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병원중심 가정간호사업 관리대상범위 확대를 위한 기초연구
이숙자,이진경,유호신,Lee, Sook-Ja,Lee, Jin-Kyung,Ryu, Ho-Sihn 한국가정간호학회 1999 가정간호학회지 Vol.6 No.-
This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health ca
이숙자(Lee Sookja) 한국정치학회 1996 한국정치학회보 Vol.29 No.4
북한 외교정책의 변화에 대한 연구는 통일을 위한 대전제이기 때문에 매우 중요하다. 본 논문의 목적은 북한이 탈냉전기에 미국과 정부간 접촉을 적극적으로 전개하게 된 결정요인을 브레쳐 모델에 적용하여 분석코자 하는 데 있었다. 논문의 분석 결과, 조작적 환경의 외적 환경요인으로는 사회주의권의 대변혁으로 인한 냉전체제의 붕괴와 국제정치경제의 역학관계로 표출되는 신국제질서의 등장, 동북아에서의 ‘북방 3각관계’의 변질, 그리고 남북한 국력의 차이가 대미 접근의 주요 결정요인으로 파악되었다. 내적 환경요인은 북한 동맹체제의 변질에 따른 안보위기의 심화가 북한체제의 정치적, 경제적 취약성을 더욱 악화시킨 요인으로 보였다. 북한은 생존을 위해 핵무기를 개발하려 했으나, 미국을 위시한 전세계의 압력에 부딪치자 핵무기를 협상카드로 활용하여 미국과의 단독회담을 이끌어 내었다. 북한은 미국과의 관계개선이 북한의 3대난(難)을 동시에 해결해 주는 중심 고리로 생각한 것 같다. 심리적 환경요인으로 북한지도자들에게 프리즘의 역할을 하는 것은 주체사상에서 연유된 배타주의, 사회주의의 우월성과 불패성, 그리고 자본주의의 필연적인 멸망에 대한 믿음 등이다. 이러한 주체이념으로 무장된 북한지도자들의 미국에 대한 호전적 이미지는 북한의 대미 관계개선 과정에서 부정적인 영향을 주는 요인으로 분석되었다. 이러한 분석 결과를 기반으로 하여 향후 북한의 대미 외교정책을 전망하면서, 대외개방이 북한에게 미칠 영향과 문제점에 대해 지적하였다.