의료 질 향상 활동에 대한 병원장의 인식 및 태도

최귀선,지영건,이선희,채유미 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : The purpose of this study was to investigate the understanding and the attitude of Korean hospital CEOs toward the healthcare quality improvement. Methods : A mailed questionnaire survey to the CEOs of hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for the study, 58 participated, yielding a response rate of 54 percent. Result : The hospital CEOs have expressed that their hospital management was arduous job, and they had been pressured by increasing competitions among healthcare providers. They indicated that the low fees of health insurance made their hospital management difficult. The results also indicated that there was general consensus that the improvement of service quality was important in encouraging their organizations, but the investment of manpower and equipment ranked higher than the improvement of service quality. The majority of the CEOs have good understanding about quality improvement activities. However the facts that in general QI must be focused at the process of services and customer satisfaction, meanwhile quality improvement activities are helpful for the organizational productivity embarrassed them. The hospital CEOs responded that there were successful changes in terms of quality of care, patient satisfaction, and process efficiency after QI activities, but no increase in patient number and profit. Lack of understanding to QI activities and limited budget seem to attribute unsatisfactory outcomes. Conclusion : The majority of Korean hospital CEOs have a good understanding and attitude about QI activities. As mentioned in the result, despite of several limitations, several facts regarding the CEOs of hospital in Korean can be elucidated. (1)The general cognition of the QI project is relatively high, and it is accepted with positive concern, (2) the priority of the QI project, however, is not set higher than other projects and (3) the specific concepts of the actual QI project such as customer(patient)-focused work driving, the recognition of the work accomplishment, and the importance of rewards have not sufficiently understood.

호스피스케어와 전통적 의료서비스 이용간의 사망전 의료비용 비교

최귀선,유창훈,이경희,김창엽,허대석,윤영호 한국보건행정학회 2005 보건행정학회지 Vol.15 No.2

The aim of this study was to compare medical cost of hospice care and that of conventional care during the last year of life, and identify factors that influenced the cost. From January to August 2003 592 terminal cancer patients receiving care from 5 hospice care units and 2 hospice care teams in general hospitals were enrolled to case group. Two hundreds and seventy two terminal cancer patients receiving conventional care from 7 general hospitals were enrolled to hospital‐based control group, and 1,636 terminal cancer patients from 122 general hospitals located in same regions with the 7 hospitals were enrolled to community‐based control. We used characteristics and medical cost from data of National Health Insurance Cooperation. Total medical cost per beneficiary in cases was about 10 millions won, 14.5 millions in hospital‐based controls and 11.1 millions in community‐based controls. The hospice care saved 45% over the last year of life compared with hospital‐based controls (p<0.0001). Saving of inpatient cost account for approximately 80% of saving per beneficiary. Hospice care saved 29% of medical cost per hospitalization day compared with hospital‐based controls and 17% compared with community‐based controls (p<0.0001). Multiple regression analyses showed that hospice care significantly saved the medical cost. This study suggest that hospice care save medical cost compared with hospital‐based control and community‐based control. Most of saving of inpatient cost account for approximately 80% of saving of medical cost.

LB Films of Comb - like Polymers Containing Perfluoroalkyl Pendants

최귀선,손종현,이범종,권영수 한국고분자학회 1994 한국고분자학회 학술대회 연구논문 초록집 Vol.1994 No.10

대장암 환자가 부담하는 직접비용: 2년간의 추적조사를 통해

최귀선,박은철,임민경,임진화,김성경,박재현,정승용,박지원,임석병,최효성,정경해,김대용,박재갑 대한대장항문학회 2008 Annals of Coloproctolgy Vol.24 No.5

Received February 1, 2008, Accepted September 11, 2008 Correspondence to: Jae-Gahb Park, Cancer Research Institute and Cancer Research Center, Seoul National University, 28, Yeongeon- dong, Jongo-gu, Seoul 110-744, KoreaTel: +82-2-8072-3380, Fax: +82-2-742-4727E-mail: jgpark@plaza.snu.ac.krCost of Colorectal Cancer Care in Korea: A Prospective Group Study with a 2-year Follow-up National Cancer Control Research Institute, 1Research Institute and Hospital, National Cancer Center, Goyang, Korea Kui Son Choi, Eun-Cheol Park, Min-Kyung Lim, Jin-Hwa Lim, Sung-Gyeong Kim, Jae Hyun Park, Seung-Yong Jeong1, Ji Won Park1, Seok-Byung Lim1, Hyo Seong Choi1, Kyung Hae Jung1, Dae Yong Kim1, Jae-Gahb Park1Purpose: The incidence of cancer incidence and the rate of mortality are increasing in Korea. Specifically, colorectal cancer in men is one of the most sharply increasing malignancies. The objective of this study was to assess the direct costs for colorectal cancer patients and to identify the factors that influence cancer costs. Methods: The direct costs of colorectal cancer were examined with a prospective group study at a hospital. The direct costs were assessed every 3 months over a 24-month period through patient interviews, medical records, and claims data. We identified the major factors associated with the cost of colorectal cancer by using a general linear model for the log-transformed data. Results: The group was comprised of 100 patients with colon cancer and 120 patients with rectal cancer. The average costs per patient during the first and the second years after diagnosis were ￦16,280,000 and ￦5,786,000, respectively. Medical costs accounted for about 68% (￦11,090,000) of the first year’s total cost and about 62% (￦3,602,000) of the second year’s total cost. National Health Insurance (NHI) paid approximately 50% of the total medical cost. The total cost of colorectal cancer was clearly associated with the stage of the disease at first diagnosis, the cancer site, therapeutic modalities, and recurrence. Conclusions: These results indicate that colorectal cancer has a heavy financial impact on cancer patients. The total cost of colorectal cancer is clearly associated with the stage of the disease at first diagnosis. Increased efforts in terms of prevention and early detection may assist in reducing the costs. 목적: 암 발생과 사망이 증가하고 있으며, 특히 남성에서 대장암 발생이 급격하게 증가하고 있다. 본 연구는 대장암 환자가 부담하는 직접비용을 추정하고, 이에 영향을 미치는 요인을 분석하였다. 방법: 일개 병원 대장암센터에 내원하여 대장암으로 치료받은 220명을 2년간 추적조사 하였다. 직접비용은 3개월마다 환자와의 인터뷰, 의료비 청구자료, 의무기록조사로 추계하였다. 로그치환된 선형회귀분석으로 직접비용에 영향을 미치는 요인을 파악하였다. 결과: 220명의 대장암 환자 중 100명은 결장암, 120명은 직장암이었다. 대장암 환자의 진단후 1년간 지출한 직접비용은 16,280,000원이었으며, 2년째 비용은 5,786,000원이었다. 이중 의료비가 62∼68%를 차지하였으며, 의료비 중 보험자 부담금은 50%였다. 환자의 진단 당시 병기, 위치, 치료유형, 재발 여부가 직접비용에 통계적으로 유의하게 영향을 미쳤다. 결론: 대장암 환자의 진단 후 1년간 직접비용은 16,280,000원으로 환자의 경제적 부담이 큰 것으로 조사되었다. 그러나 조기 대장암은 진행암에 비해 2배 이상 직접비용이 감소하였다.

Screening for Gastric Cancer: The Usefulness of Endoscopy

최귀선,서민아 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.6

Gastric cancer screening is common in countries with high prevalence rates of gastric cancer. However, data supporting the effectiveness of gastric cancer screening are lacking. Thus, the aim of this review was to examine the current evidence on gastric cancer screening. Herein, we reviewed radiographic and endoscopic tests as methods of gastric cancer screening. Previous cohort studies and case-control studies have demonstrated reduced gastric cancer mortality in study populations that had undergone gastric cancer screening with radiographic tests. Recently, a case-control study in Japan reported a 30% reduction in gastric cancer mortality when screening was undertaken via endoscopy. Also, endoscopic screening for gastric cancer exhibited higher sensitivity and specificity than radiographic screening. Moreover, most cost-effectiveness analyses on the best strategy for detecting early gastric cancer have generally concluded that endoscopy is more cost-effective than radiographic testing. Although data on the impact of endoscopy screening programs on gastric cancer mortality are limited, recent study results suggest that gastric cancer screening by endoscopy in average-risk populations performs better than radiography screening. Further evaluation of the impact of these screening methods should take into account cost and any associated reduction in gastric cancer mortality.

환자가 인지하는 의료의 질과 만족도, 서비스 가치, 재이용 의사간의 구조분석

최귀선,이선희,남정모,조우현,Choi, Kui-Son,Lee, Sun-Hee,Nam, Jung-Mo,Cho, Woo-Hyun 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To determine the relationships among quality, satisfaction, value and purchase intention in health care service. Methods : The data were gathered from out-patients who had used hospital services. They were asked to assess service quality, satisfaction, service value, and purchase intention. A total of 557 usable questionnaires were gathered. The data were analyzed using SAS version 6.12. The analysis methods employed in the study were confirmatory analysis and covariance structural analysis. Results : Service quality exhibited a significant and positive relationship with satisfaction, service value, and purchase intention. Furthermore, satisfaction had a significant and positive relationship with purchase intention. And finally, service value had a significant and positive relationship with both satisfaction and purchase intention. Based on these findings, it is evident that satisfaction was a mediator between service quality and purchase intention. Also service value played a mediating role between service quality and satisfaction. Conclusions : These results suggest that service quality is an antecedent of satisfaction and sonics value, and exerts a stronger influence on purchase intentions than satisfaction and service value do. Thus, managers may need to emphasize service quality in health care.

의과대학생과 한의과대학생, 일반대학생들의 건강통제위에 대한 차이

최귀선,이한준,이선희,Choi, Kui-Son,Lee, Han-Joon,Lee, Sun-Hee 대한예방의학회 2003 예방의학회지 Vol.36 No.3

Objectives : The objectives of this study were to examine the difference in attitude toward health-specific locus-of-control and medical care among western medical students, oriental Medical students, and non-medical school students. Methods : The subjects of this study were 667 students who agreed to respond the questionnaire :212 western medical school students, 190 oriental medical school students, and 205 non-medical school students. The health-specific locus of control was measured by the structured questionnaire developed by Lau and Ware. The attitude toward western and oriental medicine was also measured by the questionnaire. Results : Western medical students and non-medical school students were more likely than oriental medical students to place high value on 'the provider control over health' and 'the general threat to health' scales (F=20.47, F=19.98). But oriental medical school students ranked 'the self control of health' scale as more important than any other locus of control scale (F=19.34). The health specific locus of control was also different from the grade. When trte grade was increased, 'the provider control over health' scale was slowly decreased, especially in western medical students and non medical school students. However, the 'general threat to health' scale was increased in oriental medical students. Western medical school students expressed more positive attitude toward western medicine. Oriental medical school students put a higher score on oriental medicine. Nevertheless, as the grade was increased, the positive attitude toward oriental medicine slightly decreased in oriental medical school students. Conclusions : There is a difference in health-specific locus of control and attitude toward medicine among western medical students, oriental medical students, and non-medical students. The locus of control and attitude of medical students towards medicine may affect both how they behave towards patients and how they help shape future public policy. Therefore, interdisciplinary educational initiatives may be the best way to handle this issue.

환자만족도 조사설문지의 설문문항 배열에 따른 신뢰도 분석

최귀선,조우현,홍재석,이선희,강명근 한국의료QA학회 2000 한국의료질향상학회지 Vol.7 No.2

Objectives : The purpose of this study was to evaluate the reliability of questionnaire according to item arrangement on patient satisfaction questionnaire. Methods : We developed the two types of questionnaire with different item arrangement. In the first type (A), questions were arranged according to medical service dimensions. Questions in the second type (B) were arranged according to medical process. Both questionnaires were composed of six dimensions: physical environments, process, competence, courtesy, information giving, understanding patients. Measurements were performed on a 5-score Likert scale. In an outpatients and inpatient survey, total 777 patients answered the type A (outpatients: 257, inpatients: 128) or Type B (outpatients: 257, inpatients: 135). In order to compare the internal consistency of two types. Cronbach's α were calculated. Multiple regression analysis was also performed to know which type of questionnaire explain more of the overall satisfaction. Results : In outpatient survey, type A questionnaire showed higher internal consistency than B except physical environments dimension. Also in inpatient survey, type A had higer internal consistency than B in four dimensions(process, competence, courtesy, understanding patients). In the results of multiple regression analysis, type A questionnaire (R² =0.53) explained more of the variation in overall satisfaction then B questionnaire (R2=0.43) in outpatient survey. In inpatient survey, type B questionnaire (R²=0.40) explained, more of the variation in overall satisfaction than type A questionnaire (R² =0.33).But the.difference of R was not significant in inpatient survey. Conclusion : The results of this study support that type A questionnaire has higer reliability in assessment of consumer satisfaction than type B.

국가 암조기검진사업 성과에 영향을 미치는 요인 - 보건소 및 사업실무자 특성을 중심으로 -

최귀선,양정희,계수연,이선희,신해림,김창민,박은철,Choi, Kui-Son,Yang, Jeong-Hee,Kye, Su-Yeon,Lee, Sun-Hee,Shin, Hai-Rim,Kim, Chang-Min,Park, Eun-Cheol 대한예방의학회 2004 예방의학회지 Vol.37 No.3

Objectives : Cancer is the leading cause of death in Korea. Therefore, a National Cancer Screening Program (NCSP) was launched in 1999. This study planned to evaluate the performance of the NCSP to identifying the influencing factors in relation to characteristic public health centers. Methods : To analyze the performance, the database of the NCSP records for 2002 was used. The performance index was measured by the goal achievement rate, which was defined by the real number of screenees against the expected number of screenees. Also, a survey was conducted by a self-administered questionnaire to identify the factors associated with the goal achievement rate. The questionnaire was divided into two sections. In the first section, the individual characteristics of the program coordinator in each public health center were measured, and second section was comprised of questions about the organizational characteristics associated with the NCSP. A total of 121 subjects from 241 public health centers completed the questionnaire. Results : Of the 121 public health centers (50.2% response rate), the average goal achievement rate was 72.8%. The results of the regression model showed that public health centers located in rural area (parameter estimates=38.2) and had great support from a head of center or province (parameter estimates=0.20) and tended to have higher goal achievement rates. However, the characteristics of the program coordinator, especially their knowledge of and attitude toward cancer screening, were not significantly related to the goal achievement rates. Conclusions : It appears that the most important associated factors to the goal achievement rate in the NSCP were the location of the public health center and the support for the NCSP from the head of the center or province.

국내 의료기관의 질 향상 사업의 활성화에 영향을 미치는 요인 - 조직동인적 관점에서

최귀선,강혜영,조우현,채유미,이선희,Choi, Kui-Son,Kang, Hye-Young,Cho, Woo-Hyun,Chae, Yoo-Mi,Lee, Sun-Hee 대한예방의학회 2001 예방의학회지 Vol.34 No.4

Objectives : To assess the degree of quality improvement (QI) implementation and to identify its associated factors. Methods : A mailed questionnaire survey of the QI staffs at hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for inclusion in our study, 79 participated, yielding a response rate of 73.1%. After excluding 12 hospitals that did not perform any QI activities, 117 responses from 67 hospitals were used in our analysis. The degree of QI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors evaluated for association with the degree of QI implementation were cultural, technical, strategic, and structural factors of the hospitals. Results : The average 01 implementation score across the 7 dimensions of MBNQAC was 3.34 on a 5-point scale, with the highest score for the area of customer satisfaction (3.88) followed by information and analysis (3.59) and quality management (3.35). The results of regression analysis showed that hospitals with a ofter information system (p<0.05) and using scientific and systematic problem solving approach (p<0.01) tended to perform a higher degree of QI implementation. While statistically insignificant, positive associations were observed for the factors of group or developmental culture, the degree of employee empowerment, and the use of prospective strategy. Conclusions : It appears that the most important factors contributing to active implementation of QI in Korean hospitals were the use of scientific skills in decision making, and having a quality information system to produce precise and valid information.