• Journal of the Korea Convergence Society
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• v.8 no.12
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• pp.149-157
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• 2017

Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

• Proceedings of the KAIS Fall Conference
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• 2010.11b
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• pp.517-520
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• 2010

본 연구의 목적은 지방 환자의 거주지 입원과 서울 입원의 퇴원시 사망률을 비교하여 치료결과를 파악함으로써 향후의 효과성 분석을 위한 기초 자료를 제시하는데 있다. 2005년, 2008년도 환자조사 자료 중 지방거주 환자 자료 333,280건과 419,873건을 연구대상으로 하였으며, 자료분석은 기술통계, 카이제곱 검정, 로지스틱 회귀분석을 실시하였다. 퇴원시 사망에 영향을 미치는 요인에 대해 연도, 성, 보험유형, 의료기관유형, 입원경로, 내원경위, 주진단, 거주지의 효과를 통제한 후 살펴본 결과 거주지 입원환자의 퇴원시 사망률이 서울 입원환자에 비해 2.2배 높은 것으로 나타났다. 암환자의 경우도 효과를 통제한 후 퇴원시 사망률을 살펴본 결과 거주지 입원환자의 사망률이 서울 입원환자에 비해 3.4 배 높게 나타났다. 정부는 지역주민의 의료의 접근성을 높이기 위해 의료공급량의 확충과 분배보다는 지역의료의 질적수준을 향상시키는 방향으로 정책을 펼쳐야 한다.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.58-67
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• 1995

Background: This paper describes an effort to provide baseline informations for appropriate utilization of emergency room in a tertiary hospital. Methods: Authors have evaluated that the admissions in the emergency room were medically necessary by objective criteria, Appropriateness Evaluation Protocol(AEP), for one month in a tertiary hospital. Data were analysed by chi-square test and multiple logistic regression to exmaine statistical significances at the level of 0.05. Results: The prevalence of inappropriate decisions for admission was found to be 47.8%(154/322). Whether the physician decided the patient to admit or not was affected by type of services, number of departments involved, patients' medical condition, route of visit, and a day of the week visited. Level of appropriateness of admission is significantly related to patients' age, type of services, and a day of the week visited. Conclusion: We found that substantial proportion of admissions through emergency room are medically unnecessary and that non-medical factors are related to physician's for admission decisions and level of appropriateness of admission. This suggests that policy measures be required to relieve the overcrowding problem and to reduce non-emergent utilization of emergency room in a tertiary hospital.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1503-1511
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• 2002

Purpose : Although the short- and long-term outcomes of low birth weight(LBW) neonatal intensive care unit(NICU) survivors have been extensively studied, much less information is available for normal birth weight(NBW) infants(greater than 2,500 gm) who require NICU care. Methods : We retrospectively examined the neonatal hospitalizations and one year health status of 302 NBW and 131 LBW admissions to our NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone surveys and medical records. Results : After initial discharge, 21.2% of the NBW infants and 23% of the LBW infants required rehospitalization during the first year of life and there was no significant difference between the two groups. The reasons for rehospitalization of the NBW infants included respiratory disorders (32.1%), G-I problems(26.2%), genitourinary problems(11.9%), surgery(10.7%), cardiac problems(7.1%), and congenital/developmental problems(1.2%). For the LBW infants, the order of frequency was the same, with the percentages slightly different. Neonatal risk factors related to the rehospitalization of the NBW infants included mechanical ventilation, duration of mechanical ventilation, and congenital anomaly. But no positive significant correlation of neonatal risk factors with rehospitalization of LBW infants was found. Conclusion : Low and normal birthweight NICU survivors were rehospitalized at similar rates. The most common cause of rehospitalization was respiratory problems. Neonatal risk factors related to rehospitalization of NBW infants were mechanical ventilation, duration of mechanical ventilation, and congenital anomaly. However, no positive significant correlation of neonatal risk factors with rehospitalization of LBW infants was found. The data suggests that NBW infant survivors, as well as LBW infant NICU survivors, require close follow up.

• Neonatal Medicine
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• v.17 no.1
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• pp.13-20
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• 2010

Purpose : Because infants who have been hospitalized in the neonatal intensive care unit (NICU) are usually ill or premature, they are hospitalized repeatedly after their discharge. We intended to survey the frequencies and the medical costs of those rehospitalizations. Methods : The NICUs of 7 major hospitals were included. The subjects were 3,451 infants that were admitted to the NICU from July 2005 to June 2006, and discharged to home. The frequency, causes, mean cost and distribution and proportion of National Health Insurance coverage and non covered costs were analyzed. Results : The rate of rehospitalization after discharge from the NICU over 1 year was 14.8%. If multiple cases are considered as individual cases, it is 21.7%. The major causes of admission were pneumonia (15.8%), bronchiolitis (14.5%), gastroenteritis (10.4%), urinary tract infection (6.3%) and sepsis (6.3%). The mean cost for each admission was 1,652 thousand won. The mean cost of National Health Insurance coverage was 1,170 thousand won and non covered coat were 472 thousand won 70.9% and 28.6% respectively. Conclusion : The ratio of rehospitalization of infants after their discharge from the NICU over 1 year was approximately 20% and it means that follow-up management of these infants is very important and meticulous concerns after discharge should be given. However the rehospitalization and the non-coverage proportion of National Health Insurance cost is considerably high. It strongly implies that National Health Insurance should cover much more proportion, and personal cost exemption should be proceeded in case of rehospitalization of infants after discharge from the NICU.

• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.888-892
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• 2009

Purpose : To evaluate the risk factors for hospital readmission during the neonatal period among late preterm infants who were discharged after nursery care. Methods : In this retrospective study, we reviewed medical records of 135 late preterm infants readmitted to the neonatal intensive care unit (NICU) during the neonatal period, after discharge from nursery of IL Sin Christian Hospital from January 2003 to December 2008. We compared the risk factors of the hospital readmission group with the control group. Results : The gestational age and birth weight of 135 study infants were $36^{+1}{\pm}0.5$ weeks and $2,718.4{\pm}296.9gm$, respectively. Identified risk factors of hospital readmission were breastfeeding (71.9% vs. 44.4%), short duration of nursery stay ($3.3{\pm}1.6$ days vs. $4.1{\pm}2.0$ days), firstborn (60.0% vs. 45.3%), and maternal pregnancy complication (31.9% vs. 18.8%). Jaundice accounted for the majority of hospital readmissions (83.7%), and the age at hospital readmission was $6.2{\pm}3.6$ postnatal days, mostly at 5-6 postnatal days (40.7%). Identified risk factors of hospital readmission due to jaundice were spontaneous normal vaginal delivery (43.4% vs. 1.8%), younger maternal age ($29.8{\pm}3.4$ yrs vs. $32.1{\pm}4.2$ yrs), and lower maternal pregnancy complication (28.3% vs. 50%). Conclusion : Identified risk factors of hospital readmission were breastfeeding, short duration of nursery stay, firstborn, and maternal pregnancy complication. Jaundice accounted for the majority of hospital readmissions, and the age at hospital readmission was $6.2{\pm}3.6$ postnatal days.

• Korean Journal of Social Welfare Studies
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• no.39
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• pp.57-81
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• 2008

Motivation has been identified as an important factor predicting long-term outcomes of alcohol abuse treatment. Whether a patient agreed on his/her inpatient treatment at time of hospitalization could be an indicator of their motivation for treatment. This study focused on this aspect of treatment motivation and examined whether this factor predicts post-discharge abstinence. A sample of 145 individuals who were hospitalized for alcohol abuse treatment participated in the baseline data collection, of which only 66 successfully completed the 8 month follow-up telephone interview. The findings of survival analysis suggest that voluntarily admitted individuals had significantly longer duration of post-discharge abstinence compared to their counterparts. A Cox proportional hazards regression model revealed that voluntary admission and family support were significant predictors for post-discharge relapse of drinking, after controlling for the effects of marital status, living alone, and working status. Implications for social work practice are discussed.

• Proceedings of the Korea Contents Association Conference
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• 2015.05a
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• pp.349-350
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• 2015

국내 입원 스트레스와 관련된 연구는 1970년대 중반부터 꾸준히 지속되어 2000년 중반 이후 급증하였으며, 대다수의 연구가 장기 입원환자를 대상으로 한 서술적 연구였고, 대부분의 연구에서 오래 전에 개발된 Volicer et al.의 HSRS(Hospital Stress Rating Scale)에 기반하여 입원 스트레스를 측정하고 있었다. 따라서 향후에는 한국인의 사회 문화적 특성과 고유한 정서에 맞고 현재 우리나라 의료 실정에 근거한 입원 스트레스를 규명하는 질적연구를 통해 이론적인 지식체를 축적하여야 하며, 이러한 연구결과의 함의에 맞는 측정 도구의 개발로 국외에서 개발된 오래된 측정도구들을 대치할 수 있어야 할 것이다. 또한 단기 입원 환자를 대상으로 입원 스트레스를 경감시키기 위한 중재와 그 효과를 측정할 수 있는 실험연구가 보다 많이 진행되어져야 하겠다.

• The Monthly Diabetes
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• s.239
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• pp.59-61
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• 2009

미국의 사례에서 보면 전체 입원환자 중 약 7.2% 이상이 당뇨병환자이고, 이것은 비당뇨인에 비해 2.4배의 입원율에 해당한다고 한다. 우리나라에서도 사정은 비슷해 보통 1000병상에 당뇨병환자가 130명꼴에 달할 정도로 적지 않은 수를 보이고 있다. 그도 그럴 것이 당뇨병환자라면 아무 증상이 없고 불편이 없어도 혈당이 높다고 입원을 권하곤 하는데, 그 내막을 알아보자.

• Journal of the Korea Convergence Society
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• v.9 no.4
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• pp.397-408
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• 2018

The purpose of this study is to understand and describe the hospitalization stress experience of patients with schizophrenia. The subjects of this study were 15 inpatients who were hospitalized in three psychiatric hospital closure wards. As a result of the study, the contents of hospitalized stress were classified into five categories, 17 sub-categories and 58 meaningful contents. The five top categories were 'missing and guilt for family', 'discomfort due to poor therapeutic environment', 'not respected of rights Patient's, 'anxiety about life after discharge', 'social prejudice and self-perceived stigma. This study has significant implications for the provision of basic data to mediate hospitalization stress of patients with schizophrenia.