• Journal of Korean Academy of Nursing
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• v.50 no.4
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• pp.513-522
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• 2020

Purpose: This study aimed to utilize concept analysis to obtain a better understanding of the concept of "continuity of care" in chronic diseases. Methods: The concept of continuity of care was analyzed using the Walker and Avant method. Covering literature in English from 1930 to 2018, the data sources included CINAHL Complete, Academic Search Complete, MEDLINE, PsyARTICLES, Health Source: Nursing/Academic Edition, Google Scholar, Science Direct, and the Cochrane Library. Results: A comprehensive definition of concept of continuity of care was developed based on a systematic search and synthesis. The key defining attributes were identified as (a) care over time, (b) the relationship between an individual patient and a care team, (c) information transfer, (d) coordination, and (e) meeting changing needs. The antecedents of continuity of care were having a chronic disease, inexperienced with disease management, a poorly coordinated healthcare system, and medical care limitations. The consequences of continuity of care were decreasing hospital admissions, reducing costs, reducing emergency room visits, improving the quality of life, improving patient satisfaction, and delivering good healthcare. Conclusion: The thorough concept analysis provides insight into the nature of "continuity of care" in chronic diseases and also helps ground the concept in healthcare.

• The Korean Journal of Health Service Management
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• v.10 no.2
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• pp.179-191
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• 2016

Objectives : The purpose of this study was to identify the factors influencing nursing care behavior for hospitalized elderly patients who have no family caregiver. Methods : Participants were 170 nurses working in general hospitals in G city. Data were collected from November to December, 2015 and analyzed by exploratory factor analysis, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression with the SPSS/WIN 20.0 program. Results : There were significant correlations among experience, empathy, and nursing care behavior. Experience and empathy were significant factors influencing nursing care behavior and explained 29.4% of the variance in the score; in particular, empathy had a positive effect on nursing care behavior. Conclusions : The results show that theempathy of nurses' is the most important factor in caring for elderly patients who have no family caregiver. Nurse education programs should be developed that increase the empathy of nurses to improve the quality of nursing care for the elderly.

• Korea Journal of Hospital Management
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• v.9 no.3
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• pp.18-48
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• 2004

Health policies in many countries have come under critical scrutiny in recent years. This is because of increasing national health expenditures. Also many persons in health sector have been the perception that resources allocated to health services are not always deployed in an optimal fashion. And they believe that the scope of resources in health services is limited, there is need to search for ways of using existing resources more efficiently. A further concern has been the desire to ensure access to healthcare of various groups on an equitable basis. In some European countries this has been linked to a wish to enhance patient choice and to make service providers more responsive to consumers, while Korea integrated health insurance funds into single fund in 2000. Many European countries are under considerable pressure to review and restructure their health care systems. There are several reasons of pressure to reform. There are demographic changes, pattern of disease change, advances in medical sciences will also give rise to new demands within the health services, public expectations of health services are rising as those who use services demand higher standards of care. These circumstances require the change of health care delivery system based on hierarchical regionalism, which was basis of health care delivery since 1920s. Korea is also under similarly pressure to restructure our own health care systems. We will have good learning from OECD experiences. In this paper we reviewed and compared among OECD countries' various experiences.

• The Korean Journal of Health Service Management
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• v.6 no.2
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• pp.193-200
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• 2012

The purpose of this study was to research the opinion and acknowledgement about the clinical chronic disease care system subject to Medical Practitioners that copied the internal medicine and family medicine as a treatment subject and was fulfilled in the purpose of providing a basic data for the improvement and stable establishment of the chronic disease care system and the high blood pressure and diabetes mellitus patient's promotion of health. Results from the research the internal medicine was 79% and the subject's average age was 52.3 years, the proportion that the high blood pressure and the diabetes mellitus took was average 28% and the interest about the system was 65.9%. In the chronic disease care system expansion status the opposition was 75.7%, and the detail field knowledge level was 56.9%. In the opinion field about the system, all fields were shown negative. The chronic disease care system is an important government policy enforcing purposed to effectively manage the yearly increasing chronic disease, but the due to the cold attitude of Medical Practitioners that must actively accept it, the stable establishment of the system is being concerned. Therefore even if it's a good policy if it cant gain the support and agreement of the accepter, in the future when trying to implement a system there should be no idleness in the effort to gain cooperation and understanding to relevant involved ones.

• Journal of Home Health Care Nursing
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• v.15 no.2
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• pp.82-90
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• 2008

Recent shortening of hospitalization has partly led to the transition of health care services from hospitals to communities in cardiovascular (CVD) care. Home healthcare nursing is an alternative modality of care for chronically ill CVD patients. Cardiac rehabilitation (CR) has been redefined as a "secondary prevention center", consisting of: patient assessment; nutritional counseling; blood pressure and diabetes management; tobacco cessation; psychosocial management; and physical activity counseling. Improvement in health-related quality of life (HRQOL) is a major goal of the CR that integrates physical, psychological and social dimensions of care. The review of evidence on effects of CR on HRQOL may allow home healthcare nurses to provide better comprehensive care for CVD patients. There is evidence on beneficial effects of CR on HRQOL in patients with myocardial infarction (MI) as well as patients with chronic heart failure. Specifically, home-based CR, which is more cost-effective than hospital-based CR, has been reported to produce comparable improvements in HRQOL with hospital-based CR in MI patients. In conclusion, a newly-designed, home-based CR may be required to be applied to Korean home healthcare nursing system for improving HRQOL.

• Journal of Korean Academy of Nursing
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• v.47 no.5
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• pp.663-675
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• 2017

Purpose: The purpose of this study was to construct and test a structural equation model of self-management of liver transplant recipients based on self-determination theory. Methods: Participants were 275 outpatients who received liver transplantation. A structured self-report questionnaire was used to assess health care providers' autonomy support, transplant-related characteristics, illness consequence perception, autonomy, competence, family relatedness, depression and self-management. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0 program. Results: The modified model showed a good fitness with the data: GFI=.96, RMSEA=.06, CFI=.96, NFI=.93, TLI=.93, PGFI=.43, PNFI=.49. The health care providers' autonomy support, competence, family relatedness and depression were factors with a direct influence on the self-management of liver transplant recipients. The health care providers' autonomy support and illness consequence perception had an indirect influence through competence, family relatedness and depression. However, the transplant-related characteristics and autonomy did not have a significant effect on self-management. This model explained 59.4% of the variance in self-management. Conclusion: The result suggests that continuous education must be done to promote the competence of liver transplant recipients and to encourage the patient to positively perceive their current health condition with a view that enhances one's self-management. Additionally, the liver transplant recipients should be screened for depression, which would affect self-management. Most of all, health care providers, who have the most influence on self-management, should improve therapeutic communication and try to form a therapeutic relationship with the liver transplant recipients.

• Journal of Korean Academy of Nursing
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• v.30 no.4
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• pp.1045-1054
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• 2000

As cost pressures have escalated, policy makers, politicians, health care providers and families have tried to devise ways to reduce health care costs. While originally developed to enhance patient control and to provide better care at the end of life, hospice care has recently received significant attention as a mean of reducing health care costs. As a program providing care for patients who are dying at their homes, hospice has expanded slowly since the opening of the first hospice in Korea in 1963. Therefore, a variety of services that responds to the needs and concerns of many dying people and their families is limited The purpose of this study was to determine the potential cost savings at the end of life among patients who used home hospice compared with the patients who received institutional care in Korea. This study used a retrospective, descriptive design. The sample for this study included 46 patients who died of lung cancer: 25 patients who received home hospice care and 21 patients who received institutional care. Data on patient characteristics, kinds and frequencies of provided treatment and nursing services, and hospice and hospital charges during the last month before death were collected. Cost of care was measured by the average cost per patient per day in the last month of life. The results of the study indicated that there were significant differences in average cost of care between home hospice sample and institutional care sample (t=9.956, p<.001; home hospice sample: M=18,102 won, institutional care sample: M=317,578 won). The cost of the home hospice sample was approximately 6% of the cost of institutional care. The majority of the home hospice nursing services were education (35.7%) and supportive counseling (25.2%), followed by medication management (13.6%), assessment (12.1%), basic nursing (7.2%), treatment (5.5%) and others. In institutional care sample, basic nursing and treatment were more emphasized than education or supportive counseling among the nursing services provided. The results of this study showed the potential for hospice to reduce costs and implications for policymakers and clinicians to incorporate hospice program into the formal health care delivery system in Korea.

• Health Policy and Management
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• v.22 no.2
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• pp.183-206
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• 2012

Changing social conditions have resulted in a situation where elderly patients are no longer cared for by family and where medical care hospitals play a more prominent role. In this study, the unique elements of the medical service required from a long term care hospital were identified using conventional and exploratory analysis, and the causal relationship between medical service quality, relationship quality, and Revist intent was confirmed. The intermediary role and the quantitative importance of relationship quality (including trust and commitment) were also characterized. This study identifies the key points and indicators that the administrators of a long term care hospital can use to effectively plan their medical service offering in order to secure the commitment of customers through relationship quality. The theoretical indications of this study are set out below. First, four factors are selected as being the key elements determining service quality: medics, administrative service, healthcare environment, and subsidiary facilities. Second, it seems that medics, administration service, and the healthcare environment have some effect on the evaluations made in relation to trust and satisfaction (subsidiary facilities are not considered to be a key element). Third, patient satisfaction has a positive impact on trust and commitment and can be regarded as a key element for establishing connections. Fourth, commitment is likely to be strengthened when trust is significant. Fifth, as trust and commitment increase, revist intent strengthens. Lastly, this study illustrates how the levels of trust and commitment play a modulating role between patient satisfaction and revist intention. There are many practical indications from the findings of this study. First, the influences of medics, the administrative service, and the healthcare environment on trust and satisfaction vary. Especially, the healthcare environment is likely to be more important than medics. Accordingly, it is essential to establish an elderly-friendly environment, to improve a hospital's structure, and to maintain a clean environment. Second, medics must show compassion to their patients and be patient when providing explanations to elderly patients who often lack powers of concentration. Third, in order to establish patient trust, it is essential that medics provide an excellent medical service. Ultimately, these elements of relationship quality may strengthen the revist intention of elderly patients.

• The Journal of Korean Society for School & Community Health Education
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• v.11 no.1
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• pp.149-158
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• 2010

Background & Objectives: Rising concerns about patient safety and looming health provider shortages were generating new recognition for an old idea. Interprofessional education means that two or more professions learn with, from and about other to improve collaboration and the quality of healthcare. The University of British Columbia established the College of Health Disciplines in 2001 to examine the merits of interprofessional health education. The objective of this study was to review UBC's interprofessional health education and to introduce the theoretical framework of interprofessional education for collaborative patient-centered practice. Methods: This study was conducted with the materials relevant to the interprofessional education. We reviewed the journals and Web site for this subject and we obtained interview data from administrators in the University of British Columbia, College of Health Disciplines. Results: We introduced interdisciplinary education for collaborative patient-centered practice model. It is assumed valuable model in preparing the interprofessional education as well as theoretical framework for implementation. We preseuted the example for interprofessional education of the College of Health Disciplines, University of British Columbia. Conclusion: We need to introduce the interprofessional education at the health care departments of University or College in Korea.

• Korean Journal of Radiology
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• v.22 no.6
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• pp.994-1004
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• 2021

Objective: To extract pulmonary and cardiovascular metrics from chest CTs of patients with coronavirus disease 2019 (COVID-19) using a fully automated deep learning-based approach and assess their potential to predict patient management. Materials and Methods: All initial chest CTs of patients who tested positive for severe acute respiratory syndrome coronavirus 2 at our emergency department between March 25 and April 25, 2020, were identified (n = 120). Three patient management groups were defined: group 1 (outpatient), group 2 (general ward), and group 3 (intensive care unit [ICU]). Multiple pulmonary and cardiovascular metrics were extracted from the chest CT images using deep learning. Additionally, six laboratory findings indicating inflammation and cellular damage were considered. Differences in CT metrics, laboratory findings, and demographics between the patient management groups were assessed. The potential of these parameters to predict patients' needs for intensive care (yes/no) was analyzed using logistic regression and receiver operating characteristic curves. Internal and external validity were assessed using 109 independent chest CT scans. Results: While demographic parameters alone (sex and age) were not sufficient to predict ICU management status, both CT metrics alone (including both pulmonary and cardiovascular metrics; area under the curve [AUC] = 0.88; 95% confidence interval [CI] = 0.79-0.97) and laboratory findings alone (C-reactive protein, lactate dehydrogenase, white blood cell count, and albumin; AUC = 0.86; 95% CI = 0.77-0.94) were good classifiers. Excellent performance was achieved by a combination of demographic parameters, CT metrics, and laboratory findings (AUC = 0.91; 95% CI = 0.85-0.98). Application of a model that combined both pulmonary CT metrics and demographic parameters on a dataset from another hospital indicated its external validity (AUC = 0.77; 95% CI = 0.66-0.88). Conclusion: Chest CT of patients with COVID-19 contains valuable information that can be accessed using automated image analysis. These metrics are useful for the prediction of patient management.