- Analysis of the Factors Related to the Needs of Patients with Cancer.
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Jung A Lee, Sun Hee Lee, Jong Hyock Park, Jae Hyun Park, Sung Gyeong Kim, Ju Hyun Seo
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J Prev Med Public Health. 2010;43(3):222-234.
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DOI: https://doi.org/10.3961/jpmph.2010.43.3.222
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Abstract
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- OBJECTIVES
Limited research has investigated the specific needs of patients with cancer. This study was performed to explore patients needs and the related factors. METHODS: The data were collected by 1 National Cancer Center and 9 regional cancer centers in Korea. An interview survey was performed with using a structured questionnaire for the subjects(2661 patients who gave written informed consent to particiate) survey 4 months after diagnosis and review of medical records. Data were analyzed using t-test, ANOVA and multiple regression analysis. RESULTS: When comparing the relating factors related with patient needs to the sociodemographic characteristics, the female group showed a higher level of recognition for physical symptoms, social support needs. The younger group showed a significantly higher level of recognition for health care staff, psychological problems, information and education, social support, hospital services needs. In addition, the higher educated group showed a higher level of recognition for health care staff, physical symptoms, social support needs. The higher income and office workers group showed a higher level of recognition for hospital services needs. When comparing the relating factors related with patient needs to the cancer, the breast cancer group showed a higher level of recognition for all needs excluding physical symptoms, accessibility and financial support needs. The combined radiotherapy with surgery and chemotherapy group showed a higher level of recognition for psychological problems, information and education, social support needs. CONCLUSIONS: This study showed that needs on patient with cancer was significantly influenced by female, higher educagion, lower income, having religion, office worker, liver cancer, breast cancer, colon cancer, chemotherapy, and combined therapy.
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- Analysis of Behavioral Stage in Pap Testing by Using Transtheoretical Model.
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Hye Jean Lee, Sun Hee Lee, Sang Hyuk Jung, Hai Rim Shin, Dae Kyu Oh
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J Prev Med Public Health. 2005;38(1):82-92.
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To evaluate the relationships among sociodemographic characteristics, health behaviors, levels of pros and cons and stages of change in Pap testing for uterine cervical cancer. METHODS: A questionnaire survey was performed on 560 randomly sampled people who were assigned to participate in a Pap testing program by the 'National Cancer Screening Project in 2003' between 25 September and 10 October in Gyeonggi, Korea. Data about the behaviors and intentions of Pap testing, sociodemographic characteristics, health behaviors, and levels of acknowledged benefit (pros) and barrier (cons) for Pap testing was collected. The stages of change were grouped according to behaviors and intentions of Pap testing as passive, active, and relapse. RESULTS: Logistic analysis between the passive and active groups showed that city dwellers, 'high' and 'middle' groups in terms of the individual's health belief, those who had undergone a health examination within the past 2 years, and those who had undergone hormone replacement therapy had a higher odds ratios to be in the active group. As the 'benefit' scores increased and the 'Unnecessity' scores decreased, the probabilities to be in the active group increased. According to the logistic analysis results between the active and relapse groups, those who were 60 years or older, members of the National Heath Insurance, and those who had not undergone a health examination within the past 2 years had a higher odds ratio to be in the relapse group. The 'Benefit' scores were not significant in this relationship. The probabilities of being in the relapse group increased as the 'Unnecessity' and 'Shamefulness' scores increased. CONCLUSIONS: In conclusion, health planners should inform women in the passive group of the benefits and necessity of Pap testing. It would be better to reduce the barriers to the active group of undergoing Pap smear. This study might be a useful guide for future planning of Pap testing program.
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Summary
- Factors Associated with Performance of National Cancer Screening Program in Korea.
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Kui Son Choi, Jeong Hee Yang, Su Yeon Kye, Sun Hee Lee, Eun Cheol Park, Hai Rim Shin, Chang Min Kim
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J Prev Med Public Health. 2004;37(3):246-252.
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Cancer is the leading cause of death in Korea. Therefore, a National Cancer Screening Program (NCSP) was launched in 1999. This study planned to evaluate the performance of the NCSP to identifying the influencing factors in relation to characteristic public health centers. METHODS: To analyze the performance, the database of the NCSP records for 2002 was used. The performance index was measured by the goal achievement rate, which was defined by the real number of screenees against the expected number of screenees. Also, a survey was conducted by a self-administered questionnaire to identify the factors associated with the goal achievement rate. The questionnaire was divided into two sections. In the first section, the individual characteristics of the program coordinator in each public health center were measured, and second section was comprised of questions about the organizational characteristics associated with the NCSP. A total of 121 subjects from 241 public health centers completed the questionnaire. RESULTS: Of the 121 public health centers (50.2% response rate), the average goal achievement rate was 72.8%. The results of the regression model showed that public health centers located in rural area (parameter estimates=38.2) and had great support from a head of center or province (parameter estimates=0.20) and tended to have higher goal achievement rates. However, the characteristics of the program coordinator, especially their knowledge of and attitude toward cancer screening, were not significantly related to the goal achievement rates. CONCLUSIONS: It appears that the most important associated factors to the goal achievement rate in the NSCP were the location of the public health center and the support for the NCSP from the head of the center or province.
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- Factors Associated with the Degree of Quality Improvement Implementation.
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Sun Hee Lee, Kui Son Choi, Hye Young Kang, Woo Hyun Cho, Yoo Mi Chae
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Korean J Prev Med. 2001;34(4):363-371.
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To assess the degree of quality improvement (QI) implementation and to identify its associated factors. METHODS: A mailed questionnaire survey of the QI staffs at hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for inclusion in our study, 79 participated, yielding a response rate of 73.1%. After excluding 12 hospitals that did not perform any QI activities, 117 responses from 67 hospitals were used in our analysis. The degree of QI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors evaluated for association with the degree of QI implementation were cultural, technical, strategic, and structural factors of the hospitals. RESULTS: The average QI implementation score across the 7 dimensions of MBNQAC was 3.34 on a 5-point scale, with the highest score for the area of customer satisfaction (3.88) followed by information and analysis (3.59) and quality management (3.35). The results of regression analysis showed that hospitals with a etter information system (p<0.05) and using scientific and systematic problem solving approach (p<0.01) tended to perform a higher degree of QI implementation. While statistically insignificant, positive associations were observed for the factors of group or developmental culture, the degree of employee empowerment, and the use of prospective strategy. CONCLUSIONS: It appears that the most important factors contributing to active implementation of QI in Korean hospitals were the use of scientific skills in decision making, and having a quality information system to produce precise and valid information.
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- A Study of Hospital Choice on the basis of Consumption Values Theory.
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Sun Hee Lee
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Korean J Prev Med. 1997;30(2):413-427.
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- This research is based on the Consumption Values theory proposed by Sheth(1991). The purpose of this research is finding the factors related to the process of hospital choice. The expectation of six hospital outpatients 600 was analyzed by six consumption values categories: functional values, social values, emotional value, rarity value, situational values, health related values. The main results of this research is as following; 1. In the result of factor analysis 22 consumption value factors which affect the hospital preference were extracted; kindness/clearness, service speed, comfortabness of space, technical competence in functional values, high income/active social life, low income/blue calar, unmarried/man, middle aged/big family, woman/married, introvert in social values, high-class, comfortableness, reliability in emotional value, newness, classiness in rarity value, social relationship, close to residence, social reputation in situational values, priority on health, health behavior, active sense of value on health in health related values. 2. The difference of consumption values among hospital types were analyzed. The critical factors in reference for corporate hospitals newly established were kindness/ clearness, service speed, convenience, classiness, comfortableness, and newness. University hospitals were preferred by the factors of reliability, and social reputation. In general hospital, convenience and close to residence were critical factor. 3. In logistic regression, age, marital status, education level and income as sociodemographic variables were significaltly related to general hospital choice. Also service speed and close to residence were positively and high income/active social life and high class value were negatively related to general hospital choice. On university hospital choice, age and marital status, education show posive relationship whereas income showing negative relationship. Kindness/clearness, service speed, comfortableness of space, unmarried/man, comfortable feeling, newness and close to residence showed negative relationship with university hospital selection whereas technical competence, reliability in emotional value, classiness in rarity value, social relationship in functional values showed positive relationship. Lastly kindness/clearness, comfortableness of space, high income/active social life, unmarried/man, high-class, comfortableness and newness were positively related to corporate hospitals newly established choice in contast to negative relationship in reliability in emotional value and classiness. In summary, we found that hospital user also choose to hospital in base of various consumption value. Further studis to investigate the hospital consumer behavior will be needed.
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Summary
- The Economic Impact of a Rural Hospital to local Economy.
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Im Ok Kang, Sun Hee Lee, Han Joong Kim
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Korean J Prev Med. 1996;29(4):831-842.
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- Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.
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- An Analysis of Small Area Variations of Hospital Services Utilization in Korea.
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Woo Hyun Cho, Sun Hee Lee, Eun Cheol Park, Myong Sei Sohn, Se Ra Kim
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Korean J Prev Med. 1994;27(3):609-626.
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- This study was conducted to investigate whether variations in hospital services utilization across small geographic areas in Korea existed, and if so, what factors are responsible for the variation. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main finding of the research can be summarized as follows: 1. External Quotients (EQ) of hospital expenditure per capita and hospital days per capita were 2.69 and 2.73, and coefficient of variation (CV) were 0.14,both, respectively. The EQ and the CV of admission rate were also 2.71, 0.15. The EQ and the CV of expenditure per admission were 1.73, 0.10 and those of hospital days per admission were 1.29, 0.06. All these statistics were statistically significant and this result provides strong evidence for the existence of small area variations. 2. Comparing patterns of variation among areas, the area which showed higher utilization amounts is cbansungp'o. Koje area, whereas the areas which showed lower utilization amounts are Yongju, Changhung, Miryang, Mokp'o, Koch'ang area. 3. Multivariate analytic methods were used to examine factors related to the variation across areas. In terms of the health resource availability variables, beds per capita or physicians per capita were positively associated with all utilization indices. As for the health service market structure variables, the proportion of health care institutions operating for less than 5 years was positively related to the expenditure per capita, hospital days per capita and expenditure per admission. In addition the proportion of lhe private health care institutions also had a negative relationship with total utilization amount and admission rate and the proportion of physicians under age 40 was negatively associated with expenditure per capita and expenditure per admission. With regard to the socio-demographic characteristics, proportion of medicaid population was positively related to hospital days per capita, and percentage of paved road was positively related to hospital days per admission. As a conclusion, wide variations existed across small areas in Korea and supply factors were found to be important in explaining the variation.
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- An Analysis on Factors Relating to Fiscal Deficit for Regional Health Insurance Program in Korea.
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Han Joong Kim, Woo Hyun Cho, Sun Hee Lee, Hyung Kon Kang, Yang Kyun Kim
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Korean J Prev Med. 1992;25(4):399-412.
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- This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason for the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium irate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.
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- A Study on the Criteria for Selection of Medical Care Facilities.
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Woo Hyun Cho, Han Joong Kim, Sun Hee Lee
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Korean J Prev Med. 1992;25(1):53-63.
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- There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.
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- A cohort study on the relationship between pesticide use and mortality, and cancer mortality.
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Hee Chul Oh, Chung Mo Nam, Sun Hee Lee
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Korean J Prev Med. 1991;24(3):390-399.
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- The purpose of this study is to examine the relationship between pesticide use and mortality, and cancer mortality which are recognized as health hazards of pesticides. Data were analyzed from a cohort of 6,066 people aged fifty-five or over and who have been residing in the main island of Kangwha county. Death certificates, computerized citizenship registers searches, and household interview survey lead to get more than ninety-seven percents follow-up rate for the first five year observation period. Important findings are as follows: 1. Age specific mortality rates of pesticide users are significantly lower than those of pesticides nonusers. The SMR of male is 0.80, and 0.58 for females respectively probably due to healthy worker effects. But, age specific cancer mortality rates are significantly higher than those of pesticide nonusers (SMR=1.59) in males. this finding is not observed in females (SMR=0.85), however. 2. Logistic regression analyses showed that self-reported health status, drinking, and smoking histories in male are significantly associated with total mortality rate. The histories of pesticide use are also calculated to be highly associated with cancer mortality as in univariate analyses in males. In female, self-reported health status, age of first delivery are found to be significantly related to total mortality rate. Only drinking history is calculated to be associated with cancer mortalities in females. Data from further observation of 'Kangwha cohort' and indepth analyses of these are highly expected.
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- The recent trend and determinants of service diversification in Korean hospitals.
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Sun Hee Lee, Han Joong Kim, Woo Hyun Cho
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Korean J Prev Med. 1991;24(1):16-28.
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- Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
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