratios (SURs) can be introduced as effective benchmarks. Finally, the point prevalence survey can play a supplementary role in identifying new HAIs and help allocate efforts to their prevention. Among these points, the use of SIR and SUR was considered a top priority indicator for the KONIS. As the KONIS continues to evolve, it is necessary to introduce new indicators and benchmark methods to address these changes. It is of utmost importance that the KONIS be operated stably and steadily, and new enrollees in the KONIS need to understand and adapt to the KONIS before introducing new indicators. In addition, it should be evaluated which indicators and benchmarks can be well-incorporated and appropriately used in the KONIS and the government should make efforts to establish an automated surveillance system using electronic medical information.

가감지급사업 실행 후 급성기 출혈성 뇌졸중의 원내 사망률 변화 분석

설진주,유기봉,이광수,Seol, Jin-Ju,Yoo, Ki-Bong,Lee, Kwang-Soo 한국병원경영학회 2022 병원경영학회지 Vol.27 No.1

Purposes: This study purposed to evaluate the effect of a value incentive program(VIP) on the in-hospital mortality of acute stroke. Methodology: Study period was from January 2010 to December 2018. This study included 63 hospitals for acute hemorrhagic stroke that the mortality rate per month was more than one during study period. Independent variables were time variables and hospital characteristics such as hospital type, district and bed number. Interrupted time series analysis was applied to analyze the data. Findings: In case of general hospitals, the in-hospital mortality rate per month for acute hemorrhagic stroke tends to be increased by 0.03% in overall study periods but decreased by 0.32% after the implementation of the policy. On the other hand, tertiary hospital changes are not statistically meaningful. Conclusion: This study provides evidences how the VIP was effective in improving quality of acute hemorrhagic stroke care. General hospitals showed higher policy effect compare to that of tertiary hospitals.

Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus

Seo Mi Ryoung,Kim Gunwoo,Moon Ki Won,Sung Yoon-Kyoung,Yoo Jong Jin,Yoon Chong-Hyeon,Lee Eun Bong,Lee Jisoo,Kang Eun Ha,Kim Hyungjin,Park Eun-Jung,Uhm Wan-Sik,Lee Myeung Su,Lee Seung-Won,Choi Byoong Yo 대한의학회 2021 Journal of Korean medical science Vol.36 No.17

Background: There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. Methods: Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. Results: Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. Conclusion: These QIs can be used to assess and improve the quality of health care for patients with RA.

지역별 암모니터링 지표 개발을 위한 다차원적 암모니터링 지표 프레임워크: 암 환자 생애 연속성에 기반하여

권정아 ( Jeoung A Kwon ),김재현 ( Jae-hyun Kim ),장지은 ( Jieun Jang ),김우림 ( Woorim Kim ),전미선 ( Miseon Jeon ),정승연 ( Seungyeon Chung ),신재용 ( Rajaguru Vasuki ),( Jaeyong Shin ) 한국보건행정학회 2020 보건행정학회지 Vol.30 No.4

Cancer is a disease which has the huge burden in worldwide, and cancer is the number one cause of death in Korea. At this point, the new framework for cancer monitoring index is required for regional cancer monitoring. Especially, cancer survivors are the important target which is rapidly increasing recently, also cancer survivor’s quality of care should be considered in the cancer monitoring index framework. To develop the Multidimensional Cancer Monitoring Index considering cancer survivor’s quality of care, we took into account cancer continuum which including prevention, detection, diagnosis, treatment, survivorship, assessment of quality of care and monitoring cancer patient, and end-of life care for stage. For target, components of health care delivery system such as patient, family, provider, payer, and policy maker are included. Also, Donabedian model which is a framework for examining health services and evaluating quality of health care such as structure, process, and outcome is applied to contents. This new cancer monitoring framework which includes multidimensional components could help to develop regional cancer monitoring index, and to make national cancer management and prevention policy in the future.