디지털융복합연구 (Journal of Digital Convergence)

  • 제13권9호
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  • Pages.323-332
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  • 2015
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  • 2713-6434(pISSN)
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  • 2713-6442(eISSN)
한국디지털정책학회 (The Society of Digital Policy and Management)
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진료지속성이 의료이용에 미치는 영향 : 융복합 성향점수매칭 방법 적용

Effects of the Continuity of Care on Hospital Utilization : Convergence A Propensity Score Matching Analysis

  • 안이수 (신한대학교 공법행정학과)
  • Ahn, Lee-Su (Dept. of Public law administration, Shinhan University)
  • 투고 : 2015.07.14
  • 심사 : 2015.09.20
  • 발행 : 2015.09.28
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초록

본 연구는 고혈압 환자의 일차의료 지속성 수준을 파악하고, 일차 의료 지속성 수준이 환자의 입원 및 응급실이용에 미치는 영향을 실증하는 융복합적 결과연구(outcome research)이다. 후향적 코호트(retrospective cohort study)연구로써 건강보험 청구자료를 사용하여 고혈압을 주상병으로 진단받은 315,791명을 3년 동안 추척 관찰하였다. 지속성지표는 MFPC, MMCI, COC를 적용하였고 결과변수는 입원 및 응급실 방문을 고려하였다. 일차의료의 지속성 수준과 입원 및 응급실이용의 위험도를 분석한 결과, 지속성 낮은 군이 지속성 높은 군 보다 입원 할 위험도가 1.655배(95% CI: 1.547-1.771), 응급실이용은 1.669배(95% CI: 1.465-1.903) 높았다. 따라서 우리나라 고혈압 환자의 진료지속성을 높이는 정책은 급증하는 만성질환 의료비를 줄일 수 있을 것이다.

This paper examines the level of the primary care continuity for patients with high blood pressure and the effects of the primary care continuity on their convergence health outcomes. We conducted a retrospective cohort study. A total of 315,791 patients who had received new diagnoses of hypertension. We determined standard indices of continuity of care-MFPC, MMCI, and COC and evaluated their association with study outcomes over three years of follow-up. Outcome measures included hospitalization and emergency room visits. The result of the primary care continuity levels and hazard ratios of health outcome showed that, comparing continuity group, non-continuity group had higher rates of hospitalization by 1.655(95% CI: 1.547-1.771) and emergency room visits by 1.669(95% CI: 1.465-1.903). This paper argues that medical costs of chronic diseases will reduce if low continuity of care turns into high continuity of care.

키워드

참고문헌

  1. NHIS, HIRA, 2013 National Health Insurance Statistical Yearbook, NHIS, HIRA, 2014.
  2. Chai-Hyun Yoon, Sin-Jae Lee, Soo-young Choo, Ok-Ryun Moon, Jae-Hyun Park, "Continuity of Care of Patient with Diabetes and Its Affecting Factors in Korea", J Prev Med Public Health, Vol.40, No.1, pp.51-58, 2007. https://doi.org/10.3961/jpmph.2007.40.1.51
  3. MC Cyr, AC Martens, D Berbiche, S Perreault, L Blais, "Continuity of Care in the Ambulatory Treatment of Adolescents with Asthma", Journal of Adolescent Health, Vol.39, No.6, pp.926.e11-926.e17, 2006. https://doi.org/10.1016/j.jadohealth.2006.06.013
  4. Gil-Won Kim, "Using a regular hospital reduce mortality and medical cost" Yonhap News, November 17, 2014, http://www.yonhapnews.co.kr/bulletin/2014/11/17/0200000000AKR20141117062400017.HTML?input=1195m (accessed August 8, 2015).
  5. David A. Katz, Kim McCoy, Mary Vaughan Sarrazin, "Does Improved Continuity of Primary Care Affect Clinician-Patient Communication in VA?", Journal of General Internal Medicine, Vol.29, No.2, pp 682-688, 2014. https://doi.org/10.1007/s11606-013-2633-8
  6. Kathleen Heist, Mary Guese, Michelle Nikels, Rachel Swigris, Karen Chacko, "Impact of 4+1 Block Scheduling on Patient Care Continuity in Resident Clinic", Journal of General Internal Medicine, Vol.29, No.8, pp 1195-1199, 2014. https://doi.org/10.1007/s11606-013-2750-4
  7. Lauren A. Peccoralo, Sean Tackett, Lawrence Ward, Alex Federman, Ira Helenius, Colleen Christmas, David C. Thomas, "Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine", Journal of General Internal Medicine, Vol.28, No.8, pp 1020-1027, 2013. https://doi.org/10.1007/s11606-012-2280-5
  8. CL Chan1, HJ You, HT Huang, HW Ting, "Using an integrated COC index and multilevel measurements to verify the care outcome of patients with multiple chronic conditions", BMC Health Services Research, Vol.12, pp.405, 2012. https://doi.org/10.1186/1472-6963-12-405
  9. DW Shin, JH Cho, HK Yang, JH Park, HJ Lee, HS Kim, JH Oh, SH Hwang, BL Cho, E Guallar, "Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea", Ann Fam Med. Vol.12, No.6, pp.534-541, 2014. https://doi.org/10.1370/afm.1685
  10. JJ Alpert, MC Heagarty, L Robertson, J Kosa , RJ Haggerty, "Effective use of comprehensive pediatric care. Utilization of health resources", Am J Dis Child, Vol.116, No.5, pp.529-533, 1968. https://doi.org/10.1001/archpedi.1968.02100020533014
  11. JM Gill, AG Mainous III., "The role of provider continuity in preventing hospitalizations", Arch Fam Njed, Vol.7, No.4, pp.352-357, 1998. https://doi.org/10.1001/archfami.7.4.352
  12. DA Christakis, L Mell, TD Koepsell, FJ Zimmerman, FA Connell , "Association of lower continuity of care with greater risk of emergency department use and hospitalization in children", Pediatrics, Vol.107, No.3, pp.524-529, 2001. https://doi.org/10.1542/peds.107.3.524
  13. J.S. Hong, J.Y. Kim. A study on the continuity of primary care services in the elderly patients. HIRA;2007.
  14. Y.J Choi, A study on the continuity of primary care among child and adolescent patients in Korea, Ph.D. dissertation, SNU, 2006.
  15. JH Wasson, AE Sauvigne, RP Mogielnicki, WG Frey, CH Sox, C Gaudette, A Rockwell, "Continuity of outpatient medical care in elderly men. A randomized trial", JAMA, Vol.252, No.17, pp.2413-2417, 1984. https://doi.org/10.1001/jama.1984.03350170015011
  16. DA Christakis, JA Wright, TD Koepsell, S Emerson, FA Connell , "Is greater continuity of care associated with less emergency department utilization?", Pediatrics, Vol.103, No.4, pp.738-742, 1999. https://doi.org/10.1542/peds.103.4.738
  17. DC Brousseau, JR Meurer, Isenberg, ML EM Kuhn, MH Gorelick, "Association Between Infant Continuity of Care and Pediatric Emergency Department Utilization", Pediatrics, Vol.113, No.4, pp.738-741, 2004. https://doi.org/10.1542/peds.113.4.738
  18. ME Charlson, P Pompei, KL Ales, CR MacKenzie, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.", J Chronic Dis, Vol.40, No.5, 373-83, 1987. https://doi.org/10.1016/0021-9681(87)90171-8
  19. LI Iezzoni, (ed.), Risk adjustment for measuring health care outcomes, 3rd edn. AcademyHealth HAP, Ann Arbor, MI;2003
  20. H.J., Kim, A Comparative Study of glucose depression housewife with propensity score, Master's thesis Korea Uni., 2007.
  21. Gill JM, Mainous AG III, Nsereko M, "The effect of continuity of care on emergency department use", Arch Fam Med, Vol.9, No.4, pp.333-338, 2000. https://doi.org/10.1001/archfami.9.4.333
  22. JM Gill , Mainous AG 3rd, Diamond JJ, Lenhard MJ, "Impact of provider continuity on quality of care for persons with diabetes mellitus", Ann Fam Med, Vol.1, No.3, pp.162-170, 2003. https://doi.org/10.1370/afm.22
  23. MA Godkin, CA Rice, "Relationship of physician continuity to type of health problems in primary care", J Fam Pract, Vol.12, No.1., pp.99-102, 1981.
  24. P Sloane, C Egelhoff, "The relationship of continuity of care to age, sex, and race", J Fam Pract, Vol.16, No.2, pp.404-405,1983.
  25. PA Nutting, MA Goodwin, SA Flocke, SJ Zyzanski, KC Stange, "Continuity of primary care: to whom does it matter and when?", Ann Fam Med, Vol.1, No.3, pp.149-155, 2003. https://doi.org/10.1370/afm.63
  26. MF Fleming, 더 Bentz, EJ Shahady, A Abrantes, C Bolick, "Effect of case mix on provider continuity.", J Fam Pract, Vol.23, No.2, pp.137-140, 1986.
  27. Russell E. Glasgow, Martha M. Funnell., Amy E. Bonomi, Connie Davis, Valerie Beckham, Edward H. Wagner. "Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetics and heart failure teams", Annu Behav Med, Vol.24., pp.80-87, 2002. https://doi.org/10.1207/S15324796ABM2402_04