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주진료과 변경(전과) 여부에 따른 재원기간과 진료비 분석 : 담낭절제술환자를 대상으로

주진료과 변경(전과) 여부에 따른 재원기간과 진료비 분석 : 담낭절제술환자를 대상으로
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(A) study of the effect of department transfer on length of hospital stay and charges
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연세대학교 보건대학원
[한글] 재원기간과 진료비에 대한 관련변수들과 주진료과변경 (전과)과의 상관관계를 구명하고자 한 의과대학부속병원에서 1985-1986년 사이 담낭결석을 주진단으로 담낭절제술을 받은 환자 319명중 의료보험가입자로서 조사가 가능했던 총214명을 대상으로 의무기록지와 전산실의 진료비자료를 이용하여 t-검정과 이중분산분석 및 다변수 희귀분석등으로 분석하였다. 1. 전과가 응급실경유내원환자, 응급수술받은 환자, 협의진단건수가 많은 환자인 중한 그룹에 많아 질병이 중할 때 유의하계 많았음을 보였다. 2. 전과여부에 따라 재원기간과 상관성이 있는 변수는 입원경로. 주진단명, T-튜브시술 여부, 드레니지시술여부였으며, 전과여부에 따라 진료비와 상관성이 있는 변수는 입원경로, 후송여부였다. 3 .총재원기간은 내과입원군이 더 길었으나 수술후 재원기간에는 전과여부에 따라 통계학적으로 유의한 차이가 없었고, 총진료비는 내과 입원군이 더 높았으나 재원기간이 길므로 일일평균 진료비는 통계학적으로 유의하게 낮았다. 4. 재원기간과 상관성이 높아 선정된 9개변수가 외과입원군과 총재원기간을 72% 설명하는 반면 내과입원군에서는 34%를 설명하였다. 진료비와 높은 상관성을 보여 선정된 9개변수는 외과입원군의 총진료비률 61%, 설명하는데 비해 내과입원군에서는 55%를 설명하였다. 이상을 요약하면, 전과여부와 질병의 경중도와는 상관성이 있으나 질병의 경중에 관계없이 전과여부에 따라 총재원기간에 통계학적으로 유의한 차이가 있었다. 그러나 이는 전과전재원기간과 수술전 재원기간의 차이때문이며 수술후 재원기간에는 전과여부에 따라 통계학적 유의한 차이가 없었다. 따라서 입원에서 수술까지의 재원기간에 대한 현장검토 방식의 심층연구가 있어야 할 것이다.
[영문] The purpose of this study is to examine the correlation between the variables related to length of hospital stay and hospital charges, and the effect of department transfer on these variables. On the 319 inpatients whose primary diagnosis was recorded as cholelithiasis and who then received cholecystectomy at a medical college affiliated hospital during the years 1985 and 1986, 256 cases were registered for medical insurance. Fourty-two missing or incomplete charts were deleted, leaving 214. These were studied statistically for such correlation by means of t-test, 2-way anova test and multip1e regression based on medical record data and medical charges stored on computer. 1. Cases of transfer of medical department were significantly more in number in serious patients such as those admitted via emergency room, inpatients who received emergency surgery, inpatients who received three or more consultation requests. 2. The length of hospital stay was affected by four variables which correlated with transfer of medical department: admission route, major diagnosis, T-tube operation and use of drainage. The hospital charges were affected by two variables which also correlated with transfer of medical department: admission and referred-or-not. 3. In cases of transfer of medical department, total length of hospital stay was significantly longer, whereas postoperative length of stay was not. Statistically the total hospital charges were significantly higher in cases of transfer of medical department, but the daily hospital charges on an average basis were found to be significantly lower. The reason for the low daily average was the relatively long length of hospital stay. 4. Nine variables which showed a high correlation with length of hospital stay were related to 72% of length of stay of those who were not transferred to other medical departments but related only to 34% of length of stay of those who were transferred. Another nine variables correlating with hospital charges show high correlation tilth 61% of charges of the nontransferred cases but with only 55% of charges of the transferred cases. In conclusion, the transfer of medical department and seriousness of illness were correlated and there was a statistically significant difference in the total length of hospital stay between the two groups: those with department transfer and those without. Of note is the finding that the length of post-operative stay showed no significant difference between groups. Therefore, it would seem to be highly advisable to do a concurrent review of a similar selection of cases to determine the factors responsible for the variation In length of hospital stay from admittance up to operation.
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