노인 수술 환자의 간호·간병통합서비스 이용 현황 및 영향 요인

Abstract

This cross-sectional and correlational study used a secondary analysis with 2016 claims data of the Health Insurance Review and Assessment Service to identify the utilization and the influencing factors of the comprehensive nursing services in elderly surgical patients. The inpatient sample data used in this study includes 987,763 claims data extracted from 6,374 people who admitted the comprehensive nursing service and 75,466 people who admitted the general ward among the older adults after operation. Independent t-test, chi-square test and hierarchical logistic regression analysis were performed using SAS statistical software version 9.4. The results of this study are as follows. 1. Comparing the patient characteristics of comprehensive nursing service users and those of general ward showed statistically significant difference in sex (=403.96, p<.001), department (=1426.42, p<.001), major diagnosis (=2206.23, p<.001), admission route (=636.98, p<.001), intensive care unit entrance (=486.48, p<.001), and Charlson comorbidity index (=239.18, p<.001). 2. Comparing the health care institution features, there was statistically significant difference in the types of health care institutions (=2357.34 p<.001) and location (=1009.31, p<.001), the number of doctors per 50 beds (t=57.61, p<.001), and the number of nurses per 50 beds (t=-4.93, p<.001). 3. The average cost of hospitalization±standard deviation of the comprehensive nursing services users was 5,538,921±4,296,282 won, and median value was 4,567,915 won. In addition, the number of hospital days±standard deviation of comprehensive nursing services users were 14.25±11.12 days and median was 12 days. As a result of comparing the average cost of hospitalization (t=-9.80, p<.001) and the number of hospital days (t=-8.07, p<.001) with those of general wards, the number of hospital days for comprehensive nursing services was longer and cost of hospitalization were higher. 4. Factors influencing the utilization of comprehensive nursing services were significant: age, sex, department, major diagnosis, admission route, intensive care unit entrance, medical assistance type, types of health care institutions, and health care institution location as well as the number of doctors and nurses per 50 beds of health care institution. In the final model of this study, it can be confirmed that the health care institution features have the greatest influence on the utilization of comprehensive nursing services in the elderly surgical patients. This study was meaningful in that the utilization and characteristics of the use of comprehensive nursing services of elderly surgical patients were identified by comparing them with those of the general ward and analysing the influencing factors of the use of comprehensive nursing services. It provides evidence data for helping decision making of comprehensive nursing services for medical staff and eldery surgical patients, provides baseline data on guideline for the use of comprehensive nursing services for eldery surgical patients, and provide suggestions for the spread of relevant policies.