노인장기요양 방문간호 현황 및 추이

황라일 ( Hwang Rah Il ),박소영 ( Pak So Young ) 경희대학교 동서간호학연구소 2019 동서간호학연구지 Vol.25 No.2

Purpose: This study aims to provide basic data for the development of measures and promoting home health nursing by examining the current status and trends in home health nursing for long-term care (LTC) insurance beneficiaries. Methods: Secondary data, including annual LTC insurance statistics reports for 2010-2017 and LTC manpower data, were used to compute current status and trends in the provision of home health nursing. Results: Beneficiaries of home health nursing under LTC insurance, insurance-covered costs for home health nursing, home health nursing provider, and home health nursing providing institution only accounted for 3% of all insurance-covered home care services, and were on a consistent decline since 2010. In particular, vulnerable rural regions with high proportion of individuals had poor infrastructure in terms of home health nursing institutions and manpower, but had a higher home health nursing utilization rate compared to urban regions. Conclusion: In addition to measures to support home health nursing service beneficiaries, policy measures are needed to support home health nursing service personnel and institutions. Furthermore, programs to cultivate the expertise of home health nurses and improve quality of home health nursing services should be developed in order to promote home health nursing utilization in vulnerable rural regions.

저소득층 가정 부모의 아동안전사고 예방행위 실천에 영향을 미치는 요인

황라일(Hwang, Ra Il),임여진(Im, Yeo Jin) 한국보건간호학회 2013 韓國保健看護學會誌 Vol.27 No.2

Purpose: This study examined the characteristics of in-home injuries of children in low-income families and sought to identify the factors affecting parental in-home injury prevention practices. Methods: A cross-sectional descriptive survey design was applied, using questionnaires on in-home injury characteristics in children, parental in-home injury prevention practices, parental perceptions and knowledge on childhood injuries, and the Parental Stress Index. We queried 169 parents of children less than 5years of age who were enrolled in Nutrition Plus Projects at community health centers. Results: Overall, 92.7% of children had experienced in-home injuries, with sliding crashes and bumping injuries as the most frequent type of injury. The recovery rate with a scar after injury was 26.3%. Parental practices for in-home injury prevention were higher according parental age, educational status, and previous learning experiences regarding in-home safety and injury prevention. The two most significant factors affecting parental in-home injury prevention practices were age and parental perception of childhood injuries as being controllable and preventable. Conclusions: Considering the high risk of in-home childhood injuries in low-income families, safety education and the promotion of injury prevention practices for parents are recommended. The strategy to enhance the parental perception on preventing childhood injuries needs to be addressed.

병원 급식 식대 급여화에 따른 입원 환자의 급식만족도 조사

황라일(Rah Il Hwang),권진희(Jin Hee Kwon) 대한지역사회영양학회 2008 대한지역사회영양학회지 Vol.13 No.3

This study aimed to evaluate the amount of patients` satisfaction with hospital foodservices among those who were benefited from national health insurance during theirhospitalization. A total of 3,094 inpatients from 191 medical institutions were enrolled in this survey. The survey was carried out from July 23 to September 14, 2007 through the face-to-face interview method. All analyses were made using the SPSS software (version 13.0). The mean age of the participants was 53.3 years, 57.0% were women; 34.7% were high-school graduates. Among the respondents, 30.9% stayed in the hospital for 7~14 days long, and 52.0% were hospitalized in multi-patient rooms for six persons. The 87.7% of total population had a general diet, and 9.6% selected the food menu that was notcovered by health insurance. In addition, 38.3% of patients regarded the fee of foodservice as inexpensive. Overall, the satisfaction score with hospital foodservice was 3.63 on a Likert-type scale ranging from 1 (extremely dissatisfied) to 5 (extremely satisfied). However, the limitations were indicated including the lack of providing nutritional information and quality of taste. In conclusion, the quality of hospital foodservice might not deteriorate even after enforcement of national payment of medical insurance. Further efforts are required for the diversification of menus and legislative work for improving quality of food service for a successful hospital foodservice policy.

업무상 정신질환과 자살 산업재해 신청자 추이 및 특성 분석

김경하 ( Kyung Ha Kim ),황라일 ( Rah Il Hwang ),정성원 ( Sung Won Jung ) 경희대학교 동서의학연구소 2015 동서간호학연구지 Vol.21 No.1

Purpose: This study was conducted to analyze the annual trends and characteristics of work-related mental disorders including suicide among Korean workers. Methods: Employing the Industrial Accident Compensation Insurance (IACI) data collected by the Korea Worker’s Compensation & Welfare Service, we analyzed total work-related mental disorders and suicide cases (n=455) claimed to IACI from 2008 to 2012. We paid a special attention to workers’ socioeconomic status and occupational characteristics. Results: The number of injured workers and industrial accident rate decreased during the study period, whereas the case of work-related mental disorders showed significant increase. Mental disorders cases were more prevalent in workers who were male, aged the 40s, and engaged in finance, as well as with 1-5 years of working duration than their respective counterparts. Increasing trend of suicide cases was statistically significant by the Cochran- Mantel-Haenszel test (p=.002). Conclusion: This study suggests that work-related mental disorder management strategy and system should be established.

인지지원등급자의 주야간보호서비스 이용 현황에 관한 연구

권진희 ( Jin Hee Kwon ),황라일 ( Rah Il Hwang ),장혜민 ( Hye Min Jang ) 한국보건정보통계학회(구 한국보건통계학회) 2021 보건정보통계학회지 Vol.46 No.2

Objectives: The purpose of this study is to provide basic data for developing services suitable for the characteristics of cognitive assistance graders by monitoring the use of day care centers. Methods: In this study, frequency analysis and paired t-test were conducted using a survey conducted before and after the use of the services. Results: ‘Cognitive training’ and ‘Art therapy’ were the most frequent cognitive activity programs implemented, but they did not operate specialized programs for each dementia severity. In addition, day care centers presented difficulties such as a lack of manuals for operating cognitive activity programs. The rate of satisfaction with the service use of cognitive-assistance graders and willingness to continue using the service was high. It was found that they additionally hoped for mobility support necessary for going out and health care services by nurses. After using day care centers, there was little change in cognitive function, depression, and health-related quality of life of cognitive assistance graders. Conclusions: In order to develop a program suitable for the characteristics of cognitive assistance graders, it is necessary to develop a manual and provide professional training for workers in day care centers.

노인장기요양기관에 근무하는 간호사의 근무실태 및 직무만족도 영향 요인

이정석(Lee, JungSuk),황라일(Hwang, RahIl),임민경(Lim, MinKyung) 한국보건간호학회 2015 韓國保健看護學會誌 Vol.29 No.3

Purpose: Th study is to explore the working conditions and factors related to job satisfaction of nurses in long-term care facilities for the elderly. Methods: A total of 127 nurses working long-term care facilities, from June to November 2014, completed questionnaires. Face to face interviews were conducted. The questionnaire consists of a total of 32 questions, including 5 questions related to general characteristics, 15 questions related to working conditions, and 12 questions related to job satisfaction(likert scale of 1 to 5). Results: The majority of nurses were employed in institutional care facilities, in urban area, and in privately owned facilities. On average, employed nurses worked 170.7 hours per month. Only 40.9% of them got more than two million won for their monthly salary. They were satisfied with the nature and worth of their work and the workplace relationship, but not with their wages and promotion opportunity 40.2% of nurses reported satisfaction with job. In multiple logistic regression analysis, age was a statistically significant influencing factor on general job satisfaction. Conclusion: The findings suggest that policies must be to improve nurses’ working conditions, for wages, and to support them with education and training for skills development.

미취학 자녀를 둔 어머니의 취업여부에 따른 양육스트레스와 관련요인

윤지원 ( Ji Won Yoon ),황라일 ( Rah Il Hwang ),조헌하 ( Hun Ha Cho ) 한국여성건강간호학회 2009 여성건강간호학회지 Vol.15 No.4

장기요양 인정자의 사망 전 의료 및 요양서비스 이용 양상 분석

한은정(Eun-jeong Han),황라일(RahIl Hwang),이정석(Jung-suk Lee) 한국사회정책학회 2018 한국사회정책 Vol.25 No.1

본 연구는 노인장기요양보험 인정자 중에서 사망한 자의 임종 관련 의료비를 분석함으로써, 향후 임종 관련 의료비의 효율적 관리방안과 양질의 임종관리 제공방안을 모색하는데 목적이 있다. 본 연구에서 활용한 자료는 건강보험 및 노인장기요양보험 급여이용자료, 통계청 사망원인 통계자료이며, 2008년 7월 1일부터 2012년 12월 31일까지 장기요양 인정등급을 받고 같은 기간 내 사망한 자 총 271,474명을 최종 분석대상자로 하였다. 연구결과 대상자는 여성(60.6%), 75세 이상(74.7%)이 다수를 차지했고, 대부분이 2개 이상의 질환을 보유하고 있었으며, 특히 고혈압(44.3%), 치매(42.3%), 뇌졸중(29.9%) 등 비율이 높았다. 사망원인은 순환기계질환(29.8%), 암(15.3%), 선천성 기형, 변형 및 염색체 이상(14.7%) 등의 순이었고, 사망장소로는 의료기관(64.4%), 자택(22.0%), 사회복지시설(9.2%) 순이었다. 대상자의 등급인정 이후 사망까지 소요시간은 평균 516.2일이었고, 대상자 중 99.3%는 사망 전 1년간 건강보험 또는 장기요양보험 급여를 이용하였다. 특히, 1인당 평균 총 급여비는 사망한 달에 가까워질수록 규모가 커져, 사망 전 12개월 보다 사망 전 1개월에 3배 이상 높아졌다. 또한, 사망 전 1개월간 대상자의 31.8%는 연명치료 범위에 해당하는 치료를 받은 것으로 나타났다. 향후 장기요양 인정자의 임종 관련 불필요한 의료이용 감소 및 효율적 의료관리를 위해 건강보험과 장기요양보험 급여의 통합적 임종관리 전달체계 확립과 호스피스 등 임종케어의 적극적 도입을 제안한다. Purpose: This study empirically investigates the utilization and expenditure of health care and long-term care at the last year of life for long-term care beneficiaries in Korea. Methods: This study used National Health Insurance and Long-term Care Insurance claims data of 271,474 LTCI beneficiaries, who died from July 2008 to December 2012. Their cause of death, place of death, health care costs, and the provision of aggressive care were analyzed. Results: Cardio-vascular disease(29.8%) and cancer(15.3%) were reported as their major cause of death, and hospital(64.4%), home(22.0%), social care facility(9.2%) were analyzed as the place of death. 99.3% of subjects used both health care and long-term care during the last 1 year of life. The average survival period were 516.2 days after they were LTCI beneficiaries. The health care expenditure gradually increased near the death, and the last month were three times more rather than the first month. Furthermore, 31.8% experienced some aggressive cares(CPR, blood transfusion, hemo-dialysis, etc.) at the last month of life. Conclusion: The results of this study suggest that it is important to develop the end of life care policies(for example, hospice, advanced care directives) for the LTCI beneficiaries. They might contribute to the improvement of quality of life and the reduction of health care expenditure of the elderly at the end-of-life.

전국 건강보험가입자의 소득계층별 산과 의료서비스 이용 실적 비교분석

김경하 ( Kyung Ha Kim ),황라일 ( Rah Il Hwang ),윤지원 ( Ji Won Yoon ),류기진 ( Ki Jin Ryu ),홍순철 ( Soon Cheol Hong ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.11

목적 본 연구는 소득계층별 산과 진료실적 추이, 주요 다빈도 질환 및 의료기관 이용양상을 비교분석하기 위해 시도하였다. 연구방법 2004-2008년 지난 5년간 건강보험청구자료 중 산과코드(O00-O99) 전체를 발췌하여 분석하였다. 대상자의 건강보험 자격자료를 이용해 대상자의 일반적 특성을 구분하였고, 건강보험료 부과수준에 따라 소득분위를 5분위로 구분하여 분석하였다. 통계분석은 SAS 프로그램을 이용하였다. 결과 소득1분위 집단은 입원진료실적은 가장 낮은 비율을 차지하는 반면, 외래진료 실적은 최근 2년간 증가추세를 보이는 가운데 가장 높은 비율을 차지하는 것으로 나타났다. 소득1분위는 유산, 전자간증, 자간증의 진료 비율이 높고, 분만은 적은 비율을 차지하였으며, 소득5분위는 고령임부, 다태임신 비율이 높은 것으로 나타났다. 또한 소득수준이 높아질수록 대형병원의 입원 및 외래 이용률이 높은 것으로 나타났다. 결론 본 연구결과, 소득계층별로 다빈도 산과질환 및 의료기관 이용이 차이를 보이는 것으로 확인되었다. 향후 대상자의 소득수준별 특성에 맞는 산전관리프로그램이 필요하며, 특히 저소득층 임신부를 위한 제도적 지원 강화 방안 모색이 필요하다. Objective this study was conducted to compare the trend of obstetrical care service and its performance, different kinds of common obstetrical disease, and different pattern of health care utilization by the classification of income among the National Health Insurance Beneficiaries. Methods This study was investigated on the base of data which were drawn from the “nationwide claim database of Korean National Health Insurance Corporation”. Data were composed of the total cases related to pregnancy, childbirth, and the puerperium from 2004 to 2008. Subjects were divided into five income classes by the amount of medical insurance premium. Statistical analysis was performed using SAS program. Results In terms of the lowest income class, there was the lowest rate of admission but the highest rate of outpatient visits, which were remarkably increased during the last 2 years. The lowest income group showed higher rate of abortion (O00?O08), ectopic pregnancy and preeclampsia (O10?O16) but there was small number of delivery (O80?O84). The highest income group showed higher rate of multifetal gestation and elderly gravida. As they have higher income, they showed tendency to visit general hospital for admission care or outpatient care, Conclusion There were significant differences in obstetric services utilization and prevalence of common obstetrical disease according to income class. New strategy of public medical insurance is needed to support different disease category according to the socioeconomic status. Especially, institutional support should be considered for lower income women who are exposed to higher pregnancy complications.

농어촌 의료서비스 개선사업 성과에 대한 지역주민과 사업담당자간의 인식 비교

이주열(Ju Yul Lee),황라일(Rah Il Hwang) 한국농촌의학 지역보건학회 2018 농촌의학·지역보건 Vol.43 No.2

본 연구는 보건소의 농어촌 의료서비스 개선사업 담당자와 관내 지역주민을 대상으로 농어촌 의료서비스 개선사업 성과에 대한 인식을 파악하는것을 목적으로 하고 있다. 연구대상은 농어촌 의료서비스 개선사업 추진 경험이 있는 141개 보건소의 농어촌 의료서비스 개선사업 담당자와 관내 보건소, 보건지소 및 보건진료소를 방문한 지역주민이며, 자료수집은 구조화된 설문지를 이용하여 실시하였다. 자료분석은 SPSS 22.0을 이용하여 t-test, one-way ANOVA, x2-test를 사용하였다. 연구결과 사업담당자는 지역주민 보다 ‘보건기관의 건물(시설) 개선’ 항목에 대해서는 통계적으로 유의하게 긍정적으로 인식하고 있는 것으로 나타났다. 또한 시 지역 주민이 군 지역 주민 보다 대체로 ‘보건기관 이용 주민 증가’와 ‘보건기관에 대한 주민 인식 개선’ 항목에서 보다 긍정적으로 인식한 반면 사업담당자는 군 지역이 시 지역 보다 ‘새로운 보건의료사업 시작’ 항목에서 보다 긍정적으로 인식하고 있는 것으로 나타났다. 지역주민의 농어촌 의료서비스 사업 전반적 인식도는 성별, 직업별, 지역보건의료기관 종류별로 차이가 있었고, 사업담당자 경우는 직렬에 따라 통계적으로 유의한 차이가 있는 것으로 나타났다. 한편 보건지소와 보건진료소 운영 개편 관련하여 보건지소와 보건진료소 수에 대해서는 적정하다가 가장 많은 가운데 지역주민은 부족하다와 사업담당자는 많다로 응답률의 차이를 보였다. 보건지소 중심 보건진료소 팀제 운영에 대해서는 지역주민은 반대한다에 사업담당자는 찬성한다에 가장 높은 응답률을 보여 차이를 보였다. 결론적으로 농어촌 의료서비스 개선사업 성과 및 보건지소 및 보건진료소 운영체계 개편에 대해 사업담당자와 지역주민 간의 인식 차이가 있음을 확인하였으므로, 향후 획일화된 농어촌 의료서비스 제공 방안을 탈피하여 다양한 지역적 특성과 함께 지역주민의 의견을 반영한 신중한 농어촌 의료서비스 개선사업 및 보건의료체계 구축이 필요할 것이다. Objectives: The purpose of this study is to compare the perceptions of the rural healthcare service improvement project’ performance and reorganization of public health centers between project staffs and local residents. Methods: Data collection from this study was performed in 141 project areas using structured questionnaires. Data analysis was used in SPSS 22.0 version. Results: The public health center staffs were more positive about the items for improving health facilities than the local residents. Residents in the Si area generally perceived performance as more positive than residents in the Gun area, while public health center staffs in the Gun area perceived performance as more positive than public health center staffs in the Si area. Local residents expressed negative opinions about the reduction in the number of branches of public health clinics and health medical clinics. Conclusions: In conclusion, careful improvement projects for rural health care and the establishment of health care systems will be necessary, reflecting the opinions of local residents, along with a variety of regional characteristics.