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위승범 ( Seungbum Wi ),서지영 ( Gee Young Suh ) 대한내과학회 2021 대한내과학회지 Vol.96 No.1
Clinical manifestations of coronavirus disease 2019 (COVID-19) is diverse ranging from asymptomatic or mild respiratory symptoms to severe acute respiratory distress syndrome (ARDS) and respiratory failure. As the pandemic progresses, the number of critically ill COVID-19 patients continues to increase. Whether or not COVID-19 ARDS patients are distinct from conventional ARDS is not settled, and there is no definite evidence that they should be treated differently from ARDS of other origins. The use of oxygen treatment with high flow nasal cannula has been increased. Invasive mechanical ventilation should be applied with lung protective strategy in mind. Prone positioning should be actively considered. Since the primary cause of death of COVID-19 patients is respiratory failure, understanding the characteristics of COVID-19 ARDS and its treatment is necessary for optimal outcome. (Korean J Med 2021;96:22-29)
신포괄수가에 영향을 미치는 의료행태 요인 분석 - 내과 입원환자 중심으로
이경희,위승범,김석일,최병용 한국병원경영학회 2020 병원경영학회지 Vol.25 No.2
Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW –11,900±10,544, whereas it was KRW –196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.
일 대학병원에서의 알코올 의존 환자의 외래 추적시 12개월 추적률
서유나(Yu-Na Seo),정희정(Hee-Jeong Jeong),김성곤(Sung-Gon Kim),신성현(Sung-Hyun Shin),위승범(Seung-Bum Wi),변원탄(Won-Tan Byun),박선희(Sunhee Park) 한국중독정신의학회 2010 중독정신의학 Vol.14 No.1
Alcohol dependence has high prevalence and recurrence rates. To reduce these recurrence rates, alcohol dependent patients must receive continuous follow-up. However, our country has rarely studied follow-up rates for these patients. Therefore, in this study, we retrospectively investigated 3-month and 12-month ambulant follow-up rates by reviewing the hospital charts of alcohol-de-pendent patients who had received treatment in a university hospital from 2001 to 2005. The results were as follows:1) During the 5 year period, 26.6% of subjects did not make a second hospital visit in the 3 months after their first visit, and statistical analyses of alcohol-dependent patients’ follow-up rates excluded them. The patient group that was ambulant for their first psychiatric examination (outpatients) showed significantly lower rates of incomplete hospital revisiting than did the hospitalized patient group (Inpatient). 2) Regarding the final subjects, the 3-month follow-up rates was 47.9%, and the 12-month follow-up rate was 12.1%. We found no differences between the outpatient and the inpatient groups in terms of the follow-up rates. In addition, com-pared to patients admitted by psychiatric residents, patients admitted by psychiatric specialists did not show significantly lower follow-up rates. This study is the first in our country to investigate the 12-month follow-up rates for both inpatients and outpatients in this population. This study shows the need for a prospective clinical study with more participants.