No abstract available.
Diagnosis-Related Groups* ; Korea*

This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview survey performed by the korean Institute of Health & social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions; There were more elderly people over the age of 65; unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionally, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.
Aged ; Causality ; Education ; Health Resources ; Humans ; Inpatients ; Korea* ; Length of Stay ; Marital Status ; Models, Statistical ; Primary Health Care ; Public Health ; Sample Size

PURPOSE: The purpose of this study was to investigate predictors of nurses' patient safety behavior during inter-hospital transfer. The study was based on the Theory of Planned Behavior (TPB). METHODS: A descriptive survey design was used. Data were collected with a self-administrated 39-item questionnaire completed by 111 nurses from a university hospital in Seoul, South Korea. The questionnaire was developed based on the Theory of Planned Behavior (TPB) guideline and included measure of self- reported past patient safety behaviors, intentions, attitudes, subjective norms and perceived behavioral controls. Ethical approval was granted by the hospital review board. Hierarchical regression analyses were carried out. RESULTS: The average score of patient safety behavior was 4.21±0.63 (5 point scale). The TPB variables explained 49.9%of the variance in patient safety behavior. Intention and subjective norm were the most significant predictors of nurses' patient safety behavior. Attitude was related to nurses'patient safety behavior. CONCLUSION: TPB variables predicted the nurses'patient safety behavior during inter-hospital transfer of patients except for perceived behavioral controls. The results of this study suggest that better strategies for subjective norms and intentions related to patient safety behavior will be helpful in safety culture reform.
Financing, Organized ; Humans ; Intention ; Korea ; Patient Safety* ; Safety Management ; Seoul

Investigating the existence of volume-outcome relationships for specific disease groups relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. This study examined whether medical costs and lengths of stay as outcomes were affected by changes in volume within hospitals. Based on the claims data obtained from National Federation of Medical Associations, each six disease categories from medical and surgical conditions were selected and 29,720 cases from 1,266 hospitals were analyzed. Main findings of the research can be summarized as follows: 1. Analyzing volume and cost per case relationship, tonsillectomy class 1, hernia procedure class 0, appendectomy and cesarean section class 0,1 in surgical conditions showed negative relationship significantly. In cases of medical conditions, costs per case in respiratory neoplasm class 2, COPD class 1, 2, digestive malignancy were also related to volume negatively. 2. Comparing volume with length of stay per case, lens procedure class 0, hernia procedure class 0, appendectomy class 0,1 cesarean section class 1 in surgical conditions showed negative relationships significantly. In medical conditions, volume of respiratory neoplasm class 2, COPD class 1,2, digestive malignancy class 0 were associated with negatively. 3. within same disease categories, changes in cost and length of stay per case to volume were more remarkable in severe cases. These results suggested a significant inverse relationship between disease cases and cost, length of stay per case as outcome variables.
Appendectomy ; Cesarean Section ; Female ; Hernia ; Humans ; Inpatients ; Length of Stay ; Pregnancy ; Pulmonary Disease, Chronic Obstructive ; Tonsillectomy

PURPOSE: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model.METHODS: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24.RESULTS: In the final model, admission via emergency department (B=.06, p=.019), age over 65 years (B=.11, p=.001), unconsciousness (B=.18, p=.001), dependent activities (B=.12, p=.001), abnormal vital signs (B=.12, p=.001), pressure ulcer risk (B=.12, p=.001), enteral nutrition (B=.12, p=.001), and use of restraint (B=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (B=.06, p=.038), hospital length of stay (B=5.06, p=.010), and discharge to another facility (not home) (B=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium.CONCLUSION: The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.
Critical Care ; Delirium ; Drainage ; Early Ambulation ; Electronic Health Records ; Emergency Service, Hospital ; Enteral Nutrition ; Hospital Mortality ; Humans ; Intensive Care Units ; Length of Stay ; Mass Screening ; Nursing ; Pressure Ulcer ; Prognosis ; Risk Factors ; Unconsciousness ; Ventilators, Mechanical ; Vital Signs

Purpose: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian’s structure–process–outcome model. Methods: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24. Results: In the final model, admission via emergency department (Β=.06, p=.019), age over 65 years (Β=.11, p=.001), unconsciousness (Β=.18, p=.001), dependent activities (Β=.12, p=.001), abnormal vital signs (Β=.12, p=.001), pressure ulcer risk (Β=.12, p=.001), enteral nutrition (Β=.12, p=.001), and use of restraint (Β=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (Β=.06,p=.038), hospital length of stay (Β=5.06, p=.010), and discharge to another facility (not home) (Β=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium. Conclusion The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.

PURPOSE: This study was done to identify prevalence of, and factors influencing metabolic syndrome among long-term care facility patients with schizophrenia. METHODS: A cross-sectional survey was conducted using a 20-item questionnaire. Clinical data for blood triglyceride, HDL-cholesterol, and fasting blood sugar were collected from medical records. Body weight, body fat, body mass index, blood pressure, height, and abdominal circumference were measured. Data for 198 participants were analyzed using t-test, x2 test and logistic regression. RESULTS: Prevalence of metabolic syndrome was 56.1%. The number of persons who overate was significantly higher in the metabolic syndrome group than in the normal group (p<.001). Factors influencing metabolic syndrome were hyperphagia (p<.001), abdominal circumference (p<.001), systolic blood pressure (p=.040), blood triglyceride (p<.001), fasting blood sugar (p=.015), and HDL-cholesterol (p<.001). CONCLUSION: The results indicate that nurses working with patients who have chronic schizophrenic should make an effort to help patients achieve control of overeating behavior and reduce abdominal circumference to prevent metabolic syndrome.
Adipose Tissue ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; Cross-Sectional Studies ; Fasting ; Humans ; Hyperphagia ; Logistic Models ; Long-Term Care ; Medical Records ; Mental Health* ; Metabolic Syndrome X ; Obesity ; Prevalence ; Schizophrenia* ; Triglycerides

Quality Improvement(QI) is the main agenda rising rapidly at the health policy. Recent policy trend like hospital evaluation with public reporting and evaluation of appropriateness in health insurance areas show that QI become the main target agenda of government. Especially, medical societies should give their attention to this policy change because QI related policies are closely related to the credibility of medical professionals for public. Medical professionals should understand problems which recent QI policies are confronted and ask for modification as follows: the duplication at several evaluation areas, ineffective evaluation approaches, etc.
Health Policy ; Insurance, Health ; Qi ; Quality Improvement* ; Societies, Medical

OBJECTIVES: The purpose of this study is to analyse factors related to the health promotion behavior on the basis of theory of reasoned action(TRA). METHODS: 509 residents in the city of Kyunggi-do were selected through multistage random sampling. A structured questionnaire was developed on the basis of Triandis model and collected by interviewing. RESULTS: Expectation toward act and social normative influence and age showed significant relationship to health promotion behavior. Also, facilitating factors, affective attitude, education level are indirectly related to health promotion behavior. CONCLUSIONS: The result suggest that TRA is useful in understanding the mechanism of health promotion behavior.
Education ; Gyeonggi-do ; Health Behavior* ; Health Promotion ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to identify how peer attachment and parenting style differentially affect self-concept and school adjustment in adolescents with and without chronic illness. METHODS: A cross-sectional study using multiple group analysis on the Korean panel data was used. A nationwide stratified multistage cluster sampling method was used and the survey was conducted in 2013 on 2,092 first-year middle school students in Korea. We used standardized instruments by the National Youth Policy Institute to measure peer attachment, parenting style, self-concept, and school adjustment. Multiple-group structural equation modeling was used to evaluate the difference of relations for peer attachment, parenting style, self-concept, and school adjustment variable between adolescents with chronic illness and those without chronic illness. RESULTS: The model fit of a multiple-group structural equation modeling was good. The difference of the path from negative parenting style to self-concept between the two groups was significant, and a significant between-group difference in the overall path was found. This indicated that self-concept in adolescents with chronic illness was more negatively affected by negative parenting style than in adolescents without chronic illness. CONCLUSIONS: Healthcare providers can promote the process of school adjustment in several ways, such as discussing this issue directly with adolescent patients, along with their parents and peers, examining how the organization and content of the treatment can be modified according to the adolescents' school life.
Adolescent ; Chronic Disease/*psychology ; Cross-Sectional Studies ; Female ; Humans ; Interpersonal Relations ; Male ; Object Attachment ; Parenting/psychology ; Peer Group ; Self Concept ; *Social Adjustment