• 보건행정학회지
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• 제33권4호
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• pp.479-488
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• 2023

Background: By applying the suggested criteria for needs-based chronic medical care and long-term care delivery system for the elderly, the current status of delivery system was identified and regional delivery systems were categorized according to quantity and quality of delivery system. Methods: National claims data were used for this study. All claims data of medical and long-term care uses by the elderly and all claims data from long-term care hospitals and nursing homes in 2016 were analyzed to categorize the regional medical and long-term care delivery system. The current status of the delivery system with a high possibility of transition to a needs-based appropriate delivery system was identified. The necessary and actual amount of regional supply was calculated based on their needs, and the structure of delivery systems was evaluated in terms of the needs-based quality of the system. Finally, all regions were categorized into 15 types of medical and care delivery systems for the elderly. Results: Of the total 55 regions, 89.1% of regions had an oversupply of elderly medical and care services compared to the necessary supply based on their needs. However, 69.1% of regions met the criteria for less than two types of needs groups, and 21.8% of regions were identified as regions where the numbers of institutions or regions with a high possibility of transition to an appropriate delivery system were below the average levels for all four needs groups. Conclusion: In order to establish an appropriate community-based integrated elderly care system, it is necessary to analyze the characteristics of the regional delivery system categories and to plan a needs-based delivery system regionally.

• 가정간호학회지
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• 제27권3호
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• pp.241-249
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• 2020

Purpose: This study aimed to investigate possible ways to expand the services of home-visit nursing through a review of the progress, achievements, and obstacles of home-visit nursing; a pilot project of an integrated home-service; the application of the Omaha System; as well as a case analysis of providing home-visit nursing services. Method: An integrated review was conducted using various source materials, including laws, previous studies, and a case analysis. Results: In case analysis of providing visiting nursing service, rehabilitation nursing, end-of-life nursing, and dementia care showed high nursing needs. It was necessary that the various home visit nursing services in the intervention area of the Omaha System, administrative services, case management, and center operation activities were all included in the payment systems of long-term care insurance. Conclusion: In the future, home visit nursing services of long-term care insurance should be reborn in the form of a center for integrated case management in the community, which would set long-term goals until the time of a client's death and encompass the realm of human rights for health, quality of daily life, and a dignity of life.

• 한국병원경영학회지
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• 제9권3호
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• pp.18-48
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• 2004

Health policies in many countries have come under critical scrutiny in recent years. This is because of increasing national health expenditures. Also many persons in health sector have been the perception that resources allocated to health services are not always deployed in an optimal fashion. And they believe that the scope of resources in health services is limited, there is need to search for ways of using existing resources more efficiently. A further concern has been the desire to ensure access to healthcare of various groups on an equitable basis. In some European countries this has been linked to a wish to enhance patient choice and to make service providers more responsive to consumers, while Korea integrated health insurance funds into single fund in 2000. Many European countries are under considerable pressure to review and restructure their health care systems. There are several reasons of pressure to reform. There are demographic changes, pattern of disease change, advances in medical sciences will also give rise to new demands within the health services, public expectations of health services are rising as those who use services demand higher standards of care. These circumstances require the change of health care delivery system based on hierarchical regionalism, which was basis of health care delivery since 1920s. Korea is also under similarly pressure to restructure our own health care systems. We will have good learning from OECD experiences. In this paper we reviewed and compared among OECD countries' various experiences.

• 대한간호학회지
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• 제41권1호
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• pp.18-25
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• 2011

Purpose: This study was done to examine the effect of an integrated care service which included a combination of oriental and western care on health outcomes in elderly patients with degenerative arthritis. Methods: A prospective comparative design was used. Data were collected from May 1, 2008 to June 30, 2009 from 85 elderly patients with degenerative arthritis in the lower extremities who were followed in a hospital out-patient department for 8 weeks. The integrated care service group (n=36) received a combination of physical therapy, acupuncture, western medicines or herbal medicines, and the western care group (n=49) received physical therapy or western medicines. Functional independence, walking speed, rotation balance, pain intensity, service satisfaction and total medical costs for the two groups were compared at 8 weeks. Results: Functional independence (t=2.14, p=.036) and walking speed (t=2.51, p=.014) improved significantly in the integrated care group while pain intensity improved significantly in the western care group (t=3.35, p=.002). The integrated care group reported higher scores for service satisfaction (t=2.09, p=.041) and higher medical costs than the western care group (t=2.15, p=.035). Conclusion: The results suggest that integrated care services are effective modalities to improve mobility and quality of life for elders with degenerative arthritis.

• 한국의료질향상학회지
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• 제24권1호
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• pp.30-39
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• 2018

Objectives: In Korea, there are many kinds of evaluations for medical institutions. However, evaluations are increasingly burdensome for medical institutions because evaluation agencies, evaluation timing, and evaluation methods are different. The purpose of this study is to improve the efficiency of evaluation for medical institutions and ultimately to provide quality medical services to patients. Methods: In this study, 2,310 indicators of 19 kinds of evaluation for medical institutions were analyzed. Results: 1,424 indicators were available for on-site surveys and 886 indicators were not available for on-site surveys. There were 4 kinds of evaluation that can be integrated in total, 12 kinds of evaluation that can be integrated partially, and 3 kinds of evaluation that need to maintain the current evaluation system. Conclusion: In order to provide patient-centered quality medical services through reduction of burden due to the evaluation for medical institutions, it is necessary to deeply discuss the efficiency of evaluation integration and result utilization.

• 셀메드
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• 제5권3호
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• pp.20.1-20.4
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• 2015

Ayurveda is often criticized for having empirical and non-evidence based approach to treat the patients. At the same time, modern medicine is also being criticized for having a non-holistic, reductionist and mechanistic approach of treating the patients which do not help in many real clinical situations. An open minded deduction of treatment approaches in both of these systems for a common patient however makes us to rethink that ideally both systems are similar with a common objective of offering a cure although in a manner which is better understood through their own methods of learning. The differences therefore, are more superficial rather than being deeply rooted in the understanding. A more tolerant viewpoint towards the competitive medical systems may therefore be a better approach to offer optimal health care to our people through a genuine amalgamation of these two health care sciences through an integrated approach. Once this tolerance is developed, it will give us an opportunity to think for a focused selection of type of health care depending upon the type of the disease and strength of the particular system in that area.

• 한국산업정보학회논문지
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• 제15권2호
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• pp.115-126
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• 2010

현대사회는 정보화의 개념을 넘어서 유비쿼터스(Ubiquitous) 컴퓨팅 사회라고 말한다. 그리고 정보기술(IT)은 관련기술과의 융합으로 시스템들을 서로 통합하는 형태로 발전하고 있으며, 특히 유비쿼터스 환경에서의 의료정보 산업은 U-Healthcare 서비스 분야에 많은 관심을 가지고 있다. 본 연구에서는 첫째, U-Healthcare 서비스 환경과 통합의료정보시스템의 구성내용을 살펴보고, 둘째, 의료정보시스템의 통합을 위한 기본적 기술요소인 데이터웨어하우스, 네트워크, 통신 표준화 및 U-healthcare 서비스 관련기술 등을 검토한다. 마지막으로 이러한 기술적 요소들의 관점에서 U-Healthcare 서비스를 위한 새로운 통합의료정보시스템의 구축방안과 운영과제를 제안하였다. 이것은 고객들을 실시간으로 근접간호(POC : Point of Care)하고, 고객 개개인의 다양한 진료 데이터를 이용하여 정확한 진단을 하고, 그 정보가 다시 고객에게 전달됨으로써 고객만족이 향상될 것으로 기대된다.

• 의학교육논단
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• 제21권2호
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• pp.80-91
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• 2019

The tripartite mission of 'academic medicine' is education, research, and patient care. Academic medical centers (AMCs) are carrying out the mission and ultimately aiming to improve the health of people and communities. Globally, AMCs are facing a tremendous financial risk stemming from the changes in health insurance reimbursement plans and a shortage of human resources. Innovative AMCs in the United States are trying to transform their physician-centered, and siloed structure into a patient-centered, and integrated structure. They are also building integrated systems with primary healthcare groups to provide continuous patient care from primary to tertiary levels and making strategic networks based on value-based payment and the patient-centered model. These changes have been proven to improve outcomes of patient care and increase fiscal revenues, which are both crucial in supporting education and research. To address the shortage of human resources, programs are being built to develop newly appointed faculty for the future. AMCs have different approaches to bringing changes into their organizations; however, there is a common emphasis on 'a patient-centered approach,' which helps them set more explicit organizational values and make strategic decisions based on their values. Korean AMCs are facing similar challenges to AMCs in the United States in spite of many differences between the countries' healthcare systems. The innovative efforts of AMCs in the United States to address the challenges will be helpful, well-worked examples for Korean AMCs with similar challenges.

• 간호행정학회지
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• 제23권2호
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• pp.211-222
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• 2017

Purpose: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. Methods: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. Results: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. Conclusion: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.

• 농촌의학ㆍ지역보건
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• 제49권2호
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• pp.132-145
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• 2024

본 연구는 국내 의료기관 중심 보건의료·복지통합 서비스 활성 방안을 모색하기위하여 대구의료원 달구벌건강주치의사업, 삼척의료원 301 네트워크 사업, 부산의료원 3 for 1 사업 을 프로그램 논리모형을 적용하여 사례 비교하였다. 상황적 측면에서 세 사업 모두 보건의료·복지 서비스의 분절과 의료사각지대 문제를 해결하기 위해 고안되었으며, 투입 요소 중 인력은 모두 다학제 팀 구성 현황은 유사하였으나 구체적인 구성 분야, 채용 규모, 고용 형태, 에서는 기관별 차이가 있었다. 예산을 지원받는 재원 출처의 차이로 각 사업은 지역사회와 협력하고 지원하는 방식과 향후 방향성에서의 차별성도 확인할 수 있었다. 산출은 수혜대상자 수와 진료 건수에 차이가 있었으며, 투입인력 또는 운영비 대비실인원 수, 수혜대상 1인당 사업비 비교시 다른 결과를 확인하였다. 의료기관 중심의 보건의료·복지 통합제공체계의 설계 시 우선적으로 권고하는 상황은 안정적인 기금마련 기전을 확보하고 이에 합당한 대상자와 서비스 전달체계를 구축하라는 것이다. 또한, 의료기관 내 사례관리 전담기구로서 각 부문의 활동을 연계할 수 있도록 위탁이 아닌 전담부서 설치, 적정 규모의 채용, 안정적 고용 체계가 필요하며, 민·관 협력 및 경증부터 중증까지 제공할 수 있는 포괄적 제공체계 구축을 제안한다. 이를 통해 의료기관 중심보건의료복지 통합 서비스 제공 사업은 지역사회에서 풀리지 않는 난제였던 보건의료 서비스 강화와 촘촘한 연계를 가능하게 함으로 궁극적인 지역사회 건강안전망 역할 강화를 기대한다.