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      • SCOPUSKCI등재

        DRG 지불제도 도입에 따른 의료보험청구 행태 변화

        강길원,박형근,김창엽,김용익,하범만,Kang, Gil-Won,Park, Hyoung-Keun,Kim, Chang-Yup,Kim, Yong-Ik,Ha, Beom-Man 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.4

        Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

      • SCOPUSKCI등재

        민간의료기관을 이용하는 결핵환자의 의료이용 분석

        강길원,윤석준,김창엽,신영수,Kang, Gil-Won,Yoon, Seok-Jun,Kim, Chang-Yup,Shin, Young-Soo 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.4

        In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

      • KCI우수등재
      • KCI등재
      • KCI우수등재
      • KCI등재

        국내의학자가 국내외에 발표한 의학논문 현황 분석 - 1960년부터 2008년까지 -

        장혜란,강길원,이영성,탁양주,Jang, Hae-Lan,Kang, Gil-Won,Lee, Young-Sung,Tak, Yang-Ju 한국문헌정보학회 2011 한국문헌정보학회지 Vol.45 No.3

        The purpose of this study is to analyze how the changes of evaluation standards have affected Korean medical researchers' academic performance by comparing the publication status of medical articles both domestically and abroad. A total of 314,559 domestic articles in KMbase and 53,423 articles stored in MEDLINE published abroad by Korean researchers were analyzed. All of the data were compared per year according to the research field and indexed journals by numbers and proportions of articles published domestically and abroad. The analysis showed that the number of total articles and the proportion of articles published abroad increased continuously. In the early 2000s, articles published in Korea decreased, otherwise articles published abroad increased sharply. SCI articles showed a steady increase before 2000, and continued to increase over the next few years. KCI articles also showed a rapid increase in the early 2000s while other articles were decreasing. Publication trends shown in this study were similar despite quantitative and timely differences by research area. Performance evaluations focusing on SCI articles affected on quantitative decrease in the number of total articles published domestically. Quantitative growth itself is not an absolute indicator for academic achievement. Therefore, to complement any evaluation of academic achievement, qualitative analysis needs to be done as well. 의학분야의 전체 논문을 대상으로 연도별 논문 발표 현황을 살펴봄으로서 국내의학자가 국내뿐 아니라 해외에 발표한 논문의 양적 실태를 비교 분석하고자 하였다. 분석자료는 1960년부터 2008년까지 국내학자가 국내와 해외 의학학술지에 발표한 논문 367,982건으로 국내발표논문 314,559건과 해외발표논문 53,423건을 대상으로 하였다. 모든 자료는 학문분야별, 등재지별 총 발표논문 수와 해외발표 분율을 연도별로 비교하였다. 연구결과 총 발표논문 수와 해외발표 분율은 지속적으로 증가하였다. 국내발표논문 수는 1999년까지 증가하다 이 후 2004년까지 감소하였으나 해외발표논문 수는 지속적으로 증가하다 국내발표논문수가 감소하는 시기에 급증하는 현상을 보였다. 등재지별 발표논문 수에 있어 SCI등재논문 수는 지속적으로 증가하였으며 국내 KCI등재논문 수도 2000년 이 후 급격히 증가하였고 2006년 기타 학술지 발표논문 수보다 많아졌다. 이러한 현상은 의학분야별로 양적, 시기적 차이를 보였지만 추세는 유사하였다. 논문 중심의 업적평가가 총 발표논문의 양적 증가는 가져왔으나 SCI 중심의 성과평가는 국내발표논문 수를 감소시키는 중요한 요인 중의 하나로 작용하였다. 논문 수의 양적 증감이 그 분야의 성과를 판단하는 절대적 지표는 아니므로 양적 분석과 함께 질적 분석이 이루어진다면 학문분야의 성과에 대한 객관성이 보완될 수 있을 것이다.

      • KCI등재
      • SCOPUSKCI등재

        처방전달체계에 대한 사용자 만족도에 영향을 미치는 요인

        김창엽,하범만,강길원,김병익,김용익,이진석,Kim, Chang-Yup,Ha, Bum-Man,Kang, Gil-Won,Kim, Byoung-Yik,Kim, Yong-Ik,Lee, Jin-Seok 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.4

        Objectives : To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. Methods : A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was peformed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience, OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. Results : There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. Conclusions : There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.

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