• 제목/요약/키워드: Long-term Care Services

검색결과 377건 처리시간 0.024초

장기요양시설 노인의 환자구성에 관한 연구 (Study on Case-Mix in Long-Term Care Facilities for Elderly)

  • 이지전;김석일;유승흠;이상욱
    • 한국병원경영학회지
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    • 제6권3호
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    • pp.130-147
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    • 2001
  • This study is about major symptoms of elderly and medical services for elderly in long-tenn care facilities. The subject of this study was 298 patients over 00 years old staying in two geriatric hospitals and two nursing homes. The symptoms and medical services were level of patient classification from RUG(Resource Utilization Group)-III which is applied for both Medicare and Medicaid for skilled nursing facilities reimbursement system in US and designed for measuring patient characteristics and medical staff time. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). In this study, the symptoms and services were compared by facility type and they were categorized by level and compared by CMI. Major findings are as follows; 1. There were more elderly who have cognitive function problems in nursing homes than patients in geriatric hospitals. There were more patients with behavioral problems in geriatric hospitals than residents in nursing homes. These results were both statistically significant. 2. The patients in geriatric hospitals received significantly more nursing rehabilitation services, rehabilitation services and extensive services than residents in nursing homes. Other hands, special care services were provided significantly more to residents in nursing homes than elderly in geriatric hospitals. 3. ADL and depression variables had higher CMI when the symptoms were heavier condition. The CMI were not matched with levels of cognitive function problems and behavioral problems. 4. The CMI matched well significantly with levels of nursing rehabilitation services, special care services, and clinically complex services provided for the patient in geriatric hospitals and only nursing rehabilitation services in nursing homes. The CMI for rehabilitation services level and extensive services had regular trends. From the result of this study, the resource utilization level and services provided for elderly in each long-term care facilities were figured out. For the further study, it needs to have more concern about RUG-ill which classification variables were just analyzed.

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요양병원 간호인력 확보수준에 따른 입원환자의 간호결과 (Nursing outcomes of inpatient on level of nursing staffing in long term care hospitals)

  • 김은희;이은주
    • Journal of the Korean Data and Information Science Society
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    • 제26권3호
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    • pp.715-727
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    • 2015
  • 본 연구는 우리나라 요양병원의 간호인력 확보수준과 간호결과의 관련성을 파악하고 간호에 민감한 환자 결과를 알아봄으로써 요양병원의 적정 간호인력 확보에 대한 근거를 제공하기 위해 시행되었다. 자료는 건강보험심사평가원의 2012년 '요양병원 병원평가정보'를 바탕으로 분석하였다. 연구결과, 간호사 1인당 환자 수가 평균보다 많은 그룹에서 유치도뇨관 비율 (고위험군/저위험군)이 통계적으로 유의하게 높았다. 간호인력 1인당 환자 수가 평균보다 많은 그룹에서 일상생활수행능력이 감퇴한 환자비율 (치매환자군/비치매환자군), 요실금, 욕창이 새로 발생한 환자 (고위험군)비율이 통계적으로 유의하게 더 높았다. 그리고 요양병원의 등급이 향상될수록 입원환자의 간호결과가 더 좋아지는 것으로 나타났다. 이는 간호인력 확보수준이 높을수록 그리고 요양등급이 높을수록 환자의 간호결과에 긍정적인 영향이 나타난다는 결과이다. 따라서 요양병원에서 간호인력 수를 적정화시킬 수 있는 보다 강력한 정책적 접근이 필요하다는 것을 제안하는 바이다.

서울소재 3차 의료기관에 재원 중인 노인 환자의 재원기간에 영향을 미치는 관련 요인 (Factors Associated with Length of Stay in Elderly Inpatients in a General Hospital in Seoul)

  • 김선자;유승흠;오현주
    • 한국병원경영학회지
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    • 제12권2호
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    • pp.25-42
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    • 2007
  • To identify characteristics of elderly inpatients who had long term hospitalization in a general hospital, this study categorized into two groups who were hospitalized for less than 30 days and a group hospitalized for more than 30 days. To compare the groups the independent variables were the sociodemographical characteristics, the medical care utility characteristics, and the disease characteristics and finally analyzed factors affecting the hospitalization period. The data of 18,727 inpatients who were older than 65 years of age by the year 2005 were used and the data were analyzed using SPSS for Windows 12.0. With the results, it is necessary to provide intensive and positive management to elderly inpatients who belong to the more than 30 days group and also necessary to share roles and functions of hospital by medical network with local hospitals and clinics in order to manage long-term elderly inpatients and offer continuous post-management to discharged patients by encouraging them to use a long-term care center or by implementing an early discharge program. This study should provide many studies on how to manage the period of hospitalization efficiently on long-stay elderly inpatients in the future.

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노인요양원 입소자의 복약순응도 향상을 위한 평가지표의 개발 및 임상활용 (Development and Clinical Use of Assessment Indicators for Improving Medication Adherence of Elderly Residents in Nursing Home)

  • 박덕순;강민구;방준석
    • 한국임상약학회지
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    • 제26권1호
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    • pp.13-23
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    • 2016
  • Background: South Korea is rapidly being an aging-society and the demand of long-term care insurance services for elderly patients is rising. In addition, because the elderly taking multiple medicines, the adherence is lowered and the adverse events are easily occurred. Therefore, many are interested in introducing the geriatric pharmacy specialist to manage this situation. Purpose: By applying a similar program such as the geriatric pharmacy specialist working in nursing home, we conducted this study to evaluate the potential contribution to both the health insurance services and financial savings for the elderly patients. Methods: We conducted a trial in an elderly nursing home to collaborate between doctor and pharmacist making a checklist for improving medication adherence and establish a consultation system. Also we applied a smart phone application in the pharmaceutical care processes. Results: Thereby completing the drug therapy related checklist apply to nursing facilities in South Korea. And we got a performance that improves medication adherence when used in the clinical practice settings. Conclusion: By introducing a training program of pharmacy care managers and geriatric professionals such as the United States and Japan, we revealed the elderly nursing home residents and vulnerable elderly people living alone were improved the medication adherence and it will contributed to the health and quality of life of the patients.

문재인정부의 보건의료정책 평가와 차기 정부의 과제 (Moon Jae-in Government Health Policy Evaluation and Next Government Tasks)

  • 최병호
    • 보건행정학회지
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    • 제31권4호
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    • pp.387-398
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    • 2021
  • Moon Jae-in Care can be seen as a 2.0 version of Roh Moo-Hyun Care. Just as Roh Care failed to achieve its coverage rate goal and 30% share of public beds, Moon Care also failed to achieve its expected goal. The reason is that it followed Roh Care's failed strategy. Failure to control non-covered services has led to a long way to achieve a 70% coverage rate and induced the expansion of voluntary indemnity insurance, resulting in increased public burden. The universal coverage of non-covered services caused an immediate backlash from doctors. And Moon government also failed to control the private insurance market. The expansion of publicly owned beds has not become realized and has not obtained public support. Above all, it failed to overcome the resistance of doctors and failed to obtain consent from budget power groups in the cabinet for public investment. It was also insufficient to win the support of civic groups. Communication with interested groups failed and the role of private health care providers was neglected. The next government should also continue to strengthen health care coverage, but it should prioritize preventing medical poor and create a consensus with both medical providers and consumers for the control of non-covered services. Ahead of the super-aged society, the establishment of linkage between medical services and long-term care and visiting health care or welfare services is an important task. All public and private provisions and resources should be utilized in the view of a comprehensive public health perspective, and public investment should be input in sectors where public medical institutions can perform more effective functions. The next government, which will be launched in 2022, should design a new paradigm for health care in the face of a period of transformation, such as the coming super-aged society in 2026 and the Fourth Industrial Revolution, and recognize that the capabilities of the health care system represent the nation's overall capacity.

장기요양 인정자의 신체적 및 정신적 기능 상태와 삶의 질과의 관계 (Relationship Between Status of Physical and Mental Function and Quality of Life Among the Elderly People Admitted from Long-Term Care Insurance)

  • 김형선;배남규;권인선;조영채
    • Journal of Preventive Medicine and Public Health
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    • 제43권4호
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    • pp.319-329
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    • 2010
  • Objectives: This study was performed to determine the levels of quality of life (QOL) according to the grade of long-term care service for the elderly people who were admitted from long-term care insurance, and to reveal its association with the physical and mental functioning such as the Activity of Daily Living (ADL), the Instrumental Activity of Daily Living (IADL), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Mini-Mental State Examination-Korean version (MMSE-K). Methods: The interviews were performed during the period from March 1 to May 31, 2009, for 958 elderly people in urban and rural areas. The questionnaire items included various indices such as the ADL, IADL, CES-D, and MMSE-K, as independent variables and the index of QOL, as the dependent ones. For statistical analysis, t-tests were used for the mean scores of QOL according to gender and the grade of long-term care services, and Spearman's correlation was used for each variable. The effects of physical and mental functioning for QOL were assessed by covariance structure analysis. The statistical significance was set at p<0.05. Results: The mean scores of QOL among all the subjects was $55.4{\pm}15.62$ (Grade I: $49.7{\pm}14.17$, Grade II: $56.8{\pm}14.62$, Grade III: $59.4{\pm}16.36$), and it was lower according to the higher grade of long-term care insurance. In terms of the correlation matrix of the QOL and the physical and mental function factors, the QOL showed positive correlation with the ADL, IADL and MMSE-K, while it had negative correlation with depression. On the analysis of covariance, mental functioning (depression and the MMSE-K) had a greater influence on the level of QOL than the physical functioning (ADL and IADL). Conclusions: The level of the QOL in the elderly people who were admitted from long-term care insurance was lower according to higher the grade of long-term care insurance. Also, the mental functioning (depression and MMSE-K) was more influential on the level of the QOL than the physical functioning (ADL and IADL).

장기요양기관(시설급여) 평가의 효과성 검증 (Verification of effectiveness of evaluation of long-term care institution)

  • 김윤정;김영재;이상진
    • 예술인문사회 융합 멀티미디어 논문지
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    • 제9권5호
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    • pp.781-791
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    • 2019
  • 본 연구에서는 장기요양기관 관리자, 요양보호사, 입소노인을 대상으로 하여 2015년도 장기요양기관의 평가(평가등급, 평가등급의 변화, 평가지표의 적합성), 요양보호사의 서비스의 질, 입소노인의 서비스 질 만족도, 삶의 만족도, 시설 선택에 미치는 영향을 파악하고자 하였다. 이를 위해 IRB를 받은 뒤 2018년 1월과 2월에 장기요양기관 관리자 79명, 요양보호사 381명 및 입소 노인 381명을 대상으로 설문조사를 완료하였다. 설문조사는 2015년도 장기요양(시설급여) 평가결과를 반영한 할당표본을 실시하였다. 연구결과 장기요양기관 평가의 주된 목적이라 할 수 있는 입소노인의 삶의 질 향상에는 요양보호사의 서비스 질 보다 기관평가(평가등급, 평가등급의 변화, 자표의 적합성 인식)가 더 큰 영향을 미치는 것으로 나타났다. 그러나 퇴소 후 시설재선택의향은 요양보호사의 서비스의 질에 더 큰 영향을 받았다. 따라서 시설재선택의향을 제외하고 보면, 국민건강보험공단의 평가의 호과성이 부분적으로나마 검증되었다고 볼 수 있다.

노인의료보장 및 건강관리를 위한 장$cdot$단기 대책 (Long-term Policy Development for the Aged on Medical and Health Care Security)

  • 이선자;이윤숙
    • 한국보건간호학회지
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    • 제5권1호
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    • pp.70-95
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    • 1991
  • The ageing problem of the population has been emerging in Korea since 1970's so that it is expecting the elderly 65 years and over among the total population from $4.5\%$ in 1988 to be $6.3\%$ in year 2000. This study was conducted to provide secure policy development in coming years for the aged on medical and health care aspects based on the examining current status of the aged problems and health care policies and systems. The study divided into four parts; The first part examined the medical insurance program and public assistance program of the health services in relation to the aged. The second part emphasized on reduction of medical care cost for the aged. The third part studied the regular health check-up program and health education for the aged. The fourth part examined the chronic disease management programs for the aged and strategies of the health care service quality improvement and specialized programs. The following recommendations made as the results of the study. 1. At present, the medical insurance program and public assistance program for the medically indigent is not appropriate to the elderly because it is a part of general medical insurance program so that Health Security Law for the Aged is proposed. 2. Medical cost will be increased due to the high occupancy rate of hospital beds and long stay of the elderly so that it is recommended to develop an early discharge program, home health care program, Health hospice and an althernative programs. 3. At present, a regular health check-ups for the elderly is not included in medical insurance program so that it is recommended to be included in the insurance program and at the same time health education program thoroughly developed for the aged. 4. To make proper medical and nursing services on chronic diseases for the elderly, it is recommended manpower development, specialized clinics or hospitals, nursing homes and an equivalent long term care facilitices should be established on the community based and a research institutions also to be related to supper the care programs.

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치매환자 부양자부담과 생활권 내 소규모 주·야간 돌봄 서비스 모델 (Caregiver Burden of Patients with Dementia and Day Care Center of Small Size Model within a Zone of Life)

  • 나승권;박은주
    • 한국정보전자통신기술학회논문지
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    • 제9권4호
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    • pp.428-438
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    • 2016
  • 본 연구의 목적은 치매환자 부양자의 부담을 감소시키기 위해 장기요양보험 제도의 틀 안에서 새로운 서비스 개발을 제시하는 것이다. 분석 자료로 선행연구와 2012-2013년에 걸쳐 조사된 Caregivers of Alzheimer's Disease Research(CARE study)를 사용하여 부양자의 특성과 부담을 조사하였다. 치매환자의 주부양자 부담은 신체적, 심리적, 경제적 측면뿐만 아니라 다양한 측면에서 어려움을 겪고 있으며 연령, 경제력, 건강상태, 사회적지지 등 여러 요인이 부양부담에 영향을 미치고 있었다. 또한 부양자가 우울증을 겪을 위험도 높게 나왔다. 이에 부양자에 대한 제도적 지원이 필요한 시점에서 2008년부터 시행된 노인장기요양보험 제도를 활용하여 본 연구에서 추가적인 서비스를 제시하였다. 현 제도의 재가서비스 확장 모델로 소규모 주 야간보호서비스(가칭)를 신설하는 것으로 9인 이내의 규모로 주거지에서 5분 이내 거리에 개설을 하고 치매환자에만 국한시켜 질환에 대한 전문성을 높이고 서비스의 질을 향상시켜 기존의 주 야간보호서비스와 소규모 노인요양공동생활가정과 차별화하는 것이다.

노인장기요양보험제도 도입 후 의료기관 가정간호 이용실태 변화 (Changes on Hospital-based Home Care Services Utilization After Long-term Care Insurance Launch)

  • 진영란;홍월란
    • 한국노년학
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    • 제31권2호
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    • pp.371-380
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    • 2011
  • 본 연구는 노인장기요양보험제도 도입 전후 의료기관 가정간호사업소 수 및 이용량 변화를 파악하고자 하였다. 건강보험심사평가원으로부터 노인장기요양보험제도 도입 직전 1년(2007.7.1~2008.6.30)과 제도도입 후 혼란기인 6개월 후 1년(2009.1.1-12.30)간 의료기관 가정간호 기본방문료(AN100)가 청구된 자료를 받아 분석하였다. 노인장기요양보험제도 도입 후, 약 40개 의료기관 가정간호사업소가 문을 닫았고, 사업소가 한 곳도 없는 시군구가 전체 시군구 중 53%에서 59%로 증가하였다. 또한, 노인의 의료기관 가정간호 이용은 물론(이용자수 13.4% 감소, 방문건수 20.9% 감소), 비노인의 이용도 감소하였다(이용자수 3.5% 감소, 방문건수 3.9% 감소). 비노인의 가정간호 이용감소는 가정방문 간호사업소의 감소로 가정간호에 대한 접근이 낮아져 나타난 결과로 유추할 수 있다. 가정간호사업소 당 총 수입액은 2009년 1년간 평균 121,850천원으로 최소 인력인 가정전문간호사 2인의 인건비를 감안하면 수익이 크지 않은 것으로 확인되었다. 이 연구결과를 통해 노인의 의료기관 가정 간호 이용감소는 노인장기요양보험 방문간호로 대체된다고 하더라도, 비노인의 가정간호 접근성을 높이기 위해서는 의료기관 가정간호사업소를 확대할 필요가 있다.