고액진료비 환자의 특성 비교분석 - 의료보험과 의료보호환자를 중심으로 -

강선희,문옥륜,Kang, Sunny,Moon, Ok-Ryun 한국의료질향상학회 1996 한국의료질향상학회지 Vol.2 No.2

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

의무기록 완성도에 대한 병동순회 의무기록사제도의 개입효과

강선희,박훈기,이금순,문옥륜,정풍만,Kang, Sunny,Park, Hoon Ki,Lee, Keum Soon,Moon, Ok Ryun,Jung, Poong Man 한국의료질향상학회 1999 한국의료질향상학회지 Vol.6 No.1-2

Background : With the CQI concepts, which emphasize doing the right things right the first time, we tried to enhance the timely completion of medical records by changing the review process from retrospective method to concurrent one. Methods : Against the current retrospective QA activity, Medical record administrator did the concurrent QA of the inpatient medical records with the deficiency sheets. One general surgery ward was chosen as a trial one. The deficiency rate of the medical records of the discharged patients was compared before and after the enforcement of the system. Job analysis of the medical record departments was done about four tertiary care hospitals located in Seoul to estimate the cost and the time consumed by current system. Results : There was a little improvement in the completion rate of the medical records after the trial. The new system was effective. And job analysis showed that much money and time were wasted by current retrospective feedback system. Conclusion : Though the result was not so satisfactory, it should be considered that this test was a voluntary one and the interns and residents were not forced to complete the medical records during this trial period. If there be any strong motivation to complete the medical record in time, this system is sure to be succeed. As the DRG system requires the concurrent review of the medical records to confirm severity of the patient's illness and to assure the timely discharge, it is desirable to enforce this method with the DRG system together. DRG coding and reducing deficiency rate of the medical records can be accomplished simultaneously.

XML 기반 컴포넌트 명세서 모델링

강선희(Sunny Kang),이상돈(SangDon Lee),최한석(HanSuk Choi),박서영(Seoyoung Park) 한국정보과학회 2000 한국정보과학회 학술발표논문집 Vol.27 No.2Ⅰ

컴포넌트는 소프트웨어 재사용 기술의 핵심 기술로서, 소프트웨어 개발 시간을 단축시키고 생산성을 향상시킨다. 인터넷의 급속한 보급과 컴포넌트 시장의 확산으로 컴포넌트 사용자들이 인터넷 상에서 검색, 저장, 유통하기 위하여 컴포넌트 명세가 정의되어야 한다. 컴포넌트 명세는 컴포넌트 특성을 명확히 이해하기 위하여 구문적(syntatic), 의미(semantic), 그들 사이의 관계, 사용 문맥, 품질 속성들을 포함한 정보가 기술되어야 한다. 본 논문에서는 컴포넌트를 명세하기 위한 명세 요소들을 살펴보며, 컴포넌트를 표현하기 위한 기술 방법들을 정의한다. 또한, 컴포넌트 메타데이터 및 리소스 정보, 외부 인터페이스들의 논리적 구조 및 시맨틱 표현기법을 연구하고 컴포넌트 명세서 표현을 위한 메타데이타 모델을 근거로 컴포넌트 명세서를 효과적으로 생성할 수 있는 XML 기반 컴포넌트 명세서 확장 모델을 개발하고자 한다.

주문형 데이타 방송 시스템을 위한 인덱스 및 방송 데이타 구성

강선희(Sunny Kang),이상돈(Sangdon Lee) 한국정보과학회 2005 정보과학회논문지 : 데이타베이스 Vol.32 No.4

무선 이동 컴퓨팅 환경에서 배터리 용량은 클라이언트의 유용성을 결정하는 중요한 자원이다. 그러므로 무선 컴퓨팅 환경에서 데이타 방송 기법은 데이타를 빠르게 전달하는 것은 물론 이동 클라이언트의 배터리 소모를 감소시킬 수 있는 효율적인 데이타 전달 기법을 필요로 한다. 본 논문에서는 주문형 데이타 방송 환경을 위한 인덱스 구성과 방송 데이타 구성 방안에 대하여 제안한다. 제안 기법은 방송 서버 내에서 우선순위가 높은 데이타를 대상으로 개별 데이타의 방송 시간이 포함된 인덱스 정보를 구성하여 먼저 방송 시킴으로써 이동 중인 이동 클라이언트의 적응 시간을 줄인다. 또한 다음 인덱스 정보가 방송될 시점을 데이타 방송시 포함시킴으로써 인덱스 정보의 수신을 위해 필요한 적응 시간을 감소시킨다. 제안 기법이 효과적으로 이동 클라이언트의 적응 시간을 감소시키는 것을 실험을 통해 검증한다. Battery capacity of mobile clients in wireless mobile computing environments is one of the important resources that determine the availability of mobile clients. So, data broadcast techniques in mobile computing environments need not only rapid delivery of requested data but also efficient data delivery mechanisms which can reduce battery consumption of mobile clients. This paper proposes organization of an index and broadcast data for on-demand data broadcast. It organizes an index containing broadcast time of each data using some of high-priority data in a broadcast server. By sending such index information prior to the corresponding data, the proposed approach reduces tuning time of mobile clients. It also includes when the next index information will be broadcasted in each data broadcast. This can reduce tuning time of mobile clients waiting for an index to be broadcasted. Experiments show that the proposed approach effectively reduces tuning time of mobile clients.

주문형 데이타 방송을 위한 인덱스 구성

강선희(Sunny Kang),이상돈(Sangdon Lee) 한국정보과학회 2004 한국정보과학회 학술발표논문집 Vol.31 No.2Ⅱ

무선 이동 컴퓨팅 환경에서 자원의 비대칭성을 효과적으로 극복하는 것이 매우 중요하다. 이 중에서도 배터리 용량은 클라이언트의 유용성을 결정하는 중요한 자원이다. 그러므로 무선 컴퓨팅 환경에서 매우 효과적인 데이터 방송 기법은 데이터를 빠르게 전달하는 것은 물론 이동 클라이언트의 배터리 소모를 감소시킬 수 있는 효율적인 데이터 전달 기법을 필요로 한다. 본 논문에서는 주문형 데이터 방송 환경을 위한 인덱스 구성 방안을 제안한다. 제안 기법은 방송 서버에서 대기중인 데이터 접근 요구 중 방송 우선순위가 높은 일부 데이터를 대상으로 인덱스를 구성하여 미리 방송함으로써 이를 참조하는 클라이언트의 적응시간을 감소시켜 전력소모를 줄이도록 한다. 제안 기법이 효과적으로 이동 클라이언트의 적응 시간을 감소시키는 것을 실험을 통해 검증한다.

의료기관 종별 의무기록 중요서식 항목별 작성 실태 및 의무기록 완결점검표 분석

서순원,김광환,황용화,강선희,강진경,조우현,홍준현,부유경,이현실 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.2

Background : This study is to suggest the standardized format of the clinical sheets and the standardized items of every clinical sheet. The standardization of the medical records will increase the faithfulness of the contents in them and it will contribute to construct the good health information system. Method : From Jan. 1st. 2001 to March 31st 2001, we gathered as many paper clinical sheets as possible by every class of institutions to review the faithfulness of the clinical contents in them. Clinical sheets of 9 tertiary care hospitals, 6 general hospitals and 56 clinics were gathered. Two experienced medical record administrators reviewed them. The review focus was to check whether the items recommend by the hospital standardization review criteria and hospital service evaluation organization were appeared in the clinical sheets and whether the contents of every item were written. Results : Tertiary care hospitals ; In case of administrative data, the contents were filled well if the items were fixed. The clinical data like C.C, history, physical examiniation were filled well, but if the items were not fixed, some items were omitted. The result is that more items are to be filled if they are fixed. General hospitals Administrative data were filled more than 50%. Final diagnosis was filled about 66.7%. But other clinical data were not filled well and not many clinical related items were appeared in the sheets. In the legal point of view, the reason for visiting hosptals or the right diagnosis, patient condition at discharge could not be confirmed well. In surgery cases, surgical procedures could not be confirmed well as many surgical related information(surgery time, fluids and blood, number of sponges, biopsy, etc) were omitted. Clinics : More than 70% administrative data were filled and fixed as items. Among the clinical related data, laboratory result was the most credible data. But without the right diagnosis, drug orders were given and doctors’ written signatures were not appeared over 96.4%. So the clinical sheets cannot be used as a legal document. Conclusion : There was a tendency that the contents were filled well if the items were fixed in the documents, We also suggest a clinical check list to review the completeness and faithfulness of the clinical sheets. If many hospitals use the suggested clinical check list and in they make the necessary items fixed in the clinical sheets, the quality of the medical record will increase dramatically.