The analysis of changes in Coding Practices before and after the introduction of the reporting system for Present On Admission

본 연구는 의료질평가 지표 중 하나인 입원 시 상병(Present On Admission, POA) 보고체계 도입 전·후의 진단코딩 변화 분석을 파악하기 위하여 수행하였다. 이에 경기도 소재 일개 상급종합병원의 2018년 1월부터 2019년 12월까지 2년간의 퇴원환자 데이터를 전자의무기록시스템(Eletronic Medical Record, EMR)을 통해 추출하였고, 이를 분석대상 자료로 활용하여 입원 시 상병 보고체계 도입 전·후의 진단코딩 변화를 분석하였다. 본 연구의 주요 결과를 요약하면 다음과 같다. 최종 연구대상 87,055건의 퇴원을 대상으로 입원 시 상병 보고체계 도입 전·후 최종 진단코드 개수를 파악하였고, 입원 시점의 최초 진단과 퇴원 시점의 최종 진단의 진단코드 개수 차이를 비교하였다. 먼저, 최종 진단코드 개수는 입원 시 상병 보고체계 도입 전 평균 2.83개에서 도입 후 평균 3.79개로 증가하였다. 다중 선형 회귀분석 결과 인구사회학적 특성에서는 남성에 비해 여성일 때 최초 진단과 최종 진단코드의 개수 차이가 적은 것으로 나타났고, 연령이 높을수록, 의료급여환자에서 최초 진단보다 최종 진단코드가 많은 것으로 나타났다. 진료관련 특성에서는 외과계 환자에서, 응급실을 경유하여 입원하거나, 분만실이나 환아 등에 해당하는 기타경로로 입원한 환자에서, 외상환자가, 사망퇴원일 때, 8일 이상 재원한 경우 최초 진단보다 최종 진단코드의 개수가 많은 것으로 나타났다. 또, 수술을 시행한 경우에 비해 수술을 시행하지 않았을 때, 전과를 시행한 경우에 비해 전과를 시행하지 않았을 때 최초 진단코드와 최종 진단코드의 개수 차이가 적은 것으로 나타났고, 주진단 1단위코드가 C(신생물)일 때 비해 다른 모든 주진단 1단위코드에서 최초 진단코드와 최종 진단코드의 개수 차이가 적은 것으로 나타났다. 의료진 특성에서는 주치의의 연령이 30-39세에 비해 50-59세일 때와 60세 이상일 때 최초 진단코드와 최종 진단코드의 개수 차이가 적게 나타났다. 주치의 직위는 교수에 비해 조교수일 때 최초 진단보다 최종 진단코드 개수가 많은 것으로 나타났다. 이상과 같은 연구 결과를 통하여 결론을 내리면 입원 시 상병 보고체계 도입은 인구사회학적 특성, 진료관련 특성, 의료진 특성에서 최종 진단코드 개수 및 최초·최종 진단코드 개수 차이에서 유의한 영향력을 보였다. 이러한 결과는 입원 시 상병 보고체계 도입으로 인해 의료진들이 의무기록을 충실하게 작성하고, 보건의료정보관리사 역시 환자의 진료기록을 상세히 검토하여 진단코드를 누락없이 부여하였을 것으로 판단된다. 결론적으로 본 연구는 진단코딩의 변화에 있어 입원 시 상병 보고체계 도입의 효과를 확인한 사례로써 의미가 있다. The purpose of this study is to figure out the changes of coding practices which is one of the Indicators for the Healthcare Quality Evaluation before and after the introduction of the reporting system for Present On Admission (POA). Accordingly, the data of discharged patients for a general hospital in Gyung-gi province for two years from January 2018 to December 2019 was extracted through Electronic Medical Record (EMR). By utilizing the data for analysis, the changes in Coding Practices before and after the introduction of the reporting system for POA was examined. The major findings of this study summarized as follows. This study identified the number of final diagnosis codes for 87,055 cases of the discharges from hospitals before and after the introduction of the reporting system for the POA. Also, the difference in the number of diagnosis code between initial diagnosis in hospitalized and final diagnosis in discharged was compared. First, the number of final diagnosis codes increased from average 2.83 before the introduction of POA to average 3.79 after introduction of the POA. As a result of Multiple Linear Regression Analysis, women showed little differences between the number of initial and final diagnosis codes compared to men from a socio-demographic perspective. The higher the age, the more the final diagnosis codes were found in medical assistance patients than the initial diagnosis. In the case of the surgical patients in hospitalized through the emergency and delivery room or traumatic emergency patients who were hospitalized for more than eight days as a child with the disease, the number of final diagnosis codes was higher than that of the initial diagnosis. Compared to the case when the patient underwent surgery, the number of differences between the initial diagnosis and the final diagnosis code was smaller when the operation was not performed. In addition, compared to the case when the patient was transferred, the result was the same as mentioned above for the patient who did not perform the transfer. When the principal diagnosis belongs to C (neoplasm), the difference between the number of the initial diagnosis and that of the final diagnosis code is smaller in all other principal diagnosis codes. From the perspective of medical staff characteristics, the difference between the number of the initial diagnosis and the final diagnosis code was less when the age of family doctor was 50-59 and over 60 compared with the age of 30-39. Compared to when the position of a family doctor was a professor, the number of final diagnosis codes was higher than that of the initial diagnosis when he was an assistant professor. In conclusion, the introduction of the reporting system for POA showed a significant influence on the number of final diagnosis codes and the difference between the number of final diagnosis and that of final diagnosis codes, considering all socio-demographic aspects, treatment-related characteristics, and characteristics of medical staffs. These results directly indicate that due to the introduction of the POA, medical staffs faithfully prepared medical records, and the Healthcare Information Manager also granted diagnosis codes by reviewing the patient's medical records in detail. In short, this study is significantly meaningful in that it is a case that confirmed the effects of introducing POA on the change of diagnosis coding.open석

Anti-inflammatory Effects of Orobol, an Enzyme Converted Product of Genistein, on the IL-8 Production in HT-29 Colon Cells and the Dextran Sodium Sulfate (DSS)-Induced Acute Colitis Symptoms in C57BL/6 mice

학위논문 (석사)-- 서울대학교 대학원 : 농생명공학부, 2017. 2. 이기원.Inflammatory bowel disease (IBD) is a pathologic conditions of the gastrointestinal tract in humans. IBD has been suggested that that inflammatory responses play major roles in the pathogenesis though the etiology of IBD still remains unclear. Soy isoflavones are attractive source of food materials with anti-inflammation and gut-healty effects. After fermentation or bioconversion, the majority of soy isoflavones are transformed to their metabolites such as genistein, daidzein and so on. Recently, metabolites have been studied in their improved bioactivity. Orobol (7,8,3,4-tetrahydrowyisoflavone) is a metabolite of genistein. It has been known to anti-cancer effect for human ovarian and breast cancer. Although genistein exerts beneficial anti-inflammatory effects on colitis, orobol has not been studied about colitis yet. Interleukin-8 (IL-8), which is a major chemokine, plays a critical role in the inflammation including colitis. IL-8, derived epithelial cell, has been demonstrated to support neutrophil infiltration in various types of mucosal inflammation including IBD. In this study, I investigated the anti-inflammatory effect of orobol, a major metabolite of genistein in soybean. I found that oral administration of orobol decreased DSS-induced colitis symptoms such as weight loss, diarrhea, bloody fecal, and damaged colon tissue in C57BL/6 mice. Also, orobol reduced the IL-8 production and IL-8 mRNA in HT-29 cells. In luciferase assay, orobol inhibited the transactivation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-B) which is a major of transcription factor of IL-8. In a 359 whole human kinases, MAPK-interacting Ser/Thr kinase 1 (MNK1), which plays critical roles in various cytokine receptors signaling, was inhibited activity by orobol (IC50 = 33.43 nM) and suggested as a direct target of orobol. Additionally, orobol decreased tumor necrosis factor alpha (TNF-)-induced phosphorylation of eukaryotic initiation factor 4E (eIF4E) which is downstream of MNK1. Overall, orobol showed the anti-inflammatory effects in DSS-induced colitis mouse model. Also, orobol suppressed TNF--induced IL-8 production by directly targeting MNK1 in HT-29 colon cells. Thus, orobol could be a beneficial agent for reducing inflammation related to IBD.Ⅰ. INTRODUCTION. 1 Ⅱ. MATERIALS AND METHODS 4 2.1. Chemicals and reagents. 4 2.2. Animals design and scoring. 5 2.3. Tissue sample preparation. 6 2.4. Tissue staining. 7 2.5. Evaluation of tissue damage. 7 2.6. Cell culture and treatments.. 8 2.7. Enzyme-linked immunosorbent assay. 8 2.8. RNA isolation and real-time quantitative PCR. 9 2.9. Luciferase assay for NK-B transactivation 10 2.10. Western blot. 11 2.11. Kinase profiling and kinase assay. 12 2.12. Statistical analysis. 13 Ⅲ. RESULTS 14 3.1. Oral administration of orobol decreased DSS-induced acute colitis in C57BL/6 mice. 14 3.2. Orobol attenuated DSS-induced damage of colon distal tissue in C57BL/6 mice. 17 3.3. Orobol significantly decreased TNF--induced IL-8 overexpression and NF-kB transactivation in HT-29 cells. 20 3.4. Orobol inhibits MNK1 kinase activity. 23 3.5. Orobol suppressed TNF--induced eIF4E phosphorylation in HT-29 cells and proposed mechanism of orobol. 25 Ⅳ. DISCUSSION 26 Ⅴ. REFERENCES 30 Ⅵ. 국문 초록 36Maste