Satisfaction Survey on Information Technology-Based Glucose Monitoring System Targeting Diabetes Mellitus in Private Local Clinics in Korea

김헌성,양소정,정유진,김영은,홍석원,조재형 대한당뇨병학회 2017 Diabetes and Metabolism Journal Vol.41 No.3

Background: Private local clinics in Korea have little experience with information technology (IT)-based glucose monitoring (ITGM). Our aim is to examine user satisfaction and the possibility of using ITGM service practically. Methods: Patients sent their blood glucose levels to physicians in local clinics. The physicians reviewed the blood glucose values online and provided personal consultations through text messaging or phone calls. Thereafter, a satisfaction survey on the ITGM service, the modified Morisky scale, and patient assessment of chronic illness care were administered. Results: One hundred and seventy patients from seven private local clinics used the ITGM. Overall satisfaction, including that about the ITGM service, the device, and its usefulness, was rated higher than “mostly satisfied” (score 4.2±0.8 out of 5.0) and even higher among the elderly. Satisfaction was positively associated with age, especially in those older than 60 years. The main reason for intent for future use of the service was the time/place flexibility. Highly motivated patients tended to answer positively regarding information satisfaction (P=0.0377). Conclusion: Our study is the first to investigate ITGM satisfaction in private local clinics. The feasibility of users utilizing ITGM should be clarified, and future clinical research on the service’s clinical effects and cost-benefit analysis is needed.

Real-world Evidence versus Randomized Controlled Trial: Clinical Research Based on Electronic Medical Records

김헌성,이수현,김주한 대한의학회 2018 Journal of Korean medical science Vol.33 No.34

Real-world evidence (RWE) and randomized control trial (RCT) data are considered mutually complementary. However, compared with RCT, the outcomes of RWE continue to be assigned lower credibility. It must be emphasized that RWE research is a real-world practice that does not need to be executed as RCT research for it to be reliable. The advantages and disadvantages of RWE must be discerned clearly, and then the proper protocol can be planned from the beginning of the research to secure as many samples as possible. Attention must be paid to privacy protection. Moreover, bias can be reduced meaningfully by reducing the number of dropouts through detailed and meticulous data quality management. RCT research, characterized as having the highest reliability, and RWE research, which reflects the actual clinical aspects, can have a mutually supplementary relationship. Indeed, once this is proven, the two could comprise the most powerful evidence-based research method in medicine.

발제10 : 노인 적정의료 제공을 위한 “디지털 헬스”와 “비대면 관리”

김헌성 한국보건행정학회 2020 한국보건행정학회 학술대회 논문집 Vol.2020 No.2

Dementia Research Using Healthcare Big Data

김헌성,김대진 대한치매학회 2019 Dementia and Neurocognitive Disorders Vol.18 No.3

.

Efficacy of the Smartphone-Based Glucose Management Application Stratified by User Satisfaction

김헌성,최원아,백은경,김윤아,양소정,최인영,윤건호,조재형 대한당뇨병학회 2014 Diabetes and Metabolism Journal Vol.38 No.3

Background: We aimed to assess the efficacy of the smartphone-based health application for glucose control and patient satisfaction with the mobile network system used for glucose self-monitoring. Methods: Thirty-five patients were provided with a smartphone device, and self-measured blood glucose data were automatically transferred to the medical staff through the smartphone application over the course of 12 weeks. The smartphone user group was divided into two subgroups (more satisfied group vs. less satisfied group) based on the results of questionnaire surveys regarding satisfaction, comfort, convenience, and functionality, as well as their willingness to use the smartphone application in the future. The control group was set up via a review of electronic medical records by group matching in terms of age, sex, doctor in charge, and glycated hemoglobin (HbA1c). Results: Both the smartphone group and the control group showed a tendency towards a decrease in the HbA1c level after 3 months (7.7%±0.7% to 7.5%±0.7%, P=0.077). In the more satisfied group (n=27), the HbA1c level decreased from 7.7%±0.8% to 7.3%±0.6% (P=0.001), whereas in the less satisfied group (n=8), the HbA1c result increased from 7.7%±0.4% to 8.1%±0.5% (P=0.062), showing values much worse than that of the no-smartphone control group (from 7.7%±0.5% to 7.7%±0.7%, P=0.093). Conclusion: In addition to medical feedback, device and network-related patient satisfaction play a crucial role in blood glucose management. Therefore, for the smartphone app-based blood glucose monitoring to be effective, it is essential to provide the patient with a well-functioning high quality tool capable of increasing patient satisfaction and willingness to use.

New Directions in Chronic Disease Management

김헌성,조재형,윤건호 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.2

A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.

Physician Knowledge Base: Clinical Decision Support Systems

김헌성,김시라,김응희 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.1

With the introduction of electronic medical records (EMRs), it has become possible to accumulate massive amounts of qualitative medical data. As such, EMRs have become increasingly used in clinical decision support systems (CDSSs). While CDSSs aim to reduce medical errors normally occurring in the process of treating patients by physicians, technical maturity and the completeness of CDSSs do not meet standards for medical use yet. As data further accumulates, CDSS algorithms must be continuously updated to allow CDSSs to perform their core functions. Doing so, however, requires extensive time and manpower investments. In current practice, computational systems already perform a wide variety of functions in medical settings to allow medical staff to focus on other tasks. However, no prior research has evaluated the potential effectiveness of future CDSSs nor analyzed possibilities for their further development. In this article, we evaluate CDSS technology with the consideration that medical staff also understand the core functions of such systems.

(Real World Data를 활용한 임상연구) What is "Real-World Evindenc"..?

김헌성 한국성인간호학회 2018 성인간호학회 학술대회 Vol.2018 No.12

만성질환자 관리를 위한 유비쿼터스 헬스케어 시스템

김헌성,조재형,최윤희,오정아,이진희,윤건호 한국통신학회 2010 정보와 통신 Vol.27 No.9

고령화 사회의 웰빙트렌드와 생활습관에 의해서 의료서비스는 병원 중심의 치료서비스에서 개인과 의료인이 상호 긴밀하게 협력하여 질병의 예방, 관리, 건강증진 등을 제공하는 u-의료서비스 트렌드로 급속히 변화되고 있다. 최근 Biotechnology(BT), Information technology (IT)의 발달은 다양한 소형 센서 및 기기 개발을 가능하게 하고 있으며, 이렇게 측정한 환자의 데이터가 병원과 의사에게 전달되도록 함으로써 언제 어디서나 검사와 진료가 가능하도록 하는 유헬스케어 시스템이 대두되고 있다. 만성질환에 대한 유헬스케어 분야는 이제 단순한 의료차원이 아니라, BT 및 IT부문에 각각 굉장한 산업적 파급효과를 일으킬 수 있어 차세대 성장동력사업으로 발전할 수 있을 것으로 기대하고 있다.

한국인 임신성 당뇨병 여성에서 HNF-1α 유전자 변이 검색

김헌성,박소영,임창훈,윤현구,정호연,김성훈,한기옥,황선희,최은선,김경선,복정,이종영 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.1

Backgrounds: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first detection during pregnancy and mostly caused by insulin resistance and β-cell dysfunction like type 2 diabetes. However, autoimmune or monogenic diabetes can contribute to GDM. Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes characterized by an early age of onset and an autosomal dominant pattern of inheritance. Most MODY cases are attributable to mutations in HNF-1α gene, also known as MODY3. We investigated whether mutations in HNF-1α gene are present in Korean women with GDM. Methods: A total of 96 Korean women with GDM who have a family history of DM were screened for mutations in the HNF-1α gene. We evaluated the clinical characteristics of GDM women with HNF-1α gene mutations. Results: Five of 96 patients (5.2%) were found to have a mutation in HNF-1α gene. Four of those (-23C > G, 833G > A (Arg278Gln), 923C > T, IVS5 + 106A > G) were novel and one (-124G > C) in promoter region was reported in previous study. The mean age of GDM women with mutations of HNF-1α gene was 34 years. Four women with MODY3 gene mutations required insulin therapy during pregnancy. GDM women with MODY3 gene mutations appeared to be decreased insulin secretion (HOMA-%B) than those without mutations. Conclusions: We have found the existence of MODY3 as well as novel HNF-1α gene mutations in Korean women with GDM. (J Kor Diabetes Assoc 32:38~43, 2008)