1.Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki PARK ; Ji-Sook CHOI ; Min Sun SHIN ; Soomin KIM ; Hyekyoung KIM ; Nahyeong IM ; Soon Joo PARK ; Donggyo SHIN ; Youngmi SONG ; Yunjung CHO ; Hyunmi JOO ; Hyeryeon HONG ; Yong-Hwa HWANG ; Choon-Seon PARK
Yonsei Medical Journal 2025;66(3):179-186
Purpose:
This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.
Materials and Methods:
The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.
Results:
There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.
Conclusion
The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.
2.Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki PARK ; Ji-Sook CHOI ; Min Sun SHIN ; Soomin KIM ; Hyekyoung KIM ; Nahyeong IM ; Soon Joo PARK ; Donggyo SHIN ; Youngmi SONG ; Yunjung CHO ; Hyunmi JOO ; Hyeryeon HONG ; Yong-Hwa HWANG ; Choon-Seon PARK
Yonsei Medical Journal 2025;66(3):179-186
Purpose:
This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.
Materials and Methods:
The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.
Results:
There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.
Conclusion
The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.
3.Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki PARK ; Ji-Sook CHOI ; Min Sun SHIN ; Soomin KIM ; Hyekyoung KIM ; Nahyeong IM ; Soon Joo PARK ; Donggyo SHIN ; Youngmi SONG ; Yunjung CHO ; Hyunmi JOO ; Hyeryeon HONG ; Yong-Hwa HWANG ; Choon-Seon PARK
Yonsei Medical Journal 2025;66(3):179-186
Purpose:
This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.
Materials and Methods:
The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.
Results:
There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.
Conclusion
The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.
4.Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki PARK ; Ji-Sook CHOI ; Min Sun SHIN ; Soomin KIM ; Hyekyoung KIM ; Nahyeong IM ; Soon Joo PARK ; Donggyo SHIN ; Youngmi SONG ; Yunjung CHO ; Hyunmi JOO ; Hyeryeon HONG ; Yong-Hwa HWANG ; Choon-Seon PARK
Yonsei Medical Journal 2025;66(3):179-186
Purpose:
This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.
Materials and Methods:
The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.
Results:
There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.
Conclusion
The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.
5.Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea
Hyeki PARK ; Ji-Sook CHOI ; Min Sun SHIN ; Soomin KIM ; Hyekyoung KIM ; Nahyeong IM ; Soon Joo PARK ; Donggyo SHIN ; Youngmi SONG ; Yunjung CHO ; Hyunmi JOO ; Hyeryeon HONG ; Yong-Hwa HWANG ; Choon-Seon PARK
Yonsei Medical Journal 2025;66(3):179-186
Purpose:
This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.
Materials and Methods:
The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.
Results:
There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.
Conclusion
The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.
6.Medico-Artistic Analysis of Red Blood Cells in Gustav Klimt’s ‘The Kiss’
Hyunmi PARK ; Dai Hyun KIM ; Daeun KWAK ; Hwamin LEE ; Im Joo RHYU
Journal of Korean Medical Science 2024;40(5):e19-
Background:
This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings.
Methods:
This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old.
Results:
Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting.
Conclusion
This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.
7.Medico-Artistic Analysis of Red Blood Cells in Gustav Klimt’s ‘The Kiss’
Hyunmi PARK ; Dai Hyun KIM ; Daeun KWAK ; Hwamin LEE ; Im Joo RHYU
Journal of Korean Medical Science 2024;40(5):e19-
Background:
This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings.
Methods:
This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old.
Results:
Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting.
Conclusion
This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.
8.Experiences of Recording Electronic Nursing Notes among Ward Nurses in Two Hospitals
Hyunmi HWANG ; Geun-Hee KIM ; Yeoungsuk SONG
Journal of Korean Academy of Fundamental Nursing 2024;31(4):396-409
Purpose:
This study explored the experiences of recording electronic nursing notes among ward nurses in the hospital.
Methods:
A qualitative descriptive study was conducted. Data were collected through in-depth interviews with 15 nurses at two university hospitals in Daegu between November 2022 and April 2023. Hsieh and Shannon’s conventional content analysis method was applied, and MAXQDA was used for the analysis.
Results:
Three categories were identified from the data, with 12 subcategories and 46 codes. The three categories were as follows: utility, limitations to effective use, and seeking a way to expand functions efficiently.
Conclusion
Records involving electronic nursing notes played a very important role in patient care and legal protection, as well as serving as a guide to nursing diagnosis, a source of pride, and a resource with convenient functions. Areas for improvement relate to awareness, burden, discomfort, disparities, and obstacles to record-keeping. A more efficient record system needs to be established, with corresponding education. Furthermore, hospital administrators should provide policy support to improve the quality of nursing records.
9.Experiences of Recording Electronic Nursing Notes among Ward Nurses in Two Hospitals
Hyunmi HWANG ; Geun-Hee KIM ; Yeoungsuk SONG
Journal of Korean Academy of Fundamental Nursing 2024;31(4):396-409
Purpose:
This study explored the experiences of recording electronic nursing notes among ward nurses in the hospital.
Methods:
A qualitative descriptive study was conducted. Data were collected through in-depth interviews with 15 nurses at two university hospitals in Daegu between November 2022 and April 2023. Hsieh and Shannon’s conventional content analysis method was applied, and MAXQDA was used for the analysis.
Results:
Three categories were identified from the data, with 12 subcategories and 46 codes. The three categories were as follows: utility, limitations to effective use, and seeking a way to expand functions efficiently.
Conclusion
Records involving electronic nursing notes played a very important role in patient care and legal protection, as well as serving as a guide to nursing diagnosis, a source of pride, and a resource with convenient functions. Areas for improvement relate to awareness, burden, discomfort, disparities, and obstacles to record-keeping. A more efficient record system needs to be established, with corresponding education. Furthermore, hospital administrators should provide policy support to improve the quality of nursing records.
10.Medico-Artistic Analysis of Red Blood Cells in Gustav Klimt’s ‘The Kiss’
Hyunmi PARK ; Dai Hyun KIM ; Daeun KWAK ; Hwamin LEE ; Im Joo RHYU
Journal of Korean Medical Science 2024;40(5):e19-
Background:
This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings.
Methods:
This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old.
Results:
Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting.
Conclusion
This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

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