대도시지역 동단위 지역담당 방문간호서비스 효과분석 : 뇌졸중 환자를 대상으로

유호신,석민현,황라일,진달래 지역사회간호학회 2005 지역사회간호학회지 Vol.16 No.1

An Evaluation of the Visiting Nursing Service Model Based on the District Management System -focused on stroke patients -Ryu, Ho-Sihn · Suk, Min-Hyun Hwang, Rah-Il · Jin, Dal-Rae Purpose: This study was conducted to examine the effect of visiting nursing of the visiting nursing services based on the district management system on the subjects of stroke patients. Method: A nonequivalent control group pretest-posttest design was applied to 50stroke patients (31 from the experimental group, 19 from the control group). To evaluate the effects of visiting nursing services, health status(SF-36) and activity daily living(ADL/IADL) were measured from June 2003 to November 2004. Result: Health condition and the activities of living (ADL/IADL) of the subjects who received visiting nursing service were shown to be improved. Conclusion: Visiting health service model based on the district management system in public health center is considered to be an effective measure of visiting nursing services in large cities.

한국의 가정건강관리 연구에 관한 고찰 -의료기관 및 지역사회 가정간호와 보건소 방문보건을 중심으로 -

유호신,김은영,박재순,Ryu, Ho-Sihn,Kim, Eun-Young,Park, Chai-Soon 한국가정간호학회 2007 가정간호학회지 Vol.14 No.2

Purpose: This study was conducted to provide fundamental information for policy integration of the home health care system. Methods: Focused review was performed from 8 studies out of 48 literature related to home care needs. Results: Females utilized home care based on hospital and public health centers at a higher rate than males. While there had been more rate of the elderly above 60 year-old at hospital and community based home care, on the other hand below 45 year-old at public health center. The most common disease amongst users in all three types was cerebrovascular disease, the second was cancer based at hospitals, hypertension and arthritis at public health centers. There were more needs for those using artificial respiratory equipment, cancer patients, and puerpera. However, the needs for hospital and community based home care were very similar. Conclusions: Due to similar disease characteristics but varied severity at the three home care based settings, they should be managed with flexibility. Home care curriculum should be developed according to common disease type, and home care services should be strengthened for its expertise.

한국의 가정건강관리(Home Health Care) - 가정간호, 방문간호, 방문건강관리 -

유호신,Ryu, Ho-Sihn 한국가정간호학회 2007 가정간호학회지 Vol.14 No.2

Home health care system in Korea has been classified into three types of home care programs based on different laws and regulations; for example, home health care nursing(HHCN) is based on medical laws, visiting health care nursing (VHCN) is based on long-term health care insurance, and visiting health care(VHC) is based on the regional health care act. HHCN in Korea has taken on an important role under the mandate of the national health care system since 2000. VHCN will commence its role under the long term health care insurance system in 2008. The strengthening of VHC commanded health promotion and prevention for vulnerable families in the community in 2007. This is an important turning point for increasing quality management for home health care program; it suggests certain possibilities for building a foundation for further changes in the service delivery structure. Accordingly, the home health care policy makers in Korea have a major function and role that consists of developing an agenda and alternatives for policy making in a systematic manner and clearly presenting implementation strategies for elderly health care system.

저 출산 고령 사회에 대비한 재가 간호사업 정책 과제와 대안

유호신,Ryu, Ho-Sihn 한국가정간호학회 2007 가정간호학회지 Vol.14 No.1

The purpose of this study was to describe the policy agenda and alternatives for the home health care system in Korea. The home health care system development was not fully integrated while the medical laws were established in 2000, community health law in 1995, and elderly long-term health insurance law in 2007. Because of the increasing population of people over the age of 65 and dramatically decreasing fertility rate, the burden of various health-care expenses has become a great obstacle for the Korean government. Under these circumstances, the home of home health care system in has taken on an important role under the mandate of the national health care system. The types of home health care system in Korean shows a greater contrast from those utilized in other more industrialized countries, such as, U.S. or Japan. In conclusion, the strategy in overcoming the obstacles to enhance home health care system under the national health system would be developing it as a comprehensive and exchangeable consumer-focused organization.

전국 의료기관 가정간호사 근무 실태

유호신,조혜숙,김윤옥,윤영미,송종례,임지영,김순용,김인아,Ryu Hosihn,Jo Heasook,Kim Yoonok,Yoon Youngmi,Song Jongrae,Lim Ji Young,Khim Soonyong,Kim In-A 한국간호과학회 2005 Journal of Korean Academy of Nursing Vol.35 No.7

Purpose: The purpose of this research was to address the working conditions of home health nurses through a nationwide home health agency survey conducted at hospitals. Method: The mail surveys were sent to 303 home health nurses nation wide and returned with a response rate of $71.8\%$. Result: (a) Seventy-five percent of home health agencies were established within the past5 years and half of home health nurses are over 40 years old. (b) Working conditions were considered as follows: Seventy-one percent of respondents were full-time employees, sixty-sixpercent of home health nurses had unscheduled visits on a regular day of duty and forty-eight percent were on vacation. Fifty-one percent of home health nurses have experienced traffic accidents and paid. penalties ($65.9\%$). Self-reported monthly income level per year was an average of 28,364,000 won. (c) Rates were significantly higher for shoulder pain ($61.5\%$), lower back pain ($54.1\%$), knee pain ($39.4\%$), and gastrointestinal problems ($33.0\%$). Conclusion: These baseline results show the importance of improving home health nursing working conditions, a comprehensive prevention system and safeguards from physical discomfort.

대도시 보건소 방문보건관리 현황과 정책 과제

유호신,황라일 지역사회간호학회 2004 지역사회간호학회지 Vol.15 No.1

Purpose: The purpose of this study was to identify the current management status and the policy issues of visiting nursing programs at public health center in urban area. Method: A questionnaire surveys was conducted on all public health nurses in 25 health centers in Seoul. Result: The major results were as follows: The characteristics of the visiting nurse showed that the average age was 41.1 years, and total nursing experience was 122 months. Their visiting nursing experience was only 30 months. The recipients of visiting nursing services consisted of 60.1% females, and 32.5% of the recipients were over 65 years. The major health problems of the recipients were hypertension, diabetes mellitus, arthritis and psychiatric problems. The visiting frequency was an average of 5.4 times per day, and 357families were managed per visiting nurse. The major problems of visiting nursing programs were the shortages of visiting nurse manpower. The most important related policy issue was being in charge of a workload, which was not related to the visiting nursing services. Conclusion: By analyzing work for visiting nurses and identifying weak points, this research can present recommendations to be practically used as baseline data for establishing policy in relation to vitalizing visiting nursing programs.

3차 병원에 입원한 교통사고환자의 평균 재원기간과 조기퇴원시의 수입증대효과 분석연구

유호신,Ryu, Ho-Sihn 한국지역사회간호학회 1999 지역사회간호학회지 Vol.10 No.1

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

가정간호사업을 위한 의료법 제정의 의미와 과제

유호신,Ryu, Ho-Sihn 한국가정간호학회 2000 가정간호학회지 Vol.7 No.1

This article was trying to suggest an agenda and alternatives of home health care policy for the future home care growth and development and examine the significance of new health care law and regulations. In addition. It was to analyze and drive the home care system problems. of which was made an announcement on the 11th of April. that home health care project must be centered from the nationwide general hospital. As we have learned from the developed countries, the home health care have been closely related health care policy among the field of nursing area. Therefore. we need to understand our national health care policy and need to predict the future direction and goal of our home health care policy in order to enhance the growth and activation of health care system. Additionally. we also need to have a vision and ability to develop under our own health care policy with systematic and rational home care business escaping from past perspective and standpoint. We must create a master plan of home care system to fulfill one part of system of the function and an important role in order to pursue an advanced health care plan under our system. For instance. in the 21th century as we establish a master plan for the growth of our country home care plan with improving plan systematically and also we need to produce many highly qualified researching and good personal who can develop and maintain the system efficiently. Specially. based on the unique characteristics of our health care system and the direction of development of plan, we need to find and correct the problems which we have faced the present time, so that we can provide and reach the goal of advanced health care system which our government want to pursue. Finally. we have to strive our best effort to make our home health care system can be positioned and stand the right direction to have the benefit for every individual citizen in our country.

가정간호수가 적정성 검증 및 수가체계 개선 방안

유호신,정기선,임지영,Ryu Ho-Sihn,Jung Key-Sun,Lim Ji-Young 한국간호과학회 2006 Journal of Korean Academy of Nursing Vol.36 No.3

Purpose: This study focused on analysing costs per home health care nursing visit based on home health care nursing activities in medical institutes. Method: The data was collected in three stages. First, the cost elements of home health care nursing services were collected and 31 home care nurses participated. Second, the workload and caseload of home care nursing activities were measured by the Easley-Storfjell Instrument(1997). Third, the opinions on improving the home health care nursing reimbursement system were collected by a nation-wide mailing survey from a total of 125 home care agencies. Result: The cost of home health care nursing per visit was calculated as 50,626\. This was composed of a basic visiting fee of $35,090{\\}({\fallingdotseq}355$)$ and travel fee of $15,536{\\}({\fallingdotseq}15$)$. The major problems of the home care nursing payment system were the low level of the cost per visit, no distinction between first visit and revisits, and the limitations in health insurance coverage for home health care nursing services. Conclusion: This study's results will contribute as a baseline for establishing policies for improvement of the home health care nursing cost and for applying a community-based visiting nursing service cost.

우리나라 대도시 보건소 방문간호 사업유형별 방문간호원가 및 소요재정 추계 분석

유호신 한국간호과학회 2004 Journal of Korean Academy of Nursing Vol.34 No.6

Purpose: This study focused on analysing costs per visiting nursing care based on nursing activities in a public health center. Method: The Easley-Storfjell Instrument(1997) was used for a prospective descriptive analysis of self-records for workload data from 10 visiting nurses during 4 weeks on all nursing activities. In addition analysis of the 478 visiting nursing records and cost data from 5 home visiting departments in public health centers during one year of 2003 was done. Result: The workload of visiting nurses by the type of model was identified as follows: Type I showed that caseloads made up 32.9 % of all nurse activities, and type II showed that the caseloads made up 45.8 %. Second, The cost per visit in type I was 33,088 won and 31,323 won in type II. Third, the estimated budgets were 1,902,436 won to 12,057,696 won for the type I model. and 4,151,316 won to 17,432,712 won for the type II model for one year. Conclusion: This study's results will contribute to baseline data used to establish on infrastructure for visiting nursing program and visiting nursing agencies based on the budget of visiting nursing services.