비예정 재입원의 위험요인에 대한 환자-대조군 연구

유승흠,오현주,Yu, Seung-Hum,Oh, Hyohn-Joo 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.3

Objectives: This study describes the risk factors affecting the unexpected readmission of 261 patients who were discharged from a university hospital in Seoul. Methods: This case-control study reviewed medical records of inpatients who had been discharged from a hospital between 1 August 1995 and 31 October 1995 after the treatment for general diseases. The cases were 68 patients who were readmitted unexpectedly within 28 days of discharge from an index stay, and the controls were 193 Patients who were discharged without readmission during the study period. Results: Logistic regression analysis results were as follows; Patients who had no operation during their hospital stay were more likely to be readmitted unexpectedly than patients who had operation. Patients who had 1 or 2 parts of their body being involved in treatment were more likely to be readmitted unexpectedly than patients who hand more than 3 parts of their body being involved in treatment. Patients who had complications after surgery were more likely to be readmitted unexpectedly than patients who had no complications. Insufficient discharge planning caused unexpected readmissions. Conclusions: Discharge planning education should be extended to health care providers. And the assessment of discharge planning should be evaluated. Readmission is often necessary for the treatment of related problems of originating from initial hospitalization, which causes cost problems. Unexpected readmission is preventable and the models for readmission can serve as a valuable clinical tool for high risk patients.

의과대학 졸업 10년 후 활동의사의 출신대학별 근무지역과 지역별 출신대학 분포

유승흠,손태용,오현주,Yu, Seung-Hum,Sohn, Tae-Yong,Oh, Hyohn-Joo 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.3

The geographical distribution of active physicians who graduated from medical schools before 1985 were studied. Those who had emigrated, hold non-medical jobs, are in the military service, or work as public health physicians and resident staff were excluded from the study. A total of 27,728 physicians were analyzed. Our studies have shown a relationship between the location of the medical schools from the which the physicians have graduated and the geographical regions in which they practice. A statistically significant number of physicians are working near the medical colleges from which they have graduated. That is, those who had graduated from medical schools located in the southern area of the country are presently working in the same region. This relationship was shown to be especially significant for older physicians and female doctors, who work around the area of the medical colleges from which they graduated.

의사인력의 지역별 분포 -전문과목과 진료수준을 중심으로-

유승흠,정상혁,전병률,손태용,오현주,Yu, Seung-Hum,Jung, Sang-Hyuk,Cheon, Byung-Yool,Sohn, Tae-Yong,Oh, Hyohn-Joo 대한예방의학회 1993 예방의학회지 Vol.26 No.4

In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.

인구구조의 변화에 따른 의료비 추계

유승흠,정상혁,남정모,오현주,Yu, Seung-Hum,Jung, Sang-Hyuk,Nam, Jeung-Mo,Oh, Hyohn-Joo 대한예방의학회 1992 예방의학회지 Vol.25 No.3

It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data(1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows : 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10.4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,101 billion Won in 2010, and 5,699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged(65 years old and over) will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.

순천시 지역적 특성에 따른 건강 행태 비교

민혜영(Hye-Young Min),오현주(Hyohn-Joo Oh) 한국농촌의학 지역보건학회 1999 농촌의학·지역보건 Vol.24 No.1

순천시 지역적 특성에 따른 보건의료정보 요구도 비교

민혜영(Hye-Young Min),오현주(Hyohn-Joo Oh) 한국농촌의학 지역보건학회 2000 농촌의학·지역보건 Vol.25 No.2

의료전달체계 변경이 3차 의료기관 안과에 미친 영향

김양수 ( Yang Soo Kim ),유승흠 ( Seung Hum Yu ),오현주 ( Hyohn Joo Oh ),권오웅 ( Oh Whoong Kwon ) 한국병원경영학회 2002 병원경영학회지 Vol.7 No.1

According to the change of mandatory referral system in July 1,2000, the effect to the medical utihzation of outpatient clinic and medical income in ophthalmology of tertiary care medical institute, S Hospital in Seoul was evaluated for 6 months before(1999. 12-2003. 5) and after(2000. 12-2001. 5). The results were as follows : 1. The number of outpatients was reduced by 16.6%. The number of patient with blindness·low vision, retina, glaucoma increased and that of patient with accommodation·refractive error, cataract decreased. 2. The number of cataract patients was reduced by 36.6%. The major location of patient s address was changed to nearer to the hospital. The number of cataract surgery reduced in 4.1%, the waiting time reduced in 42.2%, however surgery time increased in 20.2% and number of postoperative complications increased in 11.4%. 3. The income of outpatient clinic and cataract surgery reduced. Among items of outpatient clinic income, the most increased was ocular examination and the most reduced was injection and drugs. Among items of cataract surgery income, the most increased was operation fee and the most decreased was doctor s fee. In conclusion, for the patient, due to the lowered density of outpatient population more space was provided to the patients with more severe disease entity such as blindness -low vision, retina and glaucoma. For the hospital, the need for the expansion of ophthalmology was not found, however that for creation of the special clinics dealing with more severe disease entity was found. Due to reduced income and increased need of financial investment for the equipment and manpower for the more severe disease entity, the ophthalmology of tertiary care m&cal institute is faced with financial disaster. It is strongly suggested that the cost of medical practice of more severe disease entity be raised to achieve the success after change of mandatory referral system in ophthalmology.

민간의료보험 활성화에 대한 입원환자의 인식 및 태도에 미치는 영향 -서울시내 일개 종합병원을 대상으로-

윤수진 ( Soo Jin Yoon ),김성주 ( Seong Ju Kim ),유승흠 ( Seung Hum Yu ),오현주 ( Hyohn Joo Oh ) 한국병원경영학회 2008 병원경영학회지 Vol.13 No.1

This research is aimed at analyzing and understanding the perception and attitudes of inpatients in a general hospital in Seoul towards the activation of private health insurance. Survey was conducted against 231 inpatients, results of which were analyzed in the methods of frequency analysis, chi square test, and logistic regression. The results are summarized as follows; First, better-educated population who finished college education at least, higher-income population, and people who had more knowledge about private health insurance showed more perception about activation of private health insurance. Second, better-educated population who finished college education at least, higher-income population, those who are insured in existing private insurance, oncological patients, and people who had more knowledge about private health insurance showed more positive attitude towards private health insurance paying for actual damages, long-term care insurance, and income security insurance. Third, age and education were the factors affecting perception about activation of private health insurance. The older the age is, perception was 1.035 times positive towards activation of private health insurance, and those who finished college education or above showed 3.148 times positive perception towards the same. Forth, surgical patients showed 1.087 times more positive attitude towards private health insurance paying for actual damages than internal medicine patients, while oncological patients showed 2.314 times more positive attitude than internal medicine patients. Further, understanding on the activation of private health insurance was 6.014 times higher in the higher understanding group than in the lower understanding group. Intention to use long-term care insurance was 2.692 times stronger in the male group than in the female group, and 3.616 times stronger in the oncological patients group than in internal medicine patients group. Further, understanding on the activation of private health insurance was 3.881 times deeper in the higher understanding group than in the lower understanding group. Intention to use income security insurance was 3.185 times stronger in those who have academic background of under the high school than those over the college, and 4.175 times higher in the group those whose monthly average income is over 4 million won than those under 4 million won. Also, intention to use income security insurance was 4.323 times higher in the group those who are insured by existing private insurances than those who are not insured by those insurances and it was 5.234 times higher in the group of oncological patients than in the group of internal medicine patients. Further, intention to use income security insurance was 3.559 times higher in the group those who thought that out-of-pocket money of the National Health Insurance is too much to bear than those it is quite endurable. Understanding on the activation of private health insurance was 4.875 times deeper in the higher understanding group than in the lower understanding group. There were some suggestions could be made based on the results of this research. First, reinforced publicity and education is needed for the low-educated or low-income group, as there are gaps in the understanding on the activation of private health insurance depending on the degree of education and income. Second, government should prepare administrative complementary measures to solve the problem of adverse selection by the consumer which is foreseen when private health insurances are activated. Third, government should suggest the desirable course of development of private health insurance items to ensure efficient use of enormous fund of private insurance market for health security of the people. Further, institutional complementary measures are needed to convert existing cancer insurances or specific disease insurances to private health insurances paying for actual damages guaranteeing against

의과대학생들의 학업성취 관련요인 코호트 분석

유승흠(Seung Hum Yu),남정모(Chung Mo Nam),김석일(Suk Il Kim),오현주(Hyohn Joo Oh) 한국의학교육학회 1994 Korean journal of medical education Vol.6 No.1

In order to analyze academic achievement of medical students and its related factors, a total of 2,371 students who entered the premedical course of O university from 1987 were reviewed based on cohor t of their admission year. Those who did not promoted to medical college from premedical course in two years were 15% and those who did not graduate medical school in four years were 21%. The percentage of female students and outside Seoul residents has been growing. The percentage that students parents occupation is medical profession has been decreasing. Those who failed during premedical course have higher conditional probability to fail during the medical studies. The results suggest that medical educators pay more attention to those who failed during the premedical course. Also the criteria whether students are failed or promoted to next grade is reasonable should be studied in depth.

CQI 활동 후 사후관리 체계 조사연구

현석균 ( Seok Kyun Hyun ),유승흠 ( Seung Hum Yu ),오현주 ( Hyohn Joo Oh ) 한국병원경영학회 2002 병원경영학회지 Vol.7 No.2

This study was conducted to determine whether follow-up management is carried out continuously following CQI activity and to analyze the factors behind the success and failure of follow-up management. Past presentations from 19941999 of CQI coordinators and lecturers from various institutions who presented at The Korean Society of Quality Assurance in Health Care(KoSQA) on the conditions of follow-up management in each institution were analyzed. The results of this study were as follows; Since the number of subjects on CQI increased each year at symposiums, this has expanded to all medical institutions. Although medical institutions usually conduct 11-20 subjects on CQI per year, there were many such occasions where more than 31 subjects were conducted. Moreover, institutions with less than 800 beds have come up with more projects than those with more than 800 beds, thus 23.3% of these institutions had at least 1 person involved in 4 projects. Tihs had created an overload of responsibilities for specific persons involvement, prompting them to incline toward formahties in their work rather than substantial activities. Among the projects presented at the symposiums, 51.7% demonstrated that follow-up management could be carried out. In particular, 55.3% of the projects from provincial regions could carry out follow-up management compared to 48.8% in Seoul. Moreover, it was demonstrated that 80% of the projects from institutions with 600-799 beds carried out follow-up management most effectively. With regards to previous presentations, the older they were, it was found that follow-up management could not be effectively carried out. Some institutions that responded that follow-up management was carried out effectively in their institutions were found to have conducted follow-up management without any inspection strategies or the appropriate tools. CQI activities were executed and terminated with no consistency and team members had no real concern for it. The most important factors that contribute to an effective follow-up management are the need for concern and interest from the directors of the hospitals, from the relevant departments and team members in addition to the role of the supervising department, follow-up management through management of target goals, consistency in tasks along with communication between all team members. The biggest problems were perceived to be overload of work due to accumulation of proposed projects in addition to lack of awareness pertaining to follow-up management. CQI is beneficial for all staff for the improvement of the mind and business adrmnistration and thus it is believed to be desirable. To carry out follow-up mana-gement effectively, leadership, analysis and application of information, follow-up management and planning, as well as quality management are perceived to be essential, on the other hand, the results showed a significant difference. To prevent CQI activities from becoming just an activity, the basic system should be reconstructed and augmented based on the problems derived from the results of this study. Moreover, we hope this study will be used as reference material that would encourage the administration of follow-up management after CQI activities in most hospitals. Furthermore, various studies on follow-up management should be conducted for CQI activities in the future.