• Title, Summary, Keyword: readmission

Search Result 96, Processing Time 0.043 seconds

Development of Case Management System and Analysis of Economic Feasibility under the Fee-For-Service Reimbursement (행위별 수가 지불제도 하에서의 사례관리시스템 개발 및 경제성 분석)

  • Choi, Mi Young;Chae, Young Moon;Tark, Kwan Chul;Kim, In Suk;Chun, Ja Hae
    • Quality Improvement in Health Care
    • /
    • v.11 no.1
    • /
    • pp.46-60
    • /
    • 2004
  • Background : Recently, we have experienced various changes in the healthcare environment. Healthcare organizations are facing a financial crisis due to more competitive relationships among themselves as well with low health insurance fees. The purposes of the current study were: (1) to develop a data warehouse-based system for evaluating and monitoring the case management activities, and (2) to measure and analyze its effects. Methods : In order to collect the data for the study, the database on discharged patients was utilized at a university hospital located in Seoul from June 1, 2002 through December 31, 2002. Initially, a data warehouse was built for the case management system. The case management activities were analyzed using structured methodology to establish the case management system. Results : The findings of this study were as follows: (1) A case management system was developed to make it possible to monitor of healthcare quality and resource utilization. The Case management System included monitoring functions regarding utilization reviews, critical pathways, and clinical indicators. (2) Utilizing the case management system, unplanned readmissions were documented among total discharged patients during two months from November 1, 2002 through December 31, 2002. The unplanned readmission rate was 2.3%(276 patients) in total of 11,960 discharged patients. Among them 81 patients(0.7% of total discharges, 29.3% of unplanned readmission) were readmitted to the same physician in charge under the same diagnosis. No significant differences were found in the demographic variables such as gender and age among the patients. (3) After implementing the case management system, 2.9% of average length of stay reduced. Applying cost-benefit analysis, the 2.9% reduction of length of stay represents net profit of ${\backslash}$ 279,592,000 in the year of 2004. In addition, applying value acceleration analysis, cumulative net benefit of ${\backslash}$ 1,481,000,000 was expected by the year of 2007. Also we were able to expect ${\backslash}$ 247,800,000 of cumulative benefit for the prospective 5 years in value linkage analysis. It represents average ${\backslash}$ 787,700,000 of pure net benefit a year. Conclusion : The value of present study would be not only implementing the knowledge management system into the existing case management activities, but also evaluating its effects and estimating its financial benefits. This study suggested that the case management system would be a supportive tool for monitoring and improving the quality of healthcare, and a cost-effective tool for increment of healthcare organization's financial benefit.

  • PDF

The Effect of Mandatory Diagnosis-Related Groups Payment System (포괄수가제도 당연적용 효과평가)

  • Choi, Jae-Woo;Jang, Sung-In;Jang, Suk-Yong;Kim, Seung-Ju;Park, Hye-Ki;Kim, Tae Hyun;Park, Eun-Cheol
    • Health Policy and Management
    • /
    • v.26 no.2
    • /
    • pp.135-147
    • /
    • 2016
  • Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

A Study of Anxiety of Families of Psychiatric Patients at Discharge (정신과 환자 퇴원시 가족들이 느끼는 불안에 관한 연구)

  • 김기숙
    • Journal of Korean Academy of Nursing
    • /
    • v.7 no.2
    • /
    • pp.31-42
    • /
    • 1977
  • This study investigated the anxiety of families of psychiatric patients at discharge. The purpose was to contribute to the improvement of psychiatric nursing care, rehabilitation and social adjustment of psychiatric patients and community mental health. The objectives of this study were to identify the acceptance of the psychiatric nurse by the families, their anxiety at the time of discharge, whether any help was wanted to reduce anxiety, the attitude toward the patient after discharge and feelings about the patients. The population studied consisted of 180 family members of patients from 10 mental hospitals (including local clinic) in Seoul and Kyung- Ki province, from March I to April 30, 1977. The date were collected by an interview schedule, and compared and analysed by Computer usings х$^2$- test. Results were as follows : 1. Many of the families(83.6%) expressed a acceptance of psychiatric nurse. 2. A little more than half of the families(51.1%) expressed happiness but a largo portion (38.9%) had "anxious" feelings at discharge. 3. Almost all families(92.6%) wanted a physician′s help to reduce discharge anxiety. Younger families tended to want the physician′s help more. 4. Many of the families(83.1%) wanted a nurse′s help. Families of parents patients admitted for the 1 st time wanted the nurse′s help more. 5. Comparing the feelings at a previous discharge with the present discharge, 49.1% of the family expressed greater happiness at tile latter than the former. 6. More than half the families responded positively toward the patient. Unmarried family members responded more positively than married Families of 1 st admission patients responded more positively than families of readmission patients. 7. Many families(78.8%)had positively feelings toward the patients. More negative responses came from women than from men, from lower education levels, lower incomes and readmission patients.

  • PDF

The Reliability and Validity of Patient-Generated Subjective Global Assessment (PG-SGA) in Stroke Patients (뇌졸중 환자에서 '환자 주도적 총체적 영양사정' 도구의 신뢰도 및 타당도 평가)

  • Yoo, Sung-Hee;Oh, Eui-Guem;Youn, Mi-Jung
    • Korean Journal of Adult Nursing
    • /
    • v.21 no.6
    • /
    • pp.559-569
    • /
    • 2009
  • Purpose: This study was to examine the reliability and validity of Patient-Generated Subjective Global Assessment (PG-SGA) as a nutritional measurement for stroke patients. Methods: This was a methodological study performed from May 6 to June 10, 2009 at a tertiary university hospital in Seoul. For reliability of PG-SGA, inter-rater reliability was used for statistics. For concurrent validity, BMI and biomarkers were compared between PG-SGA 0 ~ 8 and ${\geq}$ 9. In addition, sensitivity, specificity, and predictive value of PG-SGA compared with SGA were calculated using a contingency table. For predictive validity, hospital day, complications, and readmission within 1-month after discharge were compared between PG-SGA 0 ~ 8 and ${\geq}$ 9. Results: Correlation of PG-SGA score between two observers was 0.83, and kappa value for the agreement of severe malnutrition was 0.78(all $p_s$ < .001). The scored PG-SGA showed high sensitivity and specificity (100% and 96.7%, respectively). Severe undernourished patients (PG-SGA ${\geq}$ 9) had significantly low TLC, protein, albumin, and prealbumin (all $p_s$ < .01) compared with non-undernourished patients (PG-SGA 0 ~ 8). Also, in severe undernourished patients, complications and readmission (all $p_s$ = 0.01) were more often represented, and hospital days (p = .013) were significantly delayed. Conclusion: PG-SGA is a reliable and valid measurement to assess nutritional status for stroke patients.

  • PDF

A Systematic Review on Nurse-Led Transitional Care Programs for Discharged Patients from Hospital to Home (퇴원환자를 위한 간호사 주도 전환 프로그램의 내용과 효과에 관한 체계적 문헌고찰)

  • Lee, Hyun Joo;Kim, Yukyung;Oh, Eui Geum
    • Journal of Korean Clinical Nursing Research
    • /
    • v.23 no.3
    • /
    • pp.376-387
    • /
    • 2017
  • Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.

Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data

  • Park, Suin;Park, Sohee;Lee, Young Joo;Park, Choon-Seon;Jung, Young-Chul;Kim, Sunah
    • Journal of Korean Academy of Nursing
    • /
    • v.50 no.3
    • /
    • pp.333-348
    • /
    • 2020
  • Purpose: The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. Methods: The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. Results: Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. Conclusion: Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.

Comparing infective complications from transrectal ultrasound guided prostate biopsy following transition to single dose oral ciprofloxacin prophylaxis

  • Farag, Matthew;Riddell, Sophie;Daffy, John;Wong, Lih-Ming
    • Investigative and Clinical Urology
    • /
    • v.60 no.1
    • /
    • pp.54-60
    • /
    • 2019
  • Purpose: To examine the incidence of infective complications post Transrectal Ultrasound Guided Prostate Biopsy (TRUSPB), after transition to preoperative administration of single dose oral ciprofloxacin. Materials and Methods: A retrospective study of 766 consecutive patients undergoing TRUSPB at St Vincent's Hospital Melbourne (2002-2016). Antibiotic prophylaxis between 2002-2014 consisted of 3 days of perioperative oral norfloxacin±intravenous (IV) antibiotics (Group A, n=687). From November 2014 patients received a single dose of oral 750 mg ciprofloxacin pre-biopsy (Group B, n=79), to align with the American Urological Association (AUA) and a Cochrane Database Systematic Review on Antibiotic Prophylaxis for TRUSPB. Groups were compared for all postoperative complications requiring representation and/or readmission within 30 days of biopsy. Results: In Group A, 10 of 687 patients (1.5%) re-presented with post-procedural fever (temperature >38℃), requiring readmission and IV antibiotic treatment, compared to 4 of the 79 patients (5.1%) in Group B (p=0.02). Positive blood cultures were isolated in 0.9% (n=6, Group A) versus 3.8% (n=3, Group B) (p=0.02). The 4 infectious readmissions in Group B had no prior genitourinary infections, no recent travel and all had a Charlson Comorbidity Index scores <2. Two patients in Group B cultured Escherichia coli sensitive to ciprofloxacin despite receiving preoperative ciprofloxacin. Conclusions: Antibiotic prophylaxis using single dose ciprofloxacin is associated with higher infective complications post TRUSPB. The episodes of ciprofloxacin sensitive E. coli bacteraemia in Group B suggest consideration of a longer course of perioperative antibiotic prophylaxis.

Comparison of Inpatient and Outpatient Preoperative Factors and Postoperative Outcomes in 2-Level Cervical Disc Arthroplasty

  • Hill, Patrick;Vaishnav, Avani;Kushwaha, Blake;McAnany, Steven;Albert, Todd;Gang, Catherine Himo;Qureshi, Sheeraz
    • Neurospine
    • /
    • v.15 no.4
    • /
    • pp.376-382
    • /
    • 2018
  • Objective: The purpose of this study was to evaluate factors associated with inpatient admission following 2-level cervical disc arthroplasty (CDA). A secondary aim was to compare outcomes between those treated on an inpatient versus outpatient basis. Methods: Using data from the American College of Surgeons National Surgical Quality Improvement Program database, multivariate logistic regression analysis was used to assess the independent effect of each variable on inpatient or outpatient selection for surgery. Statistical significance was defined by p-values <0.05. The factors considered were age, sex, body mass index (BMI), smoking status, American Society of Anesthesiologists physical status classification, and comorbidities including hypertension, diabetes, history of dyspnea or chronic obstructive pulmonary disease, previous cardiac intervention or surgery, steroid usage, and history of bleeding. In addition, whether the operation was performed by an orthopedic or neurosurgical specialist was analyzed. Results: The number of 2-level CDA procedures increased from 6 cases reported in 2014 to 142 in 2016, although a statistically significant increase in the number of outpatient cases performed was not seen (p=0.2). The factors found to be significantly associated with inpatient status following surgery were BMI (p=0.019) and diabetes mellitus requiring insulin (p=0.043). There were no significant differences in complication and readmission rates between the inpatient and outpatient groups. Conclusion: Patients undergoing inpatient 2-level CDA had significantly higher rates of obesity and diabetes requiring insulin than did patients undergoing the same procedure in the outpatient setting. With no difference in complication or readmission rates, 2-level CDA may be considered safe in the outpatient setting in appropriately selected patients.

The Effect of Preoperative Clopidogrel on the Postoperative Bleeding after OPCAB (OPCAB 시행 전 Clopidogrel 사용이 술 후 출혈경향에 미치는 임상적 고찰)

  • Park, Kwon-Jae;Woo, Jong-Soo;Bang, Jung-Hee;Jeong, Sang-Seok
    • The Korean Journal of Thoracic and Cardiovascular Surgery
    • /
    • v.42 no.3
    • /
    • pp.311-316
    • /
    • 2009
  • Background: Clopidogrel is widely used just before coronary artery bypass surgery, yet its pharmacological effect can cause postoperative bleeding-related complications. The purpose of this study was to find the effect of preoperative clopidogrel exposure on the blood transfusion requirement and on the rate of reexploration for bleeding control and the rate of readmission caused by bleeding in patients who undergo off-pump coronary artery bypass surgery (OPCAB). Material and Method: This study included 103 patients who had been on clopidogrel preoperatively and they underwent OPCAB by one surgeon from January, 2005 to November, 2007. We divided the patient into two group. Group 1 consisted of 45 patients who stopped cloidogrel 5 days before surgery and group 2 consisted of 58 patients who were taking clopidogrel within 5 days before surgery. Two groups were compared in terms of the bleeding related reoperation rate and the readmission rate, the amount of postoperative bleeding and the required amount of transfusion. Result: There were no significant differences between the two groups concerning the demographic, echocardiographic and hematologic features. There were no significant differences in the postoperative bleeding amount, but the amount of required transfusion was greater in group 2 (p=0.018). While group 1 showed a 0% reoperation rate for hemostasis and 0% readmission rate as related to postoperative bleeding, group 2 showed a 6.9% reoperation and a 5.2% readmission rate, but three were no statistically significant differences between the two groups. Conclusion: Continuous use of clopidogrel did not cause postoperative major bleeding, but can increase the amount of bleeding and the amount of required transfusion postoperatively. We that discontinuation of clopidogrel for a while before elective OPCAB can help the patient's postoperative recovery.