• Journal of Korean Academy of Nursing
• /
• v.36 no.7
• /
• pp.1193-1203
• /
• 2006

Purpose: The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. Method: A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. Result: The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequoia of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won (${\fallingdotseq}$ 48 $, 1 $=960 Won). The costs ranged from 74,523 Won (${\fallingdotseq}$78 $, loss of chronic kidney function, N18) to 32,270 Won (${\fallingdotseq}$34 $, other cerebrovascular diseases, 167). Conclusion: Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.7 no.1
• /
• pp.58-72
• /
• 2000

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting 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 the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical 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 test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.12 no.1
• /
• pp.136-154
• /
• 2005

Purpose : This study purposed to conduct a comprehensive survey of home care nursing clients' quality of life based on the PRECEDE model. Method : This study selected 74 home care nursing clients registered at a university hospital in Incheon and performed face-to-face interviews by structured questionnaire. The research period was two months from the $2^{nd}$ of February to the $30^{th}$ of March in 2004. Result : According to the result of assessment at each stage of the PRECEDE model, home care nursing clients' quality of life was 13.88 out of 25 points, health level 15.22 out of 21, abilities to perform activities of daily living 29.26 out of 100, cognitive abilities 16.00 out of 30, social support 13.68 out of 20, and satisfaction with home care nursing service 33.26 out of 40. According to the result of stepwise regression in order to identify factors influencing home care nursing clients' quality of life, social support and abilities of daily living were found to be significant variables among the characteristics of each assessment stage. Conclusion : It is necessary to develop nursing intervention strategies for strengthening social support and enhancing abilities to perform activities of daily living in order to improve home nursing clients' quality of life.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.31 no.1
• /
• pp.44-55
• /
• 2024

Purpose: This is a retrospective secondary data analysis study based on real-world data to analyze the level of nursing care needs of patients in a comprehensive nursing care service ward, and identify factors influencing nursing needs. Methods: Study participants included patients admitted to two comprehensive nursing care service wards at a tertiary general hospital located in Gyeonggi-do, Korea. After obtaining permission from the health and medical information team of the target hospital, data were collected from their electronic medical records. Nursing care needs were measured using seven items on nursing activity and four items on daily living activities developed by the National Health Insurance Service (NHIS). The collected data were analyzed using the SPSS version 29.0 with frequency and percentage, mean and standard deviation, minimum and maximum values, t-test, ANOVA, Pearson's correlation coefficients, and multiple linear regression. Results: The level of nursing care needs of patients in comprehensive nursing care service wards was found to be higher for patients with pressure sores (β=.33), older patients (β=.26), patients who underwent procedures (β=.15), patients with present guardians (β=.15), and patients with more comorbidities (β=.10). The total explanatory power was 51.0%. Conclusion: It is necessary to accurately identify patients' nursing care needs and provide nursing care according to priority by considering the characteristics of patients in comprehensive nursing care service wards.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.8 no.2
• /
• pp.148-158
• /
• 2001

Purpose: This study is to investigate the attitudes on the Home Health Care among the physicians and nurses in P University. Method: Data were gathered from 71 physicians and 264 nurses. working at P University Hospital. from May 1 to May 15, 2001 and analyzed using descriptive statistics and Fisher exact test. Results: 1) As to the previous information about home health care program, those who have been familiar to it were 100% of physicians, and 99.6% of nurses, and 39% of the physicians and 66.1% of the nurses. were found to have responded with right answers, 2) As to the acceptance of the home health care program, 87% of physicians and 98.5% of nurses were found to be positive and there showed a significant difference(p= .019), 3) The main reasons for accepting the system were: the alleviation of the family burden of time, the maintenance of continuity of care, and the reasons for opposing the system were incomplete legal assurance. the possibility of providing illegal medical services. 4) The physician's intention rate of patient referrals to home care program reveled 49.2%. 5) According to the services related to Home Health Care. the orders of acceptance rates were medical tests related services (77.8%, 92%); therapeutic nursing interventions(69.0%, 88.2%): and services for medication(68.3%, 82.5%) among physicians and nurses. respectively. Conclusion: For the stabilization and successful implementation of home health care system. it should be accompanied with education for physicians about home care. setting specific laws and regulations for home care. legal assurance of home care business. outcome research for home care recipients. and support systems of hospital administration.

• Journal of Hospice and Palliative Care
• /
• v.13 no.2
• /
• pp.76-80
• /
• 2010

Purpose: As a part of analysis of home-based cancer patients management of public health centers, regional cancer center, and hospice institution in Jeju, this study was undertaken to establish their role. Methods: We investigated current status of hospice palliative care, especially home-based cancer patients management and summary demand of public health centers. Results: Services provided through the home-based cancer patients management project included physical, emotional, spiritual and education/informative services, even though there was little difference between them. The result showed that in the view of patients there was little relationship between public health centers, regional cancer center and hospice palliative institution. Conclusion: The relationship between home-based cancer patients management and institutions should be reinforced. Patients in acute state and difficulty care of patients should be referred to regional cancer center whereas maintenance state of patients should be referred to public health center.

• Research in Community and Public Health Nursing
• /
• v.9 no.1
• /
• pp.181-199
• /
• 1998

This study was designed to examine Home Nursing Care in Hospital-based and Community-based programs. This study investigates actual conditions of nursing needs and demands of clients and their family and the state of home nursing services. We hope that this study will improve upon the current home nursing care system. In Korea Home-Nursing Care programs are still developing and only now becoming a part of the health care delivery system. The data was collected by a questionaire the clients developed and modified through literature review by this writer and through 10 nurses who are members of 4 hospital and 3 community- based agencies. In this study 173 clients were selected. The study lasted from Oct. 1997 to March of 1998. The results show that the average age was 64.3, years older than most women clients (63.0%), the average age of a caregiver was 50.9 years old and most were female(77%). Two types of agency clients with a significant difference between social conditions [25.7%] used some form of insurance; 54.3% had the spouse pay expenses; pay 58.5% son and daughters of Hospital-based agencies: patients of social workers were 24.0%, the highest in the community agency. The condition of patients was 63.2% of the foley and nelaton catheter insertion at hospital based agencies. The range of nursing services offered is one of the highest among the 34 kinds of servies including nasogastric tube management basic nursing, ROM exercise, bladder irrigation, wound and sore dressing. For an effective care service factors that disturb each program such as a non-cooperatative family as well as patients themselves need to be lessened. Further more, the following must be emphasized, supportive counsel 27.0%, steady care for patient, 13.3%maintain a sense of security(11.7%), dressing sores and nutrition(10.0%). Although there were a large number of home nursing care services in the community, policy changes have gathered momentum. Fortunately, the scope and level at legal support will be increased in the future. The program should intergrate and link the district or community together. A project to develop a community based home nursing system as soon as possible should be developed. In conclusion, home nursing care nurses training curriculum should be strengthened.

• Journal of Korean Academy of Nursing Administration
• /
• v.12 no.2
• /
• pp.225-232
• /
• 2006

Purpose: The purpose of this study was to analyze the services and cost of CVA patients in hospital-based home health care and compare the differences of home health care cost by hospital types. Methods: The subjects of this study were 5,756 home care patients with cerebrovascular disease. Data were collected by using home health care medical expense claims from 127 hospitals in 2004. Results: The home care service 'indewelling catheterization' was the highest(19.28%), and then 'nasogastric tube insertion and change(16.72%)', 'bladder irrigation(15.98)', 'wound management(simple dressing)(10.42%)' followed. Average home health care cost per visit was 39,943 won, and the highest 46,058 won in general hospitals and the lowest 33,922 won in tertiary hospitals, so there were statistically significant among the types of hospitals(F=1112.47, p<0.0001). Conclusions: The number of home health care patients has been rapidly growing with the increase of aged population and demand for home care services is rising. So, it could be urgent to develop a reasonable cost reimbursement system for home health services and to expend scopes of the roles of home care specialist nurses. Amid the demand of more detail understanding the present status of home care, our study can be contributed to provide fundamental information of home care in Korea.

• Journal of Korean Academy of Nursing
• /
• v.30 no.6
• /
• pp.1488-1502
• /
• 2000

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

• Health Policy and Management
• /
• v.33 no.3
• /
• pp.295-310
• /
• 2023

Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.