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진료의뢰서 진단명과 퇴원 시 주진단명의 일치도 분석: 부인과 환자 대상으로
원시연 ( Si Yeon Won ),호승희 ( Seung Hee Ho ),김광환 ( Kwang Hwan Kim ),강혜영 ( Hye Young Kang ) 한국보건정보통계학회 (구 한국보건통계학회) 2007 한국보건정보통계학회지 Vol.32 No.1
Objectives: Assessing the degree of agreement between the initial diagnosis of patient encounters made by referring institutions and the final diagnosis by a referred institution. Methods: Among 505 patients referred to the department of obstetrics and gynecology of one tertiary care hospital in 2003, 291 patients hospitalized with gynecologic problems were selected as study subjects in this study. Medical chart review was conducted to compare diagnostic codes given at the time of referral by the referring institutions and those given at discharge by the referred hospital. To assess the degree of accordance between the two diagnostic codes of the same patient encounter, we developed 5-point scoring system. The score of 5 indicates a perfect accordance of all 4 digits of two comparing diagnosis codes and 4 indicates accordance of the first 3 digits. The score of 3 is assigned if the two codes do not agree on the first 3 digits, but share the common disease area. The scores of 2, 1, and 0 are assigned for the cases of accordance on the first 2 digits and the first digit, and no accordance on the first digit, respectively. To identify factors predicting the degree of accordance, decision tree analysis using CART algorithm as data mining approach was carried out. Results: The average accordance score was 3.14. According to the decision tree analysis results, the type of specialty and health care institutions are primary factors that discriminate referrals with high accordance score from those with low score. Secondary factor was diagnosis group: the score was as high as 3.69 among referrals with diagnosis of benign tumor (diagnosis code: D25-D28) and carcinoma in situ (D00-D09), and 2.92 for other diagnosis groups. Tertiary factor was the type of patient`s occupation. Conclusions: Our study showed that there`s a substantial gap between referring and referred hospital on the diagnosis for the same encounter. Effective communication between the referring and referred hospitals may reduce the gap and consequently prevent medical waste resulting from duplicated procedures and tests.
이석민(Lee, Seog-Min),원시연(Won, Si Yeon) 서울행정학회 2012 한국사회와 행정연구 Vol.22 No.4
The purpose of this study is to analyze the legislative impact on society of long-term care insurance which was enacted in 2007 and implemented in 2008. For this purpose, this article applies a logic model for a systemic approach and evaluates the performance of inputs, outputs, and outcomes. In terms of results, this study found a positive performance in the phase of inputs and outputs. In addition, the performance of inputs and outputs has influenced the short-term outcomes which are improvement of physical conditions, care expenses, and a reduced burden on family caregivers. However, it has not been sufficient to increase the opportunity for socioeconomic activities, and improved quality of life. Consequently, comprehensive system redesign or legislative responses are required if the objectives of Long-Term Care Insurance are to be achieved.
김광환,서순원,원시연,박석건,김승렬,송화식,김갑득,조혜경,부유경,이현경 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.2
We surveyed the discordance rate of principal diagnosis made at emergency room(ER) & made at ward on discharge of the patients. Subjects were four hundred eighty cases who came to the ER of one third-line hospital from January 1. 1998 to January 31, 1998. The discordance rate was higher in patients admitted to medical department's.2%) than surgical department(1.5%). If the patients were transferred to other department during hospital stay, discordance rate increased from 3.3% to 6.3%. In conclusion, discordance rate of principal diagnosis made at ER and made at ward was higher in patients with complicated problems. Medical record department should keep these findings in mind if it has a plan to support the management of ER record.