Factors Associated with Nurse Staffing Levels in Nursing Homes

( Hyang Yuol Lee ),( Mary A. Blegen ),( Charlene Harrington ) 대한보건협회 2012 대한보건연구 Vol.38 No.1

Objectives : This study examined the association of Medicaid nursing home reimbursement and resident casemix (acuity), and other factors on nurse home staffing levels in a small rural state of United States. Methods : Secondary data were used from the Online Survey Certification and Reporting (OSCAR) system, the Minimum Data Set, state reimbursement and staffing data, and the Area Resource File (ARF) to examine 195 freestanding nursing homes in Colorado. Two-stage least squares regression models were used to take into account the endogeneity of Medicaid reimbursement rates, resident case mix, and staffing levels, while controlling for clustering by geographical regions. Results : The findings showed that higher estimated Medicaid reimbursement rates were associated with higher RN hours, the percent of RN to total staffing hours, and total nurse staffing levels, but estimated resident casemix was not associated with staffing levels. Conclusion : Medicaid payment is an important incentive for improving staffing levels in nursing homes, even in a small rural state like Colorado.

Predicting Health Expenditures of Home- and Community-based Care Programs Using a National Insurance Reimbursement Data

Hyang Yuol Lee,Dohee Kwon,Gyu Chul Oh 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): This study was to predict health expenditure trajectory of the patients who utilized home- and community-based program from January 1, 2014 to October 31, 2019 using a pooled administrative data collected by the health insurance review assessment service. Method(s): We used a secondary data from the national health insurance reimbursement data. Data were analyzed with SAS 9.4 version. Univariate and multivariate regression models were performed for the prediction of total health expenditures of hospital-based home care services and home- and community-based care programs and other community-centered public health services. Independent variables were patient’s age, year of data, type of insurance, total number of days that the patient was treated (including the number of days of administration), type of treatment(surgery vs non-surgery), regional location, male/female, primary medical diagnosis, secondary medical diagnosis, main subject area (oriental medicine, dentistry, surgery, internal medicine, etc) Result(s): The hospital-based home care recipients’ health expenditure model were explained 26.58% from the regression model (n=630018), while community-based care recipients’ one model explained 57.34% (n=7887) with the same set of variables. There were significant regional differences among the health expenditure for both models and age, year, type of insurance, non-surgery, primary medical diagnosis of hypertension, stroke, diabetes, cancer, dyslipidemia, and dementia (reference: ischemic heart disease) were significant predictors, and secondary medical diagnosis of hypertension, stroke, diabetes, renal failure, dementia were significant predictors. Conclusion(s): This study results showed that the clear comparison of hospital-based treatment and community-based services using the accessible administrative data and the prediction of medical expenditures with current collected information retrieved from the patients’ reimbursement system could be used to evidence-based policy making and sound resources allocation at the national level.

Public Reporting on the Quality Ratings of Nursing Homes in the Republic of Korea

Lee, Hyang Yuol,Shin, Juh Hyun 한국간호과학회 2019 Journal of Korean Academy of Nursing Vol.49 No.2

Background: Quality ratings could provide vital information to help people in choosing a nursing home. Purpose: This study investigated factors aligned with quality ratings of nursing homes. Methods: We employed a cross-sectional descriptive design to assess publicly available data on 1,354 nursing homes with 30 or more beds in the Republic of Korea. After excluding 289 nursing homes with no reported quality-evaluation ratings, we analyzed the 2015 data of 1,065 nursing homes. To prevent multicollinearity among independent variables, we carefully selected the final set of variables based on clinical and theoretical meaningfulness to direct nursing care. Quality, the ordinal outcome, was scored from 1 to 5 with a higher score indicating higher quality of the organization. We constructed a multivariate ordered logistic regression model. Results: Higher quality ratings of nursing homes was significantly related to the number of unoccupied beds (OR=0.99, p =.024), registered nurses (RNs) (OR=1.30, p=.003), qualified care workers (OR=1.03, p=.011), cognitive-improvement programs (OR=1.05, p=.024), and other programs for residents’ activities (OR=1.09, p<.001). Conclusion: The number of RNs had the strongest influence on the publicly reported quality rating, while the rating of qualified care workers demonstrated little effect and that of nursing assistants had no effect. The number of RNs could be used as a crucial indicator for high-quality homes; more resident-engaging programs also demonstrated better quality of nursing home care.

Predicting Home- and Community-based Service Utilization in the Republic of Korea from 2014 to 2019

Hyang Yuol Lee,Dohee Kwon,Gyu Chul Oh 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): This study aimed to describe general characteristics and utilization patterns of patients and health institutions that provide home- and community-based services and attempted to predict patients’ utilization amounts with the characteristics in the Republic of Korea from January 2014 to October 2019 using national health insurance administrative data collected to reimburse healthcare services. Method(s): The study performed a secondary data analysis with a descriptive design. Data were retrieved from the Health Insurance Review and Assessment Services and analyzed with SAS 9.4. Frequencies of visits, total health expenditures, percentages, means, and standard deviations were presented by 17 geographical regions, type of insurance, different age groups, and gender. Primary/secondary medical diagnoses and univariate and multivariate regression models were utilized with the visit frequencies among patients who received hospital-based home care and community-based public health services. Result(s): Patients between 80–89 years old comprised 33.55% of the sample population, which was the largest patient group from 2014 to 2019. Age groups 70–79 and 60–69 years old followed with 31.3% and 12.42% of the population, respectively. Health utilizations covered by health insurance totaled 84.72% and the insurance of medical care services for the vulnerable was 15.28%. Of 17 geographic regions, health utilization patterns in Seoul and Kyeonggi-do provinces were the highest with 31.8% and 28.6%, respectively. Although we compared hospital-based home care to community-based health care, there were large variations between two groups depending on the general characteristics presented. In the prediction model, only 2.4% of 1-year visit frequencies and 2.3% of 6-year visit frequencies were explained by the final set of variables addressed. Conclusion(s): The results described current utilization patterns with a nationwide administrative data set. This study showed there was significant focus on hospital-centered health utilization in Korea. This evidence recommends that policymaking should support more effective community-based medical resources utilization.

The Effects of Intensive Care Hours on Postoperative Stay After Off-Pump Coronary Artery Bypass

Hyang Yuol Lee,So Young Han 한국간호과학회 2019 한국간호과학회 학술대회 Vol.2019 No.10

가정간호사업 기반 원격의료 서비스 모델 구축

조문숙 ( Moon Suk Cho ),이향열 ( Hyang Yuol Lee ) 대한보건협회 2017 대한보건연구 Vol.43 No.2

연구목적 : 본 연구는 일 상급종합병원에서 운영 중인 가정간호사업에 대한 만족도 및 가정간호사업기반 원격의료에 대한 요구도와 운영방식, 원격의료가 가능한 가정간호 활동서비스를 파악하여 가정간호사업 기반 원격의료 서비스모델을 구축하기 위한 서술적 조사연구이다. 연구방법 : 2016년 11월 14일부터 2016년 12월 12일까지 총 150부의 설문지를 배부, 수거하여 그중 136명의 주 돌봄 제공자와 10명의 가정전문간호사 설문지를 SPSS 23.0으로 분석하였다. 연구결과 : 가정간호서비스에 대한 만족도는 5점 척도에 평균 4.81점이었으며, 가정간호사업기반 원격의료에 대한 요구도는 5점 만점에 주돌봄제공자 평균 3.89, 가정전문간호사 평균 3.86이었고, 주로 사용하는 스마트 기기는 스마트 폰이었고, 원격의료 서비스 방법으로는 영상통화, 원격의료 제공 시 수가는 대면진료의 50%~31%로 응답하였고, 원격의료 의사는 담당 주치의, 원격의료 간호사는 가정전문간호사를 선호하였다. 원격의료 적용 가능한 가정간호 활동서비스는 4점 만점에 주 돌봄 제공자 평균 3.16, 가정전문간호사 평균 3.17으로, 기본간호영역의 건강상태 파악 및 관찰, 치료적 간호영역의 욕창간호 및 치료, 교육 및 훈련영역의 고/저 혈당 시 응급처치, 상처소독법, 감염증상 판별법, 기구소독법, 상담영역의 환자상태 상담, 재입원 상담, 그리고 기타영역의 가정간호 재의뢰, 검사처방, 처치처방, 약처방 및 용량조절이었다. 다음과 같은 연구결과를 가정간호사업 기반 원격의료 서비스 모델에 적용하였다. 주돌봄제공자는 원격의료를 통하여 병원 방문과 의료비용을 줄일 수 있어 원격의료가 유익할 것이라 판단하였으며, 가정전문간호사는 원격의료로 의료비용 절감 등의 유익성을 높게 판단하여 가정간호 사업에 원격의료 도입을 적극 검토할 필요가 있다고 하였다. 결론 : 가정간호사업기반 원격의료 시행 시 의료진과의 즉각적인 연결과 응급처치 제공을 가능하게 하여 비 계획된 재입원을 감소시키고, 가정간호 재의뢰를 위한 불필요한 내원 등을 줄일 수 있을 뿐만 아니라, 실시간으로 활력징후 및 혈당과 같은 신체계측 자료 전송을 영상통화 함으로써, 연속적이고 즉각적인 간호(primary care)가 이루어지게 하고, 모바일 교육자료 및 건강정보를 실시간 제공하여 가정간호 대상자와 주돌봄제공자의 건강관리 능력을 향상시킬 수 있다. 이러한 원격의료를 활용한 가정간호 모델은 거동이 불편하고 고령으로 치료의 어려움을 겪고 있는 만성질환이 많은 가정간호대상자의 치료과정에 중요한 역할을 할 수 있을 것이다. Objective: This study aimed to build a feasible telemedicine-service model in home healthcare by investigating customer satisfaction of current home healthcare, assessing the need and preferred operational style and identifying applicable activities of home healthcare telemedicine. Methods: This descriptive study used a standardized questionnaire. From November 14 to December 12, 2016; 136 primary caregivers and 10 advance practice nurses responded to the survey. Statistical analysis was performed using SPSS 23.0. Results: Satisfaction with current home healthcare scored 4.81 (of 5). Primary caregivers identified the need for telemedicine with a score of 3.89 (of 4) and advance practice nurses with 3.86. Smart phones were the major device preferred and video talk was the most preferred method for telemedicine. The majority of respondents thought it would be appropriate to pay between 31 and 50% of the cost of an in-person visit for telemedicine at home, and wanted their primary physician and advance practice nurse to conduct the telemedicine. Preference for activities applicable for telemedicine scored 3.16 (of 4) on average by primary caregivers and 3.17 by advance practice nurses. The average, 3.2, was the cut point for finalizing the model; health-status assessment, pressure-ulcer treatment, emergency care of high/low blood sugar level, wound dressing, identifying infections, instrument sterilization, patient condition consulting, the need for rehospitalization, re-referrals to home healthcare, adjusting prescriptions, treatment, and medication. Caregivers responded that telemedicine could be beneficial to diminish the number of hospital visits and lower costs; advance practice nurses responded that adoption of telemedicine is necessary for home healthcare to reduce medical costs. Conclusion: Telemedicine, combined with home healthcare, enables patients to easily connect with medical experts in hospitals who can provide first aid to patients, which would reduce unplanned or unnecessary rehospitalizations. Real-time physical data through video talk can help prompt care for the patient. Timely information with mobile guidance will consistently enhance self-care for home healthcare recipients. This telemedicine model would benefit most vulnerable immobilized patients with chronic diseases and provide high-quality care for home healthcare recipients.

임상간호사의 인수인계 인식에 관한 연구

김은만 ( Eunman Kim ),김선호 ( Seonho Kim ),이향열 ( Hyang Yuol Lee ) 대한보건협회 2014 대한보건연구 Vol.40 No.4

연구목적 : 본 연구는 국내 병원의 일반 병동에 근무하는 간호사가 수행하고 있는 인수인계 현황과 간호사들의 인수인계에 대한 인식을 조사하여, 인수인계의 질과 효율성을 높이기 위한 기초자료로 제공하고자 시도되었다. 연구방법 : 본 연구는 횡단적 조사연구로서 O’Connell 등(2008)이 개발한 인수인계인식도구와 국내외 선행연구를 바탕으로 전문가 집단의 검토 후 예비조사를 통해 개발된 문항으로 구성된 설문지로 2012년 7-8월에 국내에 있는 300병상 이상의 병원 (요양병원, 정신병원, 국군병원을 제외) 중 일반병동에 근무하고 있는 간호사를 대상으로 서술적 조사 및 분석을 수행하였다. 연구결과 : 연구결과 대부분의 인수인계는 간호 스테이션에서 구두 인수인계 방법을 사용하고 있었으며, 인수인계 시간은 평균 40분 정도 소요되고 있었다. 그리고 인수인계시 제공받는 정보가 최근의 것이고, 이해하지 못하는 정보에 대해 물어볼 기회가 있다는 인식의 점수는 높았고, 환자 간호와 관련 없는 정보를 종종 받으며, 외부 요인에 의해 방해를 받고, 인수인계에 집중하기 어렵다고 인식하는 것으로 나타났다. 결론 : 본 연구는 인수인계에 참여하는 간호사들이 현재의 인수인계 체계가 만족스럽지 않으며, 본 연구의 결과는 현재의 인수인계 체계의 변화와 업무개선을 위한 근거를 제공한다는 점에 의의가 있다. 현재 우리나라에서 수행하고 있는 간호 인수인계 과정을 향상시킬 수 있는 간호협회 또는 병원 차원의 지속적인 노력이 필요하다. Objective : Nursing handover from one shift to the next is a major task critical to the quality, safety, and continuity of patient care in any hospital. Methods : This study examined nurses` perceptions of nursing handovers using a survey method. Participants were 753 nurses who worked more than six months in general wards from hospitals with 300 beds or more. Results : Findings were scored from one to seven for each item. The items with higher scores, meaning nurses agreed more, were: “Information provided is up to date” (5.45 ± 1.06); “Have the opportunity to ask questions about things I do not understand” (5.34 ± 1.06); “Have the opportunity to debrief with other colleagues when I have had a difficult shift” (5.14 ± 1.12); “Able to clarify information that has been provided” (5.14 ± 1.01); “Patient information is provided sufficiently” (5.12 ± 1.05); and “Patient information is provided in a timely fashion” (5.11 ± 0.97). The item with the lowest score was “Patients are involved in the handover process” (2.31 ± 1.49). Conclusion : Nurses recognized that information provided during handovers was insufficient, often irrelevant to nursing care, and interrupted by external factors. Professional associations and hospitals must cooperate with each other in order to create a better handover process.

국내병원 간호사의 인수인계 실무표준, 표준지침 및표준화된 항목 개발에 대한 연구

김은만 ( Eun Man Kim ),유미 ( Mi Yu ),이향열 ( Hyang Yuol Lee ),고지운 ( Ji Woon Ko ),조의영 ( Eui Young Cho ),김을순 ( Eul Soon Kim ) 병원간호사회 2014 임상간호연구 Vol.20 No.1

간호사의 인수인계는 환자 안전의 중요한 요소로 본 연구는 인수인계 실무 표준, 표준지침과 표준화된 항목을 개발하여 적절성 여부를 검증한 서술적 조사연구이다. 연구대상자는 국내 종합병원에 근무하는 207명의 수간호사와 697명의 간호사로 개발된 실무표준은 인수인계 ‘목적’ 2항목, ‘정책’ 5항목, ‘환경’ 3항목, ‘과정’ 5항목, ‘내용’ 7항목, ‘평가’ 3항목, ‘교육기능’ 1항목의 총 26항목으로 구성되었으며, 도출된 표준화된 인수인계 항목은 Patient, Assessment, Situation, Safety concerns, Background, Action, Recommendation이었다. 본 연구결과는 국내 병원의 인수인계를 표준화하고 구조화된 시스템 개발의 기초자료로 사용될 수 있을 것이다. Addressing current status of nursing handoff provides information as to where to change practice for improvement in patient care. The aim of this study was to develop nursing a handoff practice guideline and standards for Korean hospitals. Methods: A questionnaire was used to collect data in a cross-sectional survey with 207 head nurses and 697 nurses working in general hospitals. Results: The practice guideline consisted of 2 items on purpose of handoff, 5 items on policy, 3 on environment, 5 on process, 7 on content, 3 on evaluation, and 1 on the function of education, for a total 26 of items. Standard instruction was developed related to Patients, Assessment, Situation, Safety concerns, Background, Actions, and Recommendations. Conclusion: The findings of this study indicate that the guideline can be applied in real nursing practice to improve the effectiveness of handoff procedures. It can be used to guide nurses to follow the standardized content, which presents patient details clearly. The guideline provides consistency and structure for the information that is handed over.