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Ciênc. cuid. saúde ; 20: e54294, 2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1339629


RESUMO Objetivo: analisar as percepções da equipe de enfermagem sobre preparo e administração de medicamentos em pediatria. Método: estudo de abordagem qualitativa realizado na clínica pediátrica de um hospital público. Entrevistaram-se vinte profissionais de enfermagem por meio de questões norteadoras sobreo processo de administração de medicamentos em seu local de trabalho e fatores que contribuem para os erros de medicação. As entrevistas foram gravadas e posteriormente transcritas. Os resultados foram categorizados de acordo com análise de conteúdo e o referencial teórico foi a segurança do paciente. Resultados: as categorias identificadasforam processo de trabalho relacionado à medicação; precarização do trabalho em saúde; sistema de medicação: prescrição médica; e protocolos relacionados a medicamentos. A prescrição médica foi apontada comoum dos fatores indutoresde erro de medicação, além da interrupção durante o preparoe administração de medicamentos e ausência de protocolo sobre os cuidados específicos em pediatria. Situações como sobrecarga profissional, conflitos, falta de materiais eestrutura física inadequada foram percebidas no processo de medicação em pediatria. Conclusão: as percepções da equipe de enfermagem demonstrarama necessidade de espaços de diálogos dentro da equipe multiprofissional e maior envolvimento da gestão na busca de um cuidado seguro prestado ao paciente.

RESUMEN Objetivo: analizar las percepciones del equipo de enfermería sobre la preparación y administración de medicamentos en pediatría. Método: estudio de abordaje cualitativo realizado en la clínica pediátrica de un hospital público. Fueron entrevistados veinte profesionales de enfermería por medio de preguntas orientadoras sobre el proceso de administración de medicamentos en su local de trabajo ylos factores que contribuyen para los errores de medicación. Las entrevistas fueron grabadas y posteriormente transcriptas. Los resultados fueron categorizados según el análisis de contenido yel referencial teórico fuela seguridad del paciente. Resultados: las categorías encontradas fueron proceso de trabajo relacionado a la medicación; precarización del trabajo en salud; sistema de medicación: prescripción médica; y protocolos relacionados a medicamentos. Laprescripción médica fue señalada como uno de los factores inductores de error de medicación, además de la interrupción durante la preparación yadministración de medicamentos y ausencia de protocolo sobre los cuidados específicos en pediatría. Situaciones tales como sobrecarga profesional, conflictos, falta de materiales y estructura física inadecuada fueron percibidas en el proceso de medicación en pediatría. Conclusión: las percepciones del equipo de enfermería demostraronla necesidad de espacios de diálogos dentro del equipo multiprofesional y una mayor participación de la gestiónen la búsqueda de un cuidado seguro prestado al paciente.

ABSTRACT Objective: to analyze the nursing team's perceptions of preparation and administration of medicines in pediatrics. Method: qualitative study conducted in the pediatric clinic of a public hospital. Twenty nursing professionals were interviewed by using guiding questions about the medication administration process in their workplace and factors that contribute to medication errors. The interviews were recorded and later transcribed. The results were categorized according to content analysis and the theoretical framework was patient safety. Results: the categories that have been identified are medication-related work process; poor health work conditions; medication system: medical prescription; and medication-related protocols. Medical prescription has been pointed out as one of the factors that lead to medication errors, in addition to interruption during the preparation and administration of medicines and the absence of a protocol on specific care in pediatrics. Situations such as professional overload, conflicts, lack of materials, and poor physical structure have been noticed in the medication process in pediatrics. Conclusion: the nursing team's perceptions have shown the need for spaces of dialogue within the multiprofessional team and greater management commitment and involvement in the search for safe patient care.

Humans , Male , Female , Pediatrics , Pharmaceutical Preparations , Nursing , Organization and Administration , Patient Care Team , Work , Health , Guidelines as Topic , Empathy , Prescriptions , Patient Safety , Mentoring , Insurance , Medication Errors , Nurse Practitioners , Nursing, Team
Korean Circulation Journal ; : 267-277, 2020.
Article in English | WPRIM | ID: wpr-811351


BACKGROUND AND OBJECTIVES: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea.METHODS: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated.RESULTS: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers.CONCLUSIONS: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.

Anticoagulants , Atrial Fibrillation , Humans , Insurance , Korea , National Health Programs , Nursing , Odds Ratio , Public Health , Socioeconomic Factors , Stroke , Tertiary Care Centers
Article in English | WPRIM | ID: wpr-810957


Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Abdomen , Budgets , Chest Pain , Critical Care , Dyspnea , Emergencies , Heart , Heart Arrest , Insurance Coverage , Insurance , Insurance, Health , Korea , Medical Records , National Health Programs , Patient Care , Point-of-Care Systems , Prescriptions , Shock , Thorax , Ultrasonography
Acta Medica Philippina ; : 742-750, 2020.
Article in English | WPRIM | ID: wpr-876836


@#Background. Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system. Methods. A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system. Results. By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement. Conclusion and Recommendations. With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.

Universal Health Insurance , Universal Health Care , Insurance , Health Policy , National Health Programs , Accreditation
Article in English | LILACS, BDENF | ID: biblio-1126962


Objectives: to understand the perception of nurses in emergency care units about the violence experienced at work. Method: qualitative study conducted through 21 individual interviews between November and December 2018 in two emergency care units in a city in Paraná. Symbolic Interactionism was adopted as the theoretical framework and the Thematic Content Analysis technique was used to evaluate the data. Results: from the thematic category experiencing psychological violence in the nurses' daily work, it was evidenced that it was related to threats against their lives, cursing, humiliation, embarrassment, attempt to defame them, as well as pressure from subordinates. In the category experiencing physical violence in the nurses' daily work, it was found that it was imposed through pushing, pulling hair, throwing objects, the presence of firearms and knives and, even, witnessing murder. Conclusion: nurses suffered acts of violence by external and internal people, from the emergency care units themselves. Managers, nurses and society need to look reflexively and critically at the violence that happens and implement actions to avoid them, thus providing a safe working environment for all involved and educate society in order to make the reduction of violence a priority in public policies.

Objetivos: compreender a percepção de enfermeiros de unidades de pronto atendimento sobre a violência vivenciada no trabalho. Método: estudo qualitativo realizado por meio de 21 entrevistas individuais entre novembro e dezembro de 2018 em duas unidades de pronto atendimento de uma cidade paranaense. Foi adotado o Interacionismo Simbólico como referencial teórico e a técnica de Análise de Conteúdo Temática para avaliar os dados. Resultados: da categoria temática vivenciando a violência psicológica no cotidiano laboral do enfermeiro evidenciou-se que esteve relacionada com ameaças contra as suas vidas, xingamentos, humilhações, constrangimentos, tentativa de denegri-los, bem como pela pressão dos subordinados. Já na categoria vivenciando a violência física no cotidiano laboral do enfermeiro verificou-se que foi impetrada por meio de empurrões, puxões de cabelo, arremesso de objetos, presença de armas de fogo e de facas e, até, o presenciamento de assassinato. Conclusão: os enfermeiros sofreram atos de violência por pessoas externas e internas, das próprias unidades de pronto atendimento. Os gestores, os enfermeiros e a sociedade precisam olhar reflexiva e criticamente para as violências que acontecem e implementar ações para evitá-las e, assim, propiciar um ambiente laboral seguro para todos os envolvidos, sensibilizando a sociedade para que a redução da violência seja uma prioridade nas políticas públicas.

Objetivos: comprender la percepción de los enfermeros de unidades de atención de emergencia sobre la violencia experimentada en el trabajo. Método: estudio cualitativo realizado a través de 21 entrevistas individuales entre noviembre y diciembre de 2018 en dos unidades de atención de emergencia en una ciudad de Paraná. El Interaccionismo Simbólico se adoptó como marco teórico y la técnica de análisis de contenido temático se utilizó para evaluar los datos. Resultados: desde la categoría temática situaciones de violencia psicológica en la práctica cotidiana de los enfermeros, se evidenció que la misma se hallaba vinculada con amenazas contra sus vidas, insultos, humillaciones, situaciones embarazosas, intento de denigración, así como la presión de los subordinados. En la categoría situaciones de violencia física en la práctica cotidiana de los enfermeros, se descubrió que se imponía a través de empujones, tirones de cabello, arrojando objetos, con la presencia de armas de fuego y cuchillos e, incluso, presenciando asesinato. Conclusión: los enfermeros sufrieron actos de violencia por parte de personas externas e internas, a las propias unidades de atención de emergencia. Los gerentes, las enfermeras y la sociedad deben mirar reflexiva y críticamente la violencia que ocurre e implementar acciones para evitarla y, de ese modo, ofrecer un ambiente de trabajo seguro para todos los involucrados, además de crear conciencia en la sociedad para que la reducción de la violencia se convierta en prioridad de las políticas públicas.

Humans , Male , Female , Pressure , Workplace , Occupational Risks , Occupational Health , Aggression , Emergency Medical Services , Workplace Violence , Ambulatory Care , Physical Abuse , Embarrassment , Homicide , Insurance , Nurses
Lima; Perú. Poder Ejecutivo; 20191100. 3 p.
Monography in Spanish | MINSAPERU, LILACS, MINSAPERU | ID: biblio-1122925


El documento contiene las medidas urgentes para garantizar la protección del derecho a la salud a través del cierre de la brecha de población sin cobertura de seguro en el territorio nacional, de conformidad con lo dispuesto en la Ley N° 29344, Ley Marco de Aseguramiento Universal en Salud.

Population , Protective Factors , Innovation and Development Policy , Universal Health Coverage , eHealth Strategies , Right to Health , Insurance , Jurisprudence
Salud trab. (Maracay) ; 27(1): 15-26, jun. 2019. tab, ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1103364


El sistema chileno de salud laboral sobrevivió a las enormes transformaciones que introdujo en materia de seguridad social la Dictadura Militar, y se suele presentar como un modelo a seguir en otras latitudes. En el presente artículo se expone un breve análisis de dicho sistema, comenzado por la ley del Seguro contra Accidentes del Trabajo y Enfermedades Profesionales que le da origen, para luego evaluar la operación del sistema, a fin de identificar sus mayores fortalezas y debilidades. También se revisan algunas propuestas de cambio que han aparecido en los últimos años. Se concluye que el sistema cuenta con un alto nivel de reconocimiento y legitimidad, y que presenta un desarrollo importante en el plano curativo para las tres cuartas partes de los trabajadores que están afiliados. En contraste con la cobertura que reciben los accidentes del trabajo, presenta baja sensibilidad ante las enfermedades profesionales, además de importantes desafíos en el plano preventivo, que podrían llevar a revisar algunos supuestos sobre los cuales se construyó(AU)

The Chilean occupational health system survived the enormous transformations introduced by the Military Dictatorship with regard to social security. This system is often suggested as a model to emulate overseas. In this article, I analyze the system, beginning with the law that regulates the Insurance against work accidents and occupational diseases which origins the system. Then, I examine its performance, and as a whole I identify its strengths and weaknesses. I also review some of the proposals of modification that have appeared in the last years. I conclude that the system counts on a high level of recognition and legitimacy, and that it presents an important level of development at the therapeutics sphere three fourths parts of those workers who are affiliated. In contrast with the coverage given to accidents at work, the system presents low sensibility with regard to occupational diseases, on top of important challenges in the preventive sphere. These critical elements could take us to review the basic assumptions under which the system was built on(AU)

Humans , Social Security/legislation & jurisprudence , Social Security/organization & administration , Work , Occupational Risks , Health Systems/organization & administration , Occupational Health , Insurance , Jurisprudence
Rev. cuba. med. mil ; 48(2): e379, abr.-jun. 2019.
Article in Spanish | LILACS | ID: biblio-1126609


La Universidad de Ciencias Médicas de las Fuerzas Armadas Revolucionarias de Cuba (Ucimed FAR), fue fundada el 7 de octubre de 1981, por el acuerdo No. 1074 del Comité Ejecutivo del Consejo de Ministros. Acaba de cumplir 37 años. En este periodo ha sufrido varias transformaciones, con una última etapa que comenzó en 2008. Actualmente se distingue, por ser la única institución de su tipo en el país, que forma oficiales de perfil médico y estomatológico de nivel superior. Existe el firme propósito de garantizar la formación del relevo, para que el futuro esté seguro, y egresen de nuestras aulas los mejores graduados(AU)

Science , Organizations , Counseling , Insurance
Article in English | WPRIM | ID: wpr-764422


BACKGROUND: With increased interest in oral health, several efforts have been made to improve oral health conditions. To achieve this, needs for oral health must be precisely determined and accurately measured. Therefore, factors influencing both objective unmet dental needs, which were determined by experts, and perceived unmet dental needs, which were determined by patients, were examined in this study. METHODS: Responses of 17,735 respondents aged greater than 19 years from the Korean National Health and Nutrition Survey collected using the fifth (2010~2012) rotation sample survey were analyzed. Based on the information collected from the survey and dental examination, we determined the associations between the independent (sex and socioeconomic level) and dependent variables using a chi-squared test. Moreover, ordinal logistic regression analyses on multiple categorical values were performed using perceived and objective dental needs as the dependent variables. RESULTS: Generally, factors influencing both perceived and objective dental needs were similar. These included sex, household income, educational level, private insurance, and subjective oral health status. However, the high-income groups had lesser perceived and objective dental needs compared to the low-income groups. Furthermore, factors such as sex, educational level, and marital status had different influence on both needs. CONCLUSION: Generally, factors that affect perceived and objective dental needs were similar. To minimize unmet dental needs, factors influencing both perceived and objective dental needs should be examined for a broad dental insurance coverage, and efforts to prevent oral diseases are also required.

Family Characteristics , Humans , Insurance , Insurance, Dental , Logistic Models , Marital Status , Nutrition Surveys , Oral Health , Surveys and Questionnaires
Article in English | WPRIM | ID: wpr-759001


BACKGROUND: Controversies exist whether arteriovenous fistula (AVF) placement is preferred over arteriovenous graft (AVG) for elderly patients. Current guidelines did not offer specific recommendations. Thus, this study was conducted to analyze the all-cause mortality and primary patency associated with various vascular access (VA) types according to age group. METHODS: This retrospective observational study investigated the Korean insurance claims data of chronic kidney disease patients who began hemodialysis between January 2008 and December 2016. We investigated all-cause mortality associated with initial VA in incident hemodialysis patients and primary patency between AVF and AVG according to age group. RESULTS: The proportion of patients with a tunneled dialysis catheter (TDC) that was first placed for VA increased from 18.4% in 2008 to 52.3% in 2016. Incident hemodialysis patients with a TDC or AVG for the initial VA had significantly higher mortality risk than patients with an AVF, except for patients over 85 years, who showed no significant difference in all-cause mortality regardless of VA type. In the patency analysis on initial AV access, AVG had significantly poorer primary patency than AVF in all age groups. CONCLUSION: AVF had better patency than AVG in all age groups; however, the benefit of AVF attenuated in the older age groups. The mortality rate between AVF and AVG was not significantly different in patients over 85 years. Therefore, a “patient-first” approach should be emphasized over a “fistula-first” approach in AV access creation for incident hemodialysis patients older than 85 years.

Administrative Claims, Healthcare , Aged , Arteriovenous Fistula , Catheters , Dialysis , Humans , Insurance , Mortality , National Health Programs , Observational Study , Renal Dialysis , Renal Insufficiency, Chronic , Retrospective Studies , Transplants
Radiation Oncology Journal ; : 249-253, 2019.
Article | WPRIM | ID: wpr-786566


PURPOSE: We aimed to analyze the trend in intensity-modulated radiation therapy (IMRT) use in Korea from 2011 to 2018.MATERIALS AND METHODS: We collected data from the Health and Insurance Review and Assessment Service (HIRA) big data based on the National Health Insurance Service claims and reimbursements records using primary treatment planning codes (HD 041) for IMRT from 2011 to 2018. We analyzed the changing patterns in clinical application to specific tumor sites and regional differences in IMRT utilization.RESULTS: The use of IMRT has exhibited an 18-fold steep rise from 1,921 patients in 2011 to 34,759 in 2018. With regard to IMRT in 2018, 70% of patients (24,248/34,759) were treated in metropolitan areas (Seoul, Incheon, and Gyeonggi Province). IMRT was most commonly used to treat breast, lung, and prostate cancers in 2018. Among these, the use of IMRT for breast cancer shows the most remarkable increase from 2016 when the National Health Insurance began to cover IMRT for all solid tumors.CONCLUSION: The use of IMRT is steadily increasing to treat cancer and is concentrated in metropolitan areas.

Breast , Breast Neoplasms , Humans , Insurance , Korea , Lung , National Health Programs , Prostatic Neoplasms , Radiotherapy, Intensity-Modulated
Article in Korean | WPRIM | ID: wpr-786326


PURPOSE: This study aimed to determine health problems experienced by workers in special employment relationships (WSER) and identify coping strategies used when such problems occur.METHODS: This qualitative study used the focus group interview method. Thirteen study participants included five home-visit tutors, five insurance salespersons, and three credit card recruiters. The interviews were conducted from November 2018 through January 2019, with each occupational group interview lasting about 2 hours. Analysis based on phenomenological research was independently performed by two researchers.RESULTS: Most participants had common health problems involving vocal cord symptoms, and stress related to emotional labor and traffic accidents. The unique health problems included cystitis, musculoskeletal, and digestive symptoms in home-visit tutors; reduced vision and hearing in insurance salespersons; and mental distress in credit card recruiters. There was no protection system for their health coverage, and the company emphasized their self-employed status to avoid taking responsibility for them. Twelve participants did not purchase occupational accident insurance owing to both not having adequate information and economic burden concerning premium status.CONCLUSION: WSER experienced both physical and mental health problems. These problems were caused by their unstable employment status, and the social security system for their coverage being non-functioning.

Accidents, Occupational , Accidents, Traffic , Cystitis , Employment , Focus Groups , Hearing , Humans , Insurance , Mental Health , Methods , Occupational Groups , Occupational Health , Qualitative Research , Social Security , Vision, Low , Vocal Cords
Article in Korean | WPRIM | ID: wpr-758571


PURPOSE: This study aims to investigate the effects of smoking on the development of placenta-associated syndromes, including preeclampsia, abruptio placentae, and placenta previa, which share the common pathophysiology of vascular compromise of the placenta. METHODS: A total of 966,629 pregnancies identified from the Korean National Insurance Claims Database and the National Health Information Database were analyzed from 2010 to 2014. The adjusted odds ratio and attributable risk of smoking for the development of placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, were analyzed. Maternal age, alcohol consumption, exercise habit, and economic status were controlled as confounding variables. A binary logistic regression model was used, and simple and multiple logistic regression analyses were performed. RESULTS: Among 966,629 pregnancies, 11.86% of women were ever smokers. Ever smokers had a higher risk of developing placenta previa (adjusted odds ratio, 1.23; 95% confidence interval [CI], 1.18–1.29; adjusted attributable risk, 18.70%). The adjusted odds ratio of developing placenta-associated syndromes in ever smokers compared to nonsmokers over the age of 35 years with a low economic status was 1.32 (95% CI, 1.18–1.47), with an adjusted attributable risk of 23.95%. CONCLUSION: The risk of developing placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, is high in ever smokers. Pregnant ever smokers who are >35 years and belong to the lower one-third of the economic division require special care to prevent the development of placenta-associated syndromes.

Abruptio Placentae , Alcohol Drinking , Female , Humans , Insurance , Korea , Logistic Models , Maternal Age , Odds Ratio , Placenta , Placenta Previa , Pre-Eclampsia , Pregnancy , Smoke , Smoking
Article in Korean | WPRIM | ID: wpr-758565


Several studies have reported adequate patient transfer to higher level hospitals according to the risk for improving perinatal outcomes. According to these reports, countries across the world divide the levels of maternal care on the basis of the assessment of hospital facilities and medical services as well as the assessment of high-risk pregnancies while evaluating the cases of and risks associated with maternal care that can be addressed by these hospitals at each level. Because the level of and policies on maternal care vary across countries, we aimed to evaluate risk assessments and introduction of treatment facility classifications in different countries. In Korea, birth rate is declining and the number of elderly pregnant women is increasing, whereas the number of hospitals that can deliver a baby and care for mothers at high risk is decreasing. We, therefore, need to establish an infrastructure for medically vulnerable areas, a localization center, and a medical personnel supplement. Moreover, establishing detailed guidelines and criteria for different levels of maternal care is necessary. The new guidelines will also need to supplement the policies on the requirement of well-trained obstetricians and of low medical insurance fee.

Aged , Birth Rate , Classification , Fees and Charges , Female , Humans , Insurance , Korea , Maternal-Child Health Services , Mothers , Patient Transfer , Pregnancy, High-Risk , Pregnant Women , Prenatal Care , Risk Assessment
Article in Korean | WPRIM | ID: wpr-758446


OBJECTIVE: Among emergency department patient complaints, complaints related to medical malpractice can often lead to lawsuits. This study examined the reasons for medical malpractice complaints and find ways to improve the medical process and patient satisfaction in an emergency department. METHODS: This study analyzed 269 official complaints of emergency department patients between January 1, 2007, and December 31, 2016. From these complaints, 100 complaints of medical malpractice were analyzed and the complaints of the non-medical process, such as unkindness, cost, facilities and the others, were excluded. The patients' age, sex, relationship between the patient and complainer, insurance state and visiting hour were analyzed. Details of the medical malpractice complaints were assessed and classified into four reasons: diagnosis, examination, treatment, and explanation. This study attempted to analyze the hospital's response to the complaints made during the medical process. RESULTS: Among the 100 medical malpractice complaints, 75 occurred at night duty; 40 were related to treatment, 32 to diagnosis, 22 to examination, and six to explanation. Among the treatment, wound problems were the most frequent reason for 23 cases. The hospital made financial compensation to 16 of its patients. CONCLUSION: The medical malpractice complaints occurred mainly at night. Treatment, especially wound problems, was the most frequent reason for the complaints. The rate of monetary compensation was higher than that of the other studies.

Compensation and Redress , Diagnosis , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Humans , Insurance , Malpractice , Patient Satisfaction , Retrospective Studies , Wounds and Injuries
Article in Korean | WPRIM | ID: wpr-758415


PURPOSE: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. METHODS: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. RESULTS: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=−6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=−4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). CONCLUSION: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

Diagnosis , Health Facility Size , Health Services Research , Herbicides , Hospitalization , Hospitals, General , Humans , Insecticides , Insurance , Insurance, Health , Mortality , Poisoning , Proxy , Quality of Health Care , Tertiary Care Centers
Yonsei Medical Journal ; : 467-473, 2019.
Article in English | WPRIM | ID: wpr-742558


PURPOSE: To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. MATERIALS AND METHODS: Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. RESULTS: In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25–1.61; p<0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13–3.74; p<0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71–11.32; p<0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03–2.22; p=0.033), hypertension (OR 1.40; 95% CI 1.18–1.66; p<0.001), diabetes (OR 1.59; 95% CI 1.31–1.93; p<0.001), and chronic renal failure (OR 1.28; 95% CI 1.01–1.62; p=0.039) were found to be related to APE development. CONCLUSION: The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.

Cataract Extraction , Cataract , Endophthalmitis , Foreign Bodies , Glaucoma , Hominidae , Humans , Hypertension , Incidence , Insurance , Kidney Failure, Chronic , Korea , Male , Phacoemulsification , Risk Factors , Sutures , Vitrectomy