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External causes of injury are major contributors to mortality among people with disabilities. We analyzed the 10-year trend (2008–2017) of mortality attributed to external causes of injury among people with disabilities. We conducted an observational, population-based, retrospective, cross-sectional study among people with disabilities in South Korea. The database was compiled by merging two data sets: registered people with disabilities during 2008–2017 from the Ministry of Health and Welfare, and the data published by the Korea National Statistical Office. Between 2008 and 2017, the all-cause mortality among people with disabilities showed a rising trend and increased from 2641 per 100,000 in 2008 to 2751 per 100,000 in 2017. During this 10-year period, 6.5–9.2% of the total number of deaths were caused by injuries. Disabilities that were associated with a high crude mortality rate shared the same three most frequent causes of death: suicide, motor vehicle crashes, and falling. Mortality due to external causes of injury increased among older people with disabilities. Thus, effective strategies are required to decrease preventable deaths caused by unintentional injuries among people with disabilities.

This study identified the pathways chosen by people with severe physical disabilities (PWSPD) in South Korea and Japan in using community care throughout their life and compared their experiences while navigating these pathways from their perspective. A concurrent nested mixed-method design was adopted. Quantitative data analysis included pathway mapping of facilities and services used throughout their lives. For qualitative data, interpretative phenomenological analysis (IPA) was applied. Eleven South Korean (congenital 7, acquired 4) and nine Japanese (congenital 6, acquired 3) participants were surveyed and interviewed. Pathway mapping was conducted by classifying the participants into focus groups. South Korean participants took nine years more than the Japanese participants to reach independence and showed different pathway characteristics. Superordinate themes from the IPA provided insight into the differences in experiences between PWSPD of the two countries: (1) accessibility and continuity of medical services, (2) experience of vocational training, (3) way and degree of social support for independent living, (4) care planning for receiving comprehensive services. In developing a community care model for the PWSPD to accelerate their time to independence, the government should strive for accessibility and connectivity of medical services, strengthen vocational training, social support for independent living, and information provision for the PWSPD.

Aims: To estimate the economic burden of kidney disorders in Korea. Materials and methods: The economic burden of kidney disorders was estimated using a prevalence-based approach. Related kidney diseases in patients with kidney disorders (RPWKD) were defined using codes from the tenth International Classification of Disease (E70–E90, F30–F48, F60–F69, F90–F99, K65–K67, N00–N08, N17–N19, and N30–N39). All diseases in patients with kidney disorders (APWKD) were defined as kidney disorders that involved all disease codes. Economic costs were divided into direct costs (medical costs and non-medical costs) and indirect costs (productivity loss because of morbidity and premature mortality). Results: The prevalence of kidney disorders increased from 0.08% (2008) to 0.11% (2011). The total economic burden of RPWKD also substantially increased from $898.9 million (2008) to $1.43 billion (2011). This ∼59.4% increase in the economic burden was equal to 0.12% of the Korean gross domestic product. The economic burden of APWKD also increased during the study period: $1.06 billion (2008), $1.23 billion (2009), $1.44 billion (2010), and $1.46 billion (2011). Conclusions: The present study provides the first data regarding the economic burden of kidney disorders in Korea. The findings support the need for early intervention services and prevention programs to prevent, identify, and manage kidney disorders.

Objective To investigate the effectiveness of a novel and complex intervention in community-dwelling people with intellectual disabilities.Methods Forty-three participants completed the experiment. The subjects were randomly assigned the experimental (n=33) or control (n=10) groups. The multicomponent intervention program comprised exercise and nutrition management and behavior modification. The intervention was performed for 60 minutes once weekly for 10 weeks. The assessment included anthropometric data, body composition and blood pressure analysis, and blood tests. In addition, pulmonary function, physical function, and health-related quality of life were measured before and after the intervention.Results No adverse events occurred during the intervention. After the intervention, the experimental group showed a significantly higher increase in high-density lipoprotein cholesterol level than did the control group (effect size=0.152, p=0.019).Conclusion This innovative intervention was effective in improving cardiovascular health. Even greater effects could be achieved through improvements in implementation strategies to increase compliance.

Attempts to classify the mobility levels of people with stroke (PWS) for a tailored exercise program in community settings have been few. We developed and evaluated a classified and tailored community-based (CTC) exercise program according to the mobility level of PWS. Forty-two PWS were classified into the Supine and Sitting, Sitting and Standing, and Standing and Gait groups, based on a newly developed classification model and participated in a group-based CTC exercise program for 1 h/day twice/week for 10 weeks. The health outcome measures were blood pressure, lipid profile, glucose control, body composition, ventilatory capacity, and physical and psychological function. The rate of agreement on classification results among the physiotherapists was analysed. For all participants, significant improvements were noted in the blood pressure, lipid profile, body composition, ventilatory capacity, and physical and psychological function. The lower mobility groups showed significant improvements in a greater number of health outcomes than the higher mobility group. The physiotherapists&rsquo, agreement regarding the classification results was 91.16 &plusmn, 5.14%, verifying the model&rsquo, s possible high relevance to the community. The effective improvement in participant health implied that the CTC exercise program was well tailored to the participants&rsquo, mobility levels, particularly the lower mobility groups.

Purpose. To validate performance indicators for evaluating workplace health promotion (WHP) programs based on a logic model and to analyze the structural relationships between constructs. Design. The study design is cross-sectional. Setting. Design setting was small manufacturing companies implementing WHP programs provided by the Korea Industrial Health Association. Subjects. Seventeen occupational health experts completed a questionnaire to determine the content validity of indicators. In addition, 58 health care managers completed a questionnaire to determine reliability and construct validation. The response rate was 84.1%. Measures. Based on a logic model, 13 constructs of WHP programs were identified: WHP program input, four activities for workplace environment management, two activities for employee health care management, two outputs, and two short-term outcomes. Analysis. Interrater agreement index was used for testing the content validity of indicators. Confirmatory factor analysis was used to test for the reliabilities, and the convergent and discriminant validities. Structuring equation modeling was also used to analyze the relationships among constructs. Results. A total of 35 performance indicators from 11 constructs showed good reliability and validity. All relationships among WHP input, activities, outputs, and short-term outcomes were significant, except for the relationship between environment outputs and short-term outcome. Conclusion. These findings illustrate that the logic model and structuring equation modeling can be used to develop and validate performance indicators for planning and evaluation of the WHP program.

Background: People with disabilities have higher prevalence rates and earlier onset of chronic disease than the non-disabled; there -fore, their participation in health screening is important. This study evaluates the participation rate and trends in health screening of people with disabilities, and examines the association between their participation rate and disability characteristics, and socioeco-nomic status.Methods: Data on disability-related characteristics were collected from the National Disability Registry, and participants’ corre-sponding health examination data were taken from the Korean National Health Insurance Corporation between 2002 and 2011. A total of 873,819 participants aged ≥20 years were analyzed in this study.Results: The rate of participation of people with disabilities in health screening has increased each year, but their participation rate is lower than that of the total population. The participation rate was lower in females than in males; the elderly group than in the younger group; those who live in city areas than rural areas; self-employed for health insurance than employees; those with an in-ternal organ disability than those with an external physical disability; those with a severe disability than those with a mild disability; and those with a short-term disability than for those with a long-term disability.Conclusion: The factors associated with participation rate are age, sex, socioeconomic status, and disability characteristics. These findings indicate that health check-ups of people with disabilities should be promoted using an approach that takes into account the large individual differences in socioeconomic status and disability characteristics in this population.Keywords: Health screening; Disabled persons; Participation rate; National health programs

Objectives Many medication errors can occur when ordering and dispensing medicine in hospitals. The clinical decision support system (CDSS) is widely used in an effort to reduce medication errors. This study focused on the evaluation of user satisfaction with the CDSS for medication at a university hospital. Specifically, this study aimed to identify the factors influencing user satisfaction and to examine user requirements in order to further improve user satisfaction and drug safety. Methods The study was based on survey data from 218 users (103 doctors, 103 nurses, and 15 pharmacists) at a university hospital that uses the CDSS. In order to identify the factors influencing user satisfaction with the CDSS, a multiple linear regression was performed. In order to compare the satisfaction level among the professional groups, an analysis of variance (ANOVA) was performed. Results The reliability of information, decision supporting capability, and departmental support were significant factors in influencing user satisfaction. In addition, nurses were the most satisfied group, followed by pharmacists and doctors according to the ANOVA. Areas for further improvement in enhancing drug safety were real time information searching and decision supporting capabilities to prevent adverse drug events (ADE) in a timely manner. Conclusions We found that the CDSS users were generally satisfied with the system and that it complements the nationwide drug utilization review (DUR) system in reducing ADE. Further CDSS evaluation in other hospitals is needed to improve user satisfaction and drug safety.

We developed an interactive mobile-phone based application, SmartDiet, that analyzes daily nutrition intake and patterns of daily exercise. It provides a personalized diet profile and promotes knowledge about nutrition using a diet game. We evaluated the effectiveness of the SmartDiet application in terms of acquiring dietary information, weight control and user satisfaction. A case-control study was conducted over a six-week period, with 19 people in the intervention group and 17 people in the control group. During the study, a total of 235 successful data transmissions were performed from the mobile phones and there was a mean of 12.4 transmissions per participant. The three body composition measures (fat mass, weight and body mass index) decreased significantly after the intervention in the intervention group, but there were no significant changes in the control group. In a questionnaire survey at the end of the study, the majority of the participants responded that the system was useful for obtaining information and managing the diet process. The SmartDiet mobile weight management application appears to contribute to weight loss in obese adults.

Samsung Medical Center,Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: Evaluation and feedback are fundamental components in a residency program. A portfolio assessment system is an appropriate option for making formative assessments, particularly for a family medicine resident whose training includes rotations through various disciplines at multiple locations. However, a paper-based portfolio assessment system has limitations when applied to a clinical environment due to how it is managed and cared. This study assessed the satisfaction and utility of a paper-based portfolio assessment system, and then designed and imple-mented a web-based portfolio assessment system for family medicine residents. Methods: A self-administered questionnaire focusing on the satisfaction and utility of a paper- based portfolio assessment system was given to 23 family medicine residents. A web-based port-folio assessment system was then designed using the component-based development approach. Results: The overall satisfaction and utility with the paper-based portfolio assessment system were low. Fifteen residents(62.5%) reported that following a paper-based portfolio assessment system was sometimes a waste of time and only three(13.0%) reported having no problems. The web-based portfolio assessment system was successfully designed to be easy to implement and user-friendly. Conclusion: The web-based portfolio assessment system is expected to overcome the short-comings of a paper-based portfolio assessment system and improve the level of satisfaction of medical residents. It is expected that the web-based portfolio assessment system designed in this study will be an additional tool for family medicine residencies.󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏Key Words: Educational measurement, Education, Medical, Computer-Assisted Instruction students

Cervical cancer is a leading cause of cancer deaths in woman worldwide. New approach to the analysis of risk factors and management of cervical cancer is discussed in this study. We identified the combined patterns of cervical cancer risk factors including demographic, environmental and genetic factors using induction technique. We compared logistic regression and a decision tree algorithm, CHAID (Chi-squared Automatic Interaction Detection), using a test set of 133 participants and a training set of 577 participants. The CHAID had a better predictive rate and sensitivity (72.96 and 64.00%, respectively) than logistic regression (71.83 and 40.80%, respectively). However, the CHAID had lower specificity (77.83%) than logistic regression (88.70%). In addition, we demonstrated how the decision tree algorithm could be used in risk analysis and target segmentation for cervical cancer management. This is the first study using induction technique for the analysis of risk factors for cervical cancer, and the results of this study will contribute to developing the clinical practice guideline for cervical cancer.

This study presents an analysis of healthcare quality indicators using data mining for developing quality improvement strategies. Specifically, important factors influencing the inpatient mortality were identified using a decision tree method for data mining based on 8405 patients who were discharged from the study hospital during the period of December 1, 2000 and January 31, 2001. Important factors for the inpatient mortality were length of stay, disease classes, discharge departments, and age groups. The optimum range of target group in inpatient healthcare quality indicators were identified from the gains chart. In addition, a decision support system (DSS) was developed to analyze and monitor trends of quality indicators using Visual Basic 6.0. Guidelines and tutorial for quality improvement activities were also included in the system. In the future, other quality indicators should be analyzed to effectively support a hospital-wide continuous quality improvement (CQI) activity and the DSS should be well integrated with the hospital order communication system (OCS) to support concurrent review.

In a pilot study of telemedicine in home health services (HHS) for elderly patients, we implemented and evaluated a telemedicine system with a 33-kbs narrow-band approach to determine its effectiveness in providing quality services. Fifty patients were selected for the study. We found that telemedicine was effective in terms of reducing the number of clinic visits and achieving patient satisfaction. The average number of clinic visits per month was significantly decreased from 0.64 to 0.42 (p < 0.05) after the use of telemedicine. 72% of patients were satisfied with telemedicine, but only patient location showed a significant difference for patient satisfaction (p < 0.05). Patients in their homes (82%) were more satisfied than patients in nursing homes (50%). Of four types of services provided, medical consultation (100%) was the most highly satisfactory service with telemedicine, followed by physical therapy (83.3%). Although the satisfaction scores did not indicate a significant difference in the system characteristics, the quality of verbal communication appeared to be a more important factor in influencing patient satisfaction than set-up time or quality of image. A computer-based patient record was also developed to view a patient summary and to document encounters at the patient's home. Since the system is a low-cost approach that is easy to interface with a notebook computer, it can support various other HHSs.

After a disability occurs, vocational rehabilitation is essential for promoting return to society and improving quality of life. To facilitate vocational rehabilitation, an effective counseling by human expert is essential. However, the number of the experts is not many. Thus, people with disabilities (PWD) have had difficulty in having proper vocational consultation service. To mitigate this problem, this study aims at developing a decision support system (DSS) to recommend appropriate jobs to PWD based on their characteristics. For doing this, the experts in disabilities, occupational research, and information systems participated in building the logic of the system. The DSS for scientific and quantitative vocational counseling enables job counselors to recommend appropriate occupations considering PWDs' characteristics.

This paper compared three knowledge models (namely, neural network, case-based reasoning, and discriminant analysis) for the diagnosis of asthma. The data were collected from 294 patients with asthmatic symptoms who visited the Bronchial Asthma Clinics, Internal Medicine Department of Yonsei University Severance Hospital from June 1992 to May 1995. Diagnostic capabilities for the three knowledge models varied. The neural network had the best overall prediction rate (92%) and the best prediction rate for asthma (96%); the discriminant analysis had the best prediction rate for non-asthma (80%); and the CBR had the lowest prediction rates in all categories.

We identified the combined patterns of LDL cholesterol risk factors including biometric, environmental and genetic factors using induction technique. In this hospital based cardiovascular genome study of Korean men and women, we found that CART (classification and regression tree) was a better method to predict LDL cholesterol compared to the regression method. The CART had a better prediction ability than the multiple regression for male and female, respectively. We also identified combined patterns of LDL cholesterol risk factors and segment specific information for LDL cholesterol management using induction rules. The CART method provided more detailed results according to each segmentation and subgroup. In addition, we demonstrated how the CART algorithm could be used in risk assessment and target segmentation of LDL cholesterol management.

This study examined the characteristics of the knowledge discovery and data mining algorithms to demonstrate how they can be used to predict health outcomes and provide policy information for hypertension management using the Korea Medical Insurance Corporation database. Specifically, this study validated the predictive power of data mining algorithms by comparing the performance of logistic regression and two decision tree algorithms, CHIAD (Chi-squared Automatic Interaction Detection) and C5.0 (a variant of C4.5) using the test set of 4588 beneficiaries and the training set of 13,689 beneficiaries. Contrary to the previous study, the CHIAD algorithm performed better than the logistic regression in predicting hypertension, and C5.0 had the lowest predictive power. In addition, the CHIAD algorithm and the association rule also provided the segment-specific information for the risk factors and target group that may be used in a policy analysis for hypertension management.

Objective: This study was conducted to identify 3 to 5 years of future management issues in hospital information systems (HIS). Methods: Two rounds of interview surveys were conducted based on the sample survey of 50 managers from 28 hospital information centers utilizing the Delphi method. Results: From the survey, management issues in HIS were identified in the following order: ‘top management support’, ‘close relationship with users’, ‘PACS’, ‘disaster recovery’, improving IS strategic planning’. Compared with the 1999 survey, the issues that rank within the top 10 management issues were as follows: ‘top management support’, ‘security and control’, ‘close relationship with users’. Recently surfaced issues are ‘disaster recovery’ and ‘standardization’. The issues that dropped out of the top 10 ranks were ‘network management’, ‘recruiting and developing IS human resource’which were very fundamental issues in the initial state of the introduction of the hospital information system. Conclusion: The two main significance of this study involves predicting future management issues based on the comparison of the current issues with the 1999 issues and recommendingmanagement strategies based on the classification of issues by importance and persistence. (Journal of Korean Society of Medical Informatics 13-1,9-17, 2007)

Objective: To measure the performance of a hospital enterprise resource planning (ERP) system and suggest various system improvements. Methods: A survey based on a 5-point Likert scale questionnaire and an exclusive interview was administered to 102 employees with a one-year experience of using an ERP system at one university hospital. In order to analyze the factors affecting the ERP system performance, multiple regression analysis and Chi-square test were conducted. Results: All three examined variables-system quality, information quality and integration of hospital information resources-affected the ERP system performance positively. However, the system quality variable had the lowest mean score indicating that the ERP system was difficult to understand for many users. User characteristics were not significantly associated with information quality satisfaction. Conclusion: On the basis of the study results, we recommended some suggestions to improve the ERP system performance. In order to reduce users' dissatisfaction with the new system, hospitals should publicize the needs of the ERP system for the employees, design more effective training programs, and provide more decision-supporting information for managers. (Journal of Korean Society of Medical Informatics 13-2, 77-82, 2007)

This paper analyzed the relationship among the differential diagnosis, treatment, and results for allergic rhinitis using the covariance structural model. The data were collected from 274 patients with suspected allergic rhinitis who visited the Otorlaryngology Department of the Paik Hospital during 1991-1993. After each patient's characteristics was categorized and combined into several common factors, covariance structure analysis was performed to analyze the structural relationships among the differential diagnosis, treatment, and results of treatment using the significant factors obtained from discriminant analysis. The significant characteristics influenced the diagnosis were the results of skin test from mite/animal, and from mugworts, the results from laboratory tests, rhinorrhea and sneezing, and nasal polyps. The significant characteristics that influenced the method of treatment were: nasal polyps, headache/general symptom, family history/medication, and septal deviation. Headache/general symptom was the only significantly influencing factor for the treatment results.