[논문]당뇨 또는 고혈압 환자의 상급종합병원 이용에 미치는 요인

최재우; 박소희; 최윤수; 김태경; 윤효정; 김태현

당뇨 또는 고혈압 환자의 상급종합병원 이용에 미치는 요인
Factors associated with the choice of tertiary hospitals in patients with diabetes or hypertension 원문보기

병원경영학회지 = Korea journal of hospital management, v.21 no.4, 2016년, pp.13 - 22

최재우 (연세대학교 대학원 보건학과) , 박소희 (연세대학교 보건정책 및 관리연구소) , 최윤수 (연세대학교 대학원 보건학과) , 김태경 (연세대학교 대학원 보건학과) , 윤효정 (연세대학교 대학원 보건학과) , 김태현 (연세대학교 보건정책 및 관리연구소)

초록
AI-Helper

목적: 이 연구는 당뇨와 고혈압 환자의 상급종합병원 이용에 미치는 요인을 관찰하였다. 방법: 이 연구는 한국보건사회연구원과 국민건강보험공단이 공동으로 조사하는 한국의료패널 자료를 사용하였다(2008년, 2010년, 2012년). 연구대상은 20세 이상 성인이었으며 각 2008년에 2409명, 2010년에 2424명, 2012년에 2429명을 관찰하였다. 당뇨와 고혈압에 대한 외래방문 건수는 총 64,438건이었으며 당뇨 또는 고혈압 환자의 3차 의료기관 선택에 영향을 주는 요인을 관찰하기 위해 다수준 로지스틱 회귀분석을 활용하였다. 결과: 교육수준이 높은 환자가 낮은 환자에 비해 상급종합병원을 이용할 확률이 각각 2008년에 2.04배, 2010년에 1.83배, 그리고 2012년에 1.65배 더 높았다. 또한 고소득 환자가 저소득 환자에 비해 3차 의료기관을 이용할 확률이 2008년에 1.77배, 2010년 1.91배 그리고 2012년 1.94배 더 높았다. 결론: 정책입안자들은 의료전달 시스템과 관련하여 정책을 실행할 때 이러한 환자의 특징을 고려할 필요가 있다.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

This research examined Korean diabetes or hypertension patients and their usage of medical institutes. Specifically, we analyzed the socioeconomic factors affecting the usage of tertiary hospitals.

제안 방법

This study included sex, age, education level, marital condition, income, participation in economic activities, form of medical insurance (i.e., health insurance, medical care assistant), existence of a disability, subjective health condition, and CCI as variables. Education level and income were set as socioeconomic specific variables.
This study was designed to understand the reasons behind the usage of tertiary hospitals for outpatient treatment of diabetes and hypertension patients, which is a critical component of the chronic illness management system, and provide basic data for the designing of future policies. Our results showed that patients with a high education level (above undergraduate level), a high income, medical-aid assistance as their form of medical insurance, a poor subjective health condition, and a high level of CCI had a higher probability of using tertiary hospitals.

이론/모형

Difference in outpatient usage rate of diabetes or hypertension patients was analyzed with a chi-square test. A binary logistic regression model was used to analyze the factors contributing to higher usage of tertiary hospitals in relation to clinics and hospital-level medical institutes.
To maintain the legitimacy of a national scale study, the data extraction frame was set to 90% of the 2005 population housing survey. A stratified clustered systematic method was used to select the sample of households for this research. First, sample enumeration was extracted; second, sample households were extracted from the sample enumeration.
CCI was originally developed to describe the death risk of patients in experimental studies; however, it is also widely used as a common method of describing comorbidity severity. CCI was calculated using a Quan algorithm, a coding method of the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The reason for this was that the classification for illness codes of the Korea Health Panel was based on the sixth edition of the Korean Classification Disease (KCD-6), which is similar to the ICD-10 and made one-to-one matching of illness codes possible [20].

성능/효과

Figure 1 shows the change of tertiary hospital usage level depending on the socioeconomic factors of diabetes or hypertension patients for the past 5 years. First, the usage level depending on education level decreased over time and this decrease was largest for patients with the highest level of education. In addition, a similar observation was made for income level income where the usage of tertiary hospitals continuously declined over the last 5 years with the largest decrease existing for patients with the highest income level.
This study was designed to understand the reasons behind the usage of tertiary hospitals for outpatient treatment of diabetes and hypertension patients, which is a critical component of the chronic illness management system, and provide basic data for the designing of future policies. Our results showed that patients with a high education level (above undergraduate level), a high income, medical-aid assistance as their form of medical insurance, a poor subjective health condition, and a high level of CCI had a higher probability of using tertiary hospitals.

참고문헌 (24)

Kim Y, Suh YK, Choi H. BMI and metabolic disorders in South Korean adults: 1998 Korea National Health and Nutrition Survey. Obes Res 2004;12:445-453.

상세보기
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004;22:11-19.

상세보기
Hwang J, Shon C. Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. BMJ Open 2014;4:e005710.

상세보기
OECD. Health at a glance 2013: OECD indicators. Organisation for Economic Co-operation and Development (OECD) Publishing, 2013.
Choi YJ, Kim HC, Kim HM, Park SW, Kim J, et al. Prevalence and management of diabetes in Korean adults: Korea National Health and Nutrition Examination Surveys 1998-2005. Diabetes Care 2009;32:2016-2020.

상세보기
Ofori SN, Unachukwu CN. Holistic approach to prevention and management of type 2 diabetes mellitus in a family setting. Diabetes Metab Syndr Obes 2014;7:159-168.

상세보기
Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014;383:1999-2007.

상세보기
Booth G, Cheng AY. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Methods. Can J Diabetes 2013;37 Suppl 1:S4-7.
Kaczorowski J, Del Grande C, Nadeau-Grenier V. Community-based programs to improve prevention and management of hypertension: recent Canadian experiences, challenges, and opportunities. Can J Cardiol 2013;29:571-578.

상세보기
Tocci G, Giovannelli F, Sciarretta S, Ferrucci A, Zito GB, et al. Management of hypertension and stroke prevention: results of the Italian cardiologist survey. Int J Clin Pract 2009;63: 207-216.

상세보기
Campbell N, Young ER, Drouin D, Legowski B, Adams MA, et al. A framework for discussion on how to improve prevention, management, and control of hypertension in Canada. Can J Cardiol 2012;28:262-269.

상세보기
Kim YK, Kim JS. A study on healthcare institution selection of healthcare consumers using theory of consumption values: focusing on relations among clinics or small sized hospitals, general hospitals, and large-sized hospitals. J Korean Soc Qual Manag 2009;37:71-86.
Oh YH, Do SR, Son CK, Park DS, Kim JW, et al. Development and management of monitoring system to improve the efficiency of health care resources allocation: health care resources, Korea, 2010. Korea Institute for Health and Social Affairs.
National Health Insurance Corporation. 2010 national health insurance statistical yearbook [Internet]. Seoul: National Health Insurance Corporation, 2012.
Ministry of Health and Welfare. Basic plan for re-setting role and function of medical providers [Internet]. Seoul: Ministry of Health and Welfare, 2011.
Yoo CH, Kwon YD. Factors influencing medical institution selection for outpatient services. J Korean Med Assoc 2012;55(9):898-910.

상세보기
Cho SJ, Chung SH, JY Oh. Differences between diabetic patients' tertiary hospital and non-tertiary hospital utilization according to comorbidity score. Korean J Health Policy Adm 2011;21: 527-540.

원문보기 상세보기
Lee JC, Kim KH, Kim HN, Park YH. Factors associated with the hypertension outpatients' choice of healthcare providers in Korea. J Korean Med Assoc 2011;54:961-970.

상세보기
Lee JC, Kim KH, Kim HN, Kim NS. Factors associated with diabetes outpatient use of tertiary or general hospitals as their usual source of care in Korea. J Korean Med Assoc 2012;55: 1215-1225.

상세보기
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130-1139.

상세보기
Dominick KL, Dudley TK, Coffman CJ, Bosworth HB. Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis. Arthritis Rheum 2005;53:666-672.

상세보기
Park YH. The Characteristics and utilization factors of tertiary hospital inpatients: evidence from Korea Health Panel (2008-2011). The Korean Journal of Health Service Management 2014;8(3):13-25.
Kim HJ, Kim YH, Kim HS, Woo JS, Oh SJ. The impact of outpatient coinsurance rate increase on outpatient health care service utilization in tertiary and general hospital. Korean J Health Policy Adm 2013;23(1):19-34.

원문보기 상세보기
Shin SM, Kim ES, Lee HW. Self-perception of the amount of medical aid use of outpatient over users in Korea. Korean J Health Policy Adm 2009;19:21-35.

원문보기 상세보기

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증