병원급 의료기관에 따른 임상영양서비스에 대한 전국적 실태 조사 = Hospital Nutrition Service in Korea ; Result of nationwide cross-sectional survey

다국어 초록 (Multilingual Abstract)

Clinical Nutrition Service in Long Term Care Hospital

By Mi Hyang Um
Doctor of Philosophy in Medical Nutrition
Graduate School of East-West Medical Science
Advised by Dr. Yoo Kyoung Park

The purpose of this study was to investigate how clinical nutrition services is provided at a long term care hospital in Korea and to investigate job satisfaction levels of the clinical dietitians.
Survey questionnaire was sent to dietitians working at a long term care hospital in Korea. Hospitals (n=240) were randomly selected from 1,180 long- term care hospitals using a stratified sampling method. A total of 134 long term care hospitals and 223 dietitians completed the survey of clinical nutrition services and job satisfaction questionnaires. The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas.
The results of this study are as follows. The average nutritional screening rate was 17.9% and the rate of computerized nutritional screening system was 9.7% in the participating hospitals. Nutritional intervention rate was only 3.2% of all patients. Korea Institute for Healthcare Accreditation (KOIHA) accredited hospitals showed only 50% performance rate of nutrition service evaluation area. The job satisfaction scores in all four areas ranged from 2/5 to 3/5, implying generally low job satisfaction level in hospital dietitians.
This shows that after achieving KOIHA accreditation, many hospitals do not emphasize the performance of nutritional services.


Key words
Long term care hospital, Clinical nutrition service, Korea Institute for Healthcare Accreditation (KOIHA), Job satisfaction levels

다국어 초록 (Multilingual Abstract)

Clinical Nutrition Service in Tertiary Hospital

By Mi Hyang Um
Doctor of Philosophy in Medical Nutrition
Graduate School of East-West Medical Science
Advised by Dr. Yoo Kyoung Park

Starting from the year of 2007, a total of 29 hospitals in South Korea had received accreditation from JCI (Joint Commission International). Difference in the status of clinical nutrition service provision was compared between JCI accredited tertiary hospitals and non-accredited hospitals.
General facility questionnaire and nutrition service questions were asked to JCI accredited tertiary hospitals and non-JCI accredited tertiary hospitals. Job satisfaction of clinical dietitians was collected from all 43 tertiary hospitals in South Korea. A total of 35 sets of clinical nutrition service survey and 234 sets of clinical dietitian job satisfaction survey was analyzed. The clinical nutrition service questionnaire items were largely divided into two categories of characteristics of hospital and provision of clinical nutrition task. Characteristics of hospital status was comprised of general work related to the hospital and nutrition department, while clinical nutrition task status was comprised of questions on nutrition management of inpatients, inpatient malnutrition status for one month, and post-management issues related to malnourished patients. The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas.
The results of this study are as follows. JCI accredited tertiary hospitals (N=8) showed higher, but not significantly higher, nutritional intervention rate of 12.7% on malnourished patients, compared to 7.0% in non-JCI accredited tertiary hospitals (N=27). In clinical dietitian job satisfaction, JCI accredited tertiary hospitals showed lower job satisfaction scores for job security and wages than non-JCI accredited tertiary hospitals, whereas they showed higher job satisfaction scores in pride as a clinical dietitian and occupational assessment (P<0.05). The areas of improvement for promotion of clinical nutrition service in South Korea, as shown from the top-tier hospitals surveyed, were lack of manpower (1st) and communication with medical staff (2nd).
Accreditation from JCI has shown a positive influence in advancement of not only the hospital service, but also, in the area of clinical nutrition service. However, because of the overall shortage of manpower, decision makers need to develop new strategy to prevent decline in the quality of clinical nutrition service.


Keywords
Clinical nutrition service, Clinical dietitian, Joint Commission International (JCI) accreditation, Tertiary Hospital.

다국어 초록 (Multilingual Abstract)

Clinical Nutrition Service in General Hospital

By Mi Hyang Um
Doctor of Philosophy in Medical Nutrition
Graduate School of East-West Medical Science
Advised by Dr. Yoo Kyoung Park

The purpose of this study was to investigate the status of clinical nutrition services provided at general hospitals in Korea, and to investigate job satisfaction levels of the clinical dietitians.
Survey questionnaire was sent to dietitians working at a general hospital. Hospitals (n=114) were randomly selected from 280 general hospitals using a stratified sampling method. A total of 64 general hospitals and 183 dietitians completed the survey of clinical nutrition services and job satisfaction questionnaires. The clinical nutrition service questionnaire items were largely divided into two categories of characteristics of hospital and provision of clinical nutrition task. Characteristics of hospital status was comprised of general work related to the hospital and nutrition department, while clinical nutrition task status was comprised of questions on nutrition management of inpatients, inpatient malnutrition status for one month, and post-management issues related to malnourished patients. The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas.
The results of this study are as follows. Among the general hospitals surveyed (n=64), fifty had the large-sized general hospitals (>300 beds). The average number of beds was 481 and average length of stay (LOS) was 9 days. Dietitians had 8 years of career experience, on average. 14.3% (n=2) of the medium-sized general hospitals (100-300 beds) were Korea Institute for Healthcare Accreditation (KOIHA) accredited, while 64% (n=32) of the large-sized general hospitals (n=50) were KOIHA accredited. The rate of computerized nutritional screening was 35.7% in the medium-sized general hospitals but 82.0% in the large-sized general hospitals (p<0.01). According to KOIHA accreditation, nutrition screening rate, malnutrition detection rate and nutritional intervention rate were indicating a slight implementation rate, but not a significant difference. On the other hand, according to beds, in the medium-sized general hospitals showed the lowest performance rate of nutritional care, but not a significant difference. Nutrition support team (NST) actively operating was 14.3% (n=2), in less than general hospitals and 58.0% (n=29), in more than general hospitals which indicated a higher NST actively operating rate (p<0.01) according to beds (100-300 beds vs >300 beds).
There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service between general hospitals. Therefore, local solutions are needed to implement nutritional programs and policies for improved service and care.


Key words
Korea Institute for Healthcare Accreditation (KOIHA) accredited, Clinical nutrition service, Medium-sized general hospitals, Large-sized general hospitals.
 

목차 (Table of Contents)

• Chapter １. Literature Review 1
• I. Clinical Nutrition Service 2
• 1. Definition of clinical nutrition service 2
• 2. Malnutrition in hospital 3
• 3. Definition of nutrition care process (NCP) 8
• II. Medical System in Korea 18
• 1. Type of hospital 18
• 2. Accreditation of hospital 20
• III. Reference 27
• Chapter ２. Clinical Nutrition Service in Tertiary Hospital 35
• I. Abstract 36
• II. Introduction 39
• III. Materials and Methods 44
• 1. Subjects and study design 44
• 2. Clinical nutrition service 44
• 3. Job satisfaction level 45
• 4. Data analysis 46
• IV. Results 47
• 1. General characteristics of tertiary hospitals 47
• 2. General characteristics of the clinical dietitian with tertiary hospitals 49
• 3. Food service characteristics of tertiary hospitals 51
• 4. Nutritional screening practice of tertiary hospitals 53
• 5. Variables used in tool developed by the hospital 55
• 6. Nutrition care process implementation status according to JCI accreditation. 57
• 7. Clinical practice of nutrition support team (NST) of tertiary hospitals 59
• 8. Research activity of nutrition department in tertiary hospitals 61
• 9. Job satisfaction levels of tertiary hospitals 63
• 10. Number of the clinical dietitian per 100 beds 65
• 11. Improvement area of clinical dietitian’s task of tertiary hospitals 67
• V. Discussion 69
• VI. Reference 80
• Chapter ３. Clinical Nutrition Service in General Hospital 87
• I. Abstract 88
• II. Introduction 91
• III. Methods and materials 95
• 1. Subjects and study design 95
• 2. Clinical nutrition service 95
• 3. Job satisfaction levels 96
• 4. Data analysis 96
• IV. Results 98
• 1. General characteristics of general hospitals 98
• 2. General characteristics of clinical dietitians according to the hospital size 100
• 3. Food service characteristics of general hospitals. 102
• 4. Nutritional screening practice of general hospitals 104
• 5. Variables used in tools developed by hospital 106
• 6. Nutrition care process implementation rate of general hospitals 108
• 7. Nutrition care process implementation rate according to KOIHA accreditation. 110
• 8. Clinical practice of nutrition support team (NST) in general hospitals 112
• 9. Research activity of the nutrition department in general hospitals 114
• 10. Job satisfaction levels of clinical dietitians in general hospitals 116
• 11. Number of the clinical dietitian per 100 beds 118
• 12. Improvement area of clinical dietitian’s task in general hospitals 120
• V. Discussion 122
• VI. Reference 130
• Chapter ４. Clinical Nutrition Service in Long Term Care Hospital 133
• I. Abstract 134
• II. Introduction 136
• III. Methods and materials 141
• 1. Subjects and study design 141
• 2. Clinical nutrition service 141
• 3. Job satisfaction levels 142
• 4. Data analysis 142
• IV. Results 144
• 1. General characteristics of dietitian in long term care hospitals 144
• 2. General characteristics of the long-term care hospitals. 146
• 3. Nutrition care process implementation rate of long-term care hospitals. 148
• 4. Clinical practice of nutrition support team (NST) in long-term care hospitals 150
• 5. Standards of nutritional implementation rate in KOIHA accreditation of long term care hospitals 152
• 6. Improvement area of dietitian’s tasks according to the KOIHA accreditation of long-term care hospitals. 154
• 7. Job satisfaction levels of dietitians according to the KOIHA accreditation of long-term care hospitals 156
• 8. National registration data on long term care hospital and dietitian 158
• V. Discussion 160
• VI. Reference 173