4 research outputs found
Effects of EMR and CDSS on hospital performance
보건μ 보κ΄λ¦¬νκ³Ό/μμ¬λ³Έ μ°κ΅¬λ κ° μλ£κΈ°κ΄μ EMRκ³Ό CDSS λμ
μ΄ λ³΄κ±΄λ³΅μ§λΆμ μλ£κΈ°κ΄νκ°μ μν΄ μΈ‘μ λ κ° λ³μμ μ
무 μ±κ³Όμ μ΄λ ν μν₯μ λ―ΈμΉλμ§ μμ보기 μν μ°κ΅¬μ΄λ€. μ°κ΅¬ λμμΌλ‘ 44κ°μ μκΈ μ’
ν© λ³μκ³Ό 94κ°μ μ’
ν©λ³μμ μ‘°μ¬νμλ€. 보건볡μ§λΆμ κ³ μλ 2004λ
λΆν° 2009λ
μ μλ£κΈ°κ΄νκ° κ²°κ³Ό μλ£λ₯Ό μ¬μ©νμλ€. μλ£κΈ°κ΄νκ°μ μΈλΆ νλͺ© μ€μμ μ§λ£μ²΄κ³, μ§ ν₯μ 체κ³, μλ£μ 보/μ무기λ‘, μκΈ, κ²μ¬, μ½μ νλͺ©μ λμμΌλ‘ λΆμνμλ€. EMRκ³Ό CDSS λμ
νν©μ 2005λ
κ³Ό 2010λ
μ μ€νν μ‘°μ¬ μλ£λ₯Ό μ΄μ©νκ³ μ΄λ² μ°κ΅¬μμ μΆκ°λ‘ μ‘°μ¬νμ¬ νμ
νμλ€. Wilcoxon Signed Rank Sum testλ₯Ό μ¬μ©νμ¬ EMRκ³Ό CDSS λμ
μ¬λΆμ λ°λ₯Έ μλ£κΈ°κ΄νκ° 1μ°¨μ 2μ°¨κ°μ μ μ μ°¨μ΄λ₯Ό λΉκ΅νμλ€. Logistic regressionμ μ΄μ©νμ¬ EMRκ³Ό CDSSμ λμ
μ΄ νκ° μ μμ λ―ΈμΉλ μν₯μ νμΈνμλ€. μ°κ΅¬ κ²°κ³Όλ μκΈ μ’
ν© λ³μκ³Ό μ’
ν©λ³μ λͺ¨λ EMRμ μλ£κΈ°κ΄νκ° 1μ°¨, 2μ°¨ λ λͺ¨λ λμ
ν κΈ°κ΄μ μ μκ° κ°μ₯ λμκ³ 1μ°¨ νκ° νμ EMRμ΄ λμ
λ κΈ°κ΄λ³΄λ€ λ λμλ€. λ°λΌμ μκΈ μ’
ν© λ³μ μΌμλ‘ EMRκ³Ό CDSS λμ
μΌλ‘ μλ£κΈ°κ΄ νκ°μ λμ μ μλ₯Ό λ°μ μ μμλ€. μλ£κΈ°κ΄ νμ μ κ° μΈλΆ νλͺ©μ λν λ‘μ§μ€ν± λΆμ κ²°κ³Όλ₯Ό μ΄ν΄λ³΄μμ λ, ν΅κ³μ μΌλ‘ μ μνμ§ μμ§λ§, μκΈ νλͺ©μ μ μΈν λλ¨Έμ§ 5κ°μ νλͺ© λΆλ¬Έμμ EMRκ³Ό CDSS λͺ¨λ νκ° μ μ ν₯μμ κΈ°μ¬νλ κ²μΌλ‘ λνλ¬λ€. μκΈ νλͺ©μμλ EMR λμ
λ§μ΄ μ μ ν₯μμ κΈ°μ¬νλ κ²μΌλ‘ λνλ¬λ€. μ΄μ κ°μ λΆμ κ²°κ³Όλ EMRκ³Ό CDSSκ° λ³μμ μ
무 μ±κ³Όμ κΈμ μ μΈ μν₯μ΄ μλ€λ κ²μ λνλΈλ€. λ°λΌμ μ₯κΈ°μ μΌλ‘ κ΅λ΄ μλ£κΈ°κ΄νκ°λ κ΅μΈμ JCI(Joint Commission International)μΈμ¦μ μν λλΉμ±
κ³Ό μλ£μ μ§, μ΄μμ±κ³Ό ν₯μμ μν΄ EMRκ³Ό CDSS λμ
μ μ κ·Ή κΆμ₯νλ€.ope
λΆν ν΅μ€ν κ³κΈ° λλΆμ μ± λ³λμμΈ μ°κ΅¬: 2μ°¨ λ° 4μ°¨ ν΅μ€ν μ ν λ¨λΆ κ΅λ₯νλ ₯μ μ€μ¬μΌλ‘
νμλ
Όλ¬Έ (μμ¬)-- μμΈλνκ΅ λνμ : νμ λνμ νμ νκ³Ό, 2018. 2. κΆνμ£Ό.λΆν ν΅λ¬Έμ λ 30λ
λκ² μ΄λ£¨μ΄μ§ λ€μν μ μ±
κ³Ό μ°κ΅¬μλ λΆκ΅¬νκ³ κ³μ μ
νλμλ€. νΉν λΆνμ 2006λ
λΆν° 6μ°¨λ‘μ ν΅μ€νμ μ§μνλ©° ν΅λ₯λ ₯μ κ³ λννκ³ μλ€. λΆνμ ν΅μ€νμ κ°μμ€λ½κ² λ°μνλ μ보 μκΈ°μ΄λ©°, λλΆμ μ±
μ λ³λ κ°λ₯μ±μ λμ΄λ κ΄μ¬ μ§μ€μ μ¬κ±΄μ΄λ€. λΆνμ ν΅μ€νμ΄ λ°μνλ©΄ λ¨λΆ κ΅λ₯νλ ₯μ λλΆμ μ±
μμ κ°μ₯ ν¬κ² μν₯μ λ°μ μ λ©΄μ μΈ μ€λ¨μ΄ μ΄λ£¨μ΄μ§ κ°λ₯μ±μ΄ μ¦κ°νλ€.
μ΄λ¬ν κ°λ₯μ±μ κΈ°λ°μΌλ‘ λΆνμ ν΅μ€ν λ° λλΆμ μ±
κ³Ό κ΄λ ¨ν μ¬νμ 보νΈμ μΈ μμμ΄ μ‘΄μ¬νλ€. μλ₯Ό λ€μ΄ λΆνμ ν΅λ₯λ ₯μ΄ κ³ λνλ μλ‘ λλΆμ μ±
μ λμ± μ μ¬μ μλ°μ μ€μνλ λ°©ν₯μΌλ‘ λ³λνλ©°, λΆνμ ν΅μ€νμ΄ λ°μνλ©΄ ν΅μ€ν μ κ°λ±μ λ¨λΆκ΄κ³μ 보μ μ λΆ, κ΅μ μ μΈλ λ¨λΆ κ΅λ₯νλ ₯μ λ¨μ νκ³ μ μ¬μ μλ° μΌλ³λλ‘ λλΆμ μ±
μ λ³λνλλ‘ μ΄μ§ν κ²μ΄λΌκ³ μμνλ€.
νμ§λ§ λΆνμ ν΅μ€νμ΄ λ°μνλλΌλ λ§μ νκ΅μ λλΆμ μ±
μ μ΄λ¬ν μμκ³Ό μΌμΉνμ§ μλ κ²½μ°κ° λ§μλ€. μ΄μ λ³Έ μ°κ΅¬λ μ μ±
μΉνΈμ°ν©λͺ¨νκ³Ό λ€μ€νλ¦λͺ¨νμ κ²°ν©ν 볡ν©μ μ μ±
λ³λλͺ¨νμ λ°νμΌλ‘ λΆνμ 4μ°¨ λ° 2μ°¨ ν΅μ€νμ μ νν μκΈ° λλΆμ μ±
μ λ³λμ μ΄λνλ μμΈμ μ΄ν΄λ³΄κ³ , κ·Έ κ³Όμ μμ λΆνμ ν΅μ€ν λ° λλΆμ μ±
κ³Ό κ΄λ ¨ν μ¬νμ 보νΈμ μΈ μμμ΄ νλΉνμ§, λ³λμ μ΄λνλ κ°μ₯ μ€μν μμΈμ΄ 무μμΈμ§ νμΈνμλ€.
μ°κ΅¬ κ²°κ³Ό 4μ°¨ ν΅μ€νμ μ νν μκΈ° λλΆμ μ±
μ μ λ©΄μ μΌλ‘ λ³λνκ³ λ³λμ΄ μ§μμ μΌλ‘ μ μ§λ λ°λ©΄, 2μ°¨ ν΅μ€νμ μ νν μκΈ° λλΆμ μ±
μ λΆλΆμ μ΄κ³ μΌμμ μΌλ‘ λ³λνμλ€. λΆνμ ν΅μ€ν, κ΅λ΄ μ μΉμ μμΈμ λ³λμ μ΄μ§νλ μμΈμΌλ‘, ν΅μ€ν μ΄νμ κ΅μ μ μΈλ λ³λμ μ΅μ νλ μμΈμΌλ‘ μμ©νμλ€. ν΅μ€ν μ΄μ μ λ¨λΆκ΄κ³λ μν©μ λ°λΌ μμΈμ μ±ν₯μ΄ λ¬λΌμ‘λ€.
μ°κ΅¬ κ²°κ³Όμ κ·Όκ±°νμ¬ μ²«μ§Έλ‘ λΆνμ ν΅λ₯λ ₯ μ¦κ°μ λλΆμ μ±
μ λ³λ μμ€μ λΉλ‘νμ§ μλλ€λ μ¬μ€μ νμΈνμλ€. λΆνμ ν΅μ€νμ΄ λ¨λΆ κ΅λ₯νλ ₯μ κ°μμν€λ μμΈμ΄μ§λ§, ν΅μ€νλ§λ€ κ΅λ₯νλ ₯μ΄ κ°μν μ λμ κΈ°κ°μ μ°¨μ΄κ° μμλ€. ν΅λ₯λ ₯λ³΄λ€ λμ± μ€μν κ²μ μ μ±
κ²°μ μλ€μ΄ μ μ±
λ³λμ μμ€μ λμ¬ ν΄κ²°ν΄μΌ νλ λ¬Έμ λ‘ νλ¨νλμ§ μ¬λΆμλ€.
λμ§Έλ‘ λΆνμ ν΅μ€νμ΄ λ°μν λ μ§κΆμΈλ ₯μ 보μμ μ±ν₯μ λλΆμ μ±
μ λ³λμ μ΄μ§νλ€λ μ¬μ€μ νμΈνμλ€. λ€λ§, μ§κΆμΈλ ₯μ 보μμ μ±ν₯μ λ³λμ νμμ‘°κ±΄μΌ λΏ μΆ©λΆμ‘°κ±΄μ μλμλ€.
μ
μ§Έλ‘ λΆνμ ν΅μ€νμ΄ λ°μν λ ν΅μ€ν μ΄μ μ λ¨λΆκ΄κ³κ° λλΆμ μ±
μ λ³λ μμμ μν₯μ λ―ΈμΉλ€λ μ¬μ€μ νμΈνμλ€. νλ ₯μ λ¨λΆκ΄κ³λ λΆνμ λν λ°°μ κ°κ³Ό λ°κ°, λΆνμ μλͺ»λ νλμ λν μ²λ² μꡬλ₯Ό νμ°μμΌ μ μ±
λ³λμ μ΄μ§νμλ€. λ°λ©΄, κ°λ±μ λ¨λΆκ΄κ³λ μκΈ°κ΄λ¦¬μ νμμ±μ μ¦κ°μμΌ μ μ±
λ³λμ μ΅μ νμλ€.
λ·μ§Έλ‘ λΆνμ ν΅μ€νμ΄ λ°μν λ κ΅μ μ μΈλ λλΆμ μ±
μ λ³λμ μ΅μ νλ€λ μ¬μ€μ νμΈνμλ€. λ―Έκ΅κ³Ό μ€κ΅μ νλ°λ μ μΈμ νμμ μ§λ₯Ό μ νΈνκΈ° λλ¬Έμ μ μ¬μ λνλ₯Ό λ³ννμ¬ νλ°λ μ μΈλ₯Ό κ΄λ¦¬νλ€.
λ€μ―μ§Έλ‘ κ΅λ΄ μ μΉμ μμΈμ΄ λΆνμ ν΅μ€ν μ ν λλΆμ μ±
μ λ³λμ κ°μ₯ κ²°μ μ μΈ μμΈμ΄λΌλ μ¬μ€μ νμΈνμλ€. μ μ±
λ³λμ μ΄μ§νλ κ΅λ΄ μ μΉμ μμΈκ³Ό λ€λ₯Έ μ΅μ μμΈλ€μ μν₯λ ₯ μ€ μ΄λ μͺ½μ΄ λ ν°μ§μ λ°λΌ λ³λμ μμ€κ³Ό μ§μμ±μ μ°¨μ΄κ° μμλ€. μΈλΆμ μΌλ‘λ μ κΆμμ 보μν, λ¨κΈ°κ° λ΄ μμ λ μ κ±°, μ§κΆμΈλ ₯μ 보μμ μ±ν₯, λ¨μ μ λΆμ ꡬμ±, λν΅λ Ήμ νλμ μ£Όλͺ©ν νμκ° μλ€.
λ³Έ μ°κ΅¬μμλ λΆν΅λ¬Έμ μ μ°μ ν΄κ²°μ μ νΈνλ μΉνΈμ°ν©μ΄ λΆνμ 4μ°¨ ν΅μ€νμ΄λΌλ κ³κΈ°λ₯Ό λ§μ κ΅λ΄ μ μΉμ μμΈκ³Ό λ¨λΆκ΄κ³ μμΈμ νμ©νμ¬ λλΆμ μ±
μ μ λ©΄μ μ΄κ³ μ§μμ μΈ λ³λμ λ°μμμΌ°λ€λ μ¬μ€μ νμΈνμλ€. λ³Έ μ°κ΅¬λ λΆνμ ν΅μ€νμ΄ λ°μν κ²½μ° λλΆμ μ±
μ λ³λκ³Όμ μμ κ΅λ΄ μ μΉμ μμΈμ μ€μμ±μ νμΈνμκ³ , λ³λμ μ΄μ§ μμΈκ³Ό μ΅μ μμΈμ ꡬλΆνμκ³ , λΆν ν΅λ¬Έμ λ° λλΆμ μ±
κ³Ό κ΄λ ¨λ μ¬νμ 보νΈμ μμμ΄ λλΆλΆ νλΉνμ§ μμμ μ¦λͺ
νμκ³ , λλΆμ μ±
μ λν ν©λ¦¬μ μΈ μ€μ¬μ νκ°μ νμμ±μ νκΈ°νμλ€λλ° μμκ° μλ€. μ μ±
κ²°μ μλ λ³λ μμΈλ€μ μν₯λ ₯μ μ’
ν©μ μΌλ‘ κ²ν νκ³ μ μ±
λ³λμ μΆμ§ν΄μΌ ν κ²μ΄λ€.β
. μλ‘ 11
1.1 μ°κ΅¬μ λ°°κ²½ λ° λͺ©μ 11
1.1.1 μ°κ΅¬μ λ°°κ²½ 11
1.1.2 μ°κ΅¬μ λͺ©μ 12
1.2 μ°κ΅¬μ λμ λ° λ°©λ² 14
1.2.1 μ°κ΅¬μ λμ 14
1.2.2 μ°κ΅¬μ λ°©λ² 15
β
‘. μ΄λ‘ μ λ
Όμ λ° μ νμ°κ΅¬ κ²ν 17
2.1 λλΆμ μ±
μ μμμ κ²½κ³Ό 17
2.1.1 λλΆμ μ±
μ κ°λ
17
2.1.2 λλΆμ μ±
μ νΉμ§ 18
2.1.3 μλ μ λΆμ λλΆμ μ±
κΈ°μ‘° 20
2.1.4 μ νμ°κ΅¬ κ²ν 23
2.2 λΆνμ ν΅κ°λ°κ³Ό κ΅μ μ¬νμ λμ 26
2.1.1 λΆνμ ν΅κ°λ° λͺ©μ 26
2.1.2 λΆνμ ν΅κ°λ° κ²½κ³Ό λ° λ₯λ ₯ 27
2.1.3 νκ΅ λ° μ£Όλ³κ΅μ λμ 32
2.1.4 μ νμ°κ΅¬ κ²ν 34
2.3 μ μ±
λ³λμ μμμ λͺ¨ν 37
2.3.1 μ μ±
λ³λμ μμ 37
2.3.2 μ μ±
λ³λμ λͺ¨ν 37
β
’. μ°κ΅¬ μ€κ³ 42
3.1 μ°κ΅¬ λ¬Έμ 42
3.2 μ°κ΅¬μ λΆμν 43
3.2.1 μ°κ΅¬ λͺ¨ν 43
3.2.2 μλ£μ μμ§ λ° λΆμ λ°©λ² 45
β
£. μ°κ΅¬ κ²°κ³Ό 48
4.1 λΆνμ 4μ°¨ ν΅μ€ν μ ν λλΆμ μ±
λ³λκ³Όμ 48
4.1.1 μ μ±
λ³λμ νκ²½ 48
4.1.2 μ μ±
λ³λμ κ³κΈ° 61
4.1.3 μ μ±
λ³λμ μ²λ¦¬ 66
4.1.4 μ μ±
λ³λμ κ²°κ³Ό 72
4.2 λΆνμ 2μ°¨ ν΅μ€ν μ ν λλΆμ μ±
λ³λκ³Όμ 77
4.2.1 μ μ±
λ³λμ νκ²½ 77
4.2.2 μ μ±
λ³λμ κ³κΈ° 86
4.2.3 μ μ±
λ³λμ μ²λ¦¬ 90
4.2.4 μ μ±
λ³λμ κ²°κ³Ό 94
4.3 μκ²° 97
β
€. κ²°λ‘ 100
5.1 μμ½ λ° μμ¬μ 100
5.1.1 μ°κ΅¬μ μμ½ 100
5.1.2 μ°κ΅¬μ μμ¬μ 102
5.2 μ°κ΅¬μ νκ³ λ° λ°μ λ°©μ 104
μ°Έκ³ λ¬Έν 105
Abstract 122Maste
μ½κ° μΈνμ κ³ νμ μ½μ κΈμ¬ λ° μ²λ°© κΈ°μ€μ΄ μλ£ μ¬μ©ννμ μ§μΆμ λ―ΈμΉ μν₯
Dept. of Public Health/λ°μ¬Background: Increases in pharmaceutical expenditures constitute a major issue, and in response, the Korean government has reformed the drug pricing system and adopted new guideline for prescription and reimbursement. These policies were intended to reduce drug prices and restrict reimbursement from inappropriate prescriptions.Objectives: The present study was conducted to identify the effects of the new pricing system and new guideline for antihypertensive drugs on utilization and expenditures in Korea.Methods: Decomposition analysis was conducted for the macro perspective and segmented regression analysis was for stochastic analysis with 54,295 subjects which were only with primary hypertension in the data. National patient sample data of Health Insurance Review & Assessment Service was used in both analyses. The study period was from March 2011 to December 2013. The dependent variables were daily drug utilization, prescribing days, average number of drugs per month, percentage of original drugs per prescription, drug overutilization and prohibited combinations for antihypertensive drug utilization, and antihypertensive drug costs, antihypertensive drug cost per prescribing day, outpatient medical costs whose primary diagnosis was primary hypertension(I10-I13) for expenditures.Results: The results of decomposition analysis indicated that total pharmaceutical expenditures decreased by 9.8% after implementation of the pricing policy, and by an additional 5.9% after the guideline was adopted. Following the implementation of the new pricing policy, the quantity index (-3%) and expenditures (-25%) of price-reduced drugs decreased, but the quantity (2%) and expenditures(5%) of not price-reduced drugs increased. The expenditures in both groups (price-reduced: -7%; not price-reduced: -5%) decreased without increasing quantities after the new guideline was implemented.
The indexes of therapeutic choice in both groups increased slightly following both policies. These policies could not control expensive drugs such as angiotensin receptor blockers and calcium channel blockers.From the results of segmented regression, these policies saved approximately USD 5.47 (29.1%) of sum of antihypertensive drug costs and outpatient medical cost, and USD 4.22 (28%) of antihypertensive drug costs in December 2013 compared to March 2012. The effect of the new guideline reduced expenditures more than the new drug pricing system in a segmented regression analysis. Original drug utilization rates did not change significantly as a function of the policies. Drug overutilization and prohibited combinations increased after the new pricing system, and decreased after the new guideline.Conclusions: Policymakers must consider the side effects and the comprehensive effects when controlling drug price directly. The policies saved money, but there were some side effects caused by the new pricing system. The guideline which is a kind of soft regulations was more effective, more reliable, less side effects than the direct cost control.ope