• Tuberculosis and Respiratory Diseases
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• 제84권4호
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• pp.317-325
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• 2021

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in the world, but the epidemiological data pertaining to HAP/VAP is limited in Korea. The objective of this study was to investigate the characteristics, management, and clinical outcomes of HAP/VAP in Korea. Methods: This study is a multicenter retrospective cohort study. In total, 206,372 adult patients, who were hospitalized at one of the 13 participating tertiary hospitals in Korea, were screened for eligibility during the six-month study period. Among them, we included patients who were diagnosed with HAP/VAP based on the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) definition for HAP/VAP. Results: Using the IDSA/ATS diagnostic criteria, 526 patients were identified as HAP/VAP patients. Among them, 27.9% were diagnosed at the intensive care unit (ICU). The cohort of patients had a median age of 71.0 (range from 62.0 to 79.0) years. Most of the patients had a high risk of aspiration (63.3%). The pathogen involved was identified in 211 patients (40.1%). Furthermore, multidrug resistant (MDR) pathogens were isolated in 138 patients; the most common MDR pathogen was Acinetobacter baumannii. During hospitalization, 107 patients with HAP (28.2%) had to be admitted to the ICU for additional care. The hospital mortality rate was 28.1% in the cohort of this study. Among the 378 patients who survived, 54.2% were discharged and sent back home, while 45.8% were transferred to other hospitals or facilities. Conclusion: This study found that the prevalence of HAP/VAP in adult hospitalized patients in Korea was 2.54/1,000 patients. In tertiary hospitals in Korea, patients with HAP/VAP were elderly and had a risk of aspiration, so they were often referred to step-down centers.

• 대한영양사협회학술지
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• 제30권1호
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• pp.41-60
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• 2024

The number of elderly in care facilities is increasing in parallel with a rapid increase in the elderly population in Korea. We analyzed the meal satisfaction ratings, food preferences, and nutritional intakes of 74 patients aged ≥65 years living in a nursing hospital in Daegu. Food preferences were high for cooked rice, rice gruel, meat soup, soybean paste stew, beef, frozen pollack, squid, egg, spinach, sea mustard, cabbage kimchi, apple, peanut, drinking yogurt, pickled perilla leaves, and salted squid. Preferences for duck (P<0.01) and vegetable (P<0.01) cooking method were significantly different for men and women, and preference for soybean paste stew increased with age (P<0.05). Regarding nutrient intakes, men had higher energy (P<0.01), carbohydrates (P<0.05), and zinc (P<0.05) intakes than women, while women had higher vitamin C (P<0.05) intake than men. Furthermore, energy (P<0.001), carbohydrates (P<0.001), protein (P<0.05), dietary fiber (P<0.01), vitamin B₆ (P<0.01), phosphorus (P<0.05), and zinc (P<0.001) intakes significantly decreased with age. Men had a significantly higher nutrient adequacy ratios (NARs) for carbohydrates (P<0.05) and cal- cium (P<0.01) than women, while women had a significantly higher NARs for protein (P<0.05), vitamin A (P<0.01), vitamin C (P<0.05), thiamine (P<0.01), riboflavin (P<0.001), iron (P<0.001), and zinc (P<0.01). Mean adequacy ratios were 0.69 for men and 0.75 for women. In particular, NARs for carbohydrates (P<0.01), vitamin B₆ (P<0.01), and calcium (P<0.05) decreased significantly with age. In summary, the study shows that supplementing vitamin C, vitamin B₆, calcium, and iron, reducing sodium, and providing meals that reflect preferences will improve the nutritional statuses of elderly residents in a nursing hospital.

• 한국콘텐츠학회논문지
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• 제17권4호
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• pp.585-595
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• 2017

본 연구는 의료급여와 건강보험환자의 의료이용량의 차이를 분석하여 의료급여환자의 도덕적 해이로 인한 진료비 증가문제를 평가하고 합리적 의료급여 정책결정의 근거를 제시하기 위한 것이다. 이를 위하여 서울시민대상 건강보험과 의료급여 급여자료를 성별 연령별 의료기관 종별로 비교 분석하였다. 분석결과는 다음과 같다. 첫째, 상급종합병원의 입원 외래이용 모두 의료급여환자가 건강보험환자에 비해서 적어서 도덕적 해이가 존재하지 않았다. 오히려 의료급여환자들이 고비용 의료서비스를 이용하고 못하고 있었다. 둘째, 종합병원의 입원이용은 건강보험환자가 많은 반면 외래이용은 의료급여환자가 많아서 의료급여환자들이 본인부담이 적은 외래서비스 이용을 많이 이용하고 있었다. 셋째, 병원 의원은 의료급여환자의 이용이 입원과 외래이용 모두 건강보험환자에 비해서 많았다. 따라서 의료급여환자들은 병원 의원의 입원과 외래이용, 종합병원의 외래이용시 적은 본인부담으로 인해 불필요한 의료이용을 할 가능성이 있는 반면에 상급 종합병원 입원과 외래이용, 종합병원의 입원이용시 비급여 의료비 등 과도한 의료비 부담으로 인해 필요한 의료서비스 이용을 하지 못할 가능성도 있었다. 따라서 중증질환을 가진 의료급여환자들의 의료비 부담을 경감시키기 위한 정책은 지속하고, 의원 병원을 이용하는 의료급여환자들이 불필요한 의료서비스를 이용하지 않도록 관리해야 할 것이다.

• 기본간호학회지
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• 제26권3호
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• pp.197-209
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• 2019

Purpose: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. Methods: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. Results: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=-3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=-2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=-3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. Conclusion: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.

• 보건의료산업학회지
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• 제12권1호
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• pp.81-93
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• 2018

Objectives : This cross-sectional study aims to investigate the differences in general health status (GHS) and physical care burdens (PCB) of inpatient groups in long-term care hospitals (LTCH). Methods : The data of 228 patients were analyzed by integrating the electronic medical record (EMR) data of 2016, recorded by the nurses of hospitalized patients in the hospital. Results : There was a statistically significant difference in the GHS between the high-medical demand group and the other groups, but there was no difference in the GHS among other groups. The overall PCB was higher in the high-medical demand group than in the middle-medical demand, and cognitive impairment groups, but not in the problem behavioral group. Conclusions : The current classification of patient groups has shown limitations in terms of the basis of differential benefits of the groups. In particular, the PCB of the problem behavior group was not different from that of any group; hence, it should be adjusted through further study. To control the surge of medical care costs, it is necessary to improve the irrationality of the LTCH pay system in terms of the integration and continuity for elderly care.

• 성인간호학회지
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• 제27권5호
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• pp.559-571
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• 2015

Purpose: This study is to determine the predictive validity of the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) for inpatients' fall risk. Methods: A literature search was performed to identify all studies published between 1946 and 2014 from periodicals indexed in Ovid Medline, Embase, CINAHL, KoreaMed, NDSL and other databases, using the following key words; 'fall', 'fall risk assessment', 'fall screening', 'mobility scale', and 'risk assessment tool'. The QUADAS-II was applied to assess the internal validity of the diagnostic studies. Fourteen studies were analyzed using meta-analysis with MetaDisc 1.4. Results: The predictive validity of STRATIFY was as follows; pooled sensitivity .75 (95% CI: 0.72~0.78), pooled specificity .69 (95% CI: 0.69~0.70) respectively. In addition, the pooled sensitivity in the study that targets only the over 65 years of age was .89 (95% CI: 0.85~0.93). Conclusion: The STRATIFY's predictive validity for fall risk is at a moderate level. Although there is a limit to interpret the results for heterogeneity between the literature, STRATIFY is an appropriate tool to apply to hospitalized patients of the elderly at a potential risk of accidental fall in a hospital.

• 대한임상독성학회지
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• 제17권2호
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• pp.108-117
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• 2019

Purpose: The study examined the poisoned patients' characteristics nationwide in Korea by using data from the National Emergency Department Information System (NEDIS). Methods: Among the patients' information sent to NEDIS from January 1, 2013 to December 31, 2015, the included subjects' main diagnosis in ED showed poisoning according to the 7th edition of the Korean Standard Disease Classification (KCD-7). We analyzed the patients' gender, age, initial vital signs, visit time, stay time of staying in ED, results of ED care, main diagnosis in ED, length of hospitalization, and results of hospitalization. Results: A total of 106,779 ED visits were included in the analysis. There were 55,878 males (52.3%), which was more than the number of females. The number of intentional poisoning was 49,805 (59.6%). 75,499 cases (70.8%) were discharged, and 25,858 cases (24.2%) were hospitalized. The numbers of poisoning patients per 1,000 ED visits were 14 in Chungnam and 11.9 in Jeonbuk. The most common cause of poisoning, according to the main diagnosis, was venomous animals. It was the same for hospitalized patients, and pesticide was next. Pesticide was the most common cause of mortality in ED (228 cases, 46.1%) and after hospitalization (584 cases, 54.9%). The incidence of poisoning by age group was frequent for patients in their 30s to 50s, and mortality in ED and post-hospitalization were frequent for patients in their 60s to 80s. Conclusion: This study investigated the characteristics of poisoning patients reported in the past 3 years. Pesticide poisoning had a high mortality rate for patients in ED and in-hospital. For mortality, there was a high proportion of elderly people over 60. Thus, policy and medical measures are needed to reduce this problem. Since it is difficult to identify the poison substance in detail due to nature of this study, it is necessary to build a database and monitoring system for monitoring the causative substance and enacting countermeasures.

• 한국보건간호학회지
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• 제14권1호
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• pp.41-60
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• 2000

This study was designed and undertaken to identify the related factors of family caregivers' depression & quality of life with stroke elderly patient. The data was collected from August 16th to September 5th. 1999. The subjects in this study were 70 caregivers and 70 patients with stroke who were hospitalized in 2 oriental medicine hospitals and 3 hospitals located in Junla-buk do. The data was analized using percentage. means. t-test. ANOVA and pearson's correlation coefficients, step-wise multiple regression done with the SAS program. The results of this study are as follows; 1. The score for family caregivers' depression was 45.2 when total score was 80. The family caregivers who got more than 50 scores belongs to highly depression group amount to $29\%$. 2. The score for family caregivers' quality of life was 37.04 when total score was 56. 3. In the significant relationship between family caregivers' depression and general characteristics of the family caregivers ; age. sex, income. In the significant relationship between family caregivers' quality of life and general characteristics of family caregivers: age, education, income. In the significant relationship between family caregivers' depression and quality of life and general characteristics of stroke elderly patient ; sex. 4. The depression degree showed significant differences in the variables of family caregiver's physical health(r=-0.307, p=0.011), stress(r=0.463. p=0.011). social support (r=-0.241. p=0.046) and elderly stroke patient's ADL(r=-0.313, p=0.009). The quality of life degree showed significant differences in the variables of family caregivers' depression(r=-0.564, p=0.001), stress(r=-0.322, p=0.008), social support (r=0.353. p=0.003). 5. The most important variable affecting family caregiver's depression was caregivers' physical symptom which accounted for $32.0\%$ of the total variance in which multiple regression analysis. Total variance affecting the family caregivers' depression was $49\%$. The most important variable affecting family caregivers' quality of life was caregivers' depression which accounted for $48\%$ of the total variance in which multiple regression analysis. Total variance affecting the family caregivers' quality of life was $61\%$.

• 한국임상약학회지
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• 제21권3호
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• pp.243-248
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• 2011

낙상은 노인의 건강을 위협하는 가장 심각한 문제 중의 하나이며, 조기사망, 신체손상, 운동장애, 심리학적 기능장애를 유발하는 원인이기도 하다. 본 연구의 목적은 국내 노인전문 요양병원 입원 환자들의 의약품 사용이 낙상에 미치는 영향을 평가하는데 있다. 후향적으로 원내 의무기록 정보를 이용하여 환자-대조군 연구를 수행하였고, 2008년 1월부터 2010년 12월까지 3년 기간에 입원한 65세 이상을 대상으로 하였다. 입원기간 중 낙상을 경험한 34명의 노인환자들을 환자군으로 선택하였으며 낙상을 경험하지 않은 68명의 노인환자들을 무작위 추출하여 1:2의 환자군:대조군비율로 연구 대상 환자들을 선정하였다. 환자군이 복용한 의약품을 대조군이 복용한 의약품과 비교하였으며 각 계열별 의약품과 낙상위험도 관계를 평가하였다. 두 그룹간의 인구통계학적 특성은 유사하였고 연령, 성별, 복용 의약품수, 고혈압 유무, 혈중 크레아티닌 수치, 혈중 나트륨 수치, 혈압 또는 심박수에 유의한 차이는 없었다. 항히스타민제와 본 연구에서 유일하게 기타 수면보조제로 분류된 졸피뎀이 유의하게 낙상위험도를 증가시켰다.

• 한국병원경영학회지
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• 제25권2호
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• pp.45-56
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• 2020

Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.