자문형호스피스 시범사업 성과평가 및 건강보험 적용방안 연구

박영택,오주연,신양준,이다희 건강보험심사평가원 심사평가정책연구소 2020 연구보고서 Vol.2020 No.0

Background: On August 14, 2017, the Ministry of Health and Welfare (MOHW) of South Korea implemented the Consultative Hospice Care (COHC) for terminally ill patients in the acute-care wards. COHC is different from the hospice care provided in the Independent Hospice Unit (IHU) in that COHC was offered to those in acute-care wards. There has been no study that evaluated this pilot project. Objective: To evaluate the COHC project and to review application potential and method of the national health insurance system (NHIS). Results: There were 27 hospitals participating in the project as of December 31, 2019. A total of 7,910 patients received COHC for 2.5 years. This study evaluated the project in the standpoints of structure, process, and results. As for structure, although accessibility to COHC varied upon regions, the level of appropriateness on staffing, governance, training system, and fee schedule showed above the average. Regarding process, average length of stay of COHC patients was 19.1 days which did not differ by type of hospitals nor type of insurance status (NHIS or Medical Aid). Waiting time for COHC was shorter than those of IHU. Denial rate of registrating COHC after initial consultation was 47.8%. Although the delivery of COHC was well processed, some communication difficulties were observed between attending physicians of acute-care unit and those in COHC program. Percent of non-cancer patients was as low as 1.5%. Among COHC and IHU patients who used hospice care for the first time during their entire life, COHC inpatients took up 21.3% of all patients. For result perspective, total healthcare expenditure (HE) and daily health expenditure of COHC per patient were approximately KRW 9 million and KRW 450,000 respectively. Inpatient HE of COHC per patient before 6-month death was higher than those of IHU, but lower than that of cancer patients. Both total and daily expenditure of COHC per patient were much lower than IHU and cancer patients. The COHC program was effective on early entry of terminally ill patients to a hospice program. Patient pain level significantly decreased after 7th day from admission to COHC. However, satisfaction level was relatively low among patient’s family and general public using COHC program compared to that of IHU. There are a set of prerequisite to cover COHC under NHIS efficiently. First, the government should increase the number of COHC providers to reduce accessibility imbalance by region. Second, current healthcare delivery system needs to improve connectivity to palliative medical care and hospice care including COHC. Third, the government should introduce evaluation program to COHC and provide financial incentives to high-performing hospice providers upon the result. The quality assessment should reflect experience of patients and their family as the main input, and additional evaluation item should include the structure, process, and outcome of hospice service. Fourth, the government should add a few new items to the fee schedule and/or adjust existing fees. To name a few, pre-consultative service fee can be newly introduced, and rate on the use of bereavement room in hospitals should be increased. Last but not least, other necessary items include standardization of COHC practice guideline, sharing and utilization of hospice data for quality improvement, and development of governance for policy support. Discussion: Although the HE of COHC was higher than those of IHU, overall performance level of COHC project was successful in structure, process, and outcome. Observed issues were predicted given the integration of palliative care and hospice care, and delivery of hospice services in acute-care setting. Thus, the government needs to prepare policies to allow hospice and palliative care to develop independently, yet in a mutually beneficial way, so that the quality of care can improve significantly in both hospice and palliative care.

말기환자 부양자의 호스피스 프로그램 만족도에 영향을 주는 요인연구

최명주 한국임상사회사업학회 2008 임상사회사업연구 Vol.5 No.3

의학의 발달로 질병의 조기 발견과 수명의 연장은 가능해졌으나 말기환자는 점점 증가하고 있으며 많은 말기환자들의 고통을 제거하고 편안한 삶을 유지시키기 위한 호스피스와 완화 의학의 필요성이 자연스럽게 대두되고 있다. 호스피스 서비스의 효율성을 증명하는 것은 매우 중요한 일이다(National Hospice Organization, 1996). 이 연구는 호스피스프로그램 만족도에 영향을 주는 검증을 하였다. 그 결과 구조 요인으로 개별 수퍼비전, 환자 대 직원 비율이 유의미하였다. 서비스 양에서는 교육, 간호, 영적 서비스, 서비스 질에서는 교육, 간호 서비스가 유의미하였다. 주요 요인 분석 결과 교육 서비스(질), 교육 서비스(양), 간호 서비스(질), 간호 서비스(양), 환자와의 관계 순으로 나타났다. 이러한 연구결과는 만족도에 영향을 주는 요인을 알아보고 호스피스 사회복지 서비스에 대한 만족도를 높일 수 있는 프로그램 개발에 기초 자료를 제시하였다고 의미를 부여할 수 있겠다. With advanced medicine, diseases can be detected early on and people’s life span can be extended. However, terminal patients are increasingly growing, and a need is naturally raised to secure hospice and foster palliative medicine in order to alleviate the pain of many terminal patients and help them remain comfortable. It is very important to verify the efficiency of hospice services (National Hospice Organization, 1996). An analysis of satisfaction factors for hospice workers programs suggested that as structural factors, individuals’ supervision and the ratio of patients to workers were significant. In the serv-ice quantity, education, nursing, and spiritual services were found to be significant, and in the service qual-ity, education and nursing services were significant. An analysis of major factors indicated that education service (quality),education service (quantity, nursing service (quality), nursing service (quantity), and rela-tions with patients were found to be the most important in this order. The findings suggested what are the major satisfaction factors, and provided basic data for developing programs aimed at boosting satisfaction over hospice social welfare services.

Development of Hospice Care Service for the Elderly in China

Du Peng,Wang Yongmei 서울대학교 사회발전연구소 2016 Journal of Asian Sociology Vol.45 No.2

Against the backdrop of the aging society, we need to make great efforts to develop the hospice care service for the elderly if we want to comprehensively improve “the Quality of Death” and enable more old people to enjoy benefits of dying peacefully. This essay firstly reviews the policies and practices of the development of hospice care for the elderly in China, and we discover that main obstacles that hinder its development are institutional barriers, difficulties in financing, a lack of personnel, and low acceptance rate of the general public. Considering the current construction of socialized pension service system in China, we make institutional exploration in the development of the hospice care of the elderly in China. And we hold that these are key ways to develop this career to “get through” the lifeblood of the medical and health services and the hospice care service, “extend” the socialized system of elderly care service to this service, enhance the “input” in this service, and fully develop the long-acting “safeguard” mechanism for the development of this service.

국내 호스피스 기관의 사별 관리 실태

노유자,안영란,Ro, You-Ja,An, Young-Lan 한국호스피스완화의료학회 2000 한국호스피스.완화의료학회지 Vol.3 No.2

목적 : 본 연구는 전국 호스피스 기관의 사별관리 실태를 파악하여 효율적인 사별관리 방안의 기초자료를 제공하기 위함이다. 방법 : 1차로 1999년 9월부터 10월사이, 2차로 2000년 11월부터 12월사이에 한국 가톨릭 호스피스협회와 가톨릭대학교 간호대학 호스피스 교육연구소를 통해 확인된 전국 55개 호스피스기관을 대상으로 하였으며, 본인과 연구원이 직접 전화를 걸어 조사목적을 설명한 후 기관의 책임자와 통화하여 면접조사를 하였다. 결과 : 1) 국내 호스피스 기관의 69.1%에서 사별관리를 시행하고 있었다. 2) 사별관리의 내용으로는 전화방문 28개 기관(74.5%), 사별가족 모임 26개 기관(68.4%), 가정방문 22개 기관(57.9%), 우편물 보내기 16개 기관(42.1%), 개별상담은 7개 기관(18.4%)이었다. 3) 사별가족 모임은 26개 기관(68.4%)에서 시행하고 있었고 그 빈도는 연 1회가 42.3%로 가장 많았으며 연2회가 6개 기관(23.1%), 월 1회가 6개 기관(23.1%), 월 2회가 3개 기관(11.5%)을 차지하였다. 4) 사별관리를 위해 사별사정도구를 사용하고 있는 기관은 4개 기관(10.5%)에 불과하였다. 5) 사별관리 운영상의 문제점으로는 사별가족을 모으기가 어렵다는 점이 가장 많았고 사별관리자의 전문적인 지식의 부족, 사별관리 인력의 부족, 호스피스 기관과의 지역적 거리가 먼 경우, 사별자에 대한 사회적인 관심 부족, 재정적인 어려움 등이 있었다. 6) 효율적인 사별관리 방안으로는 사별관리 프로그램의 개발, 사별관리 교육의 필요성, 전문가 양성, 인력충원, 재정 지원 등의 요구사항이 있었다. 결론 : 국내 호스피스 기관중에서 69%가 사별관리를 시행하고는 있으나, 사별관리 전문가와 인력이 부족하고 사별관리 프로그램도 다양하지 못한 실정이다. 또한 사별자의 개별적인 욕구 측면에서 사별관리 프로그램이 다양하지 못하였다. 그러므로 효율적인 사별관리를 위해 사별관리 프로그램이 개발되어야 하며 관리운영자의 전문적인 교육과 봉사자 교육 및 훈련이 있어야 하고 사별자의 개별성과 요구에 적합한 접근방법이 모색되어야 한다. 앞으로 한국실정에 맞는 토착화된 사별관리를 위한 다각적인 연구가 시도되어야 하며 이를 실무에 적용시켜야 한다. Purpose : To evaluate the present status of bereavement care in Korean hospice service as a basic database for the effective bereavement care. Method : The data were collected two sets from September to October, 1999 and from November to December, 2000, 55 hospice institutions identified by the Hospice Education Institution, College of Nursing, Catholic University were contacted for a telephone survey. The researchers conducted telephone interviews with hospice administrators for 10 to 30 minutes. Result : 1) Among the 55 Korean Hospice institutions, 38 institutions(69.1%) provided bereavement services. 2) The contents of bereavement services consisted of telephone call 28 institutions(74.5%), bereaved family meeting 26 institutions(69.4%), home visiting 22 institutions(57.9%), mail 16 institutions(42.1%), personal counselling 7 institutions(18.4%). 3) The 26 hospice institutions(68.4%) which provided meetings for bereaved families met with the following frequency : Annually is 11 institutions(42.3%), biannually 6 institutions(23.1%), monthly 6 institutions(23.1%) and bimonthly 3 institutions(11.5%). 4) Only 4 hospice institutions(10.5%) used the assessment tool to screen for high risk of bereaved. 5) The major difficulties of current bereavement services were low attendance for the bereaved family meeting, shortage of professional managers and volunteers, limited accessibility to hospice institutions, little social awareness for the bereaved, and financial difficulties. 6) The hospice administrators expressed the need for the development of bereavement program, the education program for the bereavement services, trained professionals, the sufficient provision of human resource and financial support for more effective bereavement services. Conclusion : Although many hospice institutions(69.1%) provided bereavement services, they generally lacked capable bereavement professionals and various individualized bereavement services. In conclusion, it is required to develop the specified bereavement program and the training program for the staff and volunteers, so as to provide customized bereavement services based on individual needs. Further research will be necessary to evaluate the effects of customized bereavement services in Korea before applying to practice.

호스피스 간호서비스 만족도 측정도구(HNSSS) 개발

곽수영(Kwak, Su Young),이병숙(Lee, Byoungsook) 계명대학교 간호과학연구소 2011 계명간호과학 Vol.15 No.2

Purpose: This study was performed to develop Hospice Nursing Service Satisfaction Scale(HNSSS) for hospice units in general hospitals. Methods: This study was done with two steps, the development and the verification of reliability and validity of the scale. For the development of items, literature review and In-depth interviews with ten hospice clients were done. An item analysis and factor analysis were done to verity the reliability and validity of a 5-point preliminary scale. For this procedure, 200 hospice clients who received hospice nursing services in a hospice unit of an university hospital participated. Data for the verification of the scale were collected with telephone interviews. Results: In the process of the item development, 53 items were selected after evaluating content validity of the items. The preliminary HNSSS which was developed using 53 items with 5 point scale was examined for its reliability and validity. Finally 52 items in six factors remained for HNSSS. The Cronbach a of HNSSS for the reliability of the scale was .959. As the results of Factor Analysis for the construct validity of the scale, six factors were identified and their total variance was 59.1%. Histogram of the scores in the subjects showed normal distribution. Conclusion: HNSSS was verified in reliability and validity and it could be an useful tool for the improvement of the quality of hospice nursing service and for the studies about the quality of hospice nursing services.

호스피스 스마트 환자 서비스 제공자를 위한 교육과정 개발

박재순(Park Chai-Soon),유양숙(Yoo Yang-Sook),박현정(Park Hyun-Jeong),최동원(Choi Dong-Won),최상옥(Choe Sang-O),김성은(Kim Seong-Eun),김효정(Kim Hyo-Jung) 대한종양간호학회 2009 Asian Oncology Nursing Vol.9 No.1

Purpose: The purpose of the study was to develop an educational program reflecting the educational needs of Hospice Smart Patient service providers. Method: The description, goal, curriculum, method, and process evaluation of the educational program were constructed based on Modified Tyler-type Ends-Means Model followed by the analysis of current curriculum and needs of service providers. Results: The curriculum was constructed based on hospice volunteer program currently offered in Korea and the recommendations of hospice service volunteers and experts. A total of 90 hr was required to complete the curriculum that was composed of ‘Introduction to cancer’, ‘Treatment and treatment complications of cancer’, ‘Post-treatment nutritional care’, ‘Helpful information’, ‘Introduction to hospice and palliative care’, ‘Comprehension of life and death’, ‘Holistic hospice and palliative care’, ‘How to communicate as a smart patient’, ‘Hospice and ethics’, ‘Pediatric hospice’, ‘Bereavement management’, and ‘Clinical practicum’. Conclusion: It is necessary to implement the developed educational program and evaluate its effectiveness, as well as making the service available to a greater number of cancer patients.

호스피스 봉사 경험이 삶과 죽음 태도 변화에 미치는 영향

장민희(Minhee Jang),정태연(Taeyun Jung) 대한스트레스학회 2018 스트레스硏究 Vol.26 No.2

이 연구는 호스피스 봉사 경험에 따른 삶과 죽음 태도 차이를 양적으로 검증하고, 호스피스 봉사를 통해 죽음을 직면한 후 변화된 삶과 죽음태도를 질적으로 제시하고자 하였다. 먼저 총 157명을 대상으로 호스피스 봉사 유무에 따른 삶과 죽음태도를 측정하였으며, 이후 호스피스 봉사자 10명을 대상으로 심층 인터뷰 하였다. 그 결과, 권력과 성취 등 자기중심적인 삶의 가치 추구는 호스피스와 관련이 없는 일반인이 가장 높게 보고하였지만 의미있는 삶의 요인으로 종교와 공동체는 호스피스 봉사자 집단이 유의미하게 높게 보고하였다. 죽음 불안 역시 호스피스봉사자 집단이 유의미하게 더 낮았다. 질적 연구결과, 봉사 후 가족의 소중함과 이타적인 삶의 중요성을 느꼈으며, 죽음수용적인 태도 변화를 경험했다. 이러한 결과들은 호스피스 봉사 경험을 통한 죽음 직면이 자기초월적인 이타성과 공동체 지향, 종교적인 삶, 그리고 죽음 수용 태도에 영향을 미칠 수 있음을 시사한다. Background: This study was conducted to examine the impact of hospice service experiences on the volunteers’ attitudes toward life and death. Methods: Study 1 examined differences in life and death attitudes between hospice volunteers, hospice service trainees, and lay people using one-way ANOVA. Study 2 conducted in-depth interview with 10 hospice-patient care volunteers who had at least 3 years of experience. Results: After analyzing differences between three groups of lay people, hospice trainees and hospice volunteers, both hospice trainees and hospice volunteers compared to lay people showed lower pursuit of power and achievement, which can be interpreted as a characteristic of people motivated to volunteer, rather than volunteering itself. However, only hospice volunteers reported highly of religion and community as factors of meaningful life. Also, the volunteer group showed significantly lower death anxiety compare to the group without volunteer experience. Result of qualitative study showed that people realized the importance of family and altruistic lifestyle and prepared their own demise in their lives after volunteering. Conclusions: These findings suggest that experiences of hospice service may be associated with self-transcendent life and positive death attitudes.

Analytical Study on Medical Expenses of Hospice Service for Terminal Patients

Cho, Hyun,Kim, Won-Joong,Heo, Jeung-Gue,Jin, Eun-Hee Korean Society for Hospice and Palliative Care 2005 한국호스피스.완화의료학회지 Vol.8 No.2

As Korea has just turned into an aging society with the increase of average life expectancy, and the main causes of deaths is cancer and other chronic diseases. And this corresponds to a dramatic increase in medical expenses for the aged. To curve this problem, the hospice care can be an effective alternative, which can provide patients with both quality service and intensive care to help ensure high quality life for the patients. To demonstrate the economical effect of hospice services, a comparative study on the media expenses of geriatric hospitals and general hospitals, which bear similarities in common regarding the characteristics of their patients, is performed. Thus the results of the study can serve as a quantitative indication for the management of hospice services.

요양병원 호스피스·완화의료 서비스 현황 및 종사자들의 인식 조사

조현(Hyun Cho ),심은경(Eunkyung Sim),임희영(Heeyoung Im),이소정(Sojeong Lee),전효정(Hyojeong Jeon),허현점(Hyeonjeom Heo),오수미(Sumi Oh) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.3

본 연구는 B 광역시와 K시에 소재하는 요양병원 종사자들의 호스피스·완화의료 서비스에 대한 인식 및 활성화 방안의 조사에 목적이 있다. 13개 요양병원의 종사자들 183명 대상으로 조사를 실시하였다. 2016년 7월 1일부터 7월 30일까지 한 달 동안 연구자들이 기관을 방문하여 관련 자료를 직접 조사하였고 조사대상자들의 인식 및 활성화 방안은 설문조사를 실시하였다. 회수된 설문지는 SPSS 21.0을 활용하여 기초적인 자료를 분석하였다. 연구결과 조사기관 13개 중 호스피스·완화의료 교육은 9개 기관에서 실시하고 있었으며 한 해 1회 실시되고 있었다. 183명 대상으로 조사한바 호스피스·완화의료 교육 이수자는 저조하였으며(20.9%) 주로 병원프로그램의 한 유형으로 시행하였다고 응답하였다. 대부분의 종사자들은 호스피스·완화의료의 개념은 인지하고 있었고 좋은 프로그램이라 생각하며 시행되기를 바란다고(81.9%) 응답하였다. 그러나 호스피스·완화의료가 시행되지 못하는 이유는 ‘수행할 인력이 부족하다(50.8%)’, ‘호스피스 · 완화의료 프로그램을 잘 몰라서(25.4%)’ 등으로 나타났고 이에 개선방안 및 활성화로 ‘보험수가 도입(15.8%)’, ‘서비스 교육(15%)’ 그리고 ‘정부의 재정적 지원(14%)’의 순으로 나타났다. The purpose of this study is to investigate the study subjects’ awareness on hospice & palliative care service; and explore its activation methods of Long-term care hospitals located in the metropolitan cities B and K. The total of returned survey was answered from 183 employees on Long-term care hospitals which it was selected 13 institutions. One month to study during from July 1 to July 30, 2016 the researchers visited to investigate relevant data and surveyed to examine their awareness and activation methods. The returned survey questionnaires were processed with SPSS 21.0 for basic data analysis. The results of the 13 institutions under this research, 9 institutions provided hospice & palliative care education once a year. Most of the staff members were found to be aware of the idea of hospice & palliative care, think of it as a good program, and wish it to be implemented(81.9%). They answered that the reason of not implementing the hospice&palliative care was the ‘lack of personnel(50.8%)’, ‘lack of knowledge on hospice&palliative care program; and presented activation method was ’insurance fee introduction(15.8%)’ followed by ‘service education(15%)’ and ‘governmental financial support(14%)’.

한국과 주요국의 웰다잉(Well-dying) 지원정책의 현황과 시사점

김경아(Kyoungah Kim) 한국노년학회 2023 한국노년학 Vol.43 No.3

본 연구는 주요국의 웰다잉(Well-dying) 지원정책과 호스피스·완화의료 서비스 제도 관련 해외사례 연구를 통해 주요국의 최근 동향을 살펴보고, 우리나라와의 비교분석을 통해 시사점을 도출하여 향후 필요한 개선방안과 정책제언을 제시하고자 하였다. 해외사례 연구 결과, 주요국들은 사회 구성원의 죽음의 질을 개선하고 웰다잉(Well-dying)을 지원하기 위해 지역 거점병원을 중심으로 지역포괄시스템과 재택 케어 중심의 서비스 제공을 추진하고 있었다. 또한, 웰다잉(Well-dying) 지원 관련 시설 간 연계 및 다각적인 서비스 제공을 위한 시스템 구축과 호스피스·완화의료 서비스 상호연결 네트워크를 제공하고 있었다. 그에 반해, 국내의 경우 아직까지 법적 및 제도적 기반이 제시하고 있는 죽음의 범주가 매우 협소하며, 죽음을 삶의 연속선상에서 파악하기보다는 하나의 이벤트로 간주하여 이에 필요한 최소한의 법적 및 제도적 기반을 구축하는 수준에 머무르고 있었다. 따라서 급속한 고령화의 진전과 연관성이 깊은 웰다잉과 좋은 죽음의 준비가 구현될 수 있도록 우리 역시 법적 및 제도적 기반을 점진적으로 확대해나갈 필요성이 있다. 무엇보다 현재 국내 제도가 관심을 두고 있는 웰다잉 서비스의 영역이 협소하다는 점은 한계점이며, 심리·사회 영역과 관련한 정책적 관심 역시 아직 부족한 상황이므로, 죽음을 회피하기보다는 삶의 한 요소로 편하게 논의할 수 있는 사회적 분위기를 조성하고 남은 가족을 대상으로 한 서비스 강화와 정책적 기반 마련 역시 필요하다고 본다. 이를 위해 점진적으로 큰 틀에서의 현재의 관심 대상과 영역의 협소함을 극복하기 위한 정책적 노력이 필요하며, 주요국의 사례를 참고하여 우리 실정에 맞도록 발전시켜 좀 더 다각적이고 종합적인 웰다잉 지원이 이루어질 수 있도록 제도를 개선해 나갈 필요성이 있다. This study examines the recent trends in major countries through overseas case studies related to well-dying support policies and hospice/palliative care service systems in major countries, and draws implications through comparative analysis with Korea to suggest necessary improvement measures and policy recommendations. As a result of overseas case studies, major countries are promoting the provision of services centered on regional comprehensive systems and home care centered on regional base hospitals to improve the quality of death of members of society and support well-dying. In addition, a system was established to connect facilities related to well-dying support and provide diversified services, as well as provide an interconnection network for hospice and palliative care services. On the other hand, in Korea, the scope of death proposed by the legal and institutional foundation is still very narrow, and death is regarded as an event rather than a continuum of life, and the minimum legal and institutional foundation required for this is established. Therefore, we also need to gradually expand the legal and institutional foundation so that well-dying and preparation for a good death, which are closely related to the rapid progress of aging, can be realized. Above all, it is a limitation that the area of well-dying service that the domestic system is currently interested in is narrow, and policy interest in the psychological and social areas is still lacking, so it is possible to comfortably discuss death as an element of life rather than avoiding death. It is also necessary to create a positive social atmosphere, strengthen services for the remaining family members, and prepare a policy foundation. To realize this, it is necessary to make policy efforts to gradually overcome the narrowness of current interests and areas in a larger framework. In addition, there is a need to improve the system so that more diversified and comprehensive well-dying support can be achieved by developing it to suit our situation by referring to the cases of major countries.