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일부 다빈도 입원 및 수술례의 진단과 치료과정에 대한 연구
김창엽,김윤,권영대,김용익,신영수,안형식,Kim, Chang-Yup,Kim, Yoon,Kwon, Young-Dae,Kim, Yong-Ik,Shin, Young-Soo,Ahn, Hyeong-Sik 대한예방의학회 1993 예방의학회지 Vol.26 No.3
The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.
김창엽,김선민 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.2
Background : Performance evaluation of medical care providers has become more important than before in Korea. Especially in university hospitals, job contents of medical staffs are so complicated that evaluation is not easily performed. In addition, in order that the feedback of evaluation be successful, acceptance of staffs to be evaluated is essential. This study is aimed at the development of items for evaluation and weighting of each item in one university hospital, and clustering departments by different weight given by medical staffs. Methods : Through resource group meeting, performance items were listed up by categories of education, research, medical services, and other activities in and out of the hospital. For each item, all the medical staffs were asked how important they thought, compared with publishing one original article. By factor analysis, the items in each category were grouped into a few subgroups. In turn, cluster analysis was done for the purpose of grouping departments by priority the medical staffs gave. Results and Conclusion : Among five major categories, medical staffs regard education, research, and medical services more important than other activities in and out of the hospital. Five categories consisted of two or three components. Departments in hospital were grouped into three. However, characteristics of each group was not clearly delineated. This result suggests that more comprehensive tool should be developed and applied in the process of performance evaluation in university hospitals.