노인 암 환자의 삶의 질에 영향을 미치는 요인에 대한 예비조사

강임옥,윤영호 대한가정의학회 2004 Korean Journal of Family Medicine Vol.25 No.9

Background: Because of a continuous increase in elderly population with functional disabilities and diseases including cancer in Korea, the need for measuring the quality of life in the elderly with cancer is growing. The purpose of this study was to examine the factors associated with the quality of life in the elderly with cancer. Methods: The instruments of this study were European Organization for Research and Treatment of Cancer (EORTC0 QLQ-C30, Beck Depression Inventory (BDI), and Brief Pain Inventory (BPI). We conducted the stepwise multiple regression to analyze predictors of global QOL in the elderly and the younger cancer patient groups. Results: The main findings were as follows: The regression analysis of the elderly group revealed some items as significant predictors; sadness, insomnia, fatigability of depression subscales, and work of pain interference item. The regression analysis of the younger group revealed cognitive functioning and activity of pain interference item as significant variables. Conclusion: The findings support the conclusion that depression items were the most important factors in QOL of elderly patients with cancer. Therefore, we need to take more interest concerning depression in elderly cancer patients. 연구 배경: 암환자의 삶의 질을 측정한 기존의 연구에서는 주로 암 종류별로 구분하여 그들의 삶의 질을 측정하였다. 그러나 최근 들어 노인인구가 증가하고 암으로부터 생존자의 수도 증가하는 것을 감안한다면 노인 암 환자의 삶의 질을 살펴보는 것이 필요하다. 이에 본 연구는 노인 암환자의 삶의 질에 영향을 미치는 요인을 살펴보고자 하였다. 방법: 본 연구는 6개 병원에서 암으로 진단받은 자를 대상으로 조사하였고, 연구대상자 292명 중 노인 암 환자 30명과 청장년층 암 환자 262명을 구분하여 삶의 질의 특성을 살펴보았다. 각 독립변수들의 상대적인 중요성을 확인하기 위해 노인 암환자의 전반적인 삶의 질에 대한 단계별 회귀분석(stepwise multiple regression)을 시행하였다. 노인 암 환자군과 청장년층 암 환자의 삶의 질에 영향을 미치는 요인의 구성이 차이가 나는지를 살펴보기 위해 청장년층 암 환자군을 대상으로 회귀분석을 함께 시행하였다. 결과: 65세 이상의 노인 암 환자군에서 다른 인구사회학적 변수를 보정한 상태의 회귀분석 결과를 보면 주로 우울과 관련된 변수가, 특히 슬픔(sadness) 변수가 삶의 질에 영향을 가장 많이 미치는 것으로 나타났다(partial R2=33%). 통증으로 인한 장애정도에서는 통상적인 일(work)에 장애가 적을수록 삶의 질이 좋은 것으로 나타났다(total R2=74%). 65세 미만의 청장년층 암 환자군에서는 인지적 기능이 가장 높은 partial R2 값(33%)을 보였다. 우울에서는 피로가, 장애정도에서는 활동(activity)에 대한 장애가 유의한 영향변수로 나타났다. 결론: 노인 암 환자는 우울에 의해, 청장년층 암 환자는 인지적 기능에 의해 많은 영향을 받는 것으로 판단되므로, 노인 암 환자들을 대상으로 한 사업에서는 그들이 갖는 우울 요인에 대해 보다 세심한 관심을 갖고 관리해야 할 필요가 있다고 생각된다.

Role of Healthcare in Korean Long-Term Care Insurance

강임옥,Chong Yon Park,Yunhwan Lee 대한의학회 2012 Journal of Korean medical science Vol.27 No.-

With the rapid aging of the population, Korea introduced public long-term care insurance for older people in 2008. The long-term care insurance was designed as a separate scheme from the national health insurance, with eligibility qualifications and the certification process based on functional disability, benefits and coverage of community-based and institutional care, and a financing structure through multi-party contributions. Delivering appropriate health services to long-term care beneficiaries who manifest a high prevalence of comorbid chronic conditions with rising healthcare costs, however, presents a particular challenge. The lack of coordination between the health and long-term care sectors, limited consideration of physicians’ assessments in the certification process, inadequate provision of health services in long-term care facilities, and overlapping and inefficient use of care resources act as barriers to providing comprehensive healthcare for older beneficiaries. Through active participation in the long-term care system, health professionals can help older patients navigate through the complex long-term care terrain to obtain quality healthcare.

Health-related quality of life of caregivers of cancer patients using SF36 Health Questionnaire

강임옥 한국간호과학회 2004 한국간호과학회 학술대회 Vol.2004 No.5

한 병원이 지역사회에 미치는 경제적 영향 분석

강임옥,이선희,김한중,Kang, Im-Ok,Lee, Sun-Hee,Kim, Han-Joong 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.4

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.

등급판정 관련 특성이 장기요양 인정률에 미치는 영향

강임옥,한은정,박종연 한국보건행정학회 2011 보건행정학회지 Vol.21 No.3

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.

가정간호서비스 이용 노인환자의 간호요양원(Nursing home) 필요 예측에 관한 연구

강임옥(Im Ok Kang) 한국간호행정학회 1999 간호행정학회지 Vol.5 No.3

요양병원 간병비 지급이 건강보험 진료이용량에 미치는 영향

강임옥 ( Im Ok Kang ),한은정 ( Eun Jeong Han ),이정석 ( Jung Suk Lee ) 한국보건행정학회 2009 보건행정학회지 Vol.19 No.2

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

노인인구의 간호요양원(Nurisng Home) 필요예측에 관한 연구

강임옥(Im Ok Kang) 한국간호행정학회 2000 간호행정학회지 Vol.6 No.2

우리나라 병원에서 평균재원기간 변화 추세 : 1984~1994

전기홍,강임옥,신승수,민근식,신상건 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance. From 1984 to 1994, average LOS of each hospital were analyzed according to factors such as medical departments, bed size, occupancy rate, region and ownership. This study findings are as follows: 1) The results indicated that the average LOS steadily increased until 1990 but it slightly decreased after 1990. 2) This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. Finally from this result we think, that most hospitals in Korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this tend may be caused by a fewer patients, low occupancy rate or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon results from the reimbursement method. Because of the fee-for-service reimbursement system in Korea the hospitals did not need to shorten LOS in order to save costs and increase profits. Therefore reform of hospital cost reimbursement method will be needed to reduce hospital cost in Korea. We think that the Korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the United States. This study presents some limitations such as no insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can possibly affect LOS. However, this study reports an important trend in the annual LOS from 1984 to 1994.

노인대상 의료기관 가정간호사업의 운영실태

송종례,강임옥,김윤옥,조혜숙,황문숙 지역사회간호학회 2008 지역사회간호학회지 Vol.19 No.4

Purpose: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. Method: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. Result: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. Conclusion: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.