응급의료 취약지 선정 요인이 병원 외 심정지 환자 생존퇴원율에 미치는 영향 = The Effectiveness of selection factor of the Vulnerable Area for Emergency Medical Service on Survival rate of out-of-hospital Cardiac Arrest

다국어 초록 (Multilingual Abstract)

Objectives: This research aims to grasp the effects of the selection factors of the
vulnerable area for emergency medical service on the survival rate of
out-of-hospital cardiac arrest, and to provide basic data for establishing
strategies for the enhancement of the survival rate and for the support projects
for the vulnerable areas for emergency medical service.
Materials and Methods: The research subjects were a total of 38,774 cases of
out-of-hospital cardiac arrest patients who were transferred to medical
institutions by the 1-1-9 ambulances of the fire departments of 16 cities and
provinces from January, 2011 to December 31, 2012, excluding the missing valuessuch as the cases in which the survival or cardiac arrest occurrence places could
not be confirmed in medical records. In order to grasp whether there were
differences in the survival rate according to the characteristics and factors of
occurrence places of out-of-hospital cardiac arrest, the independent two sample
t-test, variance analysis, and correlation analysis were conducted using SAS 9.2,
and in order to grasp the factors that exerted effects on the survival rate of
regions, the analysis was conducted using geographically weighted regression
analysis.
Results: The results of the analysis using the geographically weighted regression
analysis showed that, among the selection factors of the vulnerable areas of
emergency medical service, the higher the rate of the ambulance response rate with
8 minutes, the rate of the use of area emergency medical centers, and the rate of
the use of regional emergency medical centers, the higher was the survival rate of
out-of-hospital cardiac arrest patients, and the lower the rate of concordance
between out-of- hospital cardiac arrest occurrence places and the cities and
counties where medical institutions were located, the higher was the survival rate.
Conclusion: When out-of-hospital cardiac arrest occurs, it is necessary to enhance
the survival discharge rate through the appropriate counterstrategies in the stages
of the community – first aid – hospital and the qualitative enhancement of
emergency medical service, and the factors that exert influences on the result
index of emergency medical service need to be reexamined and the selection of, and
the support for, the vulnerable areas of emergency medical service need to be
improved.

목차 (Table of Contents)

• Ⅰ. 서론 1
• Ⅱ. 연구방법 3
• 1. 연구대상 3
• 1) 자료수집 3
• 2) 연구대상 3
• 2. 변수정의 4
• 1) 지역정의 4
• 2) 종속변수 6
• 3) 독립변수 7
• (1) 병원 외 요인 7
• (2) 병원 요인 8
• 3. 분석방법 10
• Ⅲ. 분석결과 11
• 1. 기초통계 11
• 1) 생존퇴원율 11
• 2) 생존퇴원율 요인 12
• 2. 발생지역 특성에 따른 생존퇴원율 차이 13
• 1) 발생지역의 도시규모 13
• 2) 응급의료 취약지 지정 여부 14
• 3. 중위수 기준 요인별 생존퇴원율 차이 15
• 1) 병원 외 요인 15
• 2) 병원 요인 16
• 4. 사분위수 기준 요인별 생존퇴원율 차이 18
• 1) 병원 외 요인 18
• 2) 병원 요인 20
• 5. 요인에 따른 생존퇴원율 상관관계 22
• 6. 생존에 영향을 미치는 요인 23
• 7. GWR로 분석한 생존퇴원율에 영향을 미치는 요인 24
• 1) 분석결과 24
• 2) 8분 이내 구급차 반응비율 지역별 회귀계수 27
• 3) 심정지 발생지 의료기관 소재지 시군구 일치율 지역별 회귀계수 28
• 4) 권역응급의료센터 이용률 지역별 회귀계수 29
• 5) 지역응급의료센터 이용률 지역별 회귀계수 30
• 8. 응급의료 취약지의 생존퇴원 모형 31
• Ⅳ. 고찰 33
• Ⅴ. 제언 36
• 참고문헌 37
• ABSTRACT 40