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의사결정나무기법을 활용한 노인장기요양보험 표준급여모형 개발

A Decision-support System for Care Plan in Long-term Care Insurance

  • 한은정 (국민건강보험공단 건강보험정책연구원) ;
  • 이정석 (국민건강보험공단 건강보험정책연구원) ;
  • 김동건 (동덕여자대학교 정보통계학과) ;
  • 권진희 (국민건강보험공단 건강보험정책연구원)
  • Han, Eun-Jeong (Health Insurance Policy Research Institute, National Health Insurance Services) ;
  • Lee, Jung-Suk (Health Insurance Policy Research Institute, National Health Insurance Services) ;
  • Kim, Dong-Geon (Department of data & Information Science, Dongduk Women's University) ;
  • Kwon, Jinhee (Health Insurance Policy Research Institute, National Health Insurance Services)
  • 투고 : 2014.05.09
  • 심사 : 2014.09.15
  • 발행 : 2014.10.31

초록

우리나라 노인장기요양보험에서는 수급자가 월 한도액 범위 내에서 필요한 서비스를 비용-효율적으로 이용할 수 있도록 지원하고자 표준장기요양이용계획서를 작성하여 제공하고 있다. 본 연구는 표준장기요양이용계획서의 객관성 확보와 업무 효율성 제고를 위하여 의사결정나무기법을 이용해 수급자의 건강 및 기능 상태에 맞는 최적의 급여계획을 도출하는 표준급여모형을 개발하였다. 타당도 높은 모형 개발을 위하여 국민건강보험공단의 전국 220개 장기요양운영센터로부터 장기요양인정조사와 표준장기요양이용계획서 작성 경험이 풍부한 직원(본 연구에서는 '훈련된 조사자'라고 함)을 추천받아 자료수집의 내용과 방법에 대해 교육을 실시하였고, 이들이 수급자의 건강 및 기능 상태를 평가하고 작성한 수급자 개인별 맞춤형 급여계획을 자료 분석에 활용하였다. 표준급여모형은 1단계로 시설 또는 재가 급여 권고 여부를 결정하는 모형을, 2단계로 재가급여를 권고했을 경우의 재가급여 세부 종류별 권고 여부를 결정하는 모형을 개발하였다. 본 연구에서 개발된 표준급여모형은 전산프로그램화 되어 국민건강보험공단 직원이 수급자에게 제공할 표준장기요양이용계획을 수립하는 과정에 실제로 활용되고 있어 표준장기요양이용계획서의 객관성 확보와 업무 효율화가 기대된다.

National Health Insurance Service(NHIS) provide care-plans for beneficiaries in the long-term care insurance(LTCI) systems that help them use LTC services appropriately. The care-plan includes recommendations for the most adequate type of care (gold standard) for beneficiaries. This study develops a decision-support system to determine the appropriate type of care plan. To develop a model, we used a data set that well-trained assessors in the NHIS investigated as a gold standard for beneficiaries: nursing home care, home-visit care, home-visit bathing, home-visit nursing, or day and night care. The decision-support system was established through a decision-tree model, because it may be easy to explain the algorithm of a decision-support system to working groups and policy makers. Our results might be useful in evidence-based care planning in an LTCI system and contribute to the efficient use of LTC services.

키워드

참고문헌

  1. Commonwealth of Australia (2006). Aged care assessment and approval guidelines.
  2. Commonwealth of Australia (2007). Aged care client record user guide.
  3. Elkan, C. (2001). The foundations of cost-sensitive learning, In proceedings of the seventeenth international joint conference on artificial intelligence (IJCAI'01), 973-978.
  4. Fries, B. E., Shugarman, L. R., Morris, J. N., Simon, S. E. and James, M. (2002). A Screening system for Michiga's home- and community-based long-term care programs, The Gerontologist, 42, 462-474. https://doi.org/10.1093/geront/42.4.462
  5. Han, E. J., Lee, J. S., Kim, D. G. and Kang, I. M.(2009). A recommending system for care plan(Res-CP) in long-term care insurance system, The Korean Journal of Applied Statistics, 22, 1229-1237. https://doi.org/10.5351/KJAS.2009.22.6.1229
  6. Hyun, K. R. and Lee, S. M.(2012). Effects on the functional status changes of LTC(Long-Term-Care) services, The Korean Gerontological Society, 32, 593-609.
  7. Hirdes, J. P., Poss, J. W. and Curtin-Telegdi, N. (2008). The method for assigning priority levels(MAPLe): A new decision-support system for allocating home care resources, BMC Medicine, 6.
  8. Jegal, H. S. (2011). The strategies for improving quality of care in long-term care insurance service: The necessity of integrated health and welfare system for old people and care management, Public Policy Institute for People.
  9. Kang, H. C., Han, S. T., Choi J. H. (1999). Data mining using SAS Enterprise Miner - The method and application, Freedom Academy Press, Seoul.
  10. Lee, Y. K., Jung, K. H., Sunwoo, D., Kim, J. S. and Kim, C. W. et al. (2013). Reform of LTC disability determination system and the development of a demential management model(2013-2-0012), Korea Institute for Health and Social Affairs, Ministry of Health and Welfare, Seoul.
  11. Lee, T. H., Ko, Y. K., Kim, B. N., Kim, H. C., Lee, I. S., Jung, S. H., Jo, E. H., Kim, C. W., Jung, S. C., Lee, E. J., Kwon, H. B., Park, N. U. and Jeon, B. H. (2011). Analysis of the achievements of the national long-term care insurance - Clinical outcomes and the development of quality indicators(series no.3), Korea Institute of Public Finance, Seoul.
  12. Lee, J. S., Han, E. J., Kwon, J. H. and Kang, I. O. (2008). The correlation between standard long-term care plan and long-term care utilization under LTC insurance system(2008-33), National Health Insurance Corporation, Seoul.
  13. Matsuda, S. and Yamamoto, M. (2001). Long-term care insurance and integrated care for the aged in Japan, International Journal of Integrated Care, 1, 1-11.
  14. National Health Insurance Corporation (2013). 2013 Manuals for working on long-term care insurance, National Health Insurance Corporation, Seoul.
  15. OECD (2011). Help wanted? Providing and paying for long-term care.
  16. Seok, J. E. (2006). Elderly longterm care insurance and service delivery system: The institutionalization of care management, Korean Academy of Social Welfare, 143-151.
  17. Sunwoo, D., Kim, C. W., Choi, J. S., Choi, H. J., Yeon, B. K. and Won, C. W. (2007). Evaluation study on the second pilot project of long-term care insurance, Ministry of Health and Welfare, Korea Institute for Health and Social Affairs, Seoul.

피인용 문헌

  1. A Target Selection Model for the Counseling Services in Long-Term Care Insurance vol.28, pp.6, 2015, https://doi.org/10.5351/KJAS.2015.28.6.1063