상급종합병원 회송환자 의료이용 분석 및 개선방안

이도경,김지우,유혜림,조상아 건강보험심사평가원 심사평가연구소 2020 연구보고서 Vol.2020 No.0

Objective: This study aims to examine health service use of returned patients from tertiary hospitals that participated in the pilot implementation of referral and return program, and to produce improvement measures for the program. Method: To understand health service use after being returned from a tertiary hospital, available returned patient-returned diagnosis episodes were collected by connecting treatment and return database and health service use in claims data. Patients who recorded 'return claim' from tertiary hospitals were tracked for type of service used, whether they used the returned hospital or partnership institution, etc. In addition, because adequate follow-up treatment is critical after being returned, readmission rate and treatment persistency of diabetics were analyzed to assess level of care after being returned. To learn more about actual practice and collect opinions of working level, paper survey was conducted to staff at medical cooperation center in tertiary hospitals and person in charge of return and referral at general hospitals, hospitals, and clinics. Result: 39% of returned patients received the first medical service after the return from tertiary hospitals, and 61.0% received it from a general hospital or a lower level institution. When we factored in type of return (inpatient/outpatient) and type of service(inpatient/outpatient) after the return, 7.9% of inpatient return cases used tertiary hospitals and 72.7% used a general hospital or lower level institution. On the other hand, outpatient return cases showed higher use of tertiary hospitals. In particular, patients who were returned to a lower level institution as an outpatient after being admitted to a tertiary hospital showed 69.9% of tertiary hospital outpatient visit rate within 180 days from return. To assess level of management of patients after the returned, we observed readmission rate and treatment persistency of diabetics. Readmission rate and treatment persistency of diabetics was slightly higher among patients, who went back to the general hospital or lower level institution they were returned to, under certain condition. However, the result was not consisently showed under other conditions. The paper survey results suggests that there is a need to improve patients' awareness about return and provide encouragement measures. Information management system of return hospitals and clinics was recommended as well. Conclusion: Analysis of medical service use after return showed that many patients who returned from a tertiary hospital continued to receive treatment from a tertiary hospital and did not move to a general hospital or lower level institution. This phenomenon requires a practical measure to return patients in a more effective way. There is a lack of process at tertiary hospitals for returned patients. Therefore, we should establish a re-use procedure, so only medically necessary patients will seek treatment at tertiary hospitals. To ease patients' unwillingness to be returned from tertiary hospital, hospitals can explain the return process at the point of admission or outpatient visit. Also, to relieve anxiety among patients and secure effective follow-up treatment, we need to build an information management system of return hospitals and clinics and to strengthen communication among medical professionals by adding more human resources to medical cooperation center.

경찰공무원의 경찰병원 이용실태와 개선방안에 관한 연구

유수빈 ( Yu Su Been ),송봉규 ( Song Bong Gyu ) 한국경찰학회 2017 한국경찰학회보 Vol.19 No.4

이 연구는 경찰공무원의 경찰병원 이용실태를 분석하여 개선방안을 모색하였다. 경찰공무원의 경찰병원 이용실태를 분석한 결과는 다음과 같다. 첫째, 경찰공무원 10명 중 3명이 경찰병원을 이용한 것으로 나타났다. 경찰공무원이 경찰병원을 이용하는 이유는 의료비지원 때문이다. 경찰공무원 10명 중 7명이 경찰병원을 이용 못하는 이유는 경찰병원이 지리적으로 멀거나 예약이 힘들기 때문이다. 둘째, 경찰공무원 근무연수나 재직기간이 증가하거나 기혼인 경우 경찰병원 이용경험도 높게 나타났다. 조사결과 경찰공무원의 경찰병원 이용은 낮은 계급보다는 높은 계급, 미혼보다는 기혼이 높게 나타났다. 셋째, 경찰병원에서 경찰공무원이 이용이 높은 진료과는 정형외과로 나타났다. 특히 남성 경찰공무원들의 정형외과 이용이 높게 나타났다. 마지막으로 경찰병원에 대한 만족도가 낮은 이유는 서울에 위치한 경찰병원이 지리적으로 멀고, 진료 및 입원대기 시간이 길기 때문이다. 따라서 경찰병원은 경찰공무원의 이용 증가와 고객만족도 향상을 위해서 경찰병원의 지리적 위치 한계 극복과 진료 및 입원예약대기 시간을 단축해야 한다. 이를 위해 지역단위 경찰병원분원 개소나 지역의 공공병원이나 대학병원과의 연계 및 협력, 내부 구성원의 직무만족도 향상, 성과체계 개선, 전문인력 확충, 의료서비스 효율성 향상 등의 개선방안이 필요하다. This study examines use status of the National Police Hospital by police officers and its improvement plans. The analysis results of use status of the National Police Hospital are as follows. First, three out of ten police officers used the National Police Hospital and the reason that they used is a medical expense subsidy for them. Seven out of ten police officers did not use the National Police Hospital because of the geographically long distance of the hospital and difficulty of reservation. Second, police officers who have been employed for a long period of time or married had higher experience of using the National Police Hospital. According to the results of research, the use of police officers in the National Police Hospital was higher than the low rank, and married rather than single. Third, department of orthopedic surgery in the National Police Hospital has been the most frequently used department of police officers. Especially, the use of orthopedics by male police officers was high. Lastly, the reason for the low satisfaction of the National Police Hospital is that the National Police Hospital which is located in Seoul is geographically far away, and the waiting time for medical treatment and hospital stay is long. Therefore, the National Police Hospital should overcome the limitation of the geographical location and shorten the waiting time for medical treatment and hospitalization to increase the use of police officers and improve customer satisfaction. In order to achieve this, the improvement plans are necessary, such as establishing local branch hospitals or cooperating with local public hospitals or university hospitals, improving the job satisfaction of the internal members of hospitals, reforming the performance system, expanding professional manpower, improving the efficiency of the medical service.

의료급여수급자의 병원 이용 경험의 의미:성바오로병원을 중심으로

김현균 한국사회복지질적연구학회 2020 한국사회복지질적연구 Vol.14 No.2

This research was purposed on discovering the experience of medical aid beneficiaries's use of hospital, and was conducted using qualitative research upon 10 subjects, who were being treated at St. Paul's hospital, which has the highest percentage of social welfare recipient usage in Seoul. As a result of the research, it was found medical aid beneficiaries, before use of St. Paul's hospital, have experienced circulation of bottom. The recipients have solely suffered economical, physical, intellectual, social deficiency. The recipients have achieved psychological composure through use of St. Paul's hospital with help of medical staff's patient oriented treatment, explanation and hospitality, the health care recipient have achieved centre in their lives, and were able to function normally in their everyday lives and was able to trust, empathize and sympathize with, thus forming a social relation with others. Welfare recipient, who lack in social support found what was needed through St. Paul's hospital. This research implicates if trust is formed between medical aid beneficiaries and the medical staff, the recipient will not seek another hospital. Secondly, the reason medical aid beneficiaries's usage in upper general hospital is lower than national health care system is due to complication of treatment process and inhospitality of the medical staff, especially lack of explanation. Thirdly, St. Paul's hospital cares the needed and poor without discrimination. The family like organisation between St. Paul's hospital's medical staff, the hospital focuses on patient oriented holistic treatment. The following research can provide basic information to prepare improvements in medical aid program, hospital's medical care system. 본 연구에서 의료급여수급자의 병원이용 경험의 의미를 알아보는데 목적을 두었으며, 이를 위하여 서울 소재 종합병원 중 의료급여수급자의 이용률이 가장 높은 성바오로병원에서 진료받고 있는 의료수급자 10명을 대상으로 심층 면접을 진행하고 질적연구 방법을 활용하여 연구하였다. 연구 결과, 의료급여수급자들은 경제적 바닥, 육체적 바닥, 병식부재의 바닥, 의료제도로부터의 바닥을 홀로 견디며 복합적인 ‘바닥체험의 순환’ 속에서 살아왔다. 이들은 성바오로병원을 이용하면서 ‘내적 안정감을 획득’하였고 ‘타인을 향한 개방’으로 새로운 사회적 관계를 형성하고 있었다. 사적지지체계가 빈약한 의료급여 환자는 성바오로병원을 통해 사회적 지지망을 얻게 되었다. 본 연구의 결과가 갖는 함의는 첫째, 의료급여환자가 의료진과의 신뢰관계가 형성되면 더 이상 다른 병원을 찾지 않게 된다. 둘째, 의료급여 환자가 상급종합병원 이용을 꺼리는 것은 복잡하고 세분화된 진료과정과 설명의 부재 때문이다. 셋째 성바오로병원은 의료적 ․ 경제적 취약자들을 차별없이 치료하고 있었다. 마지막으로 성바오로병원의 교직원들은 가족적인 조직문화가 바탕이 되어 환자중심의 서비스를 통한 전인치유를 실현하고 있었다. 본 연구를 통하여 의료급여수급자를 위한 의료복지제도와 병원이용 서비스의 질 향상을 위한 개선책을 마련하는데 기초 자료가 되고자 한다.

치과병원 PACS의 만족도, 용이성, 유용성에영향을 미치는 기능요소

신의정,장혜정 대한의료정보학회 2008 Healthcare Informatics Research Vol.14 No.2

Objectives: This study evaluated the functional characteristics of hardware and software in Picture Archiving and Communication System (PACS) in dental hospitals and examined the impact of the functional characteristics on user satisfaction, ease of use, and usefulness of PACS. Methods: A cross-sectional survey was conducted on dentists at 20 dental hospitals. The dentists assessed the functional characteristics of PACS, and also evaluated the outcomes of PACS use such as user satisfaction, ease of use, and usefulness. For each outcome variable, regression analysis was performed to determine the significant functional characteristics influencing each outcome variable. Results: The image quality of device and the diagnosis-supporting function served as the most important factors in user satisfaction. Experience of the PACS system was correlated with ease of use. Dentists specialized in oral maxillofacial surgery evaluated PACS very useful, and intention to participation in education in the future showed significant correlation with usefulness. The more experience of using PACS system and concern about education, the higher usefulness for the system. Conclusions: This study has significance in that it can be used as reference for constructing high-efficiency system in dental hospitals adopting the PACS system and also in companies producing the system.

적절성 평가지침과 이유목록의 적용 가능성 평가

신영수,김용익,김창엽,김윤,김은경,송윤미,이영성 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1

Background: An appropriate use of hospital beds can improve productivity of hospital significanlly. The authors previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropritely used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Oversall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. Thess instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.

외래환자가 지각한 의료 서비스의 질이 병원 이미지, 만족도 및 재이용 의도에 미치는 영향

조윤희(Yun-Hee Cho),박연숙(Yeon-Suk Park) 한국콘텐츠학회 2018 한국콘텐츠학회논문지 Vol.18 No.4

본 연구는 종합병원을 내원한 외래환자가 지각한 의료 서비스의 질이 병원 이미지, 만족도 및 재이용 의도에 미치는 영향을 파악하였다. 대전에 소재한 S종합병원 외래 환자에게 2017년 9월 1일부터 20일까지 3주간 설문조사를 시행하여 총 176부를 분석 결과, 첫째, 의료 서비스의 질은 재이용 의도, 만족도, 병원이미지에 유의한 영향을 미치는 것으로 나타났다. 둘째, 의료 서비스의 질과 재이용 의도에 대한 만족도의 매개작용은 유의하지 않은 것으로, 병원 이미지는 유의한 매개 영향력을 미치는 것으로 나타났다. 셋째, 병원에 대한 만족도와 이미지는 재이용 의도에 유의한 영향을 미치는 것으로 나타났다. 본 연구는 종합병원을 내원한 실제 외래환자를 대상으로 의료 서비스의 질이 병원 이미지와 만족도 그리고 재이용 의도에 미치는 영향력을 실증하였다는 데 의의가 있다, 기관에 대한 만족보다 병원 이미지가 의료의 질과 재이용 의도의 관계에서 실질적으로 매개 작용을 한다는 것을 실증함으로써 병원의 마케팅 활동에 있어 일반적인 만족 이상이 필요하다는 시사점을 제시하였다. The purpose of this study is to investigate the effect of perceived medical service quality by outpatient on hospital image, satisfaction, and re-use intention in a general hospital. A total of 176 questionnaires were administered to outpatients who presented to a S general hospital in Daejeon. The results of this study are as follows. First, medical service quality had significant effects on re-use intention, satisfaction, and hospital image. Second, the mediating effect of satisfaction on the relationship between medical service quality and re-use intention was not significant but the mediating effect of hospital image on the relationship was significant. Third, satisfaction and hospital image had significant effects on re-use intention. Consequently, this study verified the influence of perceived medical service quality by outpatient on hospital image, satisfaction, and re-use intention in a general hospital. Further, considering that hospital image, rather than satisfaction, mediates the relationship between perceived medical service quality and re-use intention, it suggests that much more general satisfaction is required in the marketing activities of hospitals.

Review of Smart Hospital Services in Real Healthcare Environments

권혁태,안선희,이호영,차원철,김성완,조민우,공현중 대한의료정보학회 2022 Healthcare Informatics Research Vol.28 No.1

Objectives: Smart hospitals involve the application of recent information and communications technology (ICT) innovationsto medical services; however, the concept of a smart hospital has not been rigorously defined. In this study, we aimedto derive the definition and service types of smart hospitals and investigate cases of each type. Methods: A literature reviewwas conducted regarding the background and technical characteristics of smart hospitals. On this basis, we conducted a focusgroup interview with experts in hospital information systems, and ultimately derived eight smart hospital service types. Results: Smart hospital services can be classified into the following types: services based on location recognition and trackingtechnology that measures and monitors the location information of an object based on short-range communicationtechnology; high-speed communication network-based services based on new wireless communication technology; Internetof Things-based services that connect objects embedded with sensors and communication functions to the internet; mobilehealth services such as mobile phones, tablets, and wearables; artificial intelligence-based services for the diagnosis and predictionof diseases; robot services provided on behalf of humans in various medical fields; extended reality services that applyhyper-realistic immersive technology to medical practice; and telehealth using ICT. Conclusions: Smart hospitals can influencehealth and medical policies and create new medical value by defining and quantitatively measuring detailed indicatorsbased on data collected from existing hospitals. Simultaneously, appropriate government incentives, consolidated interdisciplinaryresearch, and active participation by industry are required to foster and facilitate smart hospitals.

아동병원 외래 환아 보호자의 병원서비스 만족도

박선영 한국의료정보교육협회 2020 보건의료생명과학논문지 Vol.8 No.1

This study was performed to find out the hospital service satisfaction of the caregivers using the children's hospital. The impact of general features and motivations on hospital service satisfaction was investigated for the carers of patients visiting outpatient clinics in large cities using structured questionnaire. Studies have shown that telephone counseling, medical reservation, hospital facility consistency or convenience, child convenience, nurse's kindness, medical staff's kindness, explanation, etc. do not have much impact. As for considerations, other factors, but in motivation, there was the biggest difference in service satisfaction across the hospital. Although the medical staff's ability is important because customers visiting pediatric hospitals tend to be evaluated for caregivers services rather than patients, I think the hospital's overall service satisfaction is an important factor in finding hospitals, so I think the convenience of medical staff and facilities for children are necessary. 본 연구에서는 아동병원을 이용하는 환자보호자의 병원 서비스만족도를 알아보고자 시행 하였다.구조화된 설문지를 이용하여 광역시에 소재한 아동 전문 병원 외래진료를 위해 찾는 환아의 보호자를 대상으로 일반적 특성과 내원 동기가 병원서비스 만족도에 미치는 영향을 알아보았다. 연구결과는 아동병원의 내원 동기는 전화상담, 진료예약, 병원시설의 청결도나 편리성, 아동을 위한 편의시설, 접수할 때 직원의 태도나 친절도, 간호사의 친절도, 진료 시 의료진의 자세나 설명 및 배려, 기타 등은 유의한 영향을 미치지 못하는 것으로 나타났으나 내원동기에 따른 전체적인 병원 서비스 만족도에는 가장 유의한 차이가 있는 것으로 나타났다. 아동병원을 찾는 고객은 환아가 아니라 보호자 고객에 의해 서비스 평가를 받기 마련인 만큼 의료진의 실력도 중요하지만 병원의 전체적인 서비스 만족도가 병원을 찾는 중요 요소 이므로 일반 타 의료기관보다 아동에 대한 시설 배려나 보호자에 대한 편의성이 높아져야 할 것이라고 생각한다.

전문병원과 비전문병원 입원환자의 의료이용 비교 분석: 인공관절치환술(슬관절)을 대상으로

김미성,정형선,유기봉,강제구,장한솔,이광수 한국보건행정학회 2024 보건행정학회지 Vol.34 No.1

Background: The purpose of this study was to determine the effectiveness of the specialty hospital system by comparing the medical use ofinpatients who had artificial joint replacement surgery in specialty hospitals and non-specialty hospitals. Methods: This study utilized 2021–2022 healthcare benefit claims data provided by the Health Insurance Review and Assessment Service. Thedependent variable is inpatient medical use which is measured in terms of charges per case and length of stay. The independent variable waswhether the hospital was designated as a specialty hospital, and the control variables were patient-level variables (age, gender, insurer type,surgery type, and Charlson comorbidity index) and medical institution-level variables (establishment type, classification, location, number oforthopedic surgeons, and number of nurses). Results: The results of the multiple regression analysis between charges per case and whether a hospital is designated as a specialty hospitalshowed a statistically significant negative relationship between charges per case and whether a hospital is designated as a specialty hospital. This suggests a significant low in charges per case when a hospital is designated as a specialty hospital compared to a non-specialty hospital,indicating that there is a difference in medical use outcomes between specialty hospitals and non-specialty hospitals inpatients. Conclusion: The practical implications of this study are as follows. First, the criteria for designating specialty hospitals should be alleviated. Inour study, the results show that specialty hospitals have significantly lower per-case costs than non-specialty hospitals. Despite the costeffectivenessof specialty hospitals, the high barriers to be designated for specialty hospitals have gathered the specialty hospitals inmetropolitan and major cities. To address the regional imbalance of specialty hospitals, it is believed that ease the criteria for designatingspecialty hospitals in non-metropolitan areas, such as introducing “semi-specialty hospitals (tentative name),” will lead to a reduction in healthdisparities between regions and reduce medical costs. Second, it is necessary to determine the appropriateness of the size of hospitals’ medicalstaff. The study found that the number of orthopedic surgeons and nurses varied in charges per case. Therefore, it is believed that appropriatelyallocating hospital medical staff can maximize the cost-effectiveness of medical services and ultimately reduce medical costs.

지역주민 특성과 인지도가 공공병원 이용경험에 미치는 영향

심인옥 ( In Ok Sim ),황은정 ( Eun Jeong Hwang ) 한국병원경영학회 2014 병원경영학회지 Vol.19 No.4

Purpose: This study aims to explore the effects of personal characteristics, satisfaction, quality of care, role performance, image, awareness level of public hospitals perceived by community residents on use-experience of public hospitals. Methods: A cross-sectional survey was conducted with 2,100 community residents around 39 district public hospitals. The questionnaire was designed to collected information on personal characteristics and community awareness of public hospitals. The community awareness consists of 5 factors and 15 items. The data were collected utilizing call-interview by a survey company. Results: The personal characteristic and community awareness were shown significant differences between having use-experience and not-having use-experience of public hospitals (p<.001), except gender. As the results of multiple logistic regression, the significant variables of use-experience of public hospitals were satisfaction (OR=1.06 95%CI=1.010-1.116), quality of care (OR=1.07, 95%CI=1.016-1.134, level of awareness to public hospitals (OR=1.50, 95%CI=1.378-1.632), age (OR=0.43, 95%CI=0.236-0.785), education (OR=1.62, 95%CI=1.013-2.590), type of medical security (OR=0.37, 95%CI=0.142-0.945). Conclusions: Public hospitals have to effort to improve community awareness through providing quality of care, and role performance. It is possible to support them by the Central and Local Government.