자원봉사 활동 참여가 중학생 청소년의 배려에 미치는 영향

채정미 ( Chae Joung Mi ),김기영 ( Kim Ki Young ) 한국청소년활동학회 2021 한국청소년활동연구 Vol.7 No.3

배경: 본 연구는 자원봉사 활동 참여 유무에 따른 배려의 차이와 자원봉사 활동이 배려에 미치는 영향력을 알아보았다. 목적: 청소년 자원봉사 영역의 활성화 방안의 모색 및 이론적인 기초자료를 마련하는데 주된 목적이 있다. 방법: 이를 위해 서울, 경기 및 충청권 소재 중학교 1학년과 2학년 418명(남 194, 여 224)을 무선배치하였다. 수집된 자료의 분석은 SPSS 22.0 Win. Vr을 활용하였고, 분석의 방법은 집단 간 차이는 독립표본 t-test와 일원배치분산분석(ANOVA; analysis of variance)을, 자원봉사 활동 참여 유무와 인구통계학적 특징이 배려에 미치는 영향력은 다중회귀분석(multiple regression analysis)을 실시하였다. 결과: 분석에서 나타난 주요 결과는 첫째, 자원봉사 활동에 참여한 집단이 참여하지 않은 집단보다 배려 수준이 더 높게 나타났다. 둘째, 배려의 수준은 남성보다 여성 집단에서 상대적으로 높게 나타났다. 셋째, 자원봉사 활동에 많은 시간동안 참여한 집단의 배려 수준이 적은 시간 참여한 집단에 비해 높게 나타났다. 특히 주목할 만한 결과는 배려의 하위요인인 타인심정 고려에 영향을 미치는 주요인은 자원봉사 활동에 많은 시간 참여하는 요인으로 나타났다. 의의: 본 연구가 가지는 의의는, 청소년의 배려 수준 향상을 위해서는 자원봉사 활동에 참여하되 좀 더 많은 시간동안 참여 하도록 지도가 필요함을 확인하였다는데 있다. 시사점: 청소년 자원봉사 활동 영역의 이론적 토대 마련과 함께 향후 청소년 관련 지역 사회자본을 확대하는 방안을 모색할 수 있을 것으로 기대한다. Background & Purpose: This study investigated the difference in caring according to the presence or absence of volunteer activity and the effect of volunteer activity on caring. Methodology: For this purpose, 418 students (194 males, 224 females) in the first and second grades of middle schools located in Seoul, Gyeonggi and Chungcheong were randomly selected. The collected data were analyzed with SPSS 22.0, For differences between groups, independent sample t-test and one-way analysis of variance(ANOVA) were used. A multiple regression analysis was performed on the influence of volunteer participation and demographic characteristics on caring. Findings/Conclusions: The main results shown in the analysis were: First, the level of caring was higher in the group that participated in volunteer activities than the group that did not participate. Second, the level of caring was relatively higher in the female group than in the male group. Third, the level of caring of the group that participated in volunteer activities for a long time was higher than that of the group that did not participate. A particularly noteworthy result is that the main factor influencing the caring of other people's feelings, which is a sub-factor of caring is the amount of time spent in volunteer activities. Implications: The significance of this study is that it was confirmed that in order to improve the level of caring, it is necessary to participate in volunteer activities, but to provide guidance to participate for a longer period of time.

요양병원의 간호인력 확보수준과 구강간호 실시여부가 노인 환자의 폐렴발생에 미치는 영향

채정미(Jung Mi Chae),송현종(Hyun Jong Song),강근석(Gun Seog Kang),이지윤(Ji Yun Lee) 한국간호행정학회 2015 간호행정학회지 Vol.21 No.2

This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). Methods: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. Results: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. Conclusion: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

처방 총액 절감 인센티브 시범사업과 약품비 절감 노력: 질적 및 양적연구

채정미 ( Jung Mi Chae ),이수옥 ( Soo Ok Lee ),김동숙 ( Dong Sook Kim ),송현종 ( Hyun Jong Song ),장선미 ( Sun Mee Jang ) 한국보건경제정책학회(구 한국보건경제학회) 2013 보건경제와 정책연구 Vol.19 No.4

국내에서는 약품비 지출 증가율을 감소시키기 위해, 2008년 7월 외래 처방 약품비 절감 인센티브 시범사업을 도입하였다. 이는 의원 자신의 전년도 지급된 비용에 기반해 기대약품비를 산출하고, 실제약품비와 비교하여 절감된 약품비의 20∼40%를 지급하는 사업이다. 본 연구에서는 외래 처방 약품비 인센티브 시범사업에 대한 개원의사가 어떻게 반응하는지를 파악하고자, 포커스 그룹 인터뷰를 실시하였고, 시범사업 전후로 특정 질환에서 환자당 약품비와 투약 일수의 변화를 살펴보았다. 포커스 그룹 인터뷰는 시범사업을 실시한 5개 지역의 개원의사 중무작위로 명단을 추출하였고 전화로 연락을 취해 모집하였고, 27명의 의사를 5개 그룹으로 나누어 토론을 진행하였다. 또한, 고혈압, 당뇨, 급성상기도감염에서 시범사업 전후로 차이가 있었는지 2007년 7월~2009년 6월 2개년의 건강보험청구자료를 이용하였다. 시범사업은 약품비 절감 노력에 일부 긍정적 영향을 미친 것으로 관찰되었으나, 인센티브에 대해 긍정적인 인식보다는 부정적인 인식이 더 많았고, 제도에 대한 이해와 공유가 부족하였다. 참여자들은 약품비를 절감하기 위해서는 의료계 내적 측면보다는 보건의료 체계 측면, 환자 측면의 정책을 수행할 것을 요구하였다. 또한 인센티브를 받은 의료기관에서 급성상기도감염 질환에 대해서만 환자당 약품비, 투약일수가 통계적으로 유의하게 감소하는 것으로 나타났다. 처방총액 절감 인센티브 시범사업은 의사의 약제비 절감노력과 처방행태에 영향을 주는지에 대해서는 일부 효과가 있으나, 그 영향력은 미미한 것으로 판단되므로, 지속적 홍보와 교육을 통해 효과를 증진시킬 필요가 있겠다. In an attempt to curb the rapidly rising expenditure of prescribing, the government introduced a financial incentive demonstration project in July 2008, to encourage clinicians to restrain their prescribing. This study undertook a qualitative and quantitative exploration of the attitude of doctors on Prescribing Incentive Scheme(thereafter PIS) demonstration project based on the pharmaceutical cost saving. In order to explore a plurality of perspectives, data were obtained from focus groups and a series of individual semi-structured interviews with doctors. To analyze PIS demonstration project, prescribing data in 2007.7~2009.6 were used. This study suggest that PIS demonstration has being expected to enhance a few efforts to reduce pharmaceutical expenditure. In the other hand, participants concerned negative attitude to demonstration project. To change the prescribing behavior, continuous training and giving public information should be made.

요양병원의 구조적 특성이 입원 노인 환자의 일상생활수행능력 저하에 미치는 영향

채정미 ( Jung Mi Chae ),송현종 ( Hyun Jong Song ) 대한보건협회 2015 대한보건연구 Vol.41 No.3

연구목적 : 본 연구는 장기간 입원 치료 요구로 인하여 요양병원에 입원한 노인의 삶의 질에 영향을 주는 일상생활수행능력감퇴와 관련된 구조 특성을 분석하여 향후 이와 같은 노인들의 기능상태 향상을 위한 관리 방안 모색에 기초자료를 제공하고 자 수행하였다. 연구방법 : 본 연구는 2009년 6월부터 9월까지 667개의 요양병원에 입원한 노인 환자 건강보험 청구명세서 103,011건을 대상으로 건강보험심사평가원의 요양병원 현황 신고 자료, 건강보험 청구자료 및 환자평가표 자료, 요양병원 적정성 평가자료,인력차등수가자료를 사용하여 ADL 감퇴 관련 요인을 규명하였다. 본 연구에서는 분석 모형에 구조 특성으로 병상 수, 의료인력, 의료인력 구성, 시설을 포함하였고, 종속변수인 ADL 감퇴는 이전 달에 비하여 점수가 상승한 것으로 보았다. 환자의 성별,연령, 치매여부, 환자분류군은 통제변수로 투입하였다. 연구결과 : 환자특성을 통제하고 일반화추정방정식으로 추정한 결과 ADL 감퇴와 관련되는 구조특성을 도출한 결과 병상수, 최고도 또는 고도 환자 비율, 의사 1인당 병상 수, 간호인력 중 간호사 비율, 간호인력 이직률, 안전손잡이 설치율이 ADL감퇴와 유의한 관련이 있었다. 즉, 병상 수가 작을수록, 의사 1인당 병상 수가 많을수록, 간호인력 이직률이 높을수록, 안전손잡이 설치율이 낮을수록 ADL 감퇴율이 높았고 간호인력 중 간호사의 비율이 2/3 이상인 경우 ADL 감퇴율이 낮았다. 결론 : 이와 같은 연구결과를 바탕으로 요양병원 환자의 진료의 질을 향상시키기 위한 구조적인 측면에 대한 정책적 개입및 개별 요양병원에서의 프로그램의 개발이 필요하다. Objective: This study was conducted to explore the relationship between structure and outcome in long term care hospital. Methods: Hospital size, staffing level, and facility as structural characteristics put in the analytic model. Decline of ADL(activity of daily living) among elderly inpatients in long term care hospitals was used as a outcome variable. A secondary data were obtained from the Health Insurance Review and Assessment Services including hospital claims data from June to September and quality evaluation of long term care hospitals in 2009. 103,011 elderly inpatients episodes from 667 long term care hospitals were analyzed using GEE(generalized estimating equations). Results: Among organizational characteristics, number of beds, number of beds per doctor, rate of RN among nursing staff, nurse``s turnover rate, and grab bar installation rate were significantly associated with effects on the ADL decline of elderly inpatients adjusted for patients characteristics. Conclusion: To maintain and improve patient health outcomes of ADL, policy interventions for improving retention rate of nurse and safety facility should be designed. Furthermore, ADL decline prevention program should be developed based on measure the clinical problem of patients at the time of admission.

모아의 환경적 건강에 대한 출산 코호트 효과: 체계적 고찰

채정미 ( Jungmi Chae ),김현경 ( Hyun Kyoung Kim ) 한국여성건강간호학회 (구 여성건강간호학회) 2021 여성건강간호학회지 Vol.27 No.1

Purpose: This study aimed to review recent findings from birth cohort studies on maternal and child environmental health. Methods: Birth cohort studies regarding environmental health outcomes for mothers and their children were investigated through a systematic review. A literature search was conducted in PubMed, CINAHL, the Cochrane Library, Embase, and RISS to identify published studies using the keywords using a combination of the following keywords: maternal exposure, environmental exposure, health, cohort, and birth cohort. Articles were searched and a quality appraisal using the Newcastle-Ottawa Scale for cohort studies was done. Results: A review of the 14 selected studies revealed that prenatal and early life exposure to environmental pollutants had negative impacts on physical, cognitive, and behavioral development among mothers and children up to 12 years later. Environmental pollutants included endocrine disruptors, air pollution (e.g., particulate matter), and heavy metals. Conclusion: This systematic review demonstrated that exposure to environmental pollutants negatively influences maternal and children’s environmental health outcomes from pregnancy to the early years of life. Therefore, maternal health care professionals should take steps to reduce mothers’ and children’s exposure to environmental pollutants.

소방 공무원에서 간접 외상이 정신 건강에 미치는 영향

백준혁,정영은,채정미,명준표,임현우,채정호,Baik, Jun-Hyuck,Jung, Young-Eun,Chae, Jung-Mi,Myong, Jun-Pyo,Yim, Hyeon-Woo,Cha, Jeong-Ho 대한불안의학회 2010 대한불안의학회지 Vol.6 No.1

Objectives : Indirect contact with trauma may occur when a person empathically listens to detailed descriptions, exposing the person to intense emotional pain from trauma victims. Although less severe than direct trauma, indirectly traumatized persons may experience the same fear, rage, and despair as direct trauma victims. This phenomenon has been variously termed vicarious trauma, traumatic countertransference, burnout, compassion fatigue, and secondary traumatic stress. Using a psychiatric symptoms questionnaires, this study investigated the effects of indirect exposure to co-worker's trauma on the mental health of firefighters who had not directly experienced traumatic events in the previous year. Methods : We administered self-report questionnaires, such as the Impact of Event Scale-Revised (IESR) and Alcohol Use Disorder Identification Test (AUDIT), to firefighters working at two fire stations in a metropolitan city. We analyzed 188 of 232 collected surveys, after excluding falsely entered data (28 cases) and questionnaires by directly-traumatized victims (16 cases). Results : Alcohol consumption and posttraumatic stress disorder (PTSD) symptoms, as determined by the AUDIT and IES-R, were significantly higher in the indirectly-traumatized group. The ratio of high-risk members scoring higher than 23 in IES-R was larger in the indirectly traumatized group, although this was not statistically significant. Conclusion : Alcohol consumption was significantly higher in the indirectly traumatized group. This group also included more members at high risk for PTSD. Further research, with a larger group of indirectly traumatized firefighters and ongoing investigation of PTSD development and other psychiatric symptoms, is needed.

의료기관별 간호인력 활용방안

홍지연(Hong, Ji Yeon),채정미(Chae, JungMi),송미라(Song, Mi Ra),김은미(Kim, Eun Mi) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.8

본 연구는 중소병원 간호인력 현황과 관련 정책을 분석하고 인력 확보에 영향을 주는 요인을 파악하여 중소병원 간호인력 확보를 위한 정책을 입안하고 결정하는 데에 근거를 제시하고자 실시되었다. 보건복지부와 건강보험심사평가원 등에서 제시한 통계자료를 2차 분석한 후 그 결과를 다양한 내·외적 보건의료환경에 대한 이해를 기반으로 조명하였다. 연구결과 우리나라의 활동 간호사 수는 면허간호사 수의 50% 미만으로 그 수는 해마다 감소하고 있었으며, 이는 간호대학 정원 증가의 비용 대비 성과의 효율성을 재고할 필요가 있음을 의미한다. 또한 간호관리료 차등제 실시로 인해 신규간호사는 물론 간호사 인력부족이 심각한 중소병원의 경력간호사들이 상급종합병원으로 이동하게 되는 결과를 야기하였으며, 결국 중소병원 간호인력 부족 현상을 더욱 악화시키는 원인이 되었다. 따라서 입원환자 간호관리료 차등제가 중소병원 간호인력 확보정책으로 실효성이 있는지에 대한 재검토가 필요하며, 면허간호사에 대한 추적 관리 시스템을 통해 간호인력 수급의 불균형을 해소할 수 있어야 한다. This study analyzed the current situation of medium and small-sized hospital nursing staff and related policies, and identified the factors that affect staffing level to provide evidence for planning and adopting policy. By analyzing the statistical data published by public institutions such as the Ministry of Health and Welfare and Health Insurance Review and Assessment Service, the result was viewed based on the understanding of various internal and external health care environments. The number of active nurseswasless than 50% of the number of licensed nurses and has decreased every year. This means that the cost-effectiveness of increases in nursing college enrollment should be reconsidered. Inpatient nursing fees by staffing grades has caused nurses to move from medium and small-sized hospitals, where there is a severe lack of staff, to more advanced general hospitals. As a result, the lack of nursing staff in medium and small-sized hospitals has worsened. In conclusion, reexamination is needed to improveeffectiveness of inpatient nursing fees by staffing grades as a policy to secure the workforce of medium and small-sized hospitals. Furthermore, the tracking management system of licensed nurses must be able to solve the imbalance betweendemand and supply of nursing staff.

자동차보험 한방진료비 증가요인 분석

이창수(Lee ChangSoo),이현주(Lee Hyeon Ju ),채정미(Chae JungMi) 한국산학기술학회 2019 한국산학기술학회논문지 Vol.20 No.1

자동차보험 총 진료비는 2014년 대비 2015년 12% 증가하였으나 그 중 한방진료비는 36% 증가하였다. 본 연구 목적은 진료비 항등식을 이용하여 자동차보험 한방진료비의 급격한 증가 원인을 구체적으로 파악하는 것이다. 2014년~2015년 기간 중 진료하여 심사 완료된 34,351,120건의 데이터를 이용하여 분석한 결과 한방 환자수는 해당 기간 중 27%, 환자당 진료비는 7% 증가하였다. 환자당 진료비를 세분화하여 분석한 결과, 환자당 입(내)원 일수는 변하지 않았으며 일당진료비만 7% 증가하였다. 환자수 증가를 보면 한방진료만을 받은 환자는 32%, 의과와 한방을 함께 진료 받은 환자는 24% 증가한 반면 의과진료만을 받은 환자는 오히려 4% 감소하였다. 일당진료비 증가에 영향을 미치는 요인으로는 한방물리요법 등 표준화되지 않은 진료행위의 비용 상승이 있다. 그럼에도 불구하고 한방 진료비 증가에 가장 크게 영향을 미친 요인은 환자수의 증가였다. Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014∼2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

인구구조의 변화를 반영한 건강보험 진료비 추계

이창수(Lee, ChangSoo),권혁성(Kwon, HyukSung),채정미(Chae, JungMi) 한국보건간호학회 2017 韓國保健看護學會誌 Vol.31 No.1

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

항생제 사례로 살펴본 건강보험청구자료 분석 시 고려사항

김예슬,채정미,신지혜,김유정,조가영,지승연,김동숙 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

The Health Insurance Review & Assessment Service (HIRA) collects and stores medical information of all citizens and medical institutions, including pharmaceutical claims data. Claims data including consultation notes and information about the medical institution are submitted to the HIRA by medical providers. Claims data have potential to offer a high quality for research, but various factors must be strongly considered in its analysis and interpretation. This study highlights various points to be considered while utilizing claims data. First, the time period between a claims review and loading of the data onto a data warehouse (DW) must be taken into account because over 99% of claims are available on DW for extraction after 5 months, according to an analysis of claims rate for pharmaceutical expenses. Second, over 50% of pharmaceutical claims data consists of reimbursable items, of which over 99% are antimicrobial medications. Accurate determination of the precise usage of nonreimbursable pharmaceuticals is limited to estimations based on the data on pharmaceutical supply declaration, which is only partially reported on claims statements as part of the comprehensive fees system. Finally, complete data on the use of pharmaceuticals during inpatient admission is unavailable. Due to the lack of requirement to input the administration time or to differentiate prescriptions on the day of discharge, it is difficult to accurately calculate the used amounts. These factors must be considered prior to analysis and interpretation of claims data from the HIRA. Hence, to ensure a higher research quality, we recommend considering these factors when conducting a claims data-based research.