암 환자의 사망 전 6개월의 의료비용

박노례,윤영호,신순애,정은경,Park, No-Rai,Yun, Young-Ho,Shin, Soon-Ae,Jeong, Eun-Kyeong 한국호스피스완화의료학회 1999 한국호스피스.완화의료학회지 Vol.2 No.2

목적 : 말기 암 환자들을 위한 적절한 의료서비스가 제공되지 않음에 따라 비정상저인 의료행태가 발생되고 있어 말기 암 환자의 관리를 위한 포괄적인 프로그램의 필요성이 제기되고 있다. 고가의 생명유지장치의 무익성과 말기 암 환자 관리의 고 비용에 대한 관심이 늘어나고 있다. 본 연구는 의료보험에서 말기 암환자들에게 지출된 의료비용을 분석하고자 하였다. 방법 : 1997년 1월부터 1998년 6월까지 사망한 암 등록환자 중 공무원 교직원 의료보험 자료 이용이 가능한 151명의 급여내역을 추출하여 입 내원 일수와 의료보험 진료비를 조사하였다. 결과 : 사망 전 6개월 동안의 암 환자 일인당 평균 입원일수는 39일 외래일수는 14일이었다. 진료 일당 평균 진료비는 85,362원이었으며 입원 일당 평균 진료비는 105,908원, 외래 내원 일당 평균 진료비는 40,173원이었다. 진료비의 95%가 종합병원에서 지출되었으며, 진료비의 85%가 입원을 통해 지출되었다. 사망 전 6개월 동안의 진료비는 점차 증가하는 경향을 보여 사망에 가까울수록 사망 전 2개월 동안에 약 50%, 1개월 동안에 약 30%가 지출되었다. 외래진료비는 사망 전 3개월 전까지는 증가하다가 2개월 전부터는 감소하는 반면, 입원진료비는 사망에 가까울수록 증가하는 경향을 보였다. 결론 : 본 연구의 사망 전 6개월간의 의료비 분포는 미국의 메디케어의 자료와 비슷한 분포를 보였다. 향후 보다 큰 규모와 세부적인 진료서비스 내용의 분석을 통해 말기 암 환자의 관리에 대한 정책적 대안을 제시할 필요가 있다. Purpose : Because we don't have inappropriate health care system for the terminal cancer patients, there were abnormal behavior patterns of health care utilization. So, There were needs to develop the comprehensive care for terminal cancer patients. Increased attention is being paid to the futility of life-sustaining treatment and high cost of management of terminal cancer patients Materials and Methods : This study was performed on cancer patients, registered in 1996 Central Cancer Registry, who were as insured person of Korea Medical Insurance and died from January 1997 to June 1998. We studied the day of medical care and medical expenses of 151 cancer patients evaluable. Results : The mean day of inpatient care was 39 days, and the mean days of outpatient care was 14 days in study subjects. Mean expenses per day of medical care, day of inpatient, and day of outpatients care were 85,392 won, 105,908 won, and 40,173 won. 95% of medical expenses is paid to the general hospital, and 85% of medical expenses was paid for inpatient care. About half of all medical expenses in th last 6 months were incurred in the last 60 days of life, and about 30 percent were incurred in the last 30 days. Expenses of outpatients care increased between 6 month and 3 months, after which they decreased. Expenses of inpatients care increased during all last 6months Conclusion : The distribution or medical expenses during the last 6 months in our study is similar to the distribution of American Medicare costs. We need to study medical expenses during the last year of life with large scale and details in order to develop the plan about the management of terminal cancer patient.

통합보건사업을 위한 보건간호사의 업무지침 개발에 관한 연구

박노례,양숙자,전미순 국립보건연구원 1994 국립보건원보 Vol.31 No.1

학교보건교사 전염병관리교육 효과평가

박노례,권준욱,정인숙,김명순 한국보건교육건강증진학회 2007 보건교육건강증진학회지 Vol.24 No.2

Objectives: This study aimed to evaluate the educational effect of the Field Epidemiology Specialist Training Program for School Nurse which composed of 18hours curriculum. Method: The subjects were 797 who participated in the 2005 training program. Data was collected with structured questionnaires(knowledge on the control of communicable disease 15 items, attitude 15 items, and confidence in practice 14 items, demographic characteristics 4 items) before (January) and after (July to October) programs in 2005. Results: Knowledge on the control of communicable disease was improved from 9.7 points (possible range : 0-15) before program to 11.9 points after program. Attitude was improved from 53.6 points (possible range : 15-60) before program to 55.7 points after program. Confidence in practice was changed from 45.9 points (possible range : 14-56) before program to 50.0 points after program. Even though all three areas were improved after educational program, knowledge showed the largest change among them. Conclusion: We can conclude the educational program was effective because knowledge, attitude, and confidence in practice on the control of communicable were statistically significantly improved after educational program. Further educational program is recommended to be operated to get more improvement in attitude and confidence in practice. And short-term continuing educational program is needed to maintain and refresh the information on the control of communicable diseases in schools.

청소년 흡연 자가보고와 요코티닌 검사간의 일치도

박노례,함진경,정인숙,Park, No-Rai,Ham, Jin-Kyung,Jeong, Ihn-Sook 대한예방의학회 2004 예방의학회지 Vol.37 No.2

Objectives : Cotinine, the major metabolite of nicotine, is a useful marker of exposure to tobacco smoke and self-reporting of smoking status is thought not to be reliable. This study aimed to evaluate the agreement between the smoking self-report among adolescents and the urinary cotinine test. Methods : The study subjects were 1226 middle and high school students in Hanam city, who were selected by stratified random sampling. The self-report about smoking behavior was compared with urine cotinine value measured with PBM $AccuSign^{\circledR}fi$ Nicotine(Princeton BioMeditech Corporation, USA). The percentage agreement, kappa and 95% confidence interval(CI) were calculated. Results : The overall percentage agreement was 88.6%, and those for boys, girls, middle school, general school and vocational school students were 87.3%, 90.1%, 93.7%, 85,5%, 90.7%, and 78.4%, respectively. The overall kappa index was 0.46(95% CI=0.39-0.54)for overall, .and those for boys, girls, middle school, general school and vocational school students were 0.56(95% CI=0.48-0.65), 0.20(95% CI=0.07-0.32), 0.21(95% CI=0.09-0.34), 0.55(95% CI=0.47-0.64), 0.42(95% CI=0.33-0.52), and 0.48(95% CI=0.36-0.60), respectively. Conclusion : The percentage agreement was relatively high but the kappa values very low for girls, and middle school students. Though the prevalence bias can be influenced by these results, the self-report was not a sufficient tool for the evaluation of adolescents' smoking status, especially in girls or middle school students.

교육요구도 변화와 만족도에 근거한 전염병관리 전문요원 교육과정의 효과 평가

박노례,이종구,김영택,전진호,김기순,배상수,배종면,오경재,오희철,이건세,이병국,이훈재,정인숙,Park, No-Rai,Lee, Jong-Gu,Kim, Young-Taek,Chun, Jin-Ho,Kim, Ki-Soon,Bae, Sang-Soo,Bae, Jong-Myon,Oh, Gyung-Jae,Ohrr, Hee-Chul,Lee, Kun-Sei,Lee, Byun 대한예방의학회 2004 예방의학회지 Vol.37 No.1

Objectives: To evaluate the learning achievement and satisfaction levels for the Field Epidemiology Specialist Training Program (FESTP), on infectious disease control between March 19 and October 31, 2002. Methods : The FESTP was designed as a set of 84 hours curricula including lectures, discussions, self-studies, and field practicals, and organized both centrally and locally by the Division of Communicable Disease Control of the National Institute of Health and 11 universities. Before and after the program, a questionnaire survey on the educational need (49 items) and satisfaction (15 items) was conducted on 484 trainees, who were responsible for communicable disease control and immunization at 242 regional health centers. The data were analyzed with paired t-tests for comparison of the educational needs between the pre and post scores. Results : The average score for satisfaction was 3.06 out of 5.0; with relatively higher scores for sincerity (4.10) and professionalism (4.01) of the tutors, adequacy (3.54) and clearness (3.51) of the evaluation criteria, usefulness (3.54) and fitness (3.52) of the contents, but with relatively lower satisfaction for schedule (2.96) and self-studies (2.91). The average for requirement for education improved, as shown by the decrease from 2.72 to 2.22 (p<.0001) with the biggest decrease in the outbreak investigation from 2.60 to 2.08. Conclusion : The FESTP was evaluated as being effective, the trainees showed moderate satisfaction and decrease educational needs. However, the actual schedules and self-studies should be rearranged to improve the satisfaction level.

학교보건교사 전염병관리교육 효과평가

박노례,정인숙 한국보건간호학회 2006 한국보건간호학회 학술대회지 Vol.2006 No.12

學童期兒童의 결핵간호 원칙

朴魯禮 月刊看護社 1978 看護 Vol.1978 No.2

전염병관리 전문요원 교육과정 개발을 위한 교육요구 사정

박노례,정인숙,김영택,정은경,전진호,송미숙,이인숙,조성일,천병철,최보율 한국보건행정학회 2002 보건행정학회지 Vol.12 No.2

This study aimed to assess the educational need for management of communicable disease prior to developing curriculum for Field Epidemiology Specialist Training Program on Infectious Disease. We sent questionnaires(72 items) to two personnels who were related to communicable disease in each public health center through e-mail and 300 were returned(62.0% of response rate). The subject for education which showed the highest educational need was management(2.31 point), followed by immunization(2.30 point), and the lowest was surveillance(2.10 point). Generally, the educational need was higher in the aspect of attitude or practice than in that of knowledge. The subject which showed the differences in educational need by job titles were immunization(p<0.01), outbreak investigation(p<0.01), and case management and sanitation(p<0.01). There was negative correlation between communicable disease management-working duration and educational need. Considering this result, the curriculum should be focused on strengthening the ability for problem-solving especially in management and immunization.

학교보건교사 전염병관리교육 효과평가

박노례(No Yai Park),권준욱(Jun-Wook Kwon),정인숙(Ihnsook Jeong),김명순(Myung Soon Kim) 한국보건교육건강증진학회 2007 보건교육건강증진학회지 Vol.24 No.1

보건소 사업평가서 개발에 관한 연구

김행진,박노례,정태화,황금복,이명원,이종구,서현석,이원희,양숙자,전미순 국립보건연구원 1994 국립보건원보 Vol.31 No.1