지역간 의료이용 변이지표의 통계학적 분포와 검정에 대한 연구

남정모,조우현,이선희,Nam, Jung-Mo,Cho, Woo-Hyun,Lee, Sun-Hee 대한예방의학회 1999 예방의학회지 Vol.32 No.1

Objectives. The Study of Small Area Variation(SAV) is most interesting issue in the health care researches. Most studies of SAV have been concluded the existences of variation on the basis of the magnitude of variation without statistical testing. But it is difficult to explain the existence of variation with this way because variation indicies are easily influenced by several parameters and also their distribution are skewed. So, it needs for the study to investigate the distribution of these indices and develop the statistical testing model. Methods. This study was planned to analyze on the distribution of variation indices such as Extremal Quotient(EQ), Coefficient of Variation(CV), Systematic Component of Variation(SCV) and compare the statistical power among indicies. The simulations was performed on the basis of several assumptions and compared to the empirical data. Results. Main findings can be summarized as follows. 1. If other conditions are constant, the more number of regions, the larger 95 percentile of EQ. But under same situation, 95 percentile of CV and SCV were slightly decreased. 2. If the size of regional population or utilization rate were increased, 95 percentile of all statistics were decreased. Also in the cases of small population size and low utilization rate, 95 percentiles of EQ showed various change contrast to the little change of CV. 3. If the difference at the size of regional population were increased, 95 percentiles of EQ and SCV were increased contrast to the little different of CV. 4. If the utilization rate were increased, 95 percentiles of all indicies were increased. But under the same difference of utilization rate, the power of CV and SCV were increased comparing to no change of the power of EQ. 5. Usually the power of EQ were lower than that of CV or SCV and it is similar between CV and SCV. Conclusions. Therefore, we suggest that in selecting the variation indicies at the SAV, CV or SCV are superior than EQ in terms of significance level and power.

청소년기 비만지표와 초기 성인기 경동맥 내중막 두께와의 관련성: Kangwha Study

이유정,남정모,김현창,허남욱,서일,Lee, Yoo-Jung,Nam, Chung-Mo,Kim, Hyeon-Chang,Hur, Nam-Wook,Suh, Il 대한예방의학회 2008 예방의학회지 Vol.41 No.2

Objectives : The aim of this study is to investigate the association between obesity indices(body mass index, weight, waist-hip ratio and waist circumference) in adolescents and the carotid intima-media thickness (C-IMT) in early adulthood. We also wanted to identify the best predictor for C-IMT among these obesity indices. Methods : This study used community-based prospective cohort study, known as the Kangwha Study, and the data we used were from subjects who were 16-years old in 1996 (defined as "adolescence") and 25 years-old in 2005 (defined as "early adulthood"). The 256 subjects (113 men and 143 women) who were used for analysis participated in both follow-ups, and they underwent B-mode ultrasonography of the carotid arteries at the early adulthood follow-up. Obesity indices were defined as the body mass index, weight, waist-hip ratio and waist circumference. The C-IMT was defined as the mean of the maximal IMT of each common carotid artery. The C-IMT and obesity indices associations were evaluated via multivariable regression, logistic regression and the receiver-operator characteristic curve analyses. Results : In men, all the obesity indices in adolescence were showed to have statistically significant positive association with C-IMT in early adulthood. However, no such relationship was showed in women. On multiple regression and logistic regression analysis, the waist-hip ratio showed the biggest relationship with the C-IMT among the 4 obesity indices. However, there were no statistical significant differences and no best predictor was found. For the women, the obesity incidences and C-IMT showed no relationships. Conclusions : This study suggested that obesity in adolescence was related to an increase C-IMT in healthy young Korean men.

신뢰도 연구에서 급내상관계수와 관련한 표본수 결정 방법 비교

한수연,남정모,명성민,송기준,Han, Soo-Yeon,Nam, Jung-Mo,Myoung, Sung-Min,Song, Ki-Jun 한국통계학회 2010 응용통계연구 Vol.23 No.3

신뢰도 연구는 한 명의 평가자가 연구 대상을 반복 측정하거나 여러 명의 평가자가 한 대상을 평가할 때 평가자 내, 평가자 간 일치도를 알아보는 연구로 임상 의학 분야에서 빈번하게 쓰이고 있다. 이 같은 신뢰도 연구에서 적절한 표본수, 평가자수 및 반복수를 결정하는 것은 비용과 시간 측면에서 보다 더 효율적인 연구를 할 수 있게 해주는 중요한 요인이다. 본 연구의 목적은 신뢰도 연구에서 측정치가 정량적일 때 쓰이는 신뢰도 계수인 급내상관계수(ICC)와 관련한 기존의 표본수 산출 방법들을 비교분석하여 적절한 표본수나 반복수를 결정할 때 그 지침을 제공하는데 있다. 기존 논문에서 제시한 Walter 등 (1998), Giraudeau와 Mary (2001), Saito 등 (2006) 그리고 Bonett (2002)의 방법들을 비교하였다. 임의효과 일원배치 모형일 때 같은 조건에서 가장 적은 양의 정보를 필요로 하는 방법을 찾는 목적으로 요인을 변화시켜 가면서 표본수, 반복수, 신뢰구간 폭을 비교한다. 비교해 본 결과, 가장 작은 수의 표본을 필요로 하는 방법은 Giraudeau의 방법, 가장 작은 수의 반복을 필요로 하는 방법은 Saito의 방법으로 나타났다. 가장 많은 수의 표본과 반복을 필요로 한 방법은 Bonett의 방법이었다. 정도는 Giraudeau의 방법이 가장 높았고 Walter, Saito, Bonett 순으로 정도가 떨어졌다. In medical practice and research, the problem of assessing reliability between two or more quantitative measures is quite common. Intraclass correlation coefficient(ICC) is commonly used to scale of reliability. Some methods were developed to calculate the required number of subjects, raters or replicates in one-way or two-way random ANOVA models. This paper, studies and compares the performance of four methods such as Walter et al. (1998), Giraudeau and Mary (2001), Saito et al. (2006) and Bonett (2002). In order to compare the efficiency of methods we compare the number of subjects, replicates and the width of confidence interval of ICC needed for some specific ICC values. In the case of subject size, Giraudeau's method is the best. In case of the number of replicates, Saito's method was superior to others. The width of confidence interval of ICC was narrower for Giraudeau's method than any others.

요양병원의 언어치료 현황

조정진(Jung Jin Cho),김덕용(Deog Young Kim),남정모(Chung Mo Nam),김향희(Hyang Hee Kim) 한국언어청각임상학회 2014 Communication Sciences and Disorders Vol.19 No.4

배경 및 목적: 본 연구는 국내 요양병원을 대상으로 언어치료 현황을 확인하였다. 방법: 국내 1,233개 요양병원을 대상으로 전화 인터뷰 및 직접 인터뷰를 실시하였다. 요양병원의 언어치료 실시 여부를 지역에, 병상 규모, 인증 여부, 재활의학과 전문의 유무에 따라 확인하였고 지역별로 언어치료 제공인력과 언어치료사의 근무 형태를 살펴보았다. 결과: 첫째, 언어치료의 실시 여부는 지역에 따라 차이가 있었다. 전체 요양병원 기관 중 과반수 이상이 언어치료를 실시하지 않고 있었다. 둘째, 언어치료의 실시 여부는 병상 규모에 따라 달랐다. 병상 규모가 클수록 언어치료 실시 비율이 상대적으로 높았다. 셋째, 요양병원 의무인증제의 인증을 받은 기관이 인증을 받지 않은 기관보다 언어치료 실시 비율이 상대적으로 높았다. 넷째, 재활의학과 전문의가 있는 경우 언어치료의 실시 비율이 상대적으로 높았다. 다섯째, 언어치료의 제공인력은 지역에 따라 차이가 있었다. 대부분의 지역에서 언어치료사에 의해 제공되고 있었으나, 작업치료사 또는 사회복지사 등의 비전문가에 의해서도 실시되고 있었다. 여섯째, 언어치료사의 근무 형태는 시간제보다는 전일제 비율이 상대적으로 높았다. 논의 및 결론: 본 연구는 국내 요양병원의 언어치료 현황을 알아보고 비교함으로써 요양병원의 언어치료 필요성을 제고하고 향후 연구에 기초 자료를 제공하고자 하였다는 데 의의가 있다. Objectives: To examine and compare the present situations of long-term care facilities regarding the services of speech and language therapy (SLT). Methods: Phone interviews across Korea were conducted with 1,233 hospitals that were established before October 2013 and were still operating as of March 2014. Whether the long-term care facilities were providing SLT services was examined and analyzed according to the region, the size of the facilities, existence of certification from an institution, and the presence of physiatrists. Furthermore, the working conditions of staff providing SLT including speech and language therapists were thoroughly examined. Results: The SLT services were dependent on regional factors. More than half of the facilities did not include SLT as a part of their services. Also, the use of SLT varied according to the size of the facilities. Bigger hospitals tended to have a higher percentage of language therapy implementation. Institutions certified by the Ministry of Health and Welfare of Korea and the Korea Institute for Healthcare Accreditation were more likely to provide SLT services. SLT services were provided more often when a physiatrist was present. Workers providing SLT differed depending on the region. Speech and language therapists were more likely to work full-time rather than part-time. Conclusion: This study shows the present state and availability of SLT at long-term care facilities, emphasizing the necessity of the service, and providing the basis for future studies.

환자가 인지하는 의료의 질과 만족도, 서비스 가치, 재이용 의사간의 구조분석

최귀선,이선희,남정모,조우현,Choi, Kui-Son,Lee, Sun-Hee,Nam, Jung-Mo,Cho, Woo-Hyun 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To determine the relationships among quality, satisfaction, value and purchase intention in health care service. Methods : The data were gathered from out-patients who had used hospital services. They were asked to assess service quality, satisfaction, service value, and purchase intention. A total of 557 usable questionnaires were gathered. The data were analyzed using SAS version 6.12. The analysis methods employed in the study were confirmatory analysis and covariance structural analysis. Results : Service quality exhibited a significant and positive relationship with satisfaction, service value, and purchase intention. Furthermore, satisfaction had a significant and positive relationship with purchase intention. And finally, service value had a significant and positive relationship with both satisfaction and purchase intention. Based on these findings, it is evident that satisfaction was a mediator between service quality and purchase intention. Also service value played a mediating role between service quality and satisfaction. Conclusions : These results suggest that service quality is an antecedent of satisfaction and sonics value, and exerts a stronger influence on purchase intentions than satisfaction and service value do. Thus, managers may need to emphasize service quality in health care.

Growth Modulation Index의 추정에 대한 연구: 잠재적 변수와 가속실패시간 모형의 적용

박세정 ( Se Jung Park ),김윤남 ( Yoon Nam Kim ),남정모 ( Chung Mo Nam ) 한국보건정보통계학회 2016 보건정보통계학회지 Vol.41 No.3

Objectives: For cytostatic cancer trials, Growth Modulation Index (GMI) defined by an intrapatient progression-free survival (PFS) ratio, has been pro-posed to evaluate the efficacy of new target agent. The purpose of this study was to suggest new methods for the estimation of GMI with censored data in the first PFS (PFS₁) interval, and subsequent second PFS (PFS₂) interval. Methods: The proposed methods include latent variable approach based on Rank Preserving Structural Failure Time (RPSFT) model and Accelerated Failure Time (AFT) model. Simulations were conducted to compare the perfor-mance of proposed GMI estimates and estimates based on the Kaplan-Meier method in terms of bias and mean squared error (MSE) by varying depen-dency of two PFS and censoring rates. Results: Simulation results show that new GMI estimates using latent variable approach and AFT model exhibited smaller bias and MSE than the previous estimates based on the Kaplan-Meier survival function. As censoring rates increased in PFS1, bias and MSE increased in the previous GMI estimates. When the AFT model was applied in the case of high censoring rates, bias was relatively higher than those of latent variable approach. Conclusions: When using GMI as primary endpoint in cancer clinical trials, cautious statistical application and interpretation is needed, particularly for the presence of censored data in the first PFS interval.

인구구조의 변화에 따른 의료비 추계

유승흠,정상혁,남정모,오현주,Yu, Seung-Hum,Jung, Sang-Hyuk,Nam, Jeung-Mo,Oh, Hyohn-Joo 대한예방의학회 1992 예방의학회지 Vol.25 No.3

It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data(1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows : 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10.4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,101 billion Won in 2010, and 5,699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged(65 years old and over) will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.

의과대학 예방의학 성적의 비교 분석

유승흠,노재훈,정상혁,남정모,Yu, Seung-Hum,Roh, Jae-Hoon,Jung, Sang-Hyuk,Nam, Chung-Mo 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.2

The purpose of this study was to find a better evaluation methody by comparison and analysis of the subdivision-score for preventive medicine with other subjects and the total score. Among the 475 students who were second grade in 1983, 1984 and 1985, we analyzed the stores for all subjects at Yonsei University College of Medicine obtained by 443 students, with the exception of 32 students who had had a temporary absence from school, failed or had been expelled. And we analyzed the score for preventive medicine of 162 students who were second grade in 1987 and 179 students who were second grade in 1988. Statistical analysis of the above data was done using the correlation analysis, chi-square test and discriminating index. The results were as fellows: 1. The correlations of the subdivision of preventive medicine in 1984, 1987 and 1988 were statisticall significantly high(r=0.36-0.56). 2. The grades obtained for preventive medicine and for other subjects except pediatrics (clerkship) were not independent. 3. The discriminating indices that determined whether or not a pertinent evaluation was made were 0.42 in 1983, 0.52 in 1984 and 0.54 in 1985. These results were classified as excellent. These results suggest that the score of a subject is determined not by the characteristics of the subject, but by the amount of personal study.

한국 남성에서 식사의 질과 관상동맥질환 발생 위험에 대한 환자 : 대조군 연구

오경원(Oh Kyung Won),남정모(Nam Chung Mo),박정화(Park Jung Hwa),윤지영(Yoon Jee Young),심지선(Shim Jee Seon),이강희(Lee Kang Hee),서일(Suh Il) 韓國營養學會 2003 Journal of Nutrition and Health Vol.36 No.6

다수준 분석을 이용한 한국여성의 유방암 수검률 관련요인

이미화(Lee Mi-Hwa),정홍량(Jung Hong-Rayng),남정모(Nam Jeong-Mo) 한국콘텐츠학회 2013 한국콘텐츠학회 종합학술대회 논문집 Vol.2013 No.5