• Title/Summary/Keyword: Medical aid case manager

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Effectiveness of Medical Aid Case Management in Excessive Healthcare User by Interventions based on the Number of Accesss (의료급여 과다이용자의 중재방법별 접근횟수에 따른 사례관리 효과)

  • Song, Myeong-Kyeong;Cho, Jeong-Hyun;Kim, Soon-Ok
    • Journal of Digital Convergence
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    • v.15 no.7
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    • pp.259-269
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    • 2017
  • This study analyzed medical aid case management effects based on the number of access by visits, phone calls, letters, internal investigation, resource links, and requests, in medical aid case management business that is carried out to improve the quality of life of medical care beneficiaries and reduce financial cost. Secondary analysis study using data of 564 high-risk group in the medical aid case management and their healthcare utilization data. Letters had positive correlations with the scores of all case management domains. The higher visits was, the lower the score of self-health care ability was, and the higher the number of phone calls was, the higher the score for reasonable medical use was. While there was no significant difference in medical cost according to aid management by interventions, the higher visits and resource links were, the lower the subjects' total number of payment days was. There is a difference in the various areas of the quality of health -related life and medical use depending on case management by intervention method and its number. It is necessary to carry out the efficient number of access to case management by intervention method.

Effects of an Integrated Case Management Program on Medication Adherence, Pain, Physical Function and Depression among Korean Medical Aid Beneficiaries with Osteoarthritis (의료급여 관절염환자의 복약순응향상을 위한 통합중재프로그램의 효과)

  • Ahn, Yang Heui
    • Journal of Korean Public Health Nursing
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    • v.28 no.1
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    • pp.32-45
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    • 2014
  • Purpose: The purpose of this study was to test the effectiveness of an eight session integrated case management program for improvement of medication adherence, physical function, pain, and depression among medical aid beneficiaries with osteoarthritis. Method: A nonequivalent control group pre-posttest design was employed. Participants were 55 medical aid beneficiaries who agreed to participate in this study, and were assigned to an experimental group (n=28) or control group (n=27). The framework of this research derived from Cox's Interaction Model of Client Health Behavior guided the overall intervention and the components. The program led by a case manager with a medication calendar, motivating interviewing and coaching strategies and collaboration with a pharmacist. Analysis included change in scores, ${\chi}^2$-test, and t-test. Result: The results showed significant increase in medication adherence, physical function and decrease joint pain, joint stiffness and depression in the experimental group compared to the control group. Conclusion: The eight session integrated case management program indicated an effect on medication adherence, pain, physical function, and depression. Partnership with a pharmacist is recommended for medication adherence and conduct of further studies will be needed in order to determine the long-term effect of an extended integrated program on health outcomes.

Role Transition from Clinical Nurse to Case Manager for Medical-aid Beneficiaries: Taking Root in a Barren Land (임상간호사에서 의료급여관리사로의 역할 전이 과정: '척박한 땅에 뿌리내리기')

  • Park, Eun-Jun;Kim, Chun-Mi;Lim, Seung-Joo
    • Journal of Korean Academy of Nursing
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    • v.42 no.2
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    • pp.149-160
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    • 2012
  • Purpose: The purpose of this study was to explain the role transition process to nurse case managers (NCMs) for Medical-aid beneficiaries in Korea. Methods: Fourteen NCMs were interviewed regarding their experiences of becoming proficient in the new role of case manger. Data were analyzed through the application of grounded theory. Results: 'Taking root in a barren land' was the core category explaining the role transition process of NCMs. They engaged in four stages: launching, trial and error, proficiency, and wait-and-see stages. NCMs showed not only fear but also passion for case management practice. Despite their passion and effort, NCMs went through a period of trial and error. After becoming skilled, NCMs went through a stage of wait-and-see often because of job insecurity related to temporary position or few opportunities for promotion. Factors influencing NCMs' role transition process included their understanding of client characteristics, belief in case management, and support from their colleagues and families. Conclusion: NCMs experience many challenges in the process of becoming proficient NCMs. To help with their role transition, there is a need for education programs, preceptorship programs, research on their roles and functions, and regulation for securing NCMs' employment and career stability.

Job Analysis of Medical Care Client Managers based on DACUM (데이컴 (DACUM)기법을 이용한 의료급여관리사의 직무분석)

  • Choi, Jeong-Myung
    • Korean Journal of Occupational Health Nursing
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    • v.20 no.3
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    • pp.299-307
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    • 2011
  • Purpose: The purpose of this study is to establish the standards for duty of Medical Care Client Managers and analyze the extent of accomplishment, importance, and difficulty according to the standards. Methods: The draft for duty of Medical Care Client Managers was formed by the method of developing a curriculum (DACUM) and data were collected from 185 Medical Aid Client Managers in 234 areas to evaluate the actual frequency of accomplishment, importance and difficulty in comparison with the standards for duties. Results: The standard duty draft for Medical Care Client Manager is composed of five separate groups of duties and thirty five tasks. The five duties are Case Management, Extension Approval, External Cause of Injury, Duplicate Claims and Other Administrations. Seven Tasks are allocated to each duty such as Case Management, Extension Approval and External Cause of Injury. Five tasks are allocated to 'Duplicate Claims' duty and nine tasks are allocated to 'Other Administrations' duty. Conclusion: From the results of analysis for duties, it was apprehensive about overburdened responsibilities and carelessness in professional duties. It was necessary to establish specific guidelines for duties because of redundent application or regional variation in frequency of accomplishing other administrative duties. It was necessary to relieve a regional disparity of business charge and also was necessary to propose an alternative plan to relieve the overburdened responsibilities.

Short-Term Effects of an Self-Management Support Intervention on Patient Activation, Joint Flexibiltiy and Health-related Quality of Life among Korean Medical Aid Beneficiaries with Osteoarthritis (지역사회기반의 자기관리지지중재가 골관절염 의료급여수급자의 환자활력, 관절유연성 및 건강 관련 삶의 질에 미치는 단기효과)

  • Ahn, Yang Heui;Hur, Jae Bock;Choi, Eun Hee
    • 한국노년학
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    • v.36 no.3
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    • pp.595-609
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    • 2016
  • The purpose of this study was to test the effectiveness of an eight session self-management support program for improvement of patient activation, joint flexibility and health-related quality of life among medical aid beneficiaries with osteoarthritis. This study was part of a randomized and controlled research of a self-management support intervention. Participants were 60 medical aid beneficiaries who agreed to participate in this study, and were assigned to an experimental group (n=30) or control group (n=30). The 8-session and tailored program led by a trained case manager with the patient-centered approaches and cognitive-emotional-behavioral skills. Analysis included change in scores, ${\chi}^2-test$, Fisher's exact test, t-test and ANCOVA. The results showed significant increase in patient activation, joint flexibility (shoulder and right knee) except health-related quality of life in the experimental group compared to the control group. The self-management support program indicated an effect on patient activation and joint flexibility. Further research is needed to examine the outcome in the long term(9 and 12-month follow up).