• Journal of Preventive Medicine and Public Health
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• v.10 no.1
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• pp.34-43
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• 1977

This study attempts to examine the performances of Myun Health Workers-the frontline workers in the Korean rural health care delivery system. The time-activity approach was mainly utilized as a measuring tool. This study was undertaken in September 1976 with 35 Myun Health Workers at the Kang Wha County. The pretested time-activity approach sheets were filled out daily for one month by those Myun Health Workers themselves. Statistical means and variances of analysis were utilized for statistical method in comparing some activities and functions converged into time distribution Findings: 1. The workers's average working hours derived in this study is 8 hours and 48 minutes per day, which takes half an hour longer than normal schedule. 2. They spend 56% working hour for direct services, in other words, the main function, 22% for supportive function, and 22% for other activities, the unrelated health services. 3. Considering the total working hours of main function, out-center activity is far more than in-center services with the ratio of 70% to 30% respectively, which proves, therefore, that the main activity of the workers is home visiting. 4. It takes 20 minutes purely for home visiting and takes 14 minutes for transportation. 5. This research also indicates that such factors as characteristics of the health workers and myun influence in shaping the structures of the worker's function and activity: a. The workers whose working site is located in myun office spend 15% among total working hours in carring out official myun activities, which is incidentally unrelated to health services, while the health subcenter have no rooms for administrative jobs for myun office. b. The workers whose office is in health subcenter contribute much time in doing main function and those working in special project distribute more time in performing supportive function. c. The types of workers are another dominant factor to influence the components of worker's functions and activities. MCH workers and MPW I spend much time for manipulating main function. d. MPW II, whose function is reorganized by special project in 2 myuns shows different pattern of time distribution compared to the TB worker orFP worker in the ordinary area. MPW II distributes their time evenly in performing MCH program, T.B. Program, F.P. program and education activity, while the unipurpose workers engage in carring out only their dominant role. e. Another variables which involve the variation of the worker's activity can be illustrated with the variables like target population, size of myun and convenience for transportation, among which the latter two are remarkable factors in determining the time for out-center service.

• Research in Community and Public Health Nursing
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• v.17 no.1
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• pp.74-82
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• 2006

Purpose: This study used MDS-HC 2.0 to identify health problems in the elderly who live alone. Method: The subjects of this study were 100 living-alone elders aged over 65 in Daegu city. This study was performed through home visiting interviews during the period from the 1st of September to the 30th of September 2005. Analysis in this study was made using SPSS Version 11.0. Results: Frequent health problems in the living-alone elderly were: preventive heath measure (90), health promotion (80), social function (78), visual function (75), depression and anxiety (61), pain and communication disorder (60), cognition (55), environmental assessment (48) and oral health (45) in order of frequency. Informal services were provided to 73% of the subjects for emotional support. IADL services were provided to 57% of the subjects, and ADL services to 66%. Conclusion: Nursing intervention programs based on health problems from MDS-HC 2.0 should be provided in order to cope with individual health problems and living-alone elders needs. The results of this study suggest that MDS-HC 2.0 is applicable to help decide nursing interventions for the elderly who live alone in community.

• Journal of the Korean Geographical Society
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• v.44 no.6
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• pp.813-832
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• 2009

As accessibility to health-care service in less populated rural areas is geographically limited and demand for public health-care by the aging is increasing, a new approach for health-care service such as a home care service is becoming more popular. For a home care service, health-care personnels directly visit to location of health-care clients. Such changes in provision of health services require developing innovative and scientific approaches for efficient allocation of health resources and managing services by public health-care organizations. The purpose of this study is to formulate a location model for visiting health-care districting for the rural elderly and to develop an Automated Zoning Procedure (AZP) to solve this model. Mobility, workload balance and contiguity criteria are considered in the model. Three different objective functions are evaluated; 1) minimizing the sum of network distance between the unit areas in a district, 2) maximizing spatial interaction between the unit areas in a district, and 3) minimizing tour distance that visits each unit area exactly once in a district. The AZP for solving the model is developed and applied to a rural area. The application results demonstrate that the AZP can generate different districting systems for each objective functions.

• Journal of Home Health Care Nursing
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• v.7 no.1
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• pp.26-38
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• 2000

The purpose of this study was to estimate home care nursing cost for the patient with Cerebrovascular Disease based on a bundle of home care nursing services This study was conducted through four steps. The first step was to investigate home care nursing activities that were offered to the patient with Cerebrovascular Disease(CD) by home care nurse. The second step was to investigate the time spent on home care nursing service and to calculate labor and manufacturing cost. The third step was to calculate home care nursing cost per minute. And at the fourth step, home care nursing cost for a patient with Cerebrovascular Disease based on a bundle of home care nursing service was calculated. The results of the study were as follows: 1) The number of direct home care nursing activities for the patient with CD was 108, and the time of each activity was spent from 1 to 10 minutes. 2) Average time per visit was 51 minute, and the firs visit time were spent 1.6 times higher than 2nd visit time. 3) Nursing cost per minute(cost per visit ${\\}\;22,565\;\div\;$ average time per visit 51 minutes) was ${\\}\;442$. The cost per visit was calculated on Basic visiting cost(nurse's labor cost ${\\}\;15,760$ + management cost ${\\}\;6,805$) divided by average time per visit(51 minutes). 4) Home care nursing cost to the patient with CD based on bundle of home care nursing service was consisted of basic home care nursing cost, the cost of a bundle of service practiced on visit. and transportation fee. Basic home nursing cost(the time spent on basic home nursing service 20 minutes ${\times}$ nursing cost per minute ${\\}\;442$) was ${\\}\;8,840$. The cost of the bundle of home care nursing services to the patient with CD was calculated as self care ${\\}\;2.898$, Tracheostomy care ${\\}\;10,166$, immobility care ${\\}\;6,188$, sore care ${\\}\;6,188$. Foley care ${\\}\;6,630$, and Levin tube or Gastrostomy care ${\\}\;7.514$. Transportation fee which was composed of the labor cost for transportation(${\\}\;5,122$) and the car management cost(${\\}\;3.876$) was ${\\}\;8,998$. Home care nursing cost to the patient with CD based on bundle of home care nursing services consisted of basic home care nursing cost, the cost of a bundle of service practiced on visit, and transportation fee. It will contribute to improve quality of home care service, because of giving appreciate incentives to home care nurses. And it will be more efficient than current cost of hospital based home care. But it need to management than calculation of the current fee-for-services of home care.

• Journal of agricultural medicine and community health
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• v.32 no.1
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• pp.27-39
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• 2007

Objectives: The challenge of an increasing elderly population has coupled with everpresent social concerns in Korea. A major problem in health center for the frail older people is that medical, healthcare, and welfare services are often fragmented in terms of providers and settings without appropriate coordination. The purpose of this study was to investigate the need of health center-based integrated healthcare services and its related factors for the elderly. Methods: A total of 110 elderly people who had visited at a county Health Center were interviewed using a self-administered questionnaire from November to December, 2005. The questionnaire consists of five domains according to the Program of All-inclusive Care for the Elderly. Results: Respondents had high need (total mean score with the 5-point Likert-type sacle: 3.67) of health center-based integrated healthcare services including home visiting service (mean: 4.08), chronic disease care service (mean: 4.06), and transportation service (mean 4.05). According to the results of hierarchical multiple regression analysis, among three regression models the magnititude of the variance of full model that is explained by the need of welfare-domain service was significantly larger than two reduced model. Income was a significant variable in increasing the need of health care and welfare services. Conclusions: This study suggests that the health center-based integrated healthcare services for the elderly must be continuously developed and provided for the health promotion and improved the quality of life of the elderly who live in rural area in Korea.

• Journal of Korean Academy of Nursing Administration
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• v.12 no.3
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• pp.464-472
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• 2006

Purpose: The aim of this study was to define the health problem in the community-dwelling elderly of Korea and to compare differences of CAPs(Client Assessment Protocols) by characteristics. Method: Data was collected by visiting nurse from 556 elderly over 65 years in selected metropolitan areas. To evaluate the functional state of elderly in the community, I used "RAI-MDS HC; Residental Assessment Instrument Minimum Data Set-Home Care(2.0 version)" and established information exchange system among resources, by developing the data into a computer program. Results: The health problem of 'preventive health measures' was the largest(99.6%), and then 'health promotion(85.3%)', 'visual function(75.5%)', 'psychologic drug(68.9%)', 'pain(68.5%)', ‘social function(59.2%)', 'communication disorders(56.2%)', 'environmental assessment(53.2%)', 'depression & anxiety(46.9%)', 'oral health(43.4%)' followed. The number of health problems was average 10.16 in the community-dwelling elderly. Conclusion: The results suggest the need to emphasize the importance of assessment of the health problem of the elderly. We can apply it in the distribution of community resources and the development of service providing programs by figure out the health problem and resource in need for the elderly in the community.

• Women's Health Nursing
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• v.5 no.1
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• pp.133-145
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• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• Journal of Home Health Care Nursing
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• v.7 no.1
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• pp.58-72
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• 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 Physical Therapy Science
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• v.19 no.1
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• pp.27-38
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• 2012

Background : In-home physical therapy program as a result of a study of the need for in-home physical therapy, most patients were needed. This study of patients who received physical therapy were surveyed, and patients need physical therapy for what I have found that factors. The purpose of this study is the in-home physical therapy program for patients to determine that how much needs were investigated. Methods : In this study, 469 people were involved with the patients who received physiotherapy. Surveys were returned to the questionnaire. The collected data was analyzed by Chi-square and one-way ANOVA. Results : The need for in-home physical therapy to 31 to 60 years suggests that the highest. In this paper, the female respondents was higher, the damaged parts Many times patients with musculoskeletal injuries, duration of treatment was 3-1 months there. 469 people need physical therapy visits of respondents that respondents were 423 people. qualification standards of physical therapy visits and asked questions of the state or local government public agencies or public health wad the highest with 40.3%, eligibility criteria for physical therapy visits a physical therapist trained in the regular 43.3%, per visit, treatment 10,000won 43.5% less than the cost of investigation into the health insurance coverage and should apply to questions about whether the response was 50.1%. Conclusion : Further, the study of in-home physical therapy services were the patient's perspective. This information, visit the home physical therapy program will contribute to the legalization.

• Research in Community and Public Health Nursing
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• v.13 no.4
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• pp.795-807
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• 2002

Objectives: The purpose of this study was to develop a community-based nursing center model that can provide health promotion for infants and toddlers as well as a research and practice site for nursing faculty and students. Methods: Review of current health care system and health promotion programs, and workshops with brain-storming were carried out to identify needy areas of services to be provided by the nursing center. Finally, the community nursing center model was developed through expert consultation and filed visits. Results: The services and programs were developed for infants and toddlers residing in Seoul area. These services and programs include growth and developmental screening, environment and health problem assessment, infant stimulation and parent education, and self-help group. Full-time and part-time staff nurses and nurse practitioners will provide those services and offer home visiting if needed. Database system, health information system, and trainers' training programs were developed as well. Conclusion: The nursing center model developed in this study will ensure clients direct access to nursing care and increase of autonomy and accountability of nursing practices. The nursing center model focused on disease prevention and health promotion will enhance the quality of life of the infants, toddlers and their families as well as to decrease national health care expenditure.