• 응용통계연구
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• 제22권6호
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• pp.1229-1237
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• 2009

노인장기요양보험에서 가장 중요한 이슈는 급여대상자의 희망, 건강 및 기능상태에 따라 어떤 급여를 제공할 것인가 이다. 이를 해결하고자 노인장기요양보험의 보험자인 국민건강보험 공단은 급여대상자에게 '표준장기요양이용계획서'를 제공하고 있다. 본 연구에서는 표준장기요양이용계획 작성의 효율화 방안을 마련하고자 노인장기요양보험 3차 시범사업 표준이용계획 자료를 활용하여 노인장기요양급여 권고모형을 개발하였다. 모형개발에는 데이터마이닝의 의사결정나무모형, 로지스틱회귀모형, 앙상블 모형의 배깅과 부스팅 기법을 사용하였고, 이 중 실무자가 이해하기 쉬운 의사결정나무를 채택하여 권고모형을 설명 하였다. 본 연구는 노인장기요양보험 제도의 이용계획 수립의 객관성 및 과학성을 확보하고 이용계획 업무를 효율화하는 데에 기여할 것으로 기대된다.

• 대한물리치료과학회지
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• 제16권3호
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• pp.43-53
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• 2009

Background: The purpose of this study was to investigate the perception of home care team's home based physical therapy in public health center Method: We surveyed 11 questionnaires for hone care team in health center from 1st to 30th, November in 2008. Results: The person who recognized the exclusion fact of home-based physical therapy in long term care insurance was 64.2% in whole 109 people. About necessity of home-based physical therapy, "absolutely necessary" as the person answer was 43.1%. Home-based physical therapy in the insurance must come to be provided with a precedence was 81.3%. About starting time of hereafter home-based physical therapy "after 1 years" the opinion which was 60.7%. Opinion about operation institution of home-based physical therapy "the pubic hospital or health center" was 52.3%. In composition form of the home-based physical therapy team "with the physical therapist and occupation therapist come together" was investigated with 37.4%. Conclusion: As long term care insurance will be developed, discussion about quality- of-service must be continuous and depth. Relates hereupon, the academic, researchers, and the persons concerned must consider the best quality of life improvement of the citizen and prepare the ground which systemic, rational, and actual on starting of home-based physical therapy in long term care insurance.

• 간호행정학회지
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• 제14권3호
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• pp.229-240
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• 2008

Purpose: To develop the patient classification system based on the resource utilization for reimbursement of long-term care hospitals in Korea. Method: Health Insurance Review & Assessment Service (HIRA) conducted a survey in July 2006 that included 2,899 patients from 35 long-term care hospitals. To calculate resource utilization, we measured care time of direct care staff (physicians, nursing personnel, physical and occupational therapists, social workers). The survey of patient characteristics included ADL, cognitive and behavioral status, diseases and treatments. Major category criteria was developed by modified delphi method from 9 experts. Each category was divided into 2-3 groups by ADL using tree regression. Relative resource use was expressed as a case mix index (CMI) calculated as a proportion of mean resource use. Result: This patient classification system composed of 6 major categories (ultra high medical care, high medical care, medium medical care, behavioral problem, impaired cognition and reduced physical function) and 11 subgroups by ADL score. The differences of CMI between groups were statistically significant (p<.0001). Homogeneity of groups was examined by total coefficient of variation (CV) of CMI. The range of CV was 29.68-40.77%. Conclusions: This patient classification system is feasible for reimbursement of long-term care hospitals.

• 보건행정학회지
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• 제21권3호
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• pp.381-396
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• 2011

This study is to investigate the factors affecting the regional rate of certification for long-term care insurance benefits. Analyzed data were the 253,935 certified beneficiaries (equivalent to 4.9% of total elderly population) as long-term care degree (LTC degree) 1~3 extracted from the applicants for long-term care in the beginning stage of the system from April 15 2008 to July 1 2009. Although the data were collected from individuals, after restructured into regional data and then analysed in the unit of 225 administrative regions for the Korean Long-term Care Insurance. The rate of certification was operated as the percentage of people of LTC degree 1~3 to the elderly population in each region. The average rate of certification among regions was 4.91%, and ranged from 2.20% to 8.32%. In the analysing regression models, most socio-demographic variables, applicants' disease characteristics, regional service infrastructure, and the certification interviewer's characteristics were included. The most influencing variables were the disease factors of applicants, especially dementia or cerebrovascular disease rather than arthritis, osteoporosis, or fracture patients were strong factors for the regional rate of certification. However, advanced studies adding more explainable factors on the regional variance of certification rate would be necessary to provide political agenda and measures for evidence-based certification process with high reliability and validity for a sustainable LTC system in Korea.

• 대한물리치료과학회지
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• 제15권2호
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• pp.61-69
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• 2008

Background: This article reviewed the current status of home-based physical therapy infrastructure in long term care insurance and then solved the problem. Method: We used two forms of data that were acquired from ⅰ) the Ministry of Health & Welfare and the Family and National Health Insurance Corporation, ⅱ) a home-visiting health care program, and ⅲ) evaluation data from the Korea Health Industry Development Institute. The home-based physical therapy program was then analyzed. Results: The role and concept of home-based physical therapy was not clearly established. There were few home-based physical therapy programs in the community. The manpower of home-based physical therapists in the home-visiting health care program was very low. The role between home-visiting nurses (caregivers) and home-based physical therapists was mixed. Research and promotion regarding home-based physical therapy was poor. Conclusion: To establish a system of legal, long-term care insurance, we must increase the manpower of home-based physical therapists and the amount of research pertaining to the demand for home-based physical therapy.

• 응용통계연구
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• 제31권6호
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• pp.693-706
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• 2018

노인의 신체기능에 부합하는 복지용구를 제공하는 것은 노인이 가능한 한 오랫동안 자신의 집과 지역사회에서 자립하여 생활할 수 있도록 돕기 위해 매우 중요하다. 본 연구는 수급자의 신체 및 인지 기능 상태를 고려하여 개개인에게 적합한 복지용구 품목을 권고할 수 있는 과학적인 복지용구 표준급여모형 알고리즘을 개발하고자 수행되었다. 모형개발에는 데이터마이닝기법인 의사결정나무를 활용하였다. 수급자 8,084명의 장기요양인정조사자료와 파워어세서가 작성한 표준급여계획, 수급자 특성 자료를 이용하여 데이터를 구축하였고, 15개 복지용구 품목별로 표준급여모형을 개발하였다. 본 연구는 노인장기요양보험의 복지용구 급여계획의 객관성 및 과학성을 확보하고 수급자의 자립생활과 안전을 향상시키는 데에 기여할 것으로 기대된다.

• 보건행정학회지
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• 제24권1호
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• pp.71-84
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• 2014

Background: Informal care is increasingly recognized as placing a significant burden on the lives of family caregivers. The purpose of this study is to investigate factors related to family caregivers' burden with the community-dwelling disabled elderly under the long-term care insurance system, using the Stress Process Model developed by Pearlin (1990). Methods: Total 1,233 family caregivers with the disabled elderly, using the long-term care services in their home from May to June 2009, completed questionnaires finally. The questionnaire of this study consists of a total of 32 questions, including 11 questions related to background and context, 17 questions related to objective stressors, and 4 questions related to coping resourses. Family caregivers' burden is measured by the Korean Revised Caregiving Appraisal Scale (K-RCAS, Cronbach's alpha=0.86). To investigate factors related to family caregivers' burden, multiple regression analysis was conducted. Results: The average score of caregivers' burden was 22.0 (${\pm}6.12$). In multiple regression analysis, there were statistically significant factors affecting on the family caregivers' burden, that are related to background and context (region, living status, education level, relationship with beneficiary), objective stressors (duration of caregiving), coping resourses (caregiver's health status). Conclusion: This study found that family caregivers experience a considerable burden. The findings suggest that policies must be taken to relieve family caregivers of their duties temporarily, and to support them with counselling and education.

• 한국사회정책
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• 제24권1호
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• pp.67-95
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• 2017

본 연구의 목적은 장기요양시설내 노인학대 문제에 대한 WHO 및 주요국의 정책을 검토하고, 이를 바탕으로 한국의 장기요양시설 노인학대 예방정책의 방향을 도출하고자 하는 것이다. 이에 본 연구는 WHO의 노인학대 위험요인으로 지적된 요인 중에서 장기요양시설에서 문제가 되고 있는 세가지 이슈(노인의 특성(시설내 치매노인 분리수준), 종사자 특성(신체억제대 사용수준, 야간 돌봄인력 처우수준), 시설 특성(시설내 CCTV설치수준))을 중심으로 살펴보았다. 연구결과, 첫째, 많은 국가들에서 시설의 개방성에 대해서 강조하고 있었다. 관련 정책으로 옴부즈맨제도, 성인후견인제도 등을 통한 시설방문, 외부 감시체계를 운영하고 있었다. 둘째, 시설의 입소노인의 특성에 대한 고려가 필요하다. 특히, 장기요양시설 특성상 치매노인, 야간시간대 입소노인의 특성이 고려된 학대예방책이 요구되었다. 셋째, 장기요양시설의 시설종사자의 처우조건, 종사자의 시설환경 수준 등이 각 국가별로 차이가 있었다. 시설내 학대예방을 위해 시설환경의 향상과 종사자의 처우개선이 중요하였다. 넷째, 향후 입소자 중심 예방정책으로의 패러다임 변화가 요구된다. 이러한 연구결과를 토대로 본 연구는 한국의 장기요양시설내 노인학대 문제를 예방하고 해결하기 위한 정책적 제언을 제시하였다.

• 한국병원경영학회지
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• 제28권3호
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• pp.58-67
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• 2023

Purpose: The purpose of this study was to analyze the factors associated with long-term hospitalized patients in long-term care hospitals using the quality assessment data for long-term care hospitals by the Health Insurance Review. Methods: Among 1,376 long-term care hospitals, frequency analysis and descriptive statistics were used to analyze the characteristics of these hospitals. Multiple linear regression was conducted to examine the associations between infrastructure characteristics, medical personnel characteristics, health outcomes and the proportion of long-term hospitalized patients. Results: The research findings indicate that the number of patients per doctor, the number of patients per nurse, and the number of patients per nursing staff were positively associated with the proportion of long-term hospitalized patients. Among health outcomes, a higher proportion of patients with more than a 5% weight loss compared to the previous month and the proportion of patients showing improvement in ADL, were more likely to have a lower proportion of long-term hospitalized patients. However the proportion of diabetic patients with HbA1c test results within the appropriate range was positively associated with the proportion of long-term hospitalized patients. Conclusion: The present study results provide fundamental data for the establishment of policies for long-term care hospitals. Based on this study, it is important to suggest screening methods for unnecessary long-term hospitalizations, such as sufficient medical personnel to improve the quality of care in long-term care hospitals. It is also necessary to clearly separate the roles of medical institutions and long-term care facilities and implement policies to support patients' social reintegration.

• 지역사회간호학회지
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• 제19권2호
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• pp.196-204
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• 2008

Purpose: To examine factors affecting long-term care hospital patients' intention of transfer to a nursing home. Method: A questionnaire survey was conducted in Aug. 2007 that included 655 patients from 49 long-term care hospitals. The survey aimed to assess the patients' health status, family status, cost and intention of transfer to a nursing home. Institutional characteristics were analyzed from the nationwide database of Health Insurance Review & Assessment Service. The affecting factors were examined by employing chi-square test and logistic regression using SAS 8.2. Result: Of the subjects, 32.4% had intention of transfer to a nursing home. The intention of transfer to a nursing home was affected by moderate or severe pain, living together with the primary carer, high cost uncovered by insurance, and recognition of nursing home. Conclusion; For appropriate service utilization. a higher level of care is needed to satisfy patients at nursing homes and a balanced fee schedule is needed between long term care hospitals and nursing homes. It is desirable to encourage transfer to a nursing home at which nurses support patients and their families by giving information, coordination, and to make efforts to establish a reference system.