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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Quality Improvement in Health Care
Journal Basic Information
Journal DOI :
The Korean Society of Quality Assurance in Health Care
Editor in Chief :
Volume & Issues
Volume 4, Issue 2 - Dec 1997
Volume 4, Issue 1 - May 1997
Volume 3, Issue 2 - Mar 1997
Selecting the target year
Survey of completeness of medical records in one educational hospital using new checklist
Park, Seok Gun ; Kim, Heung Tae ; Kim, Kwang Hwan ; Seo, Sun Won ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 174~183
Background : Medical records thought to be reflecting the quality of medicine. By this ground, examination of medical records can be served to evaluate, and to improve the quality of medical care. To examine the medical records, we need some standards or checklists which can be used to sort out the problems. Methods: We developed checklists for medical records evaluation. We studied 1,677 medical records about its completeness using this checklists in one educational hospital. Survey was completed by 5 well trained staffs of medical record department. Results are analyzed. SPSS/PC+ program was used for statistics. Results : 13.8% of discharge summary was incomplete. Recording of the demographic information was also poor in incomplete medical records compared to complete ones. Progress note was recorded average 4.16 times during 11.9 hospital days. After 4th hospital day, recording rate of progress note dropped sharply. Rate of professor's signature on operation records was poor(27%). He or she who described the discharge summary well also wrote progress note well. Conclusions: Fill-up of demographic date should be stressed during medical record education program. Strategy to create the environment emphasizing the responsibility of professor on quality medical record should be made. We suggest new index (number of records/hospital stay) for the evaluation of completeness of progress note.
Appropriateness Evaluation of Preoperative Hospitalization: A Case Study of A Tertiary Care Hospital
Kim, Soo Young ; Lee, Key Hyo ; Kwon, Young Dae ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 184~195
Background : The purpose of this research was to evaluate the appropriateness of preoperative hospital days in a tertiary care hospital and to examine the reasons of the inappropriateness, so as to provide basic information and policy for enhancing appropriateness of preoperative hospitalization and benefit of patients and hospital. Methods : The subjects of the research were the 344 patients who received operation among discharged patients during January, 1996 in surgical departments including general surgery, neurosurgery, orthopedic surgery, plastic surgery and ophthalmology. Their medical records were reviewed and appropriateness of hospital days was evaluated by the Appropriateness Evaluation Protocol. Result : The results of evaluating the appropriateness of preoperative hospitalization showed that inappropriate hospital days were 80.8%. The reasons of inappropriate hospital stays were the tests or preparation which could be done in outpatient basis' followed by 'possible tests or preparation on the operation day' and 'cancelation of operation'. Conclusion : In order to shorten the inappropriate preoperative length of stay, it is recommended that lengthening of laboratory running time and doing most of tests necessary for operations on the outpatient basis prior to admission should be considered. In addition, the operation at the same day of hospitalization and usage of day surgery should be encouraged. Finally there should be changes in the inpatient management system and attitudes and behaviors of surgeons to shorten unnecessary preoperative and maximize the benefit for patients and hospital.
Quality Improvement Activities in Korean Hospitals
Cho, Sung-Hyun ; Kim, Hwa Joong ; Kim, Chang-Yup ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 196~209
Factors Affecting Willingness to Satisfy Patients among Nurses in Hospitals
Lee, Key Hyo ; Kim, Kong Hyun ; Son, SoonJu ; Yang, Jin Sun ; Kwon, Young Dae ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 210~221
Background : Willingness to satisfy patients(WSP) among nurses is essential to promoting patient satisfaction which is a critical component in the quality of health care and its outcomes. This study was carried out to empirically find out the affecting factors of WSP among nurses in hospital settings. Methods : The model contains seven job relating determinants and two intervening variables as follows: i) job relating variables of professional status, task requirements, pay, physician-nurse interaction, nurse-nurse interaction, organizational policies, and autonomy, ii) intervening variables of job satisfaction and organizational commitment. Data were collected from 205 nurses in two general hospitals owned by one foundation located in Pusan, Korea, using a structured and self-administered questionnaire. Results : The major results were as follows: First, the results of ANOVA on WPS by personal characteristics showed a statistically significant relationships between WPS and hierarchical orders(p<.01) ana tenure(p<.10). Comparing with the lower orders and shorter tenure, the higher orders and the longer tenure showed better WPS. Second, the results of simple correlation analysis between WPS and determinants and intervening variables showed the following variables, in order of importance, were statistically significant(p<.01): work satisfaction(+), organizational commitment(+), task requirements(+), nurse-interaction(+), professional status(+), physician-nurse interaction(+). Third, the results of path analysis showed that two intervening variables of job satisfaction and organizational commitment, and three determinants of task requirements, professional status, and nurse-nurse interaction had a positively significant direct effect to WPS. Conclusion : The results suggest that nurses who are more satisfied with task requirements, status, nurse-nurse interaction, overall job satisfaction, and organizational commitment, will behave in ways that patients find more satisfied.
병동통합관리실시에 따른 입원환자의료서비스개선 효과
Yuk, Jeom-Hui ; Choe, Seon-Ho ; Kim, Seok-Beom ; Seo, Bo-Yang ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 222~228
Effect of practice guideline reminder and flow-sheet for improvement of quality in management of hypercholesterolemia
Cho, Han Kyu ; Park, Hye Soon ; Cho, Hong-Jun ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 230~240
Background : Hypercholesterolemia is a major independent risk factor of coronary heart disease. Practice guidelines for management of hypercholesterolemia had been made in several developed countries. This study was undertaken to assess the effect of practice guideline reminders and flow-sheets to improve the quality of management of hypercholesterolemia. Methods: Practice guideline reminders and flow-sheets based on National Cholesterol Education Program Adult Treatment Panel II guidelines, were placed on the office desks of outpatient department of family medicine at the Asan Medical Center. Before this intervention, we educated the doctors to use these reminders and flow-sheets. The charts of all patients who had cholesterol levels greater than or equal to 240 mg/dl during 4 months before and after introduction of reminders and flow-sheets, were reviewed retrospectively. We compared the performances of physicians about management of hypercholesterolemia between pre-intervention period and post-intervention period. Results: The detection rate of hypercholesterolemia in post-intervention period was increased to 83.2% compared by 71.5% in pre-intervention period. Risk factor analysis for coronary heart disease increased significantly from 16.9% to 68.7%. Adequacy of management was 19.2% in pre-intervention period and 78.0% in post-intervention period. It showed statistically significant improvement in management of hypercholesterolemia. Conclusion : This study suggested that practice guideline reminders and flow-sheets were the effective methods in improving the quality in management of hypercholesterolemia.
Association Between Unplanned and Planned Readmissions in an University Hospital
Oh, Hyonh-Joo ; Yu, Seung Hum ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 242~259
This study describes associated factors of readmission of 213 inpatients from an university hospital in Seoul. This retrospective study reviewed medical records of patients who discharged from a hospital stay for general diseases between 1 August 1995 and 31 October 1995, Cases were 68 discharge patients with an unplanned readmission within 30 days of discharge from an index stay. And the other cases are 145 patients who had more than two discharges and didn't have an unplanned readmission within 30 days. Logistic regression model was analyzed and the results were as follows; 1. duration of readmission, rate of unpayed, room, path, and risk of disease were more likely to be readmitted unexpectedly than the expected readmission patients. 2. early readmission, low risk condition group, and inadquateness of discharge plann for patients had unplanned radmissions rather than planned readmissions. Therefore, discharge planning education to health care provider is required and assessement of discharge planning should be evaluated. Readmissions are usually for related problems that arose during the original hopitaliztion and caused cost problems. Especially the unplanned readmissions are frequently preventable. Ultimately, models for readmissions can serve as a valuable clinical tool for target high-risk patients and older patients and with this kind of tools we can reduce hospital readmissions and maintain high-quality of inpatient care.
Development of an evaluation tool of quality of nursing care for gastrointestinal surgery patient
Lee, Byeong-Suk ; Park, Jeong-Ho ; Jo, Hyeon ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 260~278
Background : Quality of professional nursing care is the most essential factor for survival and growth of nursing profession. Then, nursing professionals have responsibility for the evaluation of quality of professional nursing care. The purpose of this study was to develope an evaluation tool of nursing care for patients received gastrointestinal surgery with general anesthesia. This study was a primary work for the developement of a computer program for the evaluation of nursing care. Methods : This study was done through some consecutive steps. They were (1) Developement of items for the tool (2) Developement of an evaluation tool of nursing care quality for the G-I surgery patient (3) Test of reliability and validity of the tool. Two groups of experts and expert pannels who had much experience of the QA and the care of G-I surgery patients participated for developement of the items. 85 nursing records were used for the test of reliability and validity of the developed tool. The evaluation tools were developed with two types of scoring, norm-referenced tool and criterion-referenced tool. Results The system of items for tool was evaluation area evaluation item-indicator. There were 7evaluation areas which contained 32evaluation items which contained 7lindicators. Evaluation areas 1, 2, 3, 4 were for the evaluation of process and 5, 6, 7 were for the evaluation of outcome of nursing care for G-I surgery patient. For the test of interrator reliability, correlation coefficients of each scores of items and intragroup correlation coefficients were calculated. The average correlation coefficients between two rators were 0.65, 0.54 and the intragroup correlation coefficient were 0.99 and 1.00 by the types of scoring. The Cronbach alpha coefficients of the tools were 0.54 and 0.46 by the types of scoring. The average content validity index of the items was 0.95 from 4 pairs of experts. Because there were significant differences between some scores of quality of nursing care of 3 general hospitals regardless of the types of scoring, the tools could be thought to have some construct validity. And also, there were significant correlations between some scores of quality of nursing care and admission days and admission days after surgery regardless of the types of scoring, the tools could be thought to have predictive validity. Conclusion In this study, the evaluation tool of nursing care was developed for the very specified group of patient, G-I surgery patient. And the items were developed and tested by the experts of nursing practice. Because of these reasons, it was supposed that the tool could be used effectively in nursing pratice. And the procedures for the development and the test of the evaluation tool of nursing care in this study were supposed to be used for the developement of other tools.
How to organize and manage hospital QA according to specific structures of a general hospital in Korea?
Yang, Ung Suk ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 280~284
Since the start of the Korean Society of Quality Assurance in Health Care in 1994, QA has improved, but it is time to develop our own policies that are more appropriate for Korean hospitals. American Quality Assurance policies are difficult to apply to the Korean medical community due to the differences in health insurance policies, and hospital structure between the two countries. Methods : I would like to propose more efficient organization and management of Quality Assurance according to the specific structures of hospitals in Korea. All of the hospital departments and committees should report to the Quality Assurance office, which in turn should report to the director. I would like to suggest that the current insurance review staff be used for the Quality Assurance office. A nurse should be in charge of the Quality Assurance department. The Quality Assurance department should have three sections: Medical Inssurance Review, QA records for the different Medical Departments, and QA records for the Ancillary Departments. A staff physician should be the chairman of the hospital QA committee, which should serve as the advising body to the QA Department. The QA Committee should be organized into eight subcommittees so that all departments thought the hospital are represented. The current Medical Insurance Review offices in Korea have similar responsibilities to the QA Department: therefore I would like to recommend that the Medical Insurance Review office be changed the the QA office. If there are presently two separate Medical Insurance and QA offices, these should be combined into one office. Conclusion : These changes would surely benefit hospitals and strengthen the efficiency of both Insurance Review and Quality Assurance.
QA활동에서의 마케팅개념 활용
Gwak, Gyeong-Deok ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 286~293
일 병원에서의 퇴원예고제실시 활동사례
Hwang, Jeong-Hae ; Hwang, Ji-In ; Kim, Chang-Yeop ; O, Byeong-Hui ;
Quality Improvement in Health Care, volume 4, issue 2, 1997, Pages 294~302