• 디지털융복합연구
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• 제12권6호
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• pp.519-526
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• 2014

본 연구는 재입원 여부에 따른 심질환자의 간호요구를 알아보기 위하여, 2012년 3월부터 6월까지 심질환으로 입원한 환자에게 자기 스스로 직접 의사를 표현할 수 있도록 하는 자기기입식 설문조사를 실시하였다. 자료 분석은 SPSS 18.0을 이용하였고, 결과는 다음과 같다. 재입원을 경험하지 않은 신규 환자의 경우 전체 간호요구는 $4.12{\pm}.49$점, 재입원한 대상자는 $3.89{\pm}.63$ 점이었고, 두 군 간에 유의한 차이가 있었다(p=.046). 두 군 모두 간호요구 하위 항목 중 치료중재 간호요구항목이 다른 간호 요구 항목 보다 높았다. 또한 재입원에 따라 두 군 간에 간호 요구 하위 영역별 유의한 차이가 있었던 항목이 있었고, 간호 요구 순위도 각각 달랐다. 간호요구 하위 항목 중 신체적, 사회 심리적, 교육적, 치료적 간호요구는 모두 서로 유의한 순 상관관계를 보였다. 이와 같이 환자의 특성에 따른 간호요구에 기초 한 간호수행이 필요하다고 생각된다.

• 한국병원경영학회지
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• 제27권3호
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• pp.39-49
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• 2022

Purposes: This study purposed to analyze the relationship between patient safety and patient-centerendess. Methodology: The comprehensive scores from patient safety assessment program and patient experience survey conducted by Health Insurance Review & Assessment Service were used as independent variables and dependent variables. This study analyzed the relationship between 4 patient safety-related areas(i.e. risk standardized readmission ratio, intensive care unit, preventive antibiotic, the drug evaluation) and 6 patient experience areas(i.e. nurse services, doctor services, medication & treatment, hospital environment, patient's right, overall experience) by using robust regression analysis. Findings: According to results, the score in 'patient's right' and 'risk standardized readmission ratio' areas were found to have a significant relationship, and 'overall experience' and the 'preventive antibiotic' areas. The ratio of senior beds and specialists was a general characteristics of hospitals that had a significant relationship on patient experience assessment. Practical Implication: The relationships between patient safety and patient experience assessment were varied depending on areas. Further study is needed to make clear the supposed relationship.

• 중환자간호학회지
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• 제7권1호
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• pp.24-32
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• 2014

Purpose: The purpose of this study was to examine the effects of discharge planning on patient satisfaction, the readmission rate and preparedness for discharge in the elderly admitted to the emergency room (ER) for pulmonary disease. Methods: A quasi-experimental intervention study design was used. Older adults with pulmonary health problems in the ER in one general hospital were randomly allocated to either an experimental (n=21, 74.2 years) or control group (n=19, 70.7 years). The experimental group participated in a discharge planning program by a geriatric nurse practitioner. Data were collected from medical records, physical measurements and structured questionnaires including information on demographics, patient satisfaction, readmission, and preparedness for discharge. Results: Participants in the experimental group had significantly better outcomes with regard to patient satisfaction with nursing services (p=.003) and preparedness for discharge (p=.034). However, there was no significant effect on the readmission rate (p=.392) Conclusion: The results suggested that a discharge planning program could bolster nursing service satisfaction and preparedness for discharge in older patients admitted to the ER for pulmonary health problems. To clarify the effects of discharge planning on older patients admitted to the ER, a larger sample population, better instruments for various measures, a new manual on discharge planning and frequent follow-up will be necessary.

• Journal of Preventive Medicine and Public Health
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• 제56권6호
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• pp.563-572
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• 2023

Objectives: The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services. Methods: To apply transitional care services that are compatible with Korea's circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service's Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days. Results: The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41). Conclusions: Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.

• 대한간호학회지
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• 제33권1호
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• pp.122-129
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• 2003

Purpose: The purpose of this study is to examine the difference of direct nursing activity and patient outcomes as mortality rate, complication rate, readmission rate and length of stay related to graded fee of nursing management for inpatient. Method: The subjects of this study were 44 general hospitals with more than 500 beds. Data totaled to 86,044 claims provided to inpatients in Jan. 2001 requested by an electronic data interchange from a Health Insurance Review Agency. The data was analyzed by SPSS win(ver.10.0) and statistical methods used were frequency, one-way ANOVA, $X^2$-Test and regression. Result: Synthetic judgment through performance index and 95% confidence interval, direct nursing activity showed to provided adequate quality of nursing care on 2nd, 3rd, 4th and 6th nursing degree. Also, patient outcomes showed difference by graded fee of nursing management for inpatient. Mortality rate of 2nd was the lowest with P.I. 67.9, 3rd, 5th, 6th, 4th in order. In case of complication rate, 2nd, 3rd and 4th were lower than other nursing degree. Readmission rate of 4th and 5th was the lowest. Length of stay of 2nd was the shortest with P.I. 88.3, 3rd, 4th, 5th, 4th, 6th in order. Conclusion: The findings from this study showed that, the higher nurse-to-patient ratio, the greater amount of direct nursing care activity for the patient. Also, the more direct nursing activities influenced a lower mortality rate, complication rate and readmission rate, shorter length of stay.

• 대한간호학회지
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• 제50권6호
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• pp.787-798
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• 2020

Purpose: This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors. Methods: Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios. Results: Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively. Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores. Conclusion: The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.

• Child Health Nursing Research
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• 제18권1호
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• pp.9-18
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• 2012

Purpose: This study was conducted to analyze factors affecting readmission of children with home ventilator care. Methods: To collect patient data, a retrospective chart review was done of medical records of children admitted between June 1, 2007 and May 31, 2010 at one children's hospital located in Seoul. During that period 30 children were discharged with a home ventilator. Results: Twenty-one of these children had a total of 63 readmissions during the study period, averaging 2.1 readmissions per child with a mean duration of hospitalization of 7.4 days. Children with nasogastric tubes were more frequently readmitted (t=7.232, p=.012) and duration of hospitalization was significantly longer (t=4.761, p=.038). Children who had cardio-pulmonary comorbidity were more frequently readmitted and had longer hospitalization than children without comorbidity (t=5.444, p=.027). When home ventilator assisted children were admitted via emergency room, they were hospitalized longer (t=14.686, p=<.001). Cardio-pulmonary morbidity and readmission via ER explained 38.1% of variation for readmission. Feeding method explained 15.0% of variation in length of hospitalization. Conclusion: The results suggest that health care providers must give individualized education on home ventilator care to parents with children who are at risk for readmission due to cardio-pulmonary comorbidities, nasogastric tube, or readmission via ER.

• Clinics in Shoulder and Elbow
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• 제26권1호
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• pp.41-48
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• 2023

Background: Shoulder instability procedures have low morbidity; however, complications can arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission and reoperation following arthroscopic and open treatment for shoulder instability. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests, chi-square, and (where appropriate) Fisher's exact tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission and reoperation following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: Of the 11,230 cases included in our sample, only 0.54% were readmitted, and 0.23% underwent reoperation within the 30-day postoperative period. Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission and reoperation: open repair, congestive heart failure (CHF), and hospital length of stay. Conclusions: Unplanned 30-day readmission and reoperation after shoulder instability surgery is infrequent. Patients with American Society of Anesthesiologists class II, CHF, longer than average hospital length of stay, or an open procedure have higher odds of readmission than patients without those factors. Patients who have CHF, longer than average hospital length of stay, and open surgery have higher odds of reoperation than others. Arthroscopic procedures should be used to manage shoulder instability, if possible. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.252-259
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• 2023

Background: The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). Conclusions: Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure. Level of evidence: III.

• Pediatric Infection and Vaccine
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• 제24권3호
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• pp.146-151
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• 2017

목적: 본 연구에서는 소아 폐렴 환자에서 재입원의 분석을 통하여 이에 영향을 미치는 위험인자를 알아보고자 하였다. 방법: 2007년 1월부터 2016년 8월까지 전주예수병원 소아청소년과에 폐렴으로 입원한 소아를 대상으로, 퇴원 후 30일 이내에 폐렴으로 재입원한 환자(재입원군)와 초회 입원한 환자(초입원군)로 나누어 의무기록을 검토하여 후향적으로 분석하였다. 결과: 158명 중 연구군(재입원군)은 82명, 대조군(초입원군)은 76명이었다. 연령, 분절형 호중구 및 림프구 백분율, 12개월 내 입원 횟수, 동반 질환(천식 등 호흡기 질환), 우상 폐야의 병변이 재입원의 위험인자로 분석되었다. 그러나 회귀분석상 연령과 동반 질환만 의미 있는 차이를 보였고, 재입원율은 연령이 낮고 동반 질환이 있을 때 높았다. 결론: 소아 폐렴의 재입원 위험인자로 환자의 어린 연령과 동반 질환이 유의하였다. 소아 환자가 폐렴으로 입원했을 때 연령이 낮고 동반 질환이 있다면 더 정확한 검사와 치료, 퇴원 시기 결정, 외래 추적 관찰 등에 신중을 기하여 향후 재입원율을 줄이기 위한 종합적 접근이 필요하다.