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폐렴 입원환자 진료과정의 질적 수준과 이에 영향을 미치는 요인: 임상질지표를 중심으로

Quality and Affecting Factor of Care for Patients Hospitalized with Pneumonia

  • 문상준 (서울대학교 의과대학 의료관리학교실) ;
  • 이진석 (서울대학교 의과대학 의료관리학교실) ;
  • 김윤 (서울대학교 의과대학 의료관리학교실) ;
  • 유선주 (한국보건산업진흥원) ;
  • 최윤경 (한국보건산업진흥원) ;
  • 서수경 (서울대학교 의과대학 의료관리학교실) ;
  • 김용익 (서울대학교 의과대학 의료관리학교실)
  • Moon, Sangjun (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Lee, Jin-Seok (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Kim, Yoon (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • You, Sun-Ju (Korea Health Industry Development Institute) ;
  • Choi, Yun-Kyoung (Korea Health Industry Development Institute) ;
  • Suh, Soo Kyung (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Kim, Yong-Ik (Department of Health Policy and Management, Seoul National University College of Medicine)
  • 투고 : 2009.03.27
  • 심사 : 2009.04.21
  • 발행 : 2009.04.30

초록

연구배경: 감염성 질환 중 가장 흔한 질환인 폐렴의 질병부담을 줄이기 위해서 폐렴환자의 진료 과정 개선과 이에 영향을 미치는 요인에 대한 분석이 필요하다. 본 연구에서는 국내 폐렴환자의 진료 과정의 질적 수준을 평가하고, 질적 수준에 영향을 미치는 환자 및 병원 요인을 분석하고자 한다. 방 법: 500병상 이상 병원 21곳의 1989년 12월 31일이전 출생 입원 환자로 청구코드 주진단 기준 폐렴인 환자중 2006년 8월부터 10월 사이 퇴원 환자 중 무작위 표본추출 방식으로 1,001건을 표본으로 추출하였다. 환자 및 병원 요인과 과정 지표의 상관관계를 다중 로지스틱 회귀분석을 통하여 분석하였다. 결 과: 병원 도착 후 24시간 이내 혈중산소포화도 검사 시행률은 69.4%, 24시간 이내 혈액배양검사 시행률은 79.1%, 8시간 이내 항생제 투여율은 82.5%, 항생제 투약전 배양검사 시행률은 60.5%로 대부분의 지표가 높은 충족도를 보였다. 환자 요인 중에서는 연령이 24시간 이내혈중산소포화도 검사 시행률에 영향을 미쳤고, 병원 요인 중에는 병상수, 병상당 간호사수, 연간 응급실 내원자수, 병상가동률, 지역, 입원 시각 및 경로 등이 과정 지표 시행률에 영향을 미쳤다. 결 론: 본 연구에서 드러난 진료 과정상의 질적 수준이 취약한 부분에 대하여 질 개선 활동의 역량을 강화하여 보완할 필요가 있다. 또한, 과정 지표들의 병원 간 변이를 줄이기 위하여 지표 시행률이 낮은 의료기관에서는 진료프로토콜 개선 등의 활동을 통하여 진료 과정을 개선해 나가는 노력이 필요하다.

Background: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. Methods: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months' August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. Results: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. Conclusion: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.

키워드

참고문헌

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피인용 문헌

  1. 지역사회획득 폐렴 환자의 중증도 보정 재원일수 분석 vol.12, pp.3, 2009, https://doi.org/10.5762/kais.2011.12.3.1234
  2. 노인요양시설 입소자의 장기요양등급 개선과 서비스 질 관련요인 vol.8, pp.1, 2014, https://doi.org/10.12811/kshsm.2014.8.1.051