Earticle

The objective of this study is to analyze the utilization patterns of other region inpatients in general hospitals located in Seoul area. For the analysis, the study utilize the nationwide data on ‘2008 Survey of Patients’ of Ministry of Health & Welfare. The statistical methodology used in the study is the logistic regression model. This study has three major findings. First, the significant affecting sociodemographic factors in selecting general hospitals located in Seoul area was sex, age, type of payment and inpatients residence region. Second, compared to other disease groups, the inpatients on both ‘congenital malformation, deformity and chromosomal abnormalities’ and ‘neoplasm’ groups are more likely to utilize general hospitals in Seoul area. Furthermore, in ‘neoplasm’ disease group, inpatients with ‘bones and articular cartilage malignant neoplasm’ are more likely to utilize general hospitals in Seoul area. Finally, hospitals with more than 1,000 beds was chief factor in selecting Seoul-based hospitals by other region inpatients. In conclusion, the study showed that other region inpatients are more likely to utilize general hospitals located in Seoul area in case of severe disease, rare case and surgical case. Therefore, central and local authority is required to monitor local hospitals on quality of the medical service as well as support them to establish specialized medical centers by providing human and physical resources.

Purpose: The aim of this study was to examine the utilization of and satisfaction with the smart bedside station (SBS) system among users in a hospital. Methods: A cross-sectional descriptive design was used. The participants were 190 patients, 186 family caregivers, and 154 nurses in a hospital. Results: Around 78.1% of patients or family caregivers used the SBS system at least once during their hospital stay. The commonly used items on the SBS system menu were "lab findings", "hospital cost", "today's medication", and the "alarm message". Satisfaction with the SBS system of patients and family caregivers were significantly higher than those of nurses (F=39.88, p<.001). Conclusion: A patient-centered SBS system was a useful system that could increase patient satisfaction and comfort. More specific and technical service contents reflecting the current healthcare system should be added.

Background: Woosuk University College of Pharmacy delivered patient counseling education and administered Objective Structured Clinical Examination (OSCE) by utilizing standardized patients (SP) in Introductory Pharmacy Practice course. Surveys were conducted to examine students’ perception of SP and its impact on experiential education. Methods: Students learned patient counseling by didactic lecture and role-play, followed by hands-on practice with SP. Then, patient counseling skills were assessed during OSCE by utilizing SP. The first survey was conducted immediately after OSCE, and the second survey after the completion of Pharmacy Practice Experiences (PPEs). Results: According to the surveys, majority of the students agreed that utilizing SP was effective in building confidence for conducting patient counseling, reflecting on strengths and weaknesses of communication skills, and preparing for PPEs. It was particularly more effective than role-play in simulating patient counseling in a real pharmacy and reflecting on oneself. Also, OSCE was an appropriate method to assess patient counseling skills and utilizing SP for this purpose was well-suited. Conclusion: Although it is very new in South Korea, other developed countries are already widely utilizing SP, and its importance and necessity have been proven by several studies. Therefore, Korean colleges of pharmacy should begin discussing how to utilize SP to improve students’ communications skills and implementing OSCE to evaluate those skills.

Purpose: To assess the prevalence of malnutrition in gynecologic cancer patients using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. Materials and Methods: A total of 97 gynecologic cancer patients who never had any treatment but were planned for surgery were enrolled. The patients were asked to complete the scored PG-SGA form before the treatment was started. Attending physicians were also asked to complete other information in the PG-SGA form. Total scores were calculated and the patients were classified into 3 nutritional status levels. Results: Mean age was 54 years. Postoperative diagnoses were endometrial cancer in 42 cases (43.2%), ovarian cancer in 29 cases (29.9%), and cervical cancer in 26 cases (26.8%). Mean PG-SGA score was 5.2+4.7. Malnutrition (PG-SGA B and C) was found in 52 patients (53.6%, 95% CI 43.7% - 63.2%). Preoperative BMI, hemoglobin, serum albumin, and cancer stage were not significantly associated with nutritional status. Malnutrition was significantly more common among patients diagnosed with ovarian cancer, compared to other types of cancer (79.3% vs. 42.6%, p 0.004). Conclusions: Prevalence of malnutrition among gynecologic cancer patients was 53.5%, according to the scored PG-SGA. Malnutrition was significantly more common among patients with ovarian cancer.

Patient reported outcome measures (PROMs) are essential for clinical research and patient-centric care because they allow us to capture patient perspectives on their health condition. In knee arthroplasty, PROMs are frequently used to assess the risks and benefits of new interventions, surgical approaches, and other management strategies. A few examples of PROMs used in total knee arthroplasty (TKA) include the Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Forgotten Joint Score (FJS) (collectively referred to as “legacy” PROMs). More recently, attention has been brought to another PROM called the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS was developed by the National Institute of Health (NIH) and has over 300 domains assessing various aspects of patient health, including pain, physical function, and mental health. With the use of PROMIS increasing in TKA literature, there is a need to review the advancements being made in understanding and applying PROMIS for this population. Thus, the purpose of this study is to provide insight on the utilization, advantages, and disadvantages of PROMIS within the field of knee arthroplasty and to provide a comparison to legacy PROMs.

Objectives: To develop a tool which can easily access the hospital information system (HIS) to facilitate outpatient care and maximize patient satisfaction on his or her hospital visit. Methods: Our Center for Informatics developed an outpatient guidance system (OGS) after careful analysis of the list of daily tasks undergone by patients and related work processes. Bluetooth beacons were installed to assist patients, to inform them of points of interest, and to guide them along the proper routes to and within the hospital. Results: The OGS conveniently provided patients’ clinic schedules, routes to the hospital, and direct costs; all of this information was embedded in the HIS accessed from patients’ personal mobile devices or kiosks. Patients were also able to identify their locations within the hospital, receiving proper directions to subsequent task. Since its launch in October 2014, the number of mobile accesses increased from 4,011 to 8,242 per month within a year. Conclusions: The substantial growth of interest in and use of our OGS in such a short period indicate that this system has been successfully incorporated into patients’ daily activities. We believe that this system will continue to help improve health services and the well-being of those visiting the hospital.

PurposeThe current study aimed to identify the overall characteristics of cancer-related emergency department (ED) visits by adult in Korea, including analyses of factors associated with ED stay time and outcomes nationwide. Materials and MethodsWe collected data on cancer-related ED visits from the National Emergency Department Information System (NEDIS) database between 2017 and 2019. ResultsED visits by cancer patients comprised 5.5% (667,935 visits) of total ED visits from 2017 to 2019, which was slightly higher than in other counties. Patients with cancer who visited the ED were over 50 years old, the majority being males, and patients with cancer visited EDs in certified tertiary hospitals more frequently than patients without cancer. In multivariate analyses, the adjusted odds ratio for a length of stay more than 8 hours in the ED of certified tertiary hospitals was 126.34 (95% confidence interval, 1.422 to 1.460) when compared to hospitals. Nevertheless, the longer the patients stayed in the ED, the more likely they were to be admitted. ConclusionThe longer ED stay and higher proportion of cancer patient hospitalizations suggest that cancer patients visit ED to be admitted as well as to receive acute care. The frequency of ED visits and admission may be adjusted to some extent depending on outpatient education, such as self-management of symptoms and situations. Improving cancer care in local communities should be met though provisions such as linking treatment between hospitals or supplying appropriate medical personnel, even for the efficient use of ED resources in hospitals.

Purpose: This study aimed to confirm the decision-making patterns for life-sustaining treatment (LST) and analyze medical service utilization changes after enforcement of the Life-Sustaining Treatment Decision-Making Act. Materials and methods: Of 1,237 patients who completed legal forms for life-sustaining treatment (hereafter called the LST form) at three academic hospitals and died at the same institutions, 1,018 cancer patients were included. Medical service utilization and costs were analyzed using claims data. Results: The median time to death from completion of the LST form was three days (range, 0 to 248 days). Of these, 517 people died within two days of completing the document, and 36.1% of all patients prepared the LST form themselves. The frequency of use of the intensive care unit, continuous renal replacement therapy, and mechanical ventilation was significantly higher when the families filled out the form without knowing the patient's intention. In the top 10% of the medical expense groups, the decision-makers for LST were family members rather than patients (28% patients vs. 32% family members who knew and 40% family members who did not know the patient's intention). Conclusion: The cancer patient's own decision-making rather than the family's decision was associated with earlier decision-making, less use of some critical treatments (except chemotherapy) and expensive evaluations, and a trend toward lower medical costs.

Providing free primary care to everyone is an important goal pursued by many countries under universal health care programs. Countries like India need to efficiently utilize their limited capacities towards this purpose. Unfortunately, due to a variety of reasons, patients incur substantial travel and out-of-pocket expenses for getting primary care from publicly-funded facilities. We propose a set-covering optimization model to assist health policy-makers in managing existing capacity in a better way. Decision-making should consider upgrading centers with better potential to reduce patient expenses and reallocating capacities from less preferred facilities. A multinomial logit choice model is used to predict the preferences. In this article, a brief background and literature survey along with the mixed integer linear programming (MILP) optimization model are presented. The working of the model is illustrated with the help of numerical experiments.

Background and Purpose Upon referral from the primary care provider (PCP), dementia is diagnosed either by a neuropsychological evaluation (NPE) or at a multidisciplinary neurocognitive clinic (MNC). Following the NPE, patients continue receiving care from their PCP. In contrast, patients at the MNC are followed by a multidisciplinary care team that provides expertise across specialties in dementia care and education for the patient, family members, and care providers. The purpose of the study was to determine the utilization of acute healthcare services during the 2 years following a diagnosis of dementia in patients from the MNC and NPE. Methods A retrospective review was performed of 581 electronic medical records from January 2010 through December 2014 for 2 cohorts of patients diagnosed with dementia 1) by a neuropsychologist or 2) in a MNC. Acute-care hospital admissions, emergency room (ER) visits, and nonroutine PCP visits were identified. Categorical demographics and utilization variables were summarized by frequency. Chi-square analysis was used to analyze demographic characteristics and overall utilization between MNCs and NPE. Utilization in comparison with various demographic characteristics was analyzed using Spearman correlation coefficients and negative binomial regressions. Results Patients evaluated in the MNC were older, more severely impaired, and lived alone more often compared with NPE patients, but there was no increase in hospital admissions and ER visits. Patients who underwent NPE were 1.58 times more likely to have a nonroutine PCP office visit than patients evaluated in the MNC (p=0.0093). Conclusions Performing follow-up in multidisciplinary clinics provides patients with more education and may help to reduce the utilization of healthcare services.

Purpose The female sex is reported to have a higher risk of adverse events (AEs) from cytotoxic chemotherapy. Few studies examined the sex differences in AEs and their impact on the use of medical services during adjuvant chemotherapy. This sub-study aimed to compare the incidence of any grade and grade ≥ 3 AEs, healthcare utilization, chemotherapy completion rate, and dose intensity according to sex. Materials and Methods This is a sub-study of a multicenter cohort conducted in Korea that evaluated the impact of healthcare reimbursement on AE evaluation in patients who received adjuvant chemotherapy between September 2013 and December 2016 at four hospitals in Korea. Results A total of 1,170 patients with colorectal, gastric, or non?small cell lung cancer were included in the study. Female patients were younger, had fewer comorbidities, and experienced less postoperative weight loss of > 10%. Females had significantly higher rates of any grade AEs including nausea, abdominal pain, stomatitis, vomiting, and neutropenia, and experienced more grade ≥ 3 neutropenia, nausea, and vomiting. The dose intensity of chemotherapy was significantly lower in females, and they also experienced more frequent dose reduction after the first cycle. Moreover, female patients receiving platinum-containing regimens had significantly higher rates of unscheduled outpatient visits. Conclusion Our study found that females experienced a higher incidence of multiple any-grade AEs and severe neutropenia, nausea, and vomiting, across various cancer types, leading to more frequent dose reductions. Physicians should be aware of sex differences in AEs for chemotherapy decisions.

Objectives: This study aimed to explore nurses’ perceptions of, and utilization plans for, companion robots to support thephysical and mental health of patients with acute stroke. In addition, the study sought to provide foundational data for thedevelopment of companion robots tailored to acute stroke patients. It also investigated obstructive factors and potential solutionsto difficulties encountered when applying companion robots in the care of patients with acute stroke. Methods: Usingthe Delphi technique, this study surveyed 14 nurses working in the neurology ward and stroke intensive care unit of a tertiaryhospital in Seoul across three survey rounds. Results: After completion of the three Delphi survey rounds, Cronbach’s α was0.78, and stability values were all below 0.5; therefore, no additional rounds were conducted. A total of 54 items were finallyselected, including 10 items related to educational aspects for nurses and patients, 12 items addressing impacts on nurses andpatients, 19 items describing companion robot functions required for stroke patients, and 13 items identifying the most appropriatedesign elements. Conclusions: Companion robots are expected to contribute to the physical and emotional care ofpatients with acute stroke admitted to tertiary hospitals by functioning as a nursing intervention, while also reducing nurses’workload, improving the quality of nursing care, and supporting patient safety management. In addition, efforts should bemade to ensure the harmonious control and utilization of newly developed robots and to strengthen robot-related job competenciesamong nurses.

Background and Purpose Patients with refractory myasthenia gravis (MG) experience ongoing disease burden that might be reflected in their healthcare utilization. Here we examine the impact of refractory MG on healthcare utilization. Methods The 825 included participants were aged 18?64 years, enrolled in the Myasthenia Gravis Foundation of America Patient Registry between July 2013 and February 2018, and had been diagnosed with MG ≥2 years previously. Results Participants comprised 76 (9.2%) with refractory MG and 749 (90.8%) with nonrefractory MG. During the 6 months before enrollment, participants with refractory MG were significantly more likely than those with nonrefractory MG to have experienced at least one exacerbation [67.1% vs. 52.0%, respectively, p=0.01; odds ratio (OR)=1.882, 95% confidence interval (CI)=1.141?3.104], visited an emergency room at least once [43.4% vs. 27.1%, p<0.01; OR=2.065, 95% CI=1.276?3.343], been hospitalized overnight at least once (32.9% vs. 20.5%, p=0.01; OR=1.900, 95% CI=1.140?3.165), ever been admitted to an intensive care unit (ICU) (61.8% vs. 33.4%, p<0.01; OR=3.233, 95% CI=1.985?5.266), or ever required a feeding tube (21.1% vs. 9.1%, p<0.01; OR=2.671, 95% CI=1.457?4.896). A total of 75.8% younger females with refractory disease (<51 years, n=33) experienced at least one exacerbation, 69.7% had been admitted to an ICU, and 30.3% had required a feeding tube. For older females with refractory disease (≥51 years, n=33), 60.6%, 54.6%, and 6.1% experienced these outcomes, respectively (between-group differences were not significant). Conclusions Refractory MG is associated with higher disease burden and healthcare utilization than nonrefractory MG.

본 연구는 경상북도 구급 서비스 이용한 환자를 대상으로 코로나19 발생 전·후와 소방 대응 시기별에 따른 관련 요인별 환자 변화를 분석하고자 하는 후향적 관찰 연구이다. 연구 대상은 2019년 1월 20일부터 2021년 1월 19일까지 코로나19 전후 2년 동안 경상북도 119구급대를 이용한 이송된 환자로 하였고, 최종 분석 대상자는 코로나 유행 전 102,640명, 코로나19 유행 이후 91,152명으로 총 연구 대상자는 193,792명으로 하였다. 코로나19 발생 전·후와 소방 대응 시기에 따른 인구학적·이송 접근성과 임상적 특성의 범주형 변수는 빈도와 백분율로 나타내었고 유의성 검정은 카이제곱으로 분석하였다. 구급 이송 건수는 코로나19 유행 후 11,488명(11.2%) 감소하였고, 관할 외 지역, 병원 이송 거리가 30km 이상인 장거리 병원 이송이 크게 늘었고(p<.001), 대구·경북 1차 유행기인 2기에서 증가하였다(p<.001). 코로나19 유행 이후 60대 이상 환자 이송 분율이 55.8%로 고령층 이송이 증가하였다(p<.001). 손상 환자는 감소하였고, 심한 의식변화, 준 응급환자가 증가하였다(p<.001). 환자 증상 중 고열, 기침이 코로나19 유행 후 가장 높은 증가율을 보였으며(p<.001), 신경계 증상인 어지러움(5.3% 대 8.3%)과 소화기 계통의 오심·구토(6.9% 대 9.8%)가 코로나19 유행 후에 다른 증상보다 증가하였다(p<.001). 이상의 연구 결과 지리적 여건과 의료자원 부족 등으로 구급 이송에 취약한 경상북도 지역을 고려할 때, 감염병 유행 시기 장거리 이송과 고령층 이송에 대한 대응 프로토콜 개발이 필요하며, 본 연구는 코로나19 유행이 경상북도 지역의 구급활동일지를 활용한 구급 서비스 이용 양상에 미친 영향을 분석한 최초의 연구로, 향후 의료취약지역에서 감염병 대응 시스템을 구축하는데 중요한 기초자료로 활용될 수 있다.

Objective: This study is a retrospective observational study of patients who used emergency services in Gyeongsangbuk-do to analyze the changes in patients by relevant factors before and after the COVID-19 outbreak and by the timing of firefighting response. Methods: The study population included patients transported by Gyeongsangbuk-do 119 ambulance service during the two years before and after COVID-19 from January 20, 2019 to January 19, 2021. The final analysis included 102,640 patients before the outbreak and 91,152 patients after the outbreak, for a total of 193,792 patients. The categories of demographic and transportation accessibility and clinical characteristics according to the time before and after the occurrence of Covid-19 were expressed in frequency and percentage, and significance tests were analyzed by Chi-Square. Results: The number of emergency transfers decreased by 11,488 cases (11.2%) after the coronavirus outbreak, while transfers to hospitals outside the jurisdiction and to long-distance hospitals over 30 km away showed the largest increase (p<.001). This increase was particularly evident during the second period, which corresponds to the first epidemic wave in the Daegu and Gyeongsangbuk-do regions (p<.001). After the coronavirus outbreak, the proportion of patients aged 60 or older increased to 55.8% (p<.001). The number of injured patients decreased, while the number of patients with severe changes in consciousness and those in semi-emergency situations increased (p<.001). Among patient symptoms, high fever and cough showed the greatest increase after the coronavirus outbreak (p<.001). Neurological symptoms, such as dizziness (5.3% vs. 8.3%), and digestive symptoms, such as nausea and vomiting (6.9% vs. 9.8%), also saw significant increases after the outbreak (p<.001), rising more than other symptoms (p<.001) Conclusion : In consideration of the Gyeongsangbuk -do region, which is vulnerable to the transfer due to geographical conditions and lack of medical resources, it is necessary to develop a response protocol for long-distance transport and senior citizens, and this study is the first study to analyze the influence on the use of first aid services using the first emergency service in Gyeongsangbuk-do. It can be used as an important basic data to build an infectious disease response system in medical vulnerable areas.

본 연구의 목적은 시뮬레이션 실습교육의 학습효과를 고충실도 시뮬레이터와 표준화환자를 활용한 실습으로 구분하여 분석하고, 효과크기에 영향을 주는 조절변수들을 파악하기 위함이다. 이를 위해 2000년 1월∼2023년 1월까지 출판된 국내와 국외 논문 중에서 선정기준에 적합한 논문 총 20편을 선정하여 RevMan 5.4 프로그램과 R 프로그램을 사용하여 분석하였다. 시뮬레이션 실습교육의 학습효과는 인지적, 정의적, 그리고 심동적 영역으로 구분하여 효과크기를 분석하였다. 고충실도 시뮬레이터를 활용한 실습은 인지적, 정의적 영역에서 효과가 있었다. 효과크기는 인지적 영역의 지식(ES=0.99, p <.001), 비판적사고(ES=0.20, p=.05)와 정의적 영역의 자기효능감(ES=0.41, p=.002), 임상수행능력(ES=1.05, p=.003), 실습만족도(ES=0.68, p=.007), 자신감(ES=0.58, p=.01)에서 통계적으로 유의한 차이가 있었으며, 심동적 영역에서는 효과가 없었다. 표준화환자를 활용한 실습은 인지적영역과 지식(ES=2.08, p <.001)에서 효과가 있었고 통계적으로 유의한 차이가 있었다. 시뮬레이션 실습교육 효과의 이질성(I²)이 높았던 인지적, 정의적, 심동적 영역에서 학년, 중재기간, 교과목을 변수로 하여 메타 ANOVA를 수행하였다. 그 결과, 고충실도 시뮬레이터를 활용한 실습이 인지적 영역의 학년(Q=16.55, p <.001), 교과목(Q=6.23, p=044)에서 집단간 통계적인 이질성이 나타났다. 이러한 결과를 근거로 향후 시뮬레이션 실습교육 설계에서 고충실도 시뮬레이터와 표준화환자를 적절하게 선택하여 활용할 것을 제안한다.

The purpose of this study is to systematically analyze the effect of simulation practice education by dividing it into HFS(high-fidelity simulator) use and SP(standardized patient) use. A total of 20 studies were selected from domestic and foreign studies published from January 2000 to January 2023 and analyzed using the RevMan 5.4 program and the R program. The effect size was analyzed by dividing the effect of simulation practice into cognitive, affective, and psychomotor domains. In the case of using a HFS, it was effective in the cognitive and affective domains. The effect size showed a statistically significant in nursing knowledge and critical thinking in the cognitive domain, and self-efficacy, clinical performance ability, practice satisfaction, confidence in the affective domain. But there was no effect in the psychomotor domain. SP utilization practice had a statistically significant effect in cognitive areas and knowledge. As a result of meta-ANOVA with grade, intervention duration, and subject as control variables in the domains, statistical heterogeneity was found in the grade and subject in the cognitive domain when the HFS was used. Based on these results, I suggest that HFS and SP be appropriately selected and utilized in future simulation practice education design.

Salicylate poisonings are divided into acute and chronic syndromes. The most challenging aspect of the management of aspirin-poisoning may be recognition of subtle signs and symptoms of chronic, unintentional overdose. Chronic poisoning typically occurs in elderly as a result of unintentional overdosing on salicylates used to treat chronic conditions. Treatment is directed toward preventing intestinal absorption of the drugs and enhanced elimination. After the first-line treatments, aspirin overdose with its complications of hemodynamic, electrolyte and acid-base issues, is best managed by prompt hemodialysis. We report a case of a 87-year-old woman, who presented with acute on chronic salicylate poisoning. After early continuous venovenous hemodiafiltration, old woman made a good recovery from the salicylism but suffered paralytic ileus caused by aspirin enteroliths. Physician can decide a prompt hemodialysis for salicylate-poisoned patients, who worsen clinical courses despite of first-line therapies.

본 연구는 의료기관평가인증원이 발표한 환자안전통계자료를 활용하여 국내 요양병원에서 발생한 환자안전사고의 빈도, 위해수준 및 관련요인을 파악하여 추후 위해발생의 위험을 감소시키기 위한 시스템 개선전략 개발의 기초자료를 제공하기 위해 수행되었다. 2018~2022년까지 요양병원에서 발생한 환자안전사고 중에서 10,117건을 대상으로 병원관련 특성 및 환자관련 특성에 따른 환자안전사고의 위해정도의 차이는 χ2를 통한 교차분석을 하였고, 환자안전사고의 위해발생에 영향을 미치는 요인은 이항로지스틱회귀분석을 실시하였다. 위해발생위험은 500병상 이상에 비해 200병상 미만은 약 1.2배, 200~500병상 미만인 경우는 약 1.4배 높았고 투약오류에 비해 상해인 경우 약 74.8배, 자살 · 자해는 약 24.9배, 식사는 약 10.7배, 낙상은 약 7.6배 높았다. 200병상 미만의 요양병원은 법적인 사각지대에 놓여있고, 환자안전사고의 위해발생위험도가 높기때문에 환자안전관리법제화가 필요하며 상해는 투약오류에 비해 위해발생위험이 매우 높기때문에 요양병원의 상해발생원인을 구체적으로 파악하여 예방대책을 마련하는 것이 시급할 것으로 생각된다.

This study aimed to analyze the frequency, severity, and associated factors of patient safety incidents in long-term care hospitals in Korea, utilizing patient safety statistics. The objective was to provide foundational data for the development of system improvement strategies aimed at reducing the risk of harm occurrence in the future. From 2018 to 2022, a total of 10,117 patient safety incidents occurring in long-term care hospitals were analyzed. Cross-tabulation using chi-square tests was conducted to examine differences in the severity of patient safety incidents based on hospital-related characteristics and patient-related characteristics. Additionally, binary logistic regression analysis was performed to identify factors influencing the occurrence of harm in patient safety incidents. The risk of harm occurrence was approximately 1.2 times higher in hospitals with fewer than 200 beds and about 1.4 times higher in hospitals with 200-500 beds compared to those with over 500 beds. Furthermore, compared to medication errors, the risk of harm occurrence was approximately 74.8 times higher for injuries, 24.9 times higher for suicide·self-harm incidents, 10.7 times higher for meal-related incidents, and 7.6 times higher for falls. Given that long-term care hospitals with fewer than 200 beds are in a legal gray area and have a higher risk of harm occurrence in patient safety incidents, legislation for patient safety management is necessary. Additionally, since injuries pose a significantly higher risk of harm occurrence compared to medication errors, it is imperative to accurately identify the causes of injuries in long-term care hospitals and devise prevention measures.

Objectives:This study aimed (1) to investigate the utilization of the reporting system for the medical errors among Korean hospitals. (2) to investigate the utilization of computerized reporting system for the medical errors among Korean hospitals. Methods:Among 283 Chairs of the nursing department surveyed, 99(34.98%) returned the completed self-report questionnaire. A questionnaire devised by researchers was used for a survey through mail. Data were analyzed using SPSS 10.0. Results:Seventy four hospitals(75.51%) had official reporting systems, and 46 hospitals(47.42%) had official reporting procedures of medical error. The responsible staffs reporting to the president include department head(91.14%), administrative officer(8.86%), and the involved person(s)(5.06%). Forty four hospitals(44.90%) did not guarantee anonymity in reporting or recording medical errors. Medical errors were reported mostly on the paper(75hospitals, 76.53%) or verbally, and only three hospitals(3.06%) used the computerized reporting system. Conclusion:Systemic evaluation of the medical errors based on the prompt and voluntary report is an essential step to reduce systemic errors and improve patient safety. To guarantee anonymity and non-punitive treatment to the reporting, a computerized reporting system should be actively utilized in Korea.

연구 결과, 총 2,058명의 입원환자 중 14.5%인 298명이 장애인 환자 및 가족 등에 의해 입원하였다. 입원한 환자들은 17세 이하의 환자보다 18-44세 환자, 45-64세 환자, 65세 이상 환자가 각각 27.332배, 28.823배, 26.113배 많았고, 의료기관 종별유형에서 상급종합병원에 입원한 환자보다 병원 및 의원과 노인 및 요양병원에 입원한 환자가 각각 1.980배, 12.785배 많았으며, 재원 기간에서 13일 이하로 입원한 환자보다 29-30일 입원한 환자와 31일 이상 입원한 환자가 각각 8.108배, 1.635배 많았고, 진료비 지급유형에서 건강보험환자보다 의료급여환자와 국가 유공자 및 가족 특례 환자가 각각 4.499배, 3.836배 많았으며, 의료기관 선택 사유에서 다니던 병원이었기 때문에 입원한 환자보다 병원이 가까우므로 입원한 환자가 1.635배 많았다. 이에 따라, 장애인 환자 및 가족 등에 의해 입원된 장애인들이 적절한 곳에서 의료이용이 되기 위해서는 다양한 보건의료 이용정책(입원기준 마련, 사전입원허가제 도입, 본인부담금 책정 일원화, 보건의료이용정보체계 개선, 덴마크와 스웨덴의 지역사회 중심의 통합의료서비스체계 구축)들이 개발되어야겠다.

We used the 2008-2015 Korea Health Panel Data. Of the total 2,058 cases of admission, 298 cases(14.5%) of admissions are made by the decision of patients or their families with disabilities. The multiple logistic regression analysis shows that the admission decision by patients or their families with disabilities(ADPFD) is higher in the 18-44 years age group(OR:27.332) and 45-64 years of age group(OR:28.823) and 65 years old or older years of age group(OR:26.113) compared with the under 17 years age group. the ADPFD rate is higher in the patients admitted in hospital or clinics(1.980) and geriatric hospital or convalescent hospital(OR:12.785) than that of admitted in superior general hospitals. the ADPFD rate is higher in the patients admitted in 29-30 days(OR:8.108) and more than 31 days(OR:1.635) than that of admitted 13 days or less. In addition, The ADPFD rate is higher in the medical aid’s group(OR:4.499) and national merit reward beneficiaries and their family’s group(OR:3.836) compared with the National health insurance’s group. Accordingly, various health care utilization policies should be developed in order to enable disabled people who are admitted by patients with disabilities and their families to use medical services in appropriate places.

Objectives: The purpose of this study is to reflect the patient's perspective in the process of developing Korean medicine clinical practice guideline (CPG) of puerperal wind disorder by survey. Methods: Five hundred fifty patients were surveyed from November 3rd, 2021 to November 8th, 2021 by internet. This study is an exploratory cross-sectional survey study, and descriptive statistics and frequency analysis were conducted on respondents' general characteristics, postpartum symptoms, the history of using treatment institution for puerperal wind disorder, satisfaction of medical institutions and perception of postpartum care. Results: Survey results showed that 92.0% of respondents experienced symptoms after childbirth, and 56.2% of the symptoms were arthralgia, followed by obesity with 41.8%. Among puerperal wind disorder patients, 34.2% had treatment history, and 54.3% received Korean medical treatment. Treatment satisfaction was confirmed to be higher in Korean medical treatment. The necessity of postpartum care was recognized at 95.7% of respondents, and the performance rate of traditional Korean postpartum care was also high. Conclusions: Based on a realistic patient-centered basis, it is a study that can lay the foundation for standardizing Korean medicine treatment and strengthening coverage in the future.