Data Mining Approach to Clinical Decision Support System for Hypertension Management

Background: This study examined the utility of data mining algorithms for the management of hypertension. Methods: We studied 2,446 hospitalized patients with hypertension and 3,835 clinic patients with hypertension. Among data mining algorithms, we used clustering analysis and compared decision tree analysis with logistic regression. Results: On the contrary to the previous studies, decision tree performed better than logistic regression. We have also developed a CDSS (Clinical Decision Support System) with three modules (doctor, nurse, and patient) based on data warehouse architecture. Data warehouse collects and integrates relevant information from various databases from hospital information system. Conclusions: This study suggests that data mining algorithms may be an useful method for hypertension management and CDSS system can help improve decision making capability of doctors and improve accessibility of educational material for patients.ope

ERP System Performance in a Hospital

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.ope

Structured modeling of differential diagnosis, treatment and results for allergic rhinitis

보건학과/석사[한글] 산업과 문명의 발달로 인한 기인성 항원의 다양화로 알레르기성 질환이 증가하고 있는 추세이며, 비과한 임상에 알레르기성 질환에 대한 관심이 높아지고 있다. 이에 따라 알레르기성 비염에 대한 많은 연구가 진행되고 있으나 아직 정립된 연구가 없으며 임상에서 알레르기성 비염의 진단과 치료면 에서 해결해야 할 많은 문제점이 내재하고 있다. 따라서 본 연구는 임상적으로 중요한 위치를 차지하고 있는 알레르기성 비염의 감별진단과 치료방법, 치료결과간의 구조를 분석하기 위해 시행되었다. 이에 따라 환자의 특성의 공통적 요인을 규명하며, 환자의 특성과 진단, 치료방법, 치료결과간의 구조를 분석하여 이들간의 관계를 규명하고자 하였다. 이를 위해 1991년부터 1993년까지 백병원 이비인후과에 내원한 환자중 알레르기성 비염이 의심되어 설문 조사와 일련의 검사에 응한 환자 274명을 연구 대상으로, 환자의 설문지, 이학적 소견 및 검사 결과 등의 내용을 통계분석 패키지 SAS version 6.04와 LISREL version 7.20을 사용하여 분석하였다. 첫째, 환자의 특성에 관한 관련성을 분석하고 공통적 요인을 규명하기 위하여 환자의 특성 을 증상군, 증산의 정도군, 증상의 시간적 추이군, 증상의 악화 요인 및 유발요인군, 과거력 및 가족력군, 이학적 검사군, 검사실검사군의 7개의 요인 군으로 나누어 요인분석을 실시한 결과 33개의 요인이 도출되었다. 둘째, 진단과 치료 결과에 영향을 미치는 중요 요인의 판별 능력을 분석하기 위하여 판별 분석을 실시한 결과 진단의 예측도는 위의 요인군 7개를 모두 합하여 예측하였을 때가 81.31%로 가장 높았으며, 이 때 진단에 유의한 영향을 미치는 요인은 코의 소양감 및 재채기, 일준유발시간(아침, 하루종일), 비루 비중격만곡증, 비용, 피부 반응 검사(진드기, 동물), 피부 반응 검사(곰팡이 등), 피부 반응 검사(쑥 등), 알레르기의 정도를 나타내는 검사실 검사의 8개였다. 그리고 치료 결과의 예측도는 증상군에 의하여 예측되었을 때가 56.53%로 가장 높았으며, 이 때 치료 결과에 유의한 요인은 두통 및 전신 증상 뿐이었다. 셋째, 환자의 특성에 따른 알레르기성 비염의 감별진단과 치료방법 및 치료결과간의 구조를 분석하기 위하여 공변량 구조분석을 실시하였다. 그 결과 피부 반응 검사의 진드기, 동물, 쑥 등과 알레르기 정도를 나타내는 검사실 검사에 양성을 나타내고, 코의 소양감 및 재채기의 증상이 있는 경우는 알레르기성 비염으로, 비용이 있는 경우는 비(非)알레르기성 비염으로 진단이 내려짐을 보였다. 또한 두통 및 전신 증상이 있고 비용이 있으면 수술 요법을, 가족력이 있고 과거 약물 치료에 대한 효과가 있으며 비루와 비중격만곡증이 있으면 약물요법을 시행하였다. 그리고 두통 및 전신 증상은 치료 결 과에 악영향을 미치는 것으로 나타났으며, 알레르기성 비염의 치료방법은 보편적으로 약물요법이 시행됨이 나타났다. [영문] Allergic disease is increasingly prevalent as various antigens are newly induced by the development of industries and cultures. While the study on the allergic rhinitis is progressed in resent years, there is still no confirmed study in this area yet and there are many problems with diagnosis and treatment of allergic diseases in clinics. This study was to examine the patient characteristics affecting differential diagnosis, treatment, and results of the treatment for allergic rhinitis, and to determine the relationship among these factors. The data were collected from 274 patients who visited the Paik-hospital's otorhinolaryngology with suspected allergic rhinitis during 1991-1993. Patient's questionnaires, physical examination and laboratory test results were analyzed using SAS version 6.04 and LISREL version 7.20. First, factor analysis was performed to analyze the relationship between patient characteristics and to determine common factors for each of 7 categories of patient characteristics. Total of 33 factors were determined from the 7 categories; symptom category, severity category, symptom category with the times, aggravating factor, provoking factor category, past history, family history category, physical examination category, and laboratory test category. Second, discriminant analysis was performed to determine important factors affecting diagnosis and treatment result. For predicating diagnosis, all 7 categories produced the best result with the prediction rate of 81.31%. The factors significantly affecting diagnosis were nasal pruritis, sneezing, day-time of occurrence(morning, all day), rhinorrhea, nasal septal deviation, nasal polyps, skin test(mite, animal), skin test(fungi), skin test(mugwort), and laboratory theist. For predicting the results of treatment, symptom category produced the best result with the prediction rate of 56.53%. The factors significantly affecting the results were only headache and general symptom. Third, covariance structure analysis was performed to analyze the structural relationships among the differenteal diagnosis, treatment and results of treatment. The factors affecting allergic rhinitis were: skin test positive to mites, animals and mugwort, nasal pruritis, and sneezing ; whereas the factors affecting non-allergic rhinitis were nasal polyps. If there were headache, general symptom and nasal polyps, surgical therapy was performed ; and if there was the family history, the effectiveness to past drug treatment and the rhinorrhea nasal septal deviation, drug therapy was performed. Headache and general symptom had negative effects on treatment results. And the drug therapy was found to a general threatment method of allergic rhinitis.restrictio

Analysis on the Degree of Agreement between the Initial Diagnosis Made by Referring Institutions and the Final Diagnosis by a Referred Institution

Objectives: Assessing the degree of agreement between the initial diagnosis of patient encounters made by referring institutions and the final diagnosis by a referred institution. Methods: Among 505 patients referred to the department of obstetrics and gynecology of one tertiary care hospital in 2003, 291 patients hospitalized with gynecologic problems were selected as study subjects in this study. Medical chart review was conducted to compare diagnostic codes given at the time of referral by the referring institutions and those given at discharge by the referred hospital. To assess the degree of accordance between the two diagnostic codes of the same patient encounter, we developed 5-point scoring system. The score of 5 indicates a perfect accordance of all 4 digits of two comparing diagnosis codes and 4 indicates accordance of the first 3 digits. The score of 3 is assigned if the two codes do not agree on the first 3 digits, but share the common disease area. The scores of 2, 1, and 0 are assigned for the cases of accordance on the first 2 digits and the first digit, and no accordance on the first digit, respectively. To identify factors predicting the degree of accordance, decision tree analysis using CART algorithm as data mining approach was carried out. Results: The average accordance score was 3.14. According to the decision tree analysis results, the type of specialty and health care institutions are primary factors that discriminate referrals with high accordance score from those with low score. Secondary factor was diagnosis group: the score was as high as 3.69 among referrals with diagnosis of benign tumor (diagnosis code: D25-D28) and carcinoma in situ (D00-D09), and 2.92 for other diagnosis groups. Tertiary factor was the type of patient`s occupation. Conclusions: Our study showed that there`s a substantial gap between referring and referred hospital on the diagnosis for the same encounter. Effective communication between the referring and referred hospitals may reduce the gap and consequently prevent medical waste resulting from duplicated procedures and tests.ope

Web-based PBL (Problem Based Learning) in Graduate School of Public Health

Objectives: This paper is aimed to study the satisfaction level and course effects of web-based PBL of the Graduate school of Public Health. Methods: Web-based PBL was implemented from March 1 to June 22 on 19 students and a survey on the satisfaction level of the lessons was taken and analyzed. For the analysis, SAS 9.1 was carried out. Results: The relation of effectiveness of the lessons according to the satisfaction level of each evaluation items, shows a significance according to satisfaction of professors, whether or not the students were satisfied in evaluating themselves (correlation, p<0.05). The satisfaction level of the evaluation on teachers and whether or not the students were satisfied in evaluating themselves shows significant influence on the effectiveness of the lessons (simple regression, p<0.05), more specifically in active class participation and understanding by the students themselves (stepwise multiple regression, p<0.05). Conclusions: In this study the attitudes of professors and students toward the lessons are major influences on the effectiveness of the lessons. Specifically, active class participation and understanding by the students themselves are the most important influences.ope