• 가정∙방문간호학회지
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• 제10권1호
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• pp.5-14
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• 2003

Recently, there has been an increasing need for long-term care and comprehensive health care services in community settings. The Ministry of Health and Welfare introduced the Hospital-Based Home Nursing Care Program in 2000. Before this initiative, there was a Home Nursing Demonstration Center, affiliated with the Seoul Nurse Association, had offered home nursing services with the financial support from the local government. since 1993, the Center's nursing staff has been engaged in a general hospital in an effort to provide home nursing care services within Korea's health care system. The purpose of this study was to analyze and identify characteristics of community-based home nursing care supplied by a community-based home nursing team engaged in a general hospital. Also. visit nursing care services provided by public health centers were evaluated in terms of accessibility and supply versus demand, to enhance the accessibility of low-income patients living in Seoul to home nursing care services. Data were collected from home nursing insurance reimbursement claims submitted by the community-based home nursing care team from March 1 to October 30 in 2001 and a questionnaire survey on home-visit nursing services of 25 public health centers in Seoul. The subjects consisted of 197 patients and 12 public health centers. The result were as follows. First, medical institution's community-based home nursing care program was better in technical quality than health-center-based home-visit nursing care. In addition. the pattern of the subject patients was similar to that of hospital-based home nursing care program. Second, there was a high demand for community-based home nursing care while only a small number of home-visiting nurses served at public health centers in Seoul. As a result, many patients could not receive adequate care. Finally, we suggest that community-based home nursing care program should be introduced in the national health system to meet the at-home care needs of severely ill low-income patients. Furthermore, to better utilize home nursing and visit-nursing care resources and offer continued care for patients in community settings, an efficient referral network should be built among related institutions. This would require improvement of reimbursement system and amendment of the law related to health insurance system and community-based home nursing care services.

• 보건행정학회지
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• 제22권1호
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• pp.65-84
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• 2012

Because of the rising healthcare costs, there is a growing need for developing efficiency indicators for medical resources use and measuring efficiency of healthcare providers and healthcare systems using them. In this study, we aimed to develop efficiency indicators for medical resources use by means of Delphi technique. We systematically reviewed the existing measures of medical resource use. Thirty nine indicators were selected as a candidates across the six domains: medical personnel, medical equipment, medical facilities, ethical management, resource efficiency, and drug use. To develop efficiency indicators with professional consensus, a 2-round Delphi survey was conducted among 29 professional experts. The following indicators were selected based on the Delphi survey results: adjusted number of the patient per day and level of the nurse number medical personnel in medical personnel domain; the number of the scan a professional physician and the quality of the scan in medical equipment domain; bed utilization rate in medical facility domain; drug price reported pharmaceutical price by medical institutions, medical fee billing transparency, and medical care appropriateness in ethical management domain; costliness index in resource efficiency domain; and utilization of high cost drug and items per prescription in drug use domain. The efficiency indicators could provide valid information about efficiency of healthcare providers and healthcare systems with respect to their resources use and facilitate policies to improve their efficiency.

• 대한간호
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• 제36권3호
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• pp.49-69
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• 1997

The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.

• 농촌의학ㆍ지역보건
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• 제4권1호
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• pp.20-30
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• 1979

To investigate the status of morbidity and medicare utilization during last 8 months from 1 st Oct. 1977 to 31th May, 1978 in the area under Sam-Wha Medicare Insurance Union, a study was carried out through analyzing the medicare records of patients who are enrolled. For the study, 3 doctors and one nurse were mobilized and the results are as follows: 1) The total number of the Medicare insurance Union members in the study area were 5,735 composed of 3,000 males(52.3%) and 2,735 females(47.7%). 2) The total number of patients were 1,405 composed of 783 males (55. 0%) and 622 females(45. 0%) and the incidence rate per 1,000 population was 245.0 of total(261.0 in males and 227.4 in females). 3) Five major diseases with 52, 7% of total patients were acute upper respiratory infection(20.7%), peptic ulcer(12.2%), bronchitis(5.5%), injuries(5.2%) and dental problems(5.1%). 4) The order of the incidence rate of age group per 1,000 population was the year group on 0-4(342.6), 25-44(312.7), 45-64(307.0), 65 and over(240.3), 15-24(178.8) and 5-14(164.8). 5) Of the 1,405 total patients, the out-patients were 1,661(96.9%) and the in-patients were 44(3.1%) and the ratio wae 30.9 : 1.0. 6) Among the out-patients 96.7% of them were cared in primary medicare facilities, 1.0,% in secondary care, and 2.3% in tertiary care. And among the in-patients 50. 5% of them were cared in primary medicare facilities, 4. 5% in secondary care, 45. 5% in tertiary care. 7) Duration of medicare was concentrated within a week in 84. 3% of total patients.

• 간호행정학회지
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• 제15권4호
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• pp.527-538
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• 2009

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.

• 한국의료질향상학회지
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• 제21권1호
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• pp.52-61
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• 2015

Objectives: Because recently hospital had to faced with financial hardship, we have to have more effective hospital management. The purpose of this study was to reduce loss costs of the hospital through the systematic management of medical supplies and increase operational efficiency. Methods: The team was composed of outpatient nursing staff, medical record administrator, nurses in medical insurance, medical computer center, dermatologists for this study. We surveyed for 114 people including outpatient nursing staff, nurse aids, medical assistant, physician assistant. Pre-survey period was 2013.03.11 ~ 03.30(2 weeks), and post-survey period was 2013.09.03 ~ 09.17(2 weeks). Result: We improved this way through the computational improvement, conservation campaigns, inventory management, staff training, replaced by low-cost medical supplies. The finding of this study were as follows: Comparing before and after the activity of outpatient nursing staff's degree of knowledge, performance, economic consciousness, the degree of knowledge, performance was increased, but there was no significant change in economic consciousness. Performance of Married person is higher than the unmarried, In addition, the high-position people were more the degree of knowleage, economic consciousness. After activity, correlation of goods and treatment, examinations is increasing, but statistically there was no mean. Conclusion: This study revealed that knowledge in a short period of activity, but also can improve, perform the same change in behavior is not easy. This one shows the intensive training required to sustained and systematic behavioral changes, such as changes in behavior, perform rituals to help the economy. Expensive medical supplies to replace a similar effect as the cost of materials just to have a lot of cost savings. Therefore, more medical supplies change is necessary to develop alternative treatment and cost cutting.

• 농촌의학ㆍ지역보건
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• 제6권1호
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• pp.33-41
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• 1981

To investigate the status of medical accident attack rate and medicare utilization during last 27months from 1st Oct., 1977 to 31st Dec. 1979 in the area under Sam Wha Medicare Insurance Union, the study was carried out through analyzing the medicare records of patients who were enrolled. "The medical accident" in this study was used as the meaning of the state that the people who have been treated morbid condition with insurance money. For the study, 2 doctors and one nurse were mobilized and the results are as follows: 1) The total number of the Medicare Insurance Union members among the 37,044 total population of the study area, (Hea-mi, Unsan, Eumam Myun) were 57, 35 composed of 3,000 males (52.3%) and 27, 35 females (47.7%) in 1977, 3,383 composed of 2,006 males (59.3%) 1,377 females (40.7%) in 1978, 2,573 composed of 1,437 males and 1,336 females (44.2%) in 1979. 2) Total number of medical accident attack cases were 6,774 case (partially overlapped the number of the 1977 with that of the 1978) and average annual medical accident attack rate per 1,000 population was 700.9. 3) Five major disease group in the past three years were disease of the respiratory system (177.7), disease of the digestive system (165.8), disease of the skin and subcutaneous(64.9), symptoms, signs and ill-defined conditions (64.6), any injury and poisoning (51.9). Mental disorders (32.6) was the 6th order disease group. 4) The order of the medical accident attack rate of age group per 1,000 population per year was the year group of 0~4(877.8), 45~64(832.6), 25~44(810.3), 5~14(495.1) 15~24(494.7) 65 and over (460.7). 5) Medical accident attack rate of age group per 1,000 population in the 5 major disease groups were the year group of 45~64 (100.0) in the mental disorders 0~4(525.1) in the disease of the respiratory system 45~64 (328.5) in the disease of the digestive system 0~4 (202.8) in the disease of the skin and subcutanous tissue, 25~44 (98.3) in the accidents and poisoning. 6) Monthly medical accidents attack rate were 87.0 in the winter (Dsc., Jan., Feb.) and 86.2 in the summer (Jun., July, Aug.). So the trend of the medical accidents attack rate during the year was bimount figure. 7) Monthly medical accidents attack rate in the major disease group were highest in Jan., Apr., (31.1) in the disease of the respiratory system, in Jan., Feb., Mar. (24.9) in the disease of the digestive system, in Jan., Jun., Aug. (9.8) in the injury and poisoning. 8) Duration of the treatment of the 93.1% of the total cases were within 5 days. 9) 299 cases (4.5%) of the total number of cases, 6,587 cases were referred to secondary and tertiary medicare facilities. 10) The order of the major 10 kinds of diagnosis of the disease, 6,587 cases during 27 months, were URI and chillness (1,063 cases, 16.1%), gastritis(830 cases, 12. 6%) dermatitis(360 cases, 5.5%), bronchitis(291 cases, 4.4%), neurosis (284 cases, 4.3%), contusion (165 cases, 2.5%), tooth extraction (157 cases, 2.4%), tonsillitis (109 cases, 0.7%), laceration (107 cases, 1.6%), neuralgia (105 cases, 1.6%), arthritis (104 cases, 1.6%), otitis media and mastoiditis (103 cases, 1.6%), so total case were 3,678 cases (55.9%).

• 한국산학기술학회논문지
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• 제18권8호
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• pp.162-170
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• 2017

본 연구는 중소병원 간호인력 현황과 관련 정책을 분석하고 인력 확보에 영향을 주는 요인을 파악하여 중소병원 간호인력 확보를 위한 정책을 입안하고 결정하는 데에 근거를 제시하고자 실시되었다. 보건복지부와 건강보험심사평가원 등에서 제시한 통계자료를 2차 분석한 후 그 결과를 다양한 내 외적 보건의료환경에 대한 이해를 기반으로 조명하였다. 연구결과 우리나라의 활동 간호사 수는 면허간호사 수의 50% 미만으로 그 수는 해마다 감소하고 있었으며, 이는 간호대학 정원증가의 비용 대비 성과의 효율성을 재고할 필요가 있음을 의미한다. 또한 간호관리료 차등제 실시로 인해 신규간호사는 물론 간호사 인력부족이 심각한 중소병원의 경력간호사들이 상급종합병원으로 이동하게 되는 결과를 야기하였으며, 결국 중소병원 간호인력 부족 현상을 더욱 악화시키는 원인이 되었다. 따라서 입원환자 간호관리료 차등제가 중소병원 간호인력 확보 정책으로 실효성이 있는지에 대한 재검토가 필요하며, 면허간호사에 대한 추적 관리 시스템을 통해 간호인력 수급의 불균형을 해소할 수 있어야 한다.

• 가정∙방문간호학회지
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• 제6권
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• pp.5-18
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• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• 한국산학기술학회논문지
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• 제16권4호
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• pp.2674-2683
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• 2015

본 연구는 장기요양보험급여를 받고 있는 도시지역 노인들의 장기요양등급에 따른 우울수준을 파악해 보고, 우울수준에 관련된 요인을 규명해 보고자 시도하였다. 조사대상은 대전광역시 5개구에서 장기요양보험급여를 받고 있는 노인 338명을 대상으로 하였다. 조사는 2012년 3월 1일부터 5월 31일까지의 기간 동안에 표준화된 무기명식 면접조사용 설문지를 사용하여 면접조사 하였다. 연구결과, 조사대상자의 CES-D에 의한 우울수준은 정상군(CES-D 21점미만)이 21.6%, 우울군(CES-D 21점 이상)이 78.4%이었다. 장기요양등급에 따른 우울군(CES-D 21점 이상)의 분포는 장기요양 1등급에서 83.6%, 2등급에서 82.1%, 3등급에서 67.0%로 장기요양 등급이 높을수록 우울군의 분포도 유의하게 높은 것으로 나타났다. 우울 수준과 제 요인과의 관련성을 알아보기 위해 다중로지스틱회귀분석 결과 우울수준에 대한 교차비는 65-74세 연령군보다 75세이상 연령군에서, 주관적인 건강상태가 좋다는 군보다 좋지 않다는 군에서, 취미활동을 자주한다는 군보다 거의하지 않는다는 군에서 유의하게 증가하였으며, 월수입 50만원 이하군보다 50만원 이상 군에서 유의하게 감소하였다. 이 같은 결과는 우울에 관련된 요인이 개인의 기본 속성, 경제 상태, 신체의 건강상태나 활동성 등의 다양한 요인과 관련성이 있다는 것을 시사하고 있다.