• Title, Summary, Keyword: 재입원

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Estimation of cost by unnecessary readmission of the tertiary hospitals (불필요한 재입원 비용 추정에 관한 연구)

  • Shin, Min Sun;Lee, Won Jae
    • Journal of the Korea Convergence Society
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    • v.8 no.12
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    • pp.149-157
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    • 2017
  • Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

Comparison of Rehospitalization during the First Year of Life in Normal and Low Birth Weight Infants Discharged from NICU (신생아 집중치료실에서 퇴원한 정상 체중아와 저출생 체중아의 재입원에 관한 비교)

  • Min, Sae Ah;Jeon, Myung Won;Yu, Sun Hee;Lee, Oh Kyung
    • Korean Journal of Pediatrics
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    • v.45 no.12
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    • pp.1503-1511
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    • 2002
  • Purpose : Although the short- and long-term outcomes of low birth weight(LBW) neonatal intensive care unit(NICU) survivors have been extensively studied, much less information is available for normal birth weight(NBW) infants(greater than 2,500 gm) who require NICU care. Methods : We retrospectively examined the neonatal hospitalizations and one year health status of 302 NBW and 131 LBW admissions to our NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone surveys and medical records. Results : After initial discharge, 21.2% of the NBW infants and 23% of the LBW infants required rehospitalization during the first year of life and there was no significant difference between the two groups. The reasons for rehospitalization of the NBW infants included respiratory disorders (32.1%), G-I problems(26.2%), genitourinary problems(11.9%), surgery(10.7%), cardiac problems(7.1%), and congenital/developmental problems(1.2%). For the LBW infants, the order of frequency was the same, with the percentages slightly different. Neonatal risk factors related to the rehospitalization of the NBW infants included mechanical ventilation, duration of mechanical ventilation, and congenital anomaly. But no positive significant correlation of neonatal risk factors with rehospitalization of LBW infants was found. Conclusion : Low and normal birthweight NICU survivors were rehospitalized at similar rates. The most common cause of rehospitalization was respiratory problems. Neonatal risk factors related to rehospitalization of NBW infants were mechanical ventilation, duration of mechanical ventilation, and congenital anomaly. However, no positive significant correlation of neonatal risk factors with rehospitalization of LBW infants was found. The data suggests that NBW infant survivors, as well as LBW infant NICU survivors, require close follow up.

Readmission of late preterm infants after discharge from nursery (신생아실에서 퇴원한 후기 조산아들의 재입원에 대한 고찰)

  • Kim, Myo-Jing
    • Korean Journal of Pediatrics
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    • v.52 no.8
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    • pp.888-892
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    • 2009
  • Purpose : To evaluate the risk factors for hospital readmission during the neonatal period among late preterm infants who were discharged after nursery care. Methods : In this retrospective study, we reviewed medical records of 135 late preterm infants readmitted to the neonatal intensive care unit (NICU) during the neonatal period, after discharge from nursery of IL Sin Christian Hospital from January 2003 to December 2008. We compared the risk factors of the hospital readmission group with the control group. Results : The gestational age and birth weight of 135 study infants were $36^{+1}{\pm}0.5$ weeks and $2,718.4{\pm}296.9gm$, respectively. Identified risk factors of hospital readmission were breastfeeding (71.9% vs. 44.4%), short duration of nursery stay ($3.3{\pm}1.6$ days vs. $4.1{\pm}2.0$ days), firstborn (60.0% vs. 45.3%), and maternal pregnancy complication (31.9% vs. 18.8%). Jaundice accounted for the majority of hospital readmissions (83.7%), and the age at hospital readmission was $6.2{\pm}3.6$ postnatal days, mostly at 5-6 postnatal days (40.7%). Identified risk factors of hospital readmission due to jaundice were spontaneous normal vaginal delivery (43.4% vs. 1.8%), younger maternal age ($29.8{\pm}3.4$ yrs vs. $32.1{\pm}4.2$ yrs), and lower maternal pregnancy complication (28.3% vs. 50%). Conclusion : Identified risk factors of hospital readmission were breastfeeding, short duration of nursery stay, firstborn, and maternal pregnancy complication. Jaundice accounted for the majority of hospital readmissions, and the age at hospital readmission was $6.2{\pm}3.6$ postnatal days.

A Study on the Development of Readmission Predictive Model (재입원 예측 모형 개발에 관한 연구)

  • Cho, Yun-Jung;Kim, Yoo-Mi;Han, Seung-Woo;Choe, Jun-Yeong;Baek, Seol-Gyeong;Kang, Sung-Hong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.4
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    • pp.435-447
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    • 2019
  • In order to prevent unnecessary re-admission, it is necessary to intensively manage the groups with high probability of re-admission. For this, it is necessary to develop a re-admission prediction model. Two - year discharge summary data of one university hospital were collected from 2016 to 2017 to develop a predictive model of re-admission. In this case, the re-admitted patients were defined as those who were discharged more than once during the study period. We conducted descriptive statistics and crosstab analysis to identify the characteristics of rehospitalized patients. The re-admission prediction model was developed using logistic regression, neural network, and decision tree. AUC (Area Under Curve) was used for model evaluation. The logistic regression model was selected as the final re-admission predictive model because the AUC was the best at 0.81. The main variables affecting the selected rehospitalization in the logistic regression model were Residental regions, Age, CCS, Charlson Index Score, Discharge Dept., Via ER, LOS, Operation, Sex, Total payment, and Insurance. The model developed in this study was limited to generalization because it was two years data of one hospital. It is necessary to develop a model that can collect and generalize long-term data from various hospitals in the future. Furthermore, it is necessary to develop a model that can predict the re-admission that was not planned.

Factors Affecting the Readmission Experience of Liver Cirrhosis Patients (간경변증 환자의 재입원 경험에 영향을 미치는 요인)

  • Yoon, Mi-Lim;Eun, Young
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.21 no.5
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    • pp.111-120
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    • 2020
  • This study examined the factors affecting the readmission of patients with liver cirrhosis, and focused on self-care, social support, and drinking refusal self-efficacy. The subjects were 75 cirrhosis patients who were admitted to medium-sized hospitals at S-city for two months from May 2019 to June 2019. The data was analyzed with the SPSS (Version 25) program, and logistic regression analysis was performed on the factors affecting readmission. The results were self-care (27.49±0.53 out of 60), social support (52.80±16.44 out of 90), and drinking refusal self-efficacy (42.39±22.76 out of 80). The readmission method was classified into planned and unplanned admissions. Unplanned readmission was found to differ depending on the drinking experience (OR: 4.16) and the presence of complications (OR: 5.11) within a month of discharge rather than that of the planned readmissions, accounted for 19.7%. It will be very important to reduce the occurrence of complications by early management of patients with cirrhosis, and increase the drinking refusal self-efficacy, and so reduce unplanned readmission and prevent the progression and deterioration of cirrhosis. The drinking experience and the occurrence of complications can be reduced through interventions that increase self-care, social support, and drinking refusal self-efficacy. Nursing interventions are needed to prevent patients with cirrhosis from drinking and to manage the complications due to relapse into alcoholism.

Comparison in nursing needs of heart disease patients depending on whether or not readmitted (재입원 여부에 따른 심질환자의 간호요구 비교)

  • Choi, Young-Sil
    • Journal of Digital Convergence
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    • v.12 no.6
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    • pp.519-526
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    • 2014
  • The purpose of this study was investigate nursing needs of heart disease patients depending on whether or not readmitted. Who had diagnosed heart disease and admitted on a general hospital was collected as a self-administered questionnaire method from March to June 2012. Collected data were analyzed through the SPSS 18.0 program. The average of total nursing needs is $4.12{\pm}.49$ point in patient who were not in readmission, and $3.89{\pm}.63$ point in patient joined readmission, there were significant differenced(p=.046). Therapeutic nursing needs are higher than others in nursing needs, in the both groups. Each rank and sub-regions is also different nursing needs according to readmission in two group. Physical, Social-emotional, educational and therapeutic nursing needs was correlated each other in depth. Therefore, focusing on patient's nursing needs according to patient's characteristics are required to perform nursing.

Risk Factors of Readmission to Hospital for Pneumonia in Children (소아 폐렴의 재입원에 대한 위험인자)

  • Hong, Yu Chan;Choi, Eom Ji;Park, Sin-Ae
    • Pediatric Infection and Vaccine
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    • v.24 no.3
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    • pp.146-151
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    • 2017
  • Purpose: We analyzed the risk factors affecting readmission of children with pneumonia. Methods: We retrospectively analyzed the medical records of pediatric patients admitted to the Department of Pediatrics at the Jeonju Presbyterian Medical Center from January 2007 to August 2016. We classified patients who were readmitted with pneumonia within 30 days of discharge as the readmission group and patients who were admitted with pneumonia for the first time as the first admission group. Results: Among 158 patients, the study (readmission) group included 82 patients and the control (first admission) group included 76 patients. Age, the percentage of segmented neutrophils and lymphocytes, the number of admissions in the last 12 months, the associated diseases (respiratory diseases such as asthma), and the affection of the right upper lung were analyzed as risk factors for readmission. However, based on a regression analysis, only age and associated diseases were found to be significant risk factors. The rate of readmission increased with younger age. When there were associated diseases, the rate of readmission also increased. Conclusions: Young age and associated diseases were significant risk factors for readmission for patients with pediatric pneumonia. When pediatric patients are admitted with pneumonia, if they are young and/or have associated diseases, a comprehensive approach is needed to reduce the rate of readmission with careful consideration of precise examination, treatment, timing of discharge, and follow-up.

Convergence Factors of affecting Rehospitalization of Tuberculosis Patients (결핵환자의 재입원에 미치는 융복합적 영향요인)

  • Lee, Hwa-Sun;Lee, Hyun-Ju
    • Journal of Digital Convergence
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    • v.13 no.5
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    • pp.259-267
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    • 2015
  • This study is aimed at understanding the factors affecting rehospitalization of a tuberculosis patient. In a public hospital with a tuberculosis ward in Seoul, the data of 360 patients who discharged the hospital from July 1, 2012 to December 31, 2012. Data was selected from 'nursing information survey' or 'discharge analysis DB' of the department of medical records. The possibility of rehospitalization was higher in the group with those who has no job, those with medical care assistant than with health insurance, drinks about 10 times a month, personally came to the hospital, main guardian is the patient's spouse, have discharged from hospital against the doctor's advise, and principle diagnosis is not a pulmonary tuberculosis but the other respiratory disease. Therefore, it is expected that the possibility of rehospitalization would be effectively reduced if an intensive intervention is taken on the first hospitalized patients who have the features described above.

Does Process Quality of Inpatient Care Serve as a Guide to Reduce Potentially Preventable Readmission (PPR)? (의료서비스의 과정적 질과 잠재적으로 예방 가능한 재입원율과의 관계)

  • Choi, Jae-Young
    • Korea Journal of Hospital Management
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    • v.23 no.1
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    • pp.87-106
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    • 2018
  • Objective: The objective of this study is to examine the association between process quality of inpatient care and risk-adjusted, thirty-day potentially preventable hospital readmission (PPR) rates. Data Sources/Study Setting: This was an observational cross-sectional study of nonfederal acute-care hospitals located in two states California and Florida, discharging Medicare patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia January through December 31, 2007. Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services Hospital Compare database, and the American Hospital Association Annual Survey of Hospitals. Study Design: The dependent variable of this study is condition-specific, risk-adjusted, thirty-day potentially preventable hospital readmission (PPR). 3M's PPR software was utilized to determine whether a readmission was potentially preventable. The independent variable of this study is hospital performance for process quality of inpatient care, measured by hospital adherence to recommended processes of care. We used multivariate hierarchical logistic models, clustered by hospitals, to examine the relationship between condition-specific, risk-adjusted, thirty-day PPR rates and process quality of inpatient care, after taking clinical and socio-demographic characteristics of patients and structural and operational characteristics of hospitals into account. Findings: Better performance on the process quality metrics was associated with better patient outcome (i.e., low thirty-day PPR rates) in pneumonia, but not generally in two cardiovascular conditions (i.e., heart failure and acute myocardial infarction). Practical Implication: Adherence to the process quality metrics currently in use by CMS is associated with risk-adjusted, thirty-day PPR rates for patients with pneumonia, but not with cardiovascular conditions. More evidence-based process quality metrics closely linked to 30-day PPR rates, particularly for cardiovascular conditions, need to be developed to serve as a guideline to reduce potentially preventable readmissions.

Effect of Synagis (palivizumab) prophylaxis on readmission due to respiratory syncytial virus in very low birth weight infants (극소 저체중 출생아에서 Synagis (palivizumab) 접종이 respiratory syncytial virus 감염으로 인한 재입원에 미치는 영향)

  • Park, Soo Kyoung;Jung, Yu Jin;Yoo, Hye Soo;Ahn, So Yoon;Seo, Hyun Joo;Choi, Seo Hui;Kim, Myo Jing;Jeon, Ga Won;Koo, Soo Hyun;Lee, Kyung-Hoon;Chang, Yun Sil;Park, Won Soon
    • Korean Journal of Pediatrics
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    • v.53 no.3
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    • pp.358-364
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    • 2010
  • Purpose : The aim of this study was to determine the efficacy of $Synagis^{(R)}$ (palivizumab) in reducing the respiratory syncytial virus (RSV) readmission rate in very low birth weight infants (VLBWI ) and the subgroup that showed the most effective vaccination. Methods : We enrolled 350 VLBWI who had been discharged alive from the neonatal intensive care unit of Samsung Medical Center from January 2005 to December 2007 and were followed up for at least one year. A retrospective study based on medical records was performed for a period of one year after discharge. RSV readmission rate was investigated according to BPD (bronchopulmonary dysplasia, requiring oxygen at postnatal day 28) and $Synagis^{(R)}$ prophylaxis. We categorized the subgroups by the severity of BPD gestational age, and birth weight and compared the RSV readmission rates between subgroups. Results : Eleven VLBWI were readmitted. $Synagis^{(R)}$ prophylaxis resulted in a 86% reduction in the rate of readmission due to RSV infection (prophylaxis group, 0.7% and no prophylaxis group, 5.0%; P =0.02). Readmission rate in BPD patients was also reduced in the prophylaxis group (0.7% in the prophylaxis group vs. 5.2% in the no prophylaxis group, P =0.03). The readmission rate in patients without BPD was reduced in the prophylaxis group (0% in the prophylaxis group vs. 4.9% in the no prophylaxis group, P =1.00), but this was not statistically significant.Conclusion : $Synagis^{(R)}$ prophylaxis was effective at reducing RSV readmission in VLBWI. Its efficacy was verified irrespective of BPD, gestational age, or birth weight.