• Korea Journal of Hospital Management
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• v.28 no.2
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• pp.9-20
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• 2023

Purpose: This study classified the actual functions of geriatric hospitals and examined the differences in their characteristics, in order to provide a basis for discussions on defining the functions of geriatric hospitals and how to pay for care. Methodology: This study used various administrative data such as health insurance data and long-term care insurance data. Cluster analysis was used to categorize geriatric hospitals. To examine the validity of the cluster analysis results, we conducted a discriminant analysis to calculate the accuracy of the classification. To examine cluster characteristics, we examined structure, process, and outcome indicators for each cluster. Findings: The cluster analysis identified five clusters. They were geriatric hospitals with relatively short stays for cancer patients(cluster 1; cancer patient-centered), geriatric hospitals with relatively large numbers of patients using rehabilitation services(cluster 2; rehabilitation patient-centered), geriatric hospitals with a high proportion of relatively severe elderly patients(cluster 3; severe elderly patient-centered), geriatric hospitals with a high proportion of mildly ill elderly patients with various conditions(cluster 4; mildly ill elderly patient-centered), and geriatric hospitals with a significantly higher proportion of dementia patients(cluster 5; dementia patient-centered). The largest number of geriatric hospitals were categorized in clusters 4 and 5, and the structure and process indicators for these clusters were generally lower than for the other clusters. Practical Implications: We have confirmed the existence of geriatric hospitals where the medical function, which is the original purpose of a geriatric hospital, has been weakened. It has been observed that the quality level of these geriatric hospitals is likely to be lower compared to hospitals that prioritize enhanced medical functions. Therefore, it is suggested to consider the conversion of these geriatric hospitals into long-term care facilities, and careful consideration should be given to the review of care-giver payment coverage.

• Journal of Korean Academy of Nursing
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• v.40 no.1
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• pp.110-118
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• 2010

Purpose: To develop outcome indicators of urinary incontinence to measure quality of care in long term care hospitals in Korea. Methods: The draft indicators of urinary incontinence were developed from a literature review and clinical expert panel. A survey of medical records of 280 patients in 20 hospitals was conducted to test inter-rater reliability. Statistical analysis was done to test risk adjustment criteria, variation between hospitals, and stability of indicators, using assessment data from 77,918 patients in 623 hospitals. Results: The inter-rater reliability of items was high (Kappa range: 0.66- 0.92). Severe cognitive impairment (odds ratio [OR]: 3.15, confidence interval [CI]: 3.03-3.26) and total mobility activities of daily living (ADLs) dependency (OR: 4.85, CI: 4.72-4.98) increased the prevalence of urinary incontinence, thus they proved to be significant criteria to stratify high and low risk groups. The prevalence for low risk showed more substantial variation than the high risk group. The indicators were stable over one month. Conclusion: This study demonstrated the feasibility of outcome indicators of urinary incontinence. Improving the reliability of the patient assessment tool and refining the indicators through validation study is a must for future study.

• Health Policy and Management
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• v.31 no.2
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• pp.173-179
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• 2021

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

• Research in Community and Public Health Nursing
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• v.33 no.4
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• pp.357-371
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• 2022

Purpose: This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

• Korean Journal of Clinical Pharmacy
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• v.28 no.4
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• pp.300-307
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• 2018

Objective: As the demands of healthcare environment change, it is necessary to advance human health care by improving students' essential competencies including knowledge, skills, abilities, inter-professional collaboration and patient centered care. This study identified long term accomplishment and improvement of the essential competencies in clinical pharmacy practice education (CPPE) at Korean hospitals over time. Methods: This study was conducted for pharmacy students who completed CPPE evaluation related to tertiary hospitals and secondary hospitals located in Seoul and Gyeonggi-do regional area from 2014 to 2018. Results: Over the past 5 years, overall results of student evaluation on the essential competencies in CPPE at both tertiary and secondary hospitals showed a decreasing trend or did not change. Essential competency in CPPE at tertiary hospitals had been identified as superior on 'Learn clinical knowledge in the treatment of diseases' to secondary hospitals [average number of students (%): 210 (72.9%) vs 68 (68.0%)]. On the other hand, essential competencies in CPPE at secondary hospitals had been identified as better at 'inter-professionals collaborative teamwork and direct patient care' than tertiary hospitals [average number of students (%): 64 (64.0%) and 56 (56.0%) vs 121 (42.0%) and 90 (31.3%)]. A total of 176 (61.1%) students in tertiary hospitals and 66 (66.0%) in secondary hospitals evaluated that 'patient-centered care' education was good. Conclusion: In tertiary hospitals, all six essential competency outcomes have not been improved, whereas four essential competency outcomes showed an increasing trend in secondary hospitals. It will be necessary to develop outcome-based CPPE education program to better reflect the essential competencies.

• Journal of Korean Public Health Nursing
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• v.26 no.1
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• pp.101-112
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• 2012

Purpose: The purposes of this study were to identify differences of duties, tasks, and task elements of care helpers between long term care (LTC) facilities and client's home (CH), and to provide data for the development of educational programs and policies. Methods: This study was a descriptive investigation; the subjects of the study were 418 care helpers. Duties, tasks, and task elements were measured using the framework proposed by Shin et al. (2012). Data were analyzed by t-test using PASW 18.0. Results: All of the jobs were statistically significant differences between LTC and CH. Dietary assistance and Daily work assistance were more frequently in CH, and the frequency of other tasks was higher in LTC than CH. Tasks with higher-reported difficulty by those who worked in LTC were as follows: personal hygiene, position change and movement, exercise and activity assistance, safety care, communication assistance, dietary assistance, environment management, daily work assistance, emergency prevention, early detection and speedy reporting, and dementia patient care. Conclusion: These findings suggest that training for care helpers of each facility type will be differentiated. Tasks and task elements reported by care helpers were modified and added to the standard textbook.

• Journal of Korean Academy of Nursing Administration
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• v.22 no.3
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• pp.209-219
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• 2016

Purpose: To analyze the proportion of medical institutions meeting the legal standard for nurse staffing. Methods: Data collected from 29,282 institutions between 1996 and 2013 were analyzed. Nurse staffing was measured as daily patient census per registered nurse (RN). The standard for general hospitals, hospitals, and clinics is 2.5 or less, and that for long-term care hospitals is 6.0 or less of the daily patient census per RN. Clinics may substitute nursing assistants for RNs by 50% or 100% depending on their daily inpatient census; long-term care hospitals may substitute nursing assistants for RNs by two thirds of the required number of RNs. Results: The proportion of general hospitals, hospitals, clinics, and long-term care hospitals meeting the standards was 63%, 19%, 63%, and 94%, respectively, in 2013. While general hospitals had an increase in the proportion during the 1996-2013 period, small changes were found in hospitals and clinics. In 2013, nurses were estimated to care for 16 (interquartile range: 12~24) patients per shift in general hospitals. Three quarters of clinics had no RNs in 2013. Conclusion: Many medical institutions did not meet the legally mandated minimum staffing level. The government must implement policy actions for all medical institutions to meet the legal standards.

• Journal of Digital Convergence
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• v.15 no.2
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• pp.273-283
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• 2017

This study aims to develop a convergence optimized LOS(Length of Stay) management system that can provide efficient by predicting LOS on outpatient information for inducing the LOS to manage their own activities. web program has been implemented to comput in real-time predicting LOS by using the predicted LOS model of outpatient information. The predict model was derived management targets of long term predicted patient group and intensive care patient group. The optimized LOS(Length of Stay) management system was confirmed efficient for optimizing management of LOS that can provide by the long-term predicting alarm and over LOS alarm service for long term predicted patient group and intensive care patient group. Therefore the trial operating policy alternative on extension of predicted LOS is needed to utilized convergence optimizing system on LOS.

• Research in Community and Public Health Nursing
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• v.32 no.3
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• pp.382-395
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• 2021

Purpose: The purpose of this qualitative study was to explore the transition experiences of the elderly from long-term care hospitals to their homes. Methods: The participants were eight elderly medicaid beneficiaries, who had been the subjects from the community care project in Korea. The data were collected with one-on-one interviews from April to November in 2020, and analyzed by phenomenological steps. Results: The seven themes derived in this study were 'Space to escape', 'Reliable supporter opened the way to discharge', 'Comfortable life at home', 'Obstacles to independent life', 'Struggling to live alone', 'Fence for community life', and 'Energizing in daily life' Conclusion: The results revealed the positive aspects of Community Care program in Korea. However, it is suggested that active communication between hospitals and community care institutions, and improvement of home environment to live in the community before discharge should be required. And system revision is needed to adjust activity in their home and support health problems of the elderly in the early stage of discharge. The results of this study can be referred to as the foundation of transitional care for the elderly.

• Journal of dental hygiene science
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• v.23 no.2
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• pp.154-168
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• 2023

Background: Legal regulations and fees have been established in Korea to provide visiting oral health care services to individuals with long-term care insurance (LTCI). However, beneficiaries of this service are very limited. Therefore, to improve the Korean system we propose a comparative analysis with the Japanese system. Methods: This study is a descriptive analysis based on secondary data, such as statistics, laws, and service record forms from Korea and Japan. The most recent institutional documents were obtained through a Google search. The variables investigated were financial resources of LTCI, co-payment structure, monthly limit of LTCI benefits, care levels of LTCI, service providers, service costs, contents of service, and the number of cases of service. Results: In both Korea and Japan, LTCI is financed through a combination of taxes and insurance premiums. However, the monthly limit for receiving LTCI services in Japan is about 2.4 times higher than in Korea. Visiting medical and dental treatment is also possible in Japan. Furthermore, nursing staff can provide daily oral health care services according to dental hygienists' instruction unlike Korea. Oral health care services in Korea are focused on oral hygiene and prevention of oral diseases, while Japan additionally provides oral function screening, patient education for oral health management, and training for nursing staff to enhance oral function, eating, and swallowing of the patients. Conclusion: We concluded that the possibility of visiting dental treatment, differences in monthly limit of LTCI benefits, oral function assessment and guidance, as well as collaboration with other healthcare professionals contributed to the difference in the frequency of utilization of visiting oral health care services between Korea and Japan.