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KMID : 0439019930020010151
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Korean Journal of Nursing Query
1993 Volume.2 No. 1 p.151 ~ p.178
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A Study on Estimation of Early Discharge Day for Home Health Care and Medical Expense for Inpatients
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김모임/Kim, Mo Im
김의숙/유호신/추수경/이규식/이종길/Kim, Euisook/Ryu, Ho Shin/Chu, Su Kyung/Lee, Kyu Sik/Lee, Chong Kil
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Abstract
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This report was done mid way trought the study IA Demonstration-Cum-Research on the Reimbursement system and cost-effectiveness of Home Health Care Program in Koreaj. It focused on developing an estimation of early discharge day to home health care based on analysis medical records and on an analysis of medical expenses based on a detailed statement of treatment for inpatients who were hospitalized at S General Hospital in 1991.
Two reserch methods were adopted for estimation of the early discharge day. One was micro-anlaysis from the medical records and the other was macro-anlysis to clarify the estimated early discharge day to home health care for patients with four diseases judged from need assessment to be candidates for this type of program, namely patients with, Cesarian Section, Hypertension, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease(COPD).
Estimation of early discharge day to home health care were developed through many aspects of analysis of the signs and symptioms by disease in a micro-analysis in addition to a decrease in the amount of treatment, drugs, tests and changes in the test consistency, drug methods, and client´s condition in the macro-analysis.
Accordingly, an early discharge day for inpatients was finally estimated through the analysis of the client´s conditions and treatment, drugs, tests, and nursing care
activities that the patient received during hospitalization. From the research findings, the following summerized conclusions have drawn.
First, for patients with Cesarian Sections, after assessing each items using the two analysis methods, the mean period of hospitalization was 8.8 days, but the mean period of hospitalization was estimated at 4.1 days if early discharge to home health care could be done.
Second, for patients with Hypertension, the same method as for the patients with the Cesarian Sections was used and the result was reduction from a mean period of the hospitalization of 9.9 days to a mean period of the hospitalization of 5.2 days.
Third, for patients with Diabetes Mellitus there was a decrease from a mean period of the hospitalization of 11.7 days to a mean period of hospitalization of 8.4 days if early discharge to home health care could be done.
Fourth, for patients with Chronic Obstructive Pulmonary Disease, the mean period of the hospitalization was 14.3 days, but the mean period of the hospitalization could be 8.1 days if early discharge to home health care could be done.
In order to estimate fees for home health service, medical expenditure of hospital In-patients and Out-patients was analyzed to estimate number of days early discharge might be achieved by disease.
First, for patients with a Cesarian Section the mean medical expenditure per day for the early period of hospitalization was found to be 172,593 Won, whereas the mean medical expenditure per day for days after the estimated early discharge day was 64, 196 Won and the mean cost per visit for out-patients was 9,270 Won.
Second, for patients with Hypertension, the mean medical expenditure per day for the early period of hospitalization was 119,414 Won, whereas the mean medical expenditure per day for days after the estimated early discharge day was 52,414 Won and the mean cost per visit for out-patients was 28,073 Won.
Third, for patients with Diabetes Mellitus the mean medical expenditure per day for the early period of hospitalization was 93,239 Won, whereas the mean medical expenditure per day for days after the estimated early discharge day was 70,927 Won and the mean cost per visit for out-patients was 27,996 Won.
Fourth, for patients with Chronic Obstructive Pulmonary Disease, the mean medical expenditure per day for early period of hospitalization was 115,977 Won, whereas the mean medical expenditure per day for days after the estimated early discharge day was 79,808 Won and the mean cost per visit for out patients was 30,764 Won.
From these research findings, the following conclusions have been drawn. Home health care should be offered not only because it is cost effective to hospital management but also because it is satisfactory to the patient. Therefore, in order to identify the early discharge point criteria and the cost for home health care, study is required to develop a base covering the care actually received during home health care and an analysis of the medical expenses for treatment during hospitalization.
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