• Safety and Health at Work
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• 제11권1호
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• pp.10-18
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• 2020

Background: The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. Methods: The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011-2012 were compared with follow-up internal audits in 2014-2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. Results: At baseline, 25% of 60 facilities were "noncompliant" (audit score<50%), 48% "conditionally compliant" (score >50 < 80%), and only 27% "compliant" (score >80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). Conclusion: Low baseline compliance with OHS-IPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.

• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.148-155
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• 2012

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poorquality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

• 보건행정학회지
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• 제30권1호
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• pp.131-138
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• 2020

The purpose of this study was to compare the health status of South Korea with those of Organization for Economic Cooperation and Development (OECD) countries and examine the trends. Position vAlue for Relative Comparison (PARC) was used as a gauge for comparison, and five sectors of the health care system were measured: demand, supply, accessibility, quality, and cost. The Mann-Kendall test was used as a statistical analysis method to examine trend of PARC values obtained from 2000 to recent years. According to the results, the demand, supply, accessibility, and quality sectors were higher than the OECD average, while the cost was lower than the average. However, there is a recent trend of sharp increases in health care costs. Some indicators: health employment, quality of primary care and mental health care were lower than the OECD average, and health determinants showed a worsening trend. Therefore, policy-makers need to take this into account and make efforts for sustainable health care.

• Tuberculosis and Respiratory Diseases
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• 제80권3호
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• pp.221-225
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• 2017

Since 2015, the Health Insurance Review and Assessment Service (HIRA) has performed annual qualitative assessments of asthma management provided by all medical institutions that care for asthma patients in Korea. According to the third report of qualitative assessment of asthma management in 2017, the assessment appears to have contributed to improving the quality of asthma care provided by medical institutions, especially primary clinics. However, there is still a gap between the ideal goals of asthma management and actual health care policies/regulations in real clinical settings, which leads to the state of standstill with respect to the quality of asthma management despite considerable efforts such as the qualitative assessment of asthma management by national agencies such as the HIRA. At this point, a harmonized approach is needed to raise the level of asthma management among several components including medical policies, efforts of academic associations such as education and distribution of the guideline for management, and reliable financial support by the government.

• Journal of Hospice and Palliative Care
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• 제15권3호
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• pp.141-146
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• 2012

과거 수십 년에 걸쳐 '삶의 질'은 의학의 분야를 막론하고 임상과 연구 모두에서 그 중요성이 더해 가고 있다. 완화의료는 환자와 그 가족의 삶의 질 향상시키기 위한 활동으로 정의되며, 그들의 삶의 질 향상이 완화의료의 가장 중요한 목표이다. 하지만, 이질적인 정의, 세부항목의 불일치, 도구의 다양성 등으로 인해 연구간 비교가 어려운 실정이다. 본 고에서는 지금까지의 연구동향과 문제점, 그리고 그 해결책에 대해 논의해 보았으며, 향후 완화의료분야 연구에 도움이 되리라 확신한다.

• 성인간호학회지
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• 제18권3호
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• pp.457-467
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• 2006

Purpose: The purpose of this study was to identify the main factors influencing family functioning of caregivers in families with stroke. Method: A Convenient sample of 173 primary family caregivers who take care of a stroke patient at an Oriental medicine hospital in Jeonbuk. Interviews were done with a standardized questionnaire including family functioning by nurses. Results: In Pearson's correlation analysis, the influencing factors related to family functioning were ADL(p=.017), level of paralysis(p=.019) as stressors, Quality of relation(p=.000) as situational variables, and family caregivers' burden(p=.000). Stepwise multiple regression analysis showed 29.9% of the variance family functioning was significantly accounted for by the quality of relationship between stroke patient and caregiver(26.8%), and caregiver burden(3.1%). Conclusions: Findings indicate that families of stroke patients need family-focused nursing intervention as supported care to improve the relationship between patient and primary caregiver and relieve caregiver burden by culturally tailoring to Korean.

• 가정간호학회지
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• 제24권3호
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• pp.292-305
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• 2017

Purpose: The purpose of this study was to examine the factors influencing the entrapment of primary caregivers of cancer patients. Methods: From 6 general hospitals, 146 primary caregivers of cancer patients who were receiving home healthcare nursing service were selected for the study. Regarding data collection, structured questionnaires were distributed to the caregivers for data collection. T-test, ANOVA and hierarchical regression were used for data analysis. Results: The significantly influential factors on their entrapment were caregiving time, taking turms to look after the patient, disease duration, home healthcare nursing period, quality of relationship, perceived health status, and social support. And the explanatory power was 55.1% Conclusion: To reduce primary caregivers' entrapment, it is necessary to perform comprehensive and continuous nursing intervention, and to develop a standardized home healthcare nursing intervention program, and to come up with a system for using resources available in local communities.

• 임상간호연구
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• 제16권1호
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• pp.177-196
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• 2010

Purpose: This study was conducted to develop the nursing process based performance measurement tool and the evidence based care standards for nursing care in medication management and blood transfusion. Methods: The care standards and performance measurement tool were drafted through comprehensive review of relevant literature, national guidelines, hospital protocols, and standards of recognized international accrediting bodies. The proposed care standards and performance measurement tool were reviewed by the panel of experts and refined based on the panel's suggestions. Final care standards and performance measurement tool were validated by surveying the hospital nurses. Results: All items of the performance measurement tool for medication management and blood transfusion were evaluated appropriate. All contents of care standards and the measurable elements except the evaluation of discharge education were appropriate. The performance measurement tool developed in this study was found to be acceptable as a tool to evaluate quality of nursing care in medication management and blood transfusion. Conclusion: The outcomes of this study including the performance measurement tool and evidence based care standards would be the important indicators to monitor whether necessary nursing care is implemented and be the useful primary resources to improve quality of nursing care services.

• 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.

• 지역사회간호학회지
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• 제23권2호
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• pp.117-126
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• 2012

Purpose: The purpose of this study was to identify the factors associated with the health-related quality of life of family caregivers. Methods: A cross-sectional study was conducted. This study included 191 primary family caregivers of elders who used home care services (home-visit nursing, home-visit care, daycare) covered by the public long-term care insurance. Data were collected using self-report questionnaires from December 2010 to June 2011. These data were analyzed by using hierarchical multiple regression. Results: The majority of the family caregivers were female (79.6%) and daughters-in-law (28.8%). The mean depression score was $6.33{\pm}6.49$ and the mean health-related quality of life score was $0.69{\pm}0.39$. It was found that the factors affecting the health-related quality of life of family caregivers included depression (${\beta}$=-.406, p<.001), home-visit nursing use (${\beta}$=.296, p<.001), and daycare use (${\beta}$=.178, p=.015), which accounted for 36.6% of their health-related quality of life. Conclusion: Using home-visit nursing and daycare services has a positive effect on the health-related quality of life of family caregivers. To improve health-related quality of life of family caregivers, South Korea needs to fully activate the home-visit nursing and daycare services, and to strengthen family support programs.