• 한국보건간호학회지
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• 제24권2호
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• pp.182-196
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• 2010

Purpose: This study examined potential determinants of gender differences in utilization of health care services among Korean adults. Methods: The study population was 21,647 adults ${\geq}$25-years-of-age who had responded to a health interview survey conducted as part of the 2005 National Health and Nutrition Surveys. Relative gender differences in the use of each health service were assessed using chi-square test and sex ratios. The contribution of potential factors of sex differences in the use of health services was evaluated by comparing the odds ratio and sex ratio before and after adjustment for such variables. Results & Conclusions: More females had visited a physician and been admitted to hospital, but hospitalization time was longer for males. Adjustment for poor self-rated health, number of chronic disease and limit of full term for ADL led to a reduction in the odds ratio of females compared to males for health service utilization. However, adjustment for socioeconomic factors (household income, education, occupation, and health insurance) magnified the gender difference concerning length of hospitalization. Factors that explain gender-related differences in utilization of health care services are concluded to be different health needs and socioeconomic status.

• 한국의료질향상학회지
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• 제10권2호
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• pp.154-163
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• 2003

Purpose: The aim of this study is to develop and apply the critical pathway to the nasal bone fracture patients and to elucidate its effect. Methods: Critical pathway (CP) sheet and questionnaire were developed by a team approach. Critical pathway were applied to 30 nasal bone fracture patients (CP group) from June 2001 to November 2001. Length of hospitalization, cost for hospitalization and bed turnover rate of CP group were compared to those of the 30 patients who had same disease entities and treated by conventional regimen (control group). Results: Length of hospitalization in the CP group (4.20 day) were significantly shorter than that of control group (6.21 day). Mean cost for hospitalization of the CP group (492,106 won) were significantly lower than that of control group (678,376 won). Bed turnover rate in CP group (2.5) were higher than that of control group. The patients satisfaction for the medical personnel, explanation regarding operation procedure, therapeutic operation fee, and length of hospitalization were all affirmative. Conclusion: Critical pathway that we developed for nasal bone fracture definitely improved the quality of treatment and lowered cost of medical service. Furthermore, other critical pathways should be developed for another facial trauma patients.

• Asian Pacific Journal of Cancer Prevention
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• 제16권11호
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• pp.4577-4581
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• 2015

Background: To explore the hospitalizations of breast cancer patients undergoing mastectomy, and to provide a basis for management, clinical prevention and treatment. Materials and Methods: We conducted an investigation by means of the retrospective survey and the medical records retrieval system, and made out the data of patients suffered from breast cancer in a hospital in Guangzhou from 2004 to 2013, including age, medical payment methods, pathological type, treatment, treatment results, complications, hospitalization days, cost and so on. Results: The average age of the inpatients was 50.14 years old. The main histologic types were infiltrating duct carcinoma (88.06%). The main surgery was modified radical mastectomy (80.41%). The cure rate was 90.80% during the 10 years. The main medical payment method was self-paying (57.28%). The average hospital stay was 13.51 days, and average hospitalization cost was RMB 23,083.66 yuan, proportion of drug fees up to 39.70%. Postoperative complication rate was 0.79%. The self-paying group was with the highest proportion of drug fees (P<0.05), while the free medical service group was with the longest hospitalization days (P<0.05). Conclusions: The payment methods significantly affected the proportion of drug fees and hospitalization days. The therapeutic effect was satisfactory with less complications and reasonable proportion of drug fees in our hospital.

• Clinical Psychopharmacology and Neuroscience
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• 제16권4호
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• pp.398-406
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• 2018

Objective: Hospitalization of patients with delirium after visiting the emergency department (ED) is often required. However, the readmission risk after discharge from the ED should also be considered. This study aimed to explore whether (i) immediate hospitalization influences the readmission risk of patients with delirium; (ii) the readmission risk is affected by various risk factors; and (iii) the healthcare cost differs between groups within 28 days of the first ED visit. Methods: Using the National Health Insurance Research Database, the data of 2,780 subjects presenting with delirium at an ED visit from 2000 to 2008 were examined. The readmission risks of the groups of patients (i.e., patients who were and were not admitted within 24 hours of an ED visit) within 28 days were compared, and the effects of the severities of different comorbidities (using Charlson's comorbidity index, CCI), age, gender, diagnosis and differences in medical healthcare cost were analyzed. Results: Patients without immediate hospitalization had a higher risk of readmission within 3, 7, 14, or 28 days of discharge from the ED, especially subjects with more severe comorbidities ($CCI{\geq}3$) or older patients (${\geq}65years$). Subjects with more severe comorbidities or older subjects who were not admitted immediately also incurred a greater healthcare cost for re-hospitalization within the 28-day follow-up period. Conclusion: Patients with delirium with a higher CCI or of a greater age should be carefully considered for immediate hospitalization from ED for further examination in order to reduce the risk of re-hospitalization and cost of healthcare.

• 한국산학기술학회논문지
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• 제17권8호
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• pp.407-414
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• 2016

본 연구의 목적은 일 지역 내 소재 요양병원에 입원하고 있는 일당정액제 환자의 입원일수 및 진료비 특성을 파악하고, 요양병원 입원일수 및 입원진료비 관련 현황을 분석하여, 향후 요양병원의 입원진료에 대한 적정성 방안을 찾기 위해 필요한 기초자료를 제공하는 것이다. 본 연구의 대상은 2014년 1월부터 12월까지 1년 간 대전, 충남, 충북, 세종 소재 요양병원 입원 환자가 건강보험심사평가원에 청구한 월별 청구자료 중 요양병원 1일당 정액수가제에 해당하는 44,037건이었다. 분석결과 연구대상자의 일반적 특성과 주 진단명 상위 15위 간의 정준상관분석 결과 7개의 정준함수가 도출되었으며, 그 중 6개의 정준함수가 통계적으로 유의한 것으로 나타났고(p<0.001), 정준함수 1에서는 카이제곱 값이 5955.49이고 자유도가 98일 때 p<0.001 수준에서 유의하게 나타났다. 본 연구에서는 지역사회 내 보건 복지서비스를 확대하면 사회적 입원을 줄일 수 있을 것으로 판단된다. 보건 복지서비스의 확대는 고령의 노인들에 대한 삶의 질을 향상시킬 수 있으며, 아울러 요양병원 입원일수를 단축시키고 총 진료비를 절감시켜 증가 일로에 있는 국민의료비의 지출 감소에도 기여할 것으로 판단된다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권3호
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• pp.141-150
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• 2013

Objectives : The objective of this report is to identify the utilization of hospital school service during hospitalization among patients in their childhood and adolescence with psychiatric disorders. Methods : We retrospectively reviewed the medical record of child and adolescent psychiatric who were hospitalized during March 2009 through October 2012. We compared the one-year successful schooling and outpatient follow up rate between users and nonusers of the inpatient hospital school service. The hospital schooling experiences of the users were investigated upon follow-up visits to the outpatient clinic. Results : Sixty-three students received hospital school service during hospitalization among total 122 child and adolescent inpatients. Hospital school participants showed a significantly higher school reentry rate (61.9%) than non-participants (40.7%). However, there was no difference on follow up rate between the two groups. More than 60% of the 22 interviewed participants expressed an above-average level of satisfaction about hospital school service. Conclusion : Many patients with mental illness experience difficulty in receiving school education during treatment. That induces deterioration in disease, academic failure, poor social skills, low self-esteem, economic difficulties, and future job opportunities. The results of this study emphasize the importance of hospital school service and offer useful guidance for hospital school operation.

• 대한간호학회지
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• 제34권3호
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• pp.449-457
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• 2004

Purpose: The aim of this study was to analyze economical efficiency of home care service by comparing a cost-utility ratio(CUR) between home care and hospitalization. Method: The analytic framework of this study was constructed in 5 stages: Identifying the analytic perspectives, measurement of costs, measurement of utility, analysis of CUR, and sensitivity test. Data was collected by reviewing medical records, home care service records, medical fee claims, and other related research. Result: The mean of the annual total cost was 23,317,636 Won in home care and 73,739,352 Won in hospital care. QALY was 0.389 in home care and 0.474 in hospital care, so CUR was 299,712,545 QALY in home care and 777,841,266 QALY in hospital care. Conclusion: The findings affirmed that home care had an economical efficiency in the aspect of utility compared to hospitalization. Therefore, the findings of this study can be used to develop a governmental health policy or to expand the home care system. In addition, the cost-utility analysis framework and process of this study will be an example model for cost-utility analysis in nursing research. Therefore, it will be used as a guideline for future research related to cost-utility analysis in nursing.

• 보건의료산업학회지
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• 제9권4호
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• pp.145-155
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• 2015

Objectives : The purpose of this study was to test the influencing effects of health perception and family support on depression in elderly patients. Methods : Two-hundred forty-nine hospitalized geriatric patients were recruited in B city, South Korea. They were asked to complete a questionnaire, and 214 data sets were included in multiple regression analysis. Results : Subjects perceived a higher level of depression. Influencing factors of depression were hospitalization experience (t=3.476, p=.001), health perception (t=-3.310, p=.001), education (t=2.684, p=.008), economic satisfaction (t=2.579, p=.011), satisfaction with allowance (t=2.262, p=.025), and family support (t=-2.200, p=.029). The model was statistically significant explaining 36.3% of the variance (F=21.257, p<.001). Conclusions : In dealing with depression, nurses in elderly care facilities should be more concerned about patients with hospitalization experiences. Interventions to improve health perception should be provided to elderly patients, and educational programs on how to support patients are needed for the families of patients.

• 가정간호학회지
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• 제10권2호
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• pp.123-131
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• 2003

This study was to compare the functional status. complication and readmission rates. and client satisfaction with nursing care of home-based care and hospital-based care for clients with Coronary Artery Bypass Graft. Raw data were collected by interviewing and reviewing charts of 41 clients with Coronary Artery Bypass Graft between June 2001 and July 2002 at an university hospital located in Seoul. Korea. Out of 41 clients. 15 were in home care group and 26 were in hospitalization group. The baseline characteristics of the groups were almost identical. Mean age was 61.7 and 75.6% of clients being male. For home care group. the data collection was made at discharge and at termination of home care. and for hospitalization group. at discharge and at the first visit of outpatient department. Complication and readmission rates were investigated at one month after operation. Collected data were then analysed by conducting Chi-square test. Wilcoxon rank sum test. and Wilcoxon signed ranks test with SPSS program. The level of significance was .05. The results of the study are summarized as follows: 1. Postoperative length of stay of the home care group was shorter than that of hospitalization group by 1. 14 days(8.45 days vs. 9.59 days). On average. 1.8 home visits per client were observed. 2. The functional status (Barthel Index) at the termination of home care was significantly increased from that at discharge. For hospitalization group. a significant increase was observed between the functional status at the discharge and that at the first visit of outpatient department. The differencies in incremental of the scores. between the groups. were however not significant. 3. Complication and readmission rates; no statistically significant difference between the groups was observed. 4. The client satisfaction with nursing care (CSS) at termination of home care was significantly higher than that at hospital discharge. In conclusion. the outcomes of the analysis suggest that the home care benefits clients with Coronary Artery Bypass Graft. Client satisfaction with nursing care rises at termination of home care as compare to that measured at hospital discharge. Meanwhile. there was no significant differences in functional status. and complication and readmission rates. Further. home care reduced the length of stay in hospital.

• Journal of Preventive Medicine and Public Health
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• 제41권3호
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• pp.147-152
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• 2008

Objectives : Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. Methods : Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. Results : The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the non-fluoridated cities. Conclusions : We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.