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한휘종 한국의료QA학회 2008 한국의료질향상학회지 Vol.14 No.2
흔히 관리의료 (Managed Care)라 불려지는 미국의 의료체계는 과거 약 30여년간 미국내 의료비용증가의 억제, 의료서비스 접근성 개선, 의료의 질향상이라는 세가지 목표를 이루기위해 시행되어 왔다. 이 관리의료체계는 지속적으로 증가하는 의료비용을 어느정도 억제하는데는 성공하였으나, 몇년전부터 의료정책전문가들은 관리의료체계의 의료비용증가 억제 역할은 이미 한계에 다다렀다고 판단하고 있으며, 의료서비스 접근성 개선이나 의료의 질향상에는 큰 성과를 이루지 못했다고 평가하고 있다. 그럼에도 불구하고 미국의 의료서비스 질향상을 위한 노력은 지속적이면서도 체계적으로 진행되어왔다고 자부하고 있다. 최근 미국내 의료서비스 질향상을 위한 형태를 살펴보면 자주 거론되는 것이 Prevention activity, Physician Profiling, Pay-for-Performance (P4P), Clinical Practice Guideline, Health Information Technology (Health IT)등임을 알 수있다. 미국의 이러한 노력들이 최근 1-2년사이 한국내에도 널리 알려지고 이미 일부는 시범사업형태로 실시되고 있는점을 감안하면 별반 다를것이 없다고 여겨질 수 있으나, 여기서 주목할 것은 이러한 노력들이 미국내에서 시도되게된 계기와 목적, 그리고 그 과정들을 눈여겨 볼 필요가 있다는 점이다. 하지만 민간보험 주도 형태의 미국 의료시장에서 탄생한 이런 일련의 노력들이 정부주도하의 전국민건강보험체계로 운영되는 국내 의료시장에 도입되어 실효를 거두기 위해서는 모방형 도입이 아닌 국내 의료체계와 실정에 적합하도록 수정 혹은 개선된 형태로 선별, 도입되어야 함을 암시하고 있음도 주지해야 한다.
한국의 병원 구조에서 QA 팀을 어떻게 구성하고 운영 할 것인가?
양웅석 한국의료QA학회 1997 한국의료질향상학회지 Vol.4 No.2
Since the start of the Korean Society of Quality Assurance in Health Care in 1994, QA has improved, but it is time to develop our own policies that are more appropriate for Korean hospitals. American Quality Assurance policies are difficult to apply to the Korean medical community due to the differences in health insurance policies, and hospital structure between the two countries. Methods : I would like to propose more efficient organization and management of Quality Assurance according to the specific structures of hospitals in Korea. All of the hospital departments and committees should report to the Quality Assurance office, which in turn should report to the director. I would like to suggest that the current insurance review staff be used for the Quality Assurance office. A nurse should be in charge of the Quality Assurance department. The Quality Assurance department should have three sections : Medical Inssurance Review, QA records for the different Medical Departments, and QA records for the Ancillary Departments. A staff physician should be the chairman of the hospital QA committee, which should serve as the advising body to the QA Department. The QA Committee should be organized into eight subcommittees so that all departments throught the hoapital are represented. The current Medical Insurance Review offices in Korea have similar responsibilities to the QA Department : therefore I would like to recommend that the Medical Insurance Review office be changed the the QA office. If there are presently two separate Medical Insurance and QA offices, these should be combined into one office. Conclusion : These changes would surely benefit hospitals and strengthen the efficiency of both Insurance Review and Quality Assurance.
황지인,황정해,김창엽,신희영,오병희 한국의료QA학회 1999 한국의료질향상학회지 Vol.6 No.1-2
Background : Although a number of studies are related to QA improvement, there are few studies applied various method of QA tools. This study reviewed the availability of general quality assurance(QA) tools according to ten steps in performing quality improvement activities at emergency room of a tertiary teaching hospital which has more than 1,000 beds. Methods : All patients in emergency room from 15th Oct. 1997 to 5th Sep. 1998 were surveyed. The survey .data based on the patient's records of emergency room were evaluated according to length of stay, and we tried to identify problems with management of emergency room. To solve the problems, our team applied general QA tools(brainstorming, flow chart, nominal group technique, benchmarking, cause-and-effect diagram, run chart, control chart) to quality improvement activities and discussed the availability of the tools. Results : After the activities such as changes of staffing, the establishment of local area network and chest pain clinic, application of triage and so on, the percentage of patient who had stayed more than six hours was reduced from 56.0% to 46.8%. The mean number of patients per day in emergency room was increased from 49 to 62. But the reporting time for laboratory test was not changed after these activities. Conclusion : Each QA tool has unique benefit and limitation, but we can implement and evaluate the quality improvement activities more scientifically and systematically by applying these tools to practice according to QA ten steps.
권준욱 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.1
의료환경안전관리란 병원 내 감염뿐만 아니라, 혈액, 약품, 의료기기 등 전반적 안전관리 및 그 대상에 있어서도 환자 뿐 아니라 의료인까지 포함하고 있는 확대된 개념이며 이를 위해서는 의료기관 내에서의 감염관리 - 의료진, 다른 환자, 오염된 의료기기, 병원 내의 주위 환경 등 - 가 내성관리, 전파 차단의 핵심으로 볼 수 있다. 최근 선진국을 중심으로 의료 환경 개선과 질 향상을 위한 감시체계 가동 및 감시 자료를 바탕으로 분석된 근거에 따라 각종 지침, 권고를 통해서 의료 환경개선을 위한 노력이 활발하게 전개되고 있다. 병원감염은 궁극적으로 유병율의 증가, 치료 지연 및 심한 경우 환자 사망까지 발생시키고 있으며 나아가 주요 원인균들이 항생제 내성을 획득하여 다른 환자의 치료에도 지장을 초래하게 된다. 국내에서도 병원감염은 보건 의료의 질을 떨어뜨려 국민 건강을 위협하는 공중 보건문제이며 보건의료 비용 증가로 건강보험 재정에 악영향을 미치며 또한 입원기간의 연장으로 의료비용이 증가하여 경제적 손실이 크다. 이에 질병관리본부는 의료환경안전관리를 위해 2004년부터 전국병원감염감시체계를 구축 운영하고 있으며, 관계 전문학회 등과의 파트너쉽을 통해 의료기관에서 필요로 하는 감염관리 지침개발, 예방홍보물 지원 등으로 병원감염으로 인해 발생하는 국민건강 위해를 줄이고자 적극적인 사업을 추진하고 있다.
의무기록정리율의 문제점과 개선책 : PROBLEMS AND MEASURES FOR IMPROVEMENT
김세철,김민순 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1
As the first step to improve the medical recording for the hospitalized patients, we tried to identify problems of completion rate of the medical recording and made the completion rate of the medical recording within due date known to the public in the hospital and commended the best Department and resident officially. The results were as follows: 1. The average number of the medical recordings per a recorder by years of residency(average number to quorum) was 293.3(398.8) in 1st year, 82.5(68.1) in 2nd year, 21.2(8.3) in 3rd year, and 20.5(1.9) in 4th year-residents. There was only 2 residents who prepared the medical recordings more than the average of 125.6 recordings per a resident. 2. Among 13 Departments, the medical recording was wholly put in charge of the 1st year-resident in 6 Departments. The duty was shared with the 2nd year-resident in 5 Departments and the 3rd year-resident in 1 and the 4th year-resident in Only 1 Department. 3. The more the cases requiring the medical recording, the lower the completion rate(80% less than 100 recordings, 70% in 100-299, 60% in 300-399 and 33.3% in more than 400). 4. There was no difference in the completion rate of the medical recording before(1991) and after(1993) a public nitice(1992). However, 4 Departments showed improvement of 21-45% in the completion rate, and no case was found where billing for medical assurance was postponed due to delayed completion of the medical recording. 5. The completion rate was relatively low(72-78%) from January to March. The main reasons were shortage of men power due to preparation of board examination, attendance to military duty, and lack of training in the medical recording for the new 1st year-residents. 6. The official commendation of the best Department and resident by letters did not improve the completion rate of the medical recording. In conclusion, The main reason of the low completion rate of the medical recording was the fact that the 1st year-residents were almost exclusively responsible for the medical recording. Hence, it is mandatory that this practice gets staffs attention to improve the completion rate. Public notice of the completion rate of the medical recording shows prompt improvement of the completion rate. Prize money rather than commendation by a letter for the best Department would also be more effective to improve the quality of medical recording.
양웅석 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1
우리 나라의 의료계에 QA가 도입되면서 진료내용의 공개, 객관적인 치료, 의료관리 등에 대한 개념들을 평가하고 더욱이 QA를 정례화하고 더욱 발전시킬 수 있는 확회가 창립되어 이 분야의 발전에 크게 기대가 되는 바이다.