• Health Policy and Management
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• v.12 no.1
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• pp.21-53
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• 2002

The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.2
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• pp.19-34
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• 1995

The purpose of this study was to analysis level on family caregiver's burden for the elderly with chronic disease in a rural area and to choose priority care group, thereby facilitating the development of interventions to reduce the caregiver's burden. For this purpose, data were collected by questionaire from June 10 to October 8, 1994. The instruments for data collection were Caregiver Burden Inventory by Novak(1989) and Zarit et al(1982), severity of dementia by Hughes Scales(1982), ADL by Lawton(1971), patients' family caregiving activity by pre-survey and reference review(Lee, 1993 ; Jang, 1990 ; Yoo, 1982). The subjects were 213 family caregiver of elderly with chronic disease in a rural area. The data was analysed by the use of t-test, ANOVA, correlation and multiple regression. The results were as follows ; 1. Total burden was evaluated below average, the mean of family burden was 46.98. By the diagnostic classification, Hypertension was 27.37, DM 32.46, CVA 62.96, Dementia 61.24. 2. Significant variables which were correlated to the family caregiver's burden were the patient's disease diagnosis (F=33.82, p<0.001), severity of dementia(F=30.52, p<0.001), the status of disease management(F=11.53, p<0.001), ADL(F=10.54, p<0.001), PADL(F=7.50, p<0.001), income(F=7.17, p<0.001), caregiver's health status(F=24.53, p<0.001), a view of patient's prognosis (F=22.17, p<0.001), relationship with the patient(F=33.82, p<0.001), the number of hours per day spent on caregiving(F=77.52, p<0.001), level of intimacy of caregiver and patients(F=8.75, p<0.001), level of helping(F=4.90, p<0.01), the frequency of caregiving activity(F=3.80, p<0.01), the number of admission(F=5.54, p<0.01), the length of caregiving(F=4.43, p<0.01), other chronic patient in family(t=2.81, p<0.01), caregiver's job(F=3.11, p<0.01), the duration of illness(F=2.98, p<0.05), caregiver's religion(F=2.93, p<0.05), medical security(F=3.89, p<0.05), caregiving's helper(t=2.42, p<0.05). 3. PADL was the most important predictor to family caregiver burden(R2=0.6611). In addition to this, IADL, caregiver's health status, the length of caregiving. level of intimacy of caregiver and patients, patient's age, the patient's disease diagnosis and patient's job accounted for 76% of family caregiver burden. 4. The criteria of priority care group were as follows ; the mean of family caregiver burden was above 58, above of moderate ADL, the number of hours per day spent on caregiving above of 8 hours, above of moderate dementia. By the diagnostic classification, number of priority care group, Hypertension was 4 (8.0%), DM 4(8.0%), CVA 34(64.1%), Dementia 45(75.0%).

• The Korean Journal of Health Service Management
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• v.12 no.1
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• pp.81-93
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• 2018

Objectives : This cross-sectional study aims to investigate the differences in general health status (GHS) and physical care burdens (PCB) of inpatient groups in long-term care hospitals (LTCH). Methods : The data of 228 patients were analyzed by integrating the electronic medical record (EMR) data of 2016, recorded by the nurses of hospitalized patients in the hospital. Results : There was a statistically significant difference in the GHS between the high-medical demand group and the other groups, but there was no difference in the GHS among other groups. The overall PCB was higher in the high-medical demand group than in the middle-medical demand, and cognitive impairment groups, but not in the problem behavioral group. Conclusions : The current classification of patient groups has shown limitations in terms of the basis of differential benefits of the groups. In particular, the PCB of the problem behavior group was not different from that of any group; hence, it should be adjusted through further study. To control the surge of medical care costs, it is necessary to improve the irrationality of the LTCH pay system in terms of the integration and continuity for elderly care.

• Proceedings of the Safety Management and Science Conference
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• 2009.11a
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• pp.51-60
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• 2009

To investigate acute drug intoxication trends in the elderly visited Emergency Medical Centers, Data was collected from the records of poisoning patients visited Five different Hospitals from January 1. 2007 to December 31. 2007. The analysis was conducted by using 135 cases of 624 cases. When considering only the elderly and making comparisons between the urban areas and the rural areas the following data was produced. In regard to patients with acute drug intoxication, the main substance of choice was pesticides. Cases of acute drug intoxication are definitely higher for those categorized as the rural elderly (75.0%) when compared with those categorized as the urban elderly (44.1%). The male to female ratio, those living together as a family, past suicide attempts, mental state and sobriety condition when they came, monthly distribution etc. between the two groups did not demonstrate a difference between them. In regard to reasons given for acute drug intoxication, suicide was the highest at 60.7% of the cases. When comparing accidental reasons for poisoning, the urban elderly, at 34.2% of their cases, were higher than in the rural elderly, at 23.7%. After first aid was administered, the admission rate was higher for the rural elderly (47.4%) than for the urban elderly (33.9%). This shows that the rural elderly have a more severe acute drug intoxication poisoning problem than the urban elderly do.

• Journal of Korean Public Health Nursing
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• v.31 no.1
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• pp.5-18
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• 2017

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

• Fire Science and Engineering
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• v.29 no.5
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• pp.96-103
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• 2015

This study investigates the socio-economic and clinical characteristics associated with emergency medical transport use by the elderly based on 2008~2011 Korea Health Panel data. A model of emergency medical transport use was analyzed, and the results indicate that use of 119 ambulances and private ambulances by the elderly accounted for 46.8% of all users, and 35.1% of their emergency room visits. Statistically significant factors associated with emergency medical transport use were gender (OR = 2.19, 95% CI = 1.51-3.17), relationship to household (OR = 2.19, 95% CI = 1.45-3.32), insurance type (OR = 1.41, 95% CI = 1.10-1.82), handicap (OR = 1.44, 95% CI = 1.14-1.83), reason for emergency department visits (OR = 1.53, 95% CI = 1.20-1.97), and treatment after emergency medical service completed (OR = 3.45, 95% CI = 2.80-4.25). The increased elderly population in an aging society will lead to a surge in demand for emergency patient transport services, and emergency medical services that are tailored to the elderly need to be developed accordingly.

• Journal of Preventive Medicine and Public Health
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• v.45 no.4
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• pp.219-226
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• 2012

Objectives: To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. Methods: Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. Results: One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. Conclusions: Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

• Journal of Korean Critical Care Nursing
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• v.7 no.1
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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.

• The Journal of the Korea Contents Association
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• v.11 no.10
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• pp.301-311
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• 2011

This paper is aimed at providing fundamental data for marketing strategies needed to determine the direction of policy to operate hospitals in an effective way. From the analysis, it was found that: first, expectation toward hospitality of the staff, facilities, environment and administrative service of hospitals for the elderly exercises significantly positive(+) effects on satisfaction of patients; second, trust in and satisfaction with administrative service of hospitals for the elderly exerts significantly positive(+) effects on the intent of patients for revisit and information by word of mouth; and third, the intent for revisit influences positively the intent for information by word of mouth significantly. It is therefore needed to try to understand the motives and tendencies of the elderly in selecting hospitals, to promote their satisfaction and to cultivate the spirit for patient-oriented service. Furthermore, efforts should be made to gain trust of medical staff, effects of medical treatment as well as medical equipment in addition to laborious endeavors to work out marketing strategies backed up by price competitiveness of paradigm.

• Korean Journal of Adult Nursing
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• v.13 no.4
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• pp.601-609
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• 2001

Purpose: The purpose of this study was to identify the degree of perceived powerlessness in hospitalized elderly patients of the medical and surgical unit. Method: The instrument for this study was the Powerlessness Behavioral Assessment Tool(Miller, 1983). The reliability of the instruments was .85. The data was analyzed by descriptive statistics, t-test, and ANOVA. Results: The results were as follows ; 1. The mean score of powerlessness was $35.02(SD={\pm}9.24)$ in a range of 19 to 64, and the mean of powerlessness was total 1.84. Among 4 subscales, the highest score was in the area of verbal response (M=1.98), and the lowest score for powerlessness was in the area of daily activities(M=1.74). In all items, 'verbal expression of fatalism' showed the highest score(M=2.78), and 'verbal expressions of giving up' showed the lowest score(M=1.38). 2. There were significant differences in the level of powerlessness according to hospitalization experience(t=-3.03, p=0.006), medical treatment experience(t=.291, p=.004). Especially, there was significant difference according to the hospitalization experience of the hospital in all sub- scales. Conclusion: Based on these conclusions, nursing education for patient's diseases and treatment can be used for proper nursing intervention in reducing the level of powerlessness of hospitalized elderly.