의료전달체계 이슈에서 좀 더 고려되어야 할 문제들

옥민수 대한의사협회 의료정책연구소 2022 의료정책포럼 Vol.20 No.2

위해사건 확인을 위한 증례검토지 개발

옥민수,이상일,김윤,이재호,이진용,조민우,김선하,손우승,김현주,Ock, Min-su,Lee, Sang-il,Kim, Yoon,Lee, Jae-ho,Lee, Jin-yong,Jo, Min-woo,Kim, Seon-ha,Son, Woo-seung,Kim, Hyun-joo 한국의료질향상학회 2015 한국의료질향상학회지 Vol.21 No.1

Objectives: The purpose of this study is to develop a case review form for detecting adverse events through a medical records review in hospitalized patients in South Korea. Methods: To develop the case review form, several literatures were reviewed, first. Through the clinical expert meeting, screening criteria were selected and case review form was developed. Result: The Korean version of case review form consisted of the review form-1 for adverse event screening and form-2 for adverse event identification. The applied methodology for the case review form is determined according to the previous studies. For example, the method used in the first stage review is nurse review. Furthermore, the National Coordinating Council for Medication Errors Reporting and Prevention index is used to categorize disability, and a scale of 1 to 6 was used in the causation scores and preventability scores, respectively. Through the clinical expert meeting, a total of 41 screening criteria were selected. Conclusion: The Korean specific case review form was developed for detecting adverse events in hospitalized patients. The results from this study can be used in a large-scale study regarding the nationwide incidence of adverse events.

보건의료계 종사자들의 전자기장에 대한 위험 인식

옥민수,임소윤,김화정,류현미,이나리,이무송 대한임상건강증진학회 2015 Korean Journal of Health Promotion Vol.15 No.2

Background: This study assessed the perceptions of healthcare staff of the health risks of exposure to electromagnetic fields (EMF). Methods: In total, 328 healthcare workers (e.g., physicians, nurses, medical students, and paramedics) completed a self-administered questionnaire. The questionnaire assessed the following: risk perceptions of 17 environmental factors as potential health threats; EMF sources; information for the potential risks of EMF; and thoughts on how to protect the public from potential EMF-related health risks. Results: Of the included environmental factors, high-tension power lines and mobile phone handsets were ranked as the second and fourth lowest perceived risk, respectively. Approximately 60% of respondents were concerned about the potential health risks of EMF and dissatisfied with the information they received. The main reason for dissatisfaction was insufficient information. The most frequently cited action was that the government should review the available scientific evidence on potential EMF-related health risks. Conclusions: Having scientific basis through well-designed researches and providing accurate information to the public on the potential health risks of EMF will be important in the future. 연구배경: 이번 연구의 목적은 보건의료계 종사자들의전자기장에 대한 위험인식을 평가하는 것이다. 방법: 총 328명의 보건의료계 종사자들(의사직, 간호사직, 의과대학생, 의료보조원직)을 대상으로 자기기입식 설문조사를 수행하였다. 설문지는 잠재적으로 건강에 위협이 될 수 있는 17개 건강위험 요인에 대한 위험 인식 수준평가, 10개의 전자기장 배출원에 대한 지식 평가, 전자기장의 잠재적 건강위험에 대한 정보 습득 경로 및 만족 수준, 정부가 전자기장으로부터의 보호를 위해 취하고 있는조치에 대한 평가 및 우선적으로 취해야 할 조치에 대한물음 등을 포함하고 있다. 결과: 응답자들은 총 17개 건강위험 요인들 중 고압 송전선과 휴대전화를 하위 16번째와 14번째로 건강위험이크다고 생각하였다. 응답자들의 60%는 전자기장의 잠재적 건강위험에 대해 걱정된다고 밝혔으며, 전자기장에 관련된 잠재적 건강 위험에 대하여 들었던 정보에 대하여만족하지 않는다고 응답하였다. 이들이 만족하지 못한 주된 이유는 전자기장에 대한 정보의 설명이 불충분하였기때문이었다. 또 응답자들은 정부가 전자파와 관련된 위험으로부터 사람들을 보호하기 위해서는 가장 우선적으로전자기장이 건강에 미치는 영향에 대한 과학적 근거를 검토하여야 한다고 밝혔다. 결론: 이번 연구의 결과를 활용했을 때, 전자기장의 잠재적 건강 위험에 대한 과학적 근거를 마련하고, 정확한정보를 제공하는 것이 우선적으로 요구된다.

Assessing Reliability of Medical Record Reviews for the Detection of Hospital Adverse Events

옥민수,이상일,이진용,조민우,김선하 대한예방의학회 2015 Journal of Preventive Medicine and Public Health Vol.48 No.5

Objectives: The purpose of this study was to assess the inter-rater reliability and intra-rater reliability of medical record review for the detection of hospital adverse events. Methods: We conducted two stages retrospective medical records review of a random sample of 96 patients from one acute-care general hospital. The first stage was an explicit patient record review by two nurses to detect the presence of 41 screening criteria (SC). The second stage was an implicit structured review by two physicians to identify the occurrence of adverse events from the positive cases on the SC. The inter-rater reliability of two nurses and that of two physicians were assessed. The intra-rater reliability was also evaluated by using test-retest method at approximately two weeks later. Results: In 84.2% of the patient medical records, the nurses agreed as to the necessity for the second stage review (kappa, 0.68; 95% confidence interval [CI], 0.54 to 0.83). In 93.0% of the patient medical records screened by nurses, the physicians agreed about the absence or presence of adverse events (kappa, 0.71; 95% CI, 0.44 to 0.97). When assessing intra-rater reliability, the kappa indices of two nurses were 0.54 (95% CI, 0.31 to 0.77) and 0.67 (95% CI, 0.47 to 0.87), whereas those of two physicians were 0.87 (95% CI, 0.62 to 1.00) and 0.37 (95% CI, -0.16 to 0.89). Conclusions: In this study, the medical record review for detecting adverse events showed intermediate to good level of inter-rater and intra-rater reliability. Well organized training program for reviewers and clearly defining SC are required to get more reliable results in the hospital adverse event study.

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

옥민수,임소윤,조민우,이상일 대한예방의학회 2017 예방의학회지 Vol.50 No.2

Objectives: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. Results: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. Conclusions: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

울산광역시 시민에서 금연 광고가 금연 의향 및 유지에 미치는 영향

옥민수,옥종우,표지희,김서준,유철인 한국보건의료기술평가학회 2018 보건의료기술평가 Vol.6 No.2

Objectives: In this study, we evaluated the effectiveness of the typical anti-smoking advertisement on smoking cessation intention in citizens of Ulsan Metropolitan City. Methods: A total of 700 citizens (600 adults and 100 high school student) participated in face-to-face interviews survey using paper questionnaire. Three anti-smoking advertisements were used in this study; chronic obstructive pulmonary disease (COPD) patient video advertisement, tobacco hazard information advertisement, and COPD patient voice advertisement. Each participant randomly evaluated only one of the three non-smoking anti-smoking advertisements. Participants were asked whether they had seen or heard anti-smoking advertisements before and asked whether they understood the advertisement well. They also assessed the effectiveness of non-smokers to maintain smoking cessation and how effective it would be to help smokers quit. Results: Among the three anti-smoking advertisements, 54.8% of participants said that they watched COPD patient video advertisement before. More than 95% of participants said they can understood anti-smoking advertisements. Among the three anti-smoking advertisements, tobacco hazard information advertisement was evaluated to be most effective to maintain non-smokers’ smoking cessation (234, 92.5%). Tobacco hazard information advertisement was also evaluated to be most effective to make smokers quit smoking (216, 84.7%). Conclusion: Anti-smoking advertisements have a positive effect on non-smoker’s willingness to keep smoking and smokers’ willingness to quit smoking. In future studies, it would be meaningful to look at the long-term effects of smoking cessation or to evaluate the effectiveness of the more various anti-smoking advertisements.

환자안전사건 소통하기의 필요성: 윤리 및 의료의질 측면에서

옥민수,이상일 대한의사협회 2017 대한의사협회지 Vol.60 No.5

Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study

옥민수,김화정,전보민,김예지,류현미,이무송 대한예방의학회 2018 Journal of Preventive Medicine and Public Health Vol.51 No.1

Objectives: The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes. Methods: We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others. Results: Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%). Conclusions: Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.

환자안전 보고 시스템의 구성 요소 및 그 현황 분석

옥민수,이상일,김장한,이재호,이진용,조민우,이미숙,김선하,김현주,손우승 한국보건의료기술평가학회 2015 보건의료기술평가 Vol.3 No.1

Objectives: To propose future directions of patient safety reporting system (PSRS) in South Korea based on the analysis of current PSRSs in some developed countries. Methods: We summarized the components of external PSRS in ten countries through literature review. Based on the same framework used in the literature review, we collected informations about three domestic external PSRSs. We also did e-mail interviews with those who are in charge of operating domestic PSRSs to collect additional information. Results: The components of PSRS can be divided into three factors: reporting method (events to be reported, type of reporting system, reporter and means of report- ing); data analysis (organization in charge of analysis and dissemination of results for analysis); and confidentiality of data and reporter (independent patient safety law, confidentiality and privilege and organization dedicated to patient safety). Conclusion: In accordance with the components of PSRS, the following points should be considered for establishing a national PSRS in Korea: intro- ducing mandatory reporting for serious reportable events; expanding events to be reported, report- er and means of reporting; developing infrastructure for analysing reported data; disseminating analysis results; providing a confidentiality protection and legal privilege to reporters or reported data; and establishing a patient safety center which is in charge of managing PSRSs.

의료기관 내 환자안전사건 소통하기

옥민수 한국간호윤리학회 2021 한국간호윤리학회 학술대회 Vol.2021 No.11