[논문]한국형 재활환자분류체계 버전 1.0 개발

황수진; 김애련; 문선혜; 김지희; 김진휘; 하영혜; 양옥영

doi:10.4332/kjhpa.2016.26.4.289

한국형 재활환자분류체계 버전 1.0 개발
The Development of Korean Rehabilitation Patient Group Version 1.0 원문보기

Health policy and management = 보건행정학회지, v.26 no.4, 2016년, pp.289 - 304

황수진 (건강보험심사평가원) , 김애련 (건강보험심사평가원) , 문선혜 (건강보험심사평가원) , 김지희 (건강보험심사평가원) , 김진휘 (건강보험심사평가원) , 하영혜 (건강보험심사평가원) , 양옥영 (건강보험심사평가원)

Abstract ▼ AI-Helper

Background: Rehabilitations in subacute phase are different from acute treatments regarding the characteristics and required resource consumption of the treatments. Lack of accuracy and validity of the Korean Diagnosis Related Group and Korean Out-Patient Group for the acute patients as the case-mix and payment tool for rehabilitation inpatients have been problematic issues. The objective of the study was to develop the Korean Rehabilitation Patient Group (KRPG) reflecting the characteristics of rehabilitation inpatients. Methods: As a retrospective medical record survey regarding rehabilitation inpatients, 4,207 episodes were collected through 42 hospitals. Considering the opinions of clinical experts and the decision-tree analysis, the variables for the KRPG system demonstrating the characteristics of rehabilitation inpatients were derived, and the splitting standards of the relevant variables were also set. Using the derived variables, we have drawn the rehabilitation inpatient classification model reflecting the clinical situation of Korea. The performance evaluation was conducted on the KRPG system. Results: The KRPG was targeted at the inpatients with brain or spinal cord injury. The etiologic disease, functional status (cognitive function, activity of daily living, muscle strength, spasticity, level and grade of spinal cord injury), and the patient's age were the variables in the rehabilitation patients. The algorithm of KRPG system after applying the derived variables and total 204 rehabilitation patient groups were developed. The KRPG explained 11.8% of variance in charge for rehabilitation inpatients. It also explained 13.8% of variance in length of stay for them. Conclusion: The KRPG version 1.0 reflecting the clinical characteristics of rehabilitation inpatients was classified as 204 groups.

주제어

질의응답

핵심어	질문	논문에서 추출한 답변
	환자분류체계의 사용 분야는?	환자분류체계(patient classification system)는 상병, 시술 및 기능상태 등을 이용하여 자원소모나 임상적 측면에서 유사한 그룹으로 분류하는 체계이다. 환자분류체계는 포괄수가제의 지불단위이며, 병원 간 진료비용, 사망률 및 질 지표 비교, 의료기관 기능평가 등에 광범위하게 사용되고 있다. 현재 우리나라 보건의료제도 내에서 널리 사용되는 의과 환자분류체계인 한국형 입원환자분류 체계(Korean Diagnosis Related Group, KDRG)와 한국형 외래환자분류체계(Korean Out-Patient Group, KOPG)는 주로 급성기 환자에 적용된다[1].
	국외의 재활환자분류체계는 어떠한 것들이 있는가?	제외국의 재활환자분류체계는 독립적 환자분류체계 형태로 운영되거나 급성기 입원환자분류체계 내에서 재활환자분류체계를 별도 형태로 운영하고 있다. 독립적 형태로는 미국 Case-Mix Groups (CMG), 호주 Australian National Subacute and Non-Acute Patient Casemix Classification (AN-SNAP), 캐나다 Rehabilitation Patient Groups (RPG) 등이 있다. 급성기 입원환자분류체계 내에서 운영되는 형태는 영국의 Healthcare Resource Group (HRG)에서 재활 질병군이 23개 배정되는 경우와 Nord-DRG에서 33개의 재활 질병군이 할당되는 경우이다[2-4]. 이 중 미국, 호주와 영국의 재활환자분류체계에 대한 주요한 내용은 Table 1과 같으며[2,4-9], 호주 AN-SNAP의 경우는 급성기 이후 의료서비스 영역(재활의료, 완화의료, 노인 정신의료, 노인건강 평가 및 관리, 유지관리)과 의료 제공 유형(입원, 당일 입원, 외래, 지역사회 기반)을 모두 분류하는 환자분류체계로 본 연구의 범위인 입원 재활 부분만 포함하였다.
	환자분류체계는 무엇인가?	환자분류체계(patient classification system)는 상병, 시술 및 기능상태 등을 이용하여 자원소모나 임상적 측면에서 유사한 그룹으로 분류하는 체계이다. 환자분류체계는 포괄수가제의 지불단위이며, 병원 간 진료비용, 사망률 및 질 지표 비교, 의료기관 기능평가 등에 광범위하게 사용되고 있다.

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