Establishment, Present Condition, and Developmental Direction of the New Korean Healthcare Accreditation System

장후선,이선희 대한의학회 2012 Journal of Korean medical science Vol.27 No.-

On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency,the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system.

The Socioeconomic Burden of Coronary Heart Disease in Korea

장후선,김한중,남정모,임승지,장영화,김세라,강혜영 대한예방의학회 2012 Journal of Preventive Medicine and Public Health Vol.45 No.5

Objectives: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. Methods: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. Results: Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183,which is about 2 times higher than the cost for angina ($1556). Conclusions: The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Economic Burden of Cancer in Korea during 2000-2010

이광식,장후선,이선미,박은철 대한암학회 2015 Cancer Research and Treatment Vol.47 No.3

Purpose This study estimated the economic burden of cancer in Korea during 2000-2010 by cancer site, gender, age group, and cost component. Materials and Methods Data came from national health insurance claims data and information from Statistics Korea. Based on the cost of illness method, this study calculated direct, morbidity and mortality cost of cancer in the nation during 2000-2010 by cancer site, gender, and age group. Results With an average annual growth rate of 8.9%, the economic burden of cancer in Korea increased from 11,424 to 20,858 million US$ (current US dollars) during 2000-2010. Colorectal, thyroid, and breast cancers became more significant during the period, i.e., the 5th/837, the 11th/257, and the 7th/529 in 2000 to the 3rd/2,210, the 5th/1,724, and the 6th/1,659 in 2010, respectively (rank/amount in million US$ for the total population). In addition, liver and stomach cancers were prominent during the period in terms of the same measures, i.e., the 1st/2,065 and the 2nd/2,036 in 2000 to the 1st/3,114 and the 2nd/3,046 in 2010, respectively. Finally, the share of mortality cost in the total burden dropped from 71% to 51% in Korea during 2000-2010, led by colorectal, thyroid, breast, and prostate cancers during the period. These results show that the economic burden of cancer in Korea is characterized by an increasing importance of chronic components. Conclusion Incorporation of distinctive epidemiological, sociocultural contexts into Korea’s cancer control program, with greater emphasis on primary prevention such as sodium-controlled diet and hepatitis B vaccination, may be needed.

의사국가시험 실기시험 도입에 따른 인턴과 전공의 임상수행능력의 변화

김수미,박인철,장후선,박은철 한국의학교육학회 2012 Korean journal of medical education Vol.24 No.4

Purpose: To evaluate the clinical performance through the Korean Medical Licensing Examination clinical skills assessment (KMLE CSA) this survey was done. Methods: A survey of 130 interns and residents (46 applicants and 84 non-applicants for the KMLE CSA) at a university hospital in Seoul was conducted in January and February 2012. The data were gathered using a structured and self-administered questionnaire. For the items that assessed the clinical performance of these subjects, we selected 15 items that are mostly frequently used by Delphi's technique, and difficult procedural skills based on the results of medical students' performance. We also used subcomponents of the clinical problems test of the KMLE CSA. Results: The total score on the KMLE CSA improved by 1.33 points (a perfect score is 10), 1.49 points for procedural skills, and 0.84 points for clinical problems by multiple regression analysis. The variables that influenced clinical skills were sex (females had 0.86 more points than males), experience in military or public services (1.04 points higher than persons without experience), and type of school (graduates of medical school had 1.41 more points than graduates of professional graduate school). Conclusion: Implementation of the KMLE CSA improved the clinical performance of medical graduates.

사회경제적 위치와 유방암 수술 후 총 사망위험과의 관련성

박미진,정우진,이선미,박종혁,장후선,Park, Mi-Jin,Chung, Woo-Jin,Lee, Sun-Mi,Park, Jong-Hyock,Chang, Hoo-Sun 대한예방의학회 2010 예방의학회지 Vol.43 No.4

Objectives: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. Methods: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson’s index score, emergency hospitalization, the type of hospital and the hospital ownership. Results: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For allcause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. Conclusions: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.

건강보험 청구자료를 이용한 우리나라 뇌졸증 환자의 사회경제적 비용 추계

임승지,김한중,남정모,장후선,장영화,김세라,강혜영,Lim, Seung-Ji,Kim, Han-Joong,Nam, Chung-Mo,Chang, Hoo-Sun,Jang, Young-Hwa,Kim, Se-Ra,Kang, Hye-Young 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. Methods : We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients and caregivers productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. Results : A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. Conclusions : Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.

젊은 성인에서 교정 QT간격과 심혈관질환 위험요인의 관련성: 강화연구

안성복,김현창,허남욱,하경수,장후선,김진배,서일,Ahn, Song-Vogue,Kim, Hyeon-Chang,Hur, Nam-Wook,Ha, Kyoung-Soo,Jang, Hoo-Sun,Kim, Jin-Bae,Suh, Il 대한예방의학회 2006 예방의학회지 Vol.39 No.6

Objectives : Prolongation of the heart rate-corrected QT (QTc) interval has been reported to be associated with cardiovascular morbidity and mortality. However, few studies have examined the relationship between the QTc interval and cardiovascular risk factors in young healthy people, The aim of this study was to examine the associations between the QTc interval and cardiovascular risk factors in young healthy adults. Methods : This study was performed as part of the Kangwha study, which started in 1986, and is an on-going follow-up study on blood pressure and related cardiovascular risk factors. In follow-up examinations during 2005, cardiovascular risk factors, including anthropometrics, blood pressure, blood chemistry and carotid ultrasonography, were measured, and questionnaires on health behaviors completed by 127 men and 149 women aged 25 years. The QTc interval was measured on the resting 12-lead electrocardiogram using an automatic analysis program. Results : The mean QTc interval was significantly longer in women $(419{\pm}17ms)$ than in men $(405{\pm}17ms)$ (p<0.001). A significant positive correlation was found between the QTc interval and waist-hip ratio (p=0.030) in men. Women showed a positive correlation between the QTc interval and systolic blood pressure (p=0.017). On a multiple regression analysis, the QTc interval was positively associated with the waist-hip ratio in men (p=0.012) and with the systolic blood pressure (p=0.020) in women. Conclusions : In young healthy Korean adults, the QTc interval was independently associated with the waist-hip ratio in men and with the systolic blood pressure in women.

출산에 따른 여성전공의 수련환경 실태와 개선방안

김소윤,김상현,이향애,김소연,신정빈,장후선,김한나,신현영,임지성,이동현,주지은 대한의사협회 의료정책연구소 2013 대한의사협회 의료정책연구소 연구보고서 Vol.- No.-

퇴원환자 요약정보를 이용한 이탈환자 특성과 관련 요인 연구: 일개 대학병원 사례

김영옥 ( Young Ok Kim ),김태현 ( Tae Hyun Kim ),박소희 ( So Hee Park ),장후선 ( Hoo Sun Chang ) 한국보건정보통계학회(구 한국보건통계학회) 2013 보건정보통계학회지 Vol.38 No.2

Objectives: Patients who are discharged from hospital prematurely have become strategically important for hospital customer relationship management. The purpose of this study was to investigate the characteristics of patients who were discharged prematurely and the associated factors using patient discharge data. Methods: This study used a retrospective, cross-sectional design. Primary data source comes from medical records of patients who were discharged from a university medical center during 2011. Data were analyzed using chi-square test, T-test, Mann-Whitney U test, and multivariate logistic regression to find significant patient characteristics and factors associated with premature discharge. Results: Final research subjects were 18,104 patients after excluding duplicated discharge patients, death patients, and discharges against medical advice. Male sex, older age, and living further away from Seoul were positively associated with premature discharge. Patients who were admitted via emergency room, due to car accident, and referred by other medical providers were more likely to discharge prematurely. Those who were diagnosed with neoplasm or circulatory system illness, and having comorbidities or complications were related to premature discharge. Other factors, such as having consultation treatment, non-favorable treatment outcome, and staying in intensive care unit had higher odds of premature discharge. Conclusions: It is suggested that hospitals monitor patients who would be more likely to be discharged prematurely, and need to address any quality issues during hospitalization if they lead patients to discharge early.