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관상동맥스텐트 삽입술환자의 가정간호 효과 및 비용분석

Other Titles
 Effectiveness and cost of home health care after coronary stent implantation 
Authors
 김재은 
Issue Date
2008
Description
가정간호전공/석사
Abstract
[한글] 본 연구는 관상동맥스텐트 삽입술을 한 환자를 대상으로 병원입원과 가정간호에서의 효과 및 비용을 비교함으로서 가정간호서비스 효과와 경제적 타당성을 분석하고자 한 실험연구이다. 연구대상은 서울소재의 일 대학병원에서 안정성협심증으로 스텐트 삽입술을 받은 환자이며, 연구대상자는 대조군(병원입원환자군)과 실험군(가정간호환자군)에 무작위 배정되었다. 연구대상자수는 병원입원환자군 20명, 가정간호환자군 12명으로 총 32명이었다. 병원입원과 가정간호 효과 비교는 활력증상, 식욕상태, 배뇨양상, 배변양상, 수면양상, 일상생활수행능력, 합병증 발생, 재입원율과 응급실 방문율과 같은 환자결과와 주돌봄자의 부담감 정도를 통해 평가되었다. 비용비교는 총의료비를 통해 평가되었다. 수집된 자료는 SPSS 12.0 을 이용하여 전산 통계처리 하였다. 빈도와 백분율, 평균과 표준편차, Mann-Whitney U 검정, Chi-squre 또는 Fisher's Exact test로 분석한 것으로 결과는 다음과 같다. 1) 환자결과(Patient outcome) 식욕상태 및 수면양상은 가정간호를 받은 대상자들에게서 호전되어 유의한 차이가 있는 것으로 나타났다. 그 외 활력증상, 배뇨양상, 배변양상, 일상생활수행능력, 합병증(시술부위 출혈, 열감, 부종, 분비물 배액, 혈종, 통증 및 허리통증), 재입원율과 응급실 방문율은 서비스 이용형태별로 유의한 차이가 없는 것으로 나타났다. 2) 주돌봄자의 부담감 주돌봄자의 부담감의 세부항목 중??환자에게 드는 비용이 너무 비싸다??에서 병원입원환자군의의 평균점수가 가정간호환자군의 평균점수보다 높아 두 군간에 유의하게 차이가 있는 것으로 나타났다(z=-2.55, p=.01). 그 외 부담감을 조사한 다른 항목이나 총점은 서비스 이용형태별 유의한 차이가 없는 것으로 파악되었다. 3) 비용효과측면 시술후 1일째부터 시술후 2일째까지의 총의료비용은 병원입원군에서 438216.35 ± 153771.47원, 가정간호군에서 240642.75 ± 143680.64원으로 두 군간에는 유의한 차이를 보였으며(p=.00), 관상동맥 스텐트 삽입술 후 가정간호를 받은 환자의 경우 1인당 약 50%정도 비용절감 효과가 있는 것으로 나타났다. 본 연구의 결과 병원입원환자군과 가정간호환자군 비교시 환자결과와 합병증 발생빈도에 차이가 없고, 식욕상태 및 수면양상은 가정간호환자군에서 유의하게 호전되었으며, 가정간호 환자군에서 주돌봄자 부담감이 낮았고, 의료비용이 저렴한 것으로 나타났으므로 불안정성 협심증, 급성심근경색 등으로 관상동맥스텐트 삽입술을 받은 환자, Percutaneous Transluminal Angioplasty(PTA)받은 환자, Coronary Artery Bypass Graft(CABG) 또는 Cardiac valve repair 수술 받은 환자들 중에 저위험도를 보인 환자들에게 가정간호 연계를 통한 조기퇴원으로 환자와 병원 그리고 국가적으로 많은 의료비의 절감을 가져올 수 있을 것으로 사료된다.
[영문] This study is the experimental research to analyse the effect of home health care service and economical propriety by comparing the effect and the cost of home health care with the hospitalization for the patients who had the coronary stent implantation. The object is the patients who get the coronary stent implantation for stable angina in the University hospital in Seoul. The patients are assigned randomly to control group(the patients who was in hospitalization) and experimental group(the patients who had home nursing care). The objects are total thirty-two patients composed of twenty patients in control group and twelve patients in experimental group. The comparison of the effect between hospitalization and home health care was evaluated by this. That is the result of vital sign, urination state, sleeping state, ADL, the occurrence of complication, the rate of re-hospitalization and the visits of ER , and the pressure's degree of main care-giver. The collecting data was taken statistics by SPSS 12.0. The result was descriptive of the below analysed by the frequency, the percentage and the mean, the standard deviation, and the official approval of Mann-Whitney U, Chi-square, and Fisher's Exact test. 1) Patient outcome The data showed the special difference by the result of changing for the better in the appetite and the sleeping state for the patients who got home health care service. Besides, other variables, which was vital sign, urination state, defecation state, complications(bleeding in the operation-site, heat feeling(fever), edema, the leakage of the secretion, hematoma, the pain and back pain), did not make the difference statistically. 2) The pressure of main care-giver Among the specific items of the care-giver's pressure, the item which explained like this; "The cost burdened to the patients is so expensive" showed the special difference by the low mean scores of home health care service patients compared to the mean of the hospitalization patients (z=-2.55, p=.01). Aside from that, for service usage type, it was acquired of no special difference in the other item or total score investigating the pressure. 3) The cost-effective aspect The total medical fee from first day to second day after procedure was 438216.35 ± 153771.47 won in hospitalization group and 240642.75 ± 143680.64 won in home health care group. Like this, there was the special difference between two groups(p=.00). Moreover, in the case of the patient who got home-nursing care after stent implantation , there appeared 50 % cost-reduction effect per one person. In the result of this study, comparing hospitalization group with home health care group, there was no difference in patient outcome and the frequency of complication. The appetite and sleeping condition was improved statistically in the group of home nursing group. In addition, in the home nursing care group, the pressure of main care-giver was low and the medical fee was cheaper than hospitalization group. In the end, we could think that the plenty medical fee would be cut down in the side of the patient, the hospital, and the nation through the early-discharge connected with home health care, especially to the patients who had coronary stent implantation for unstable angina, MI, the patients Percutaneous Transluminal Angioplasty(PTA), and the patients who appeared low-risk among the patients who got Coronary Artery Bypass Graft(CABG) or Cardiac valve repair operation.
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Appears in Collections:
3. College of Nursing (간호대학) > Others (기타) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/137176
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