• 한국병원경영학회지
• /
• 제27권3호
• /
• pp.39-49
• /
• 2022

Purposes: This study purposed to analyze the relationship between patient safety and patient-centerendess. Methodology: The comprehensive scores from patient safety assessment program and patient experience survey conducted by Health Insurance Review & Assessment Service were used as independent variables and dependent variables. This study analyzed the relationship between 4 patient safety-related areas(i.e. risk standardized readmission ratio, intensive care unit, preventive antibiotic, the drug evaluation) and 6 patient experience areas(i.e. nurse services, doctor services, medication & treatment, hospital environment, patient's right, overall experience) by using robust regression analysis. Findings: According to results, the score in 'patient's right' and 'risk standardized readmission ratio' areas were found to have a significant relationship, and 'overall experience' and the 'preventive antibiotic' areas. The ratio of senior beds and specialists was a general characteristics of hospitals that had a significant relationship on patient experience assessment. Practical Implication: The relationships between patient safety and patient experience assessment were varied depending on areas. Further study is needed to make clear the supposed relationship.

• 디지털융복합연구
• /
• 제12권6호
• /
• pp.519-526
• /
• 2014

본 연구는 재입원 여부에 따른 심질환자의 간호요구를 알아보기 위하여, 2012년 3월부터 6월까지 심질환으로 입원한 환자에게 자기 스스로 직접 의사를 표현할 수 있도록 하는 자기기입식 설문조사를 실시하였다. 자료 분석은 SPSS 18.0을 이용하였고, 결과는 다음과 같다. 재입원을 경험하지 않은 신규 환자의 경우 전체 간호요구는 $4.12{\pm}.49$점, 재입원한 대상자는 $3.89{\pm}.63$ 점이었고, 두 군 간에 유의한 차이가 있었다(p=.046). 두 군 모두 간호요구 하위 항목 중 치료중재 간호요구항목이 다른 간호 요구 항목 보다 높았다. 또한 재입원에 따라 두 군 간에 간호 요구 하위 영역별 유의한 차이가 있었던 항목이 있었고, 간호 요구 순위도 각각 달랐다. 간호요구 하위 항목 중 신체적, 사회 심리적, 교육적, 치료적 간호요구는 모두 서로 유의한 순 상관관계를 보였다. 이와 같이 환자의 특성에 따른 간호요구에 기초 한 간호수행이 필요하다고 생각된다.

• Journal of Preventive Medicine and Public Health
• /
• 제43권6호
• /
• pp.523-534
• /
• 2010

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

• Advances in pediatric surgery
• /
• 제20권2호
• /
• pp.28-32
• /
• 2014

Purpose: Laparoscopic appendectomy (LA) has become a gold standard for children even in complicated appendicitis. The purpose of this study was to compare the postoperative surgical site infection rates between laparoscopic and open appendectomy (OA) group in pediatric complicated appendicitis. Methods: A total of 1,158 pediatric patients (age ${\leq}$ 15 years) underwent operation for appendicitis over a period of 8 years. Among these patients, 274 patients (23.7%) were diagnosed with complicated appendicitis by radiologic, operative and pathologic findings, and their clinical outcomes were retrospectively analyzed. Results: Of the 274 patients with complicated appendicitis, 108 patients underwent LA and 166 patients underwent OA. Patients in the LA group returned to oral intake earlier (1.9 days vs. 2.7 days; p<0.01) and had a shorter hospital stay (5.0 days vs. 6.3 days; p<0.01). However, rate of postoperative intra-abdominal infection (organ/space surgical site infection) was higher in the LA group (LA 15/108 [13.9%] vs. OA 12/166 [7.2%]; p<0.01). Readmission rate was also higher in the LA group (LA 9/108 [8.3%] vs. OA 3/166 [1.8%]; p<0.01). Conclusion: The minimally invasive laparoscopic technique has more advantages compared to the open procedure in terms of hospital stay and early recovery. However, intra-abdominal infection and readmission rates were higher in the laparoscopy group. Further studies should be performed to evaluate high rate of organ/space surgical infection rate of laparoscopic procedure in pediatric complicated appendicitis.

• Hip & pelvis
• /
• 제34권3호
• /
• pp.127-139
• /
• 2022

There is still controversy regarding clinical outcomes following primary hip arthroplasty after solid organ transplantation (SOT). The aim of this study was to determine whether clinical outcomes after hip arthroplasty differ between previous SOT recipients and control subjects with no history of undergoing SOT. We conducted a systematic search of MEDLINE, Embase, and the Cochrane Library for studies comparing the clinical outcomes after hip arthroplasty following SOT published up to January 5, 2022. A comparison of medical and surgery-related complications, as well as the readmission rate and 90-day mortality rate between previous SOT recipients and control subjects was performed. Subgroup analyses of the SOT types, liver transplantation (LT) and kidney transplantation (KT), were also performed. Ten studies that included 3,631,861 cases of primary hip arthroplasty were included; among these, 14,996 patients had previously undergone SOT and 3,616,865 patients had not. Significantly higher incidences of cardiac complications, pneumonia, and acute kidney injury were observed in the SOT group compared with the control group. Regarding surgical complications, a higher transfusion rate was observed in the SOT group. The readmission rate and 90-day mortality rate were also significantly higher in the SOT group. A significantly higher incidence of deep vein thrombosis was observed in the KT subgroup compared with the control group. A higher risk of medical and surgical complications, as well as higher readmission and mortality rates after hip arthroplasty was observed for previous SOT recipients compared to patients with no history of SOT.

• 한국간담췌외과학회지
• /
• 제26권4호
• /
• pp.375-385
• /
• 2022

Backgrounds/Aims: Prehabilitation aims for preoperative optimisation to reduce postoperative complications. However, there is a paucity of data on its use in patients undergoing pancreaticoduodenectomy (PD). Thus, this study aims to evaluate the outcomes of a home-based outpatient prehabilitation program (PP) versus no-PP in patients undergoing PD. Methods: This retrospective cohort study compared patients who underwent PP versus no-PP before elective PD from January 2016 to December 2020. Inclusion criteria for PP were < 65 years or 65-74 years with FRAIL score < 3. No-PP included dietician, case manager and anesthesia review. PP included additional physiotherapy sessions, caregiver training and interim phone consultation. Univariate and multivariate analysis were used to evaluate length of stay (LOS), morbidity, 30-day readmission, and 90-day mortality. Results: Seventy-one patients (PP: n = 50 [70.4%]; no-PP: n = 21 [29.6%]) were included in this study. Median age was 65 years (interquartile range [IQR]: 58-72 years). Majority (n = 58 [81.7%]) of patients underwent open surgery. Ductal adenocarcinoma was the most common histology (49.3%). Patient demographics were comparable between both groups. Overall median LOS was 11.0 days (IQR: 8.0-17.0 days). Compared to no-PP, PP was not independently associated with reduced intra-abdominal collections (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.03-6.11, p = 0.532), major morbidity (OR: 1.31; 95% CI: 0.09-19.47; p = 0.845) or 30-day readmission (OR: 3.16; 95% CI: 0.26-38.27; p = 0.365). There was one (1.4%) 30-day mortality. Conclusions: Our outpatient PP with unsupervised exercise regimes did not improve postoperative outcomes following elective PD.

• Neurospine
• /
• 제15권4호
• /
• 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.

• 임상간호연구
• /
• 제23권3호
• /
• 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.

• 성인간호학회지
• /
• 제21권6호
• /
• 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.

• 근관절건강학회지
• /
• 제27권3호
• /
• pp.219-228
• /
• 2020

Purpose: This study was a comparative analysis of stroke-related factors between recurrent patients and non-recurrent patients. Methods: A retrospective cohort study design was used, and data were collected from March 2020 to April 2020 using electronic medical records. 244 patients (221 first-timers and 23 recurrent) were included in this study. Results: The stroke recurrence rate in 5 years was 9.4%, the readmission rate was 39.3%, and the mortality rate was 2.0%. The number of patients hospitalized for stroke was greater among men than among women. Of the patients, 60.7% had an underlying disease. With regard to daily life abilities, over 70% of participants needed more than moderate dependence and about 40% of participants had more than mild cognitive impairment. More than 50% were moved to wheelchairs or stretcher cars. The difference in the stroke readmission rate between recurrent and non-recurrent patients was statistically significant. Conclusions: Based on our findings, a program to prevent recurrence of stroke should be developed to considering age, ability of daily living, place of discharge, gait ability at discharge, and place of discharge.