인구 고령화와 서구화된 생활로 인한 허혈성 심장질환이 지속적으로 증가하고 있으며, 우리나라는 OCED 국가 중에서 허혈성 심장질환의 재원일수가 높은 국가에 속한다. 재원일수 증가는 진료비 상승의 주요 원인이므로, 허혈성 심장질환의 재원일수 관리방안 마련이 필요하다. 이에 본 연구는 허혈성 심장질환자의 재원일수에 영향을 미치는 요인을 파악하여 재원 일수 관리에 필요한 기초자료를 제공하고자 시도되었다. 연구대상자는 일개 상급종합병원의 2015년1월1일부터 12월31일까지 순환기내과의 퇴원환자 중에서 주진단명이 허혈성 심장질환인 환자 566명이다. 자료분석은 IBM SPSS ver. 23.0을 이용하여 빈도분석, 교착분석, Fisher's test, One-way ANOVA, $Scheff{\acute{e}}$ test, 더미변수를 이용한 다중회귀분석을 실시하였다. 연구결과는 첫째, 흉통을 주호소로 입원한 환자가 가장 많았다. 둘째, 평균 재원일수는 4.89일이었으며, 허혈성 심장질환 종류별로 재원일수에 차이가 있었다. 셋째, 75세이상, 당뇨병, 호흡곤란 증상이 재원일수를 증가시키는 요인으로 나타났다. 따라서 허혈성 심장질환의 적정 재원일수 관리를 위해서는 당뇨병을 동반한 허혈성 심장질환자의 경우에는 혈당조절을 통해서 질병의 진행을 막는 것이 중요하며, 증상이 나타났을 경우 빠른 시간 내에 의료기관을 방문할 수 있는 체계마련이 필요하다.
인구 고령화와 서구화된 생활로 인한 허혈성 심장질환이 지속적으로 증가하고 있으며, 우리나라는 OCED 국가 중에서 허혈성 심장질환의 재원일수가 높은 국가에 속한다. 재원일수 증가는 진료비 상승의 주요 원인이므로, 허혈성 심장질환의 재원일수 관리방안 마련이 필요하다. 이에 본 연구는 허혈성 심장질환자의 재원일수에 영향을 미치는 요인을 파악하여 재원 일수 관리에 필요한 기초자료를 제공하고자 시도되었다. 연구대상자는 일개 상급종합병원의 2015년1월1일부터 12월31일까지 순환기내과의 퇴원환자 중에서 주진단명이 허혈성 심장질환인 환자 566명이다. 자료분석은 IBM SPSS ver. 23.0을 이용하여 빈도분석, 교착분석, Fisher's test, One-way ANOVA, $Scheff{\acute{e}}$ test, 더미변수를 이용한 다중회귀분석을 실시하였다. 연구결과는 첫째, 흉통을 주호소로 입원한 환자가 가장 많았다. 둘째, 평균 재원일수는 4.89일이었으며, 허혈성 심장질환 종류별로 재원일수에 차이가 있었다. 셋째, 75세이상, 당뇨병, 호흡곤란 증상이 재원일수를 증가시키는 요인으로 나타났다. 따라서 허혈성 심장질환의 적정 재원일수 관리를 위해서는 당뇨병을 동반한 허혈성 심장질환자의 경우에는 혈당조절을 통해서 질병의 진행을 막는 것이 중요하며, 증상이 나타났을 경우 빠른 시간 내에 의료기관을 방문할 수 있는 체계마련이 필요하다.
Due to population aging and westernized lifestyle, ischemic heart diseases are increasing, and Korea has one of the highest lengths of stay for ischemic heart diseases. Since the increase in the length of stay is a major cause of the increase in medical expenses, it is necessary to prepare a plan to...
Due to population aging and westernized lifestyle, ischemic heart diseases are increasing, and Korea has one of the highest lengths of stay for ischemic heart diseases. Since the increase in the length of stay is a major cause of the increase in medical expenses, it is necessary to prepare a plan to manage the length of stay. Accordingly, this study was conducted to identify the factors influencing the length of stay of ischemic heart disease, and provide the elementary resources necessary for the management of the length of stay. The study subjects were 566 ischemic heart disease patients of a tertiary hospital. As the result of the study, first, the number of inpatients with chest pain as the chief complaint was the largest. Second, the average length of stay was 4.89 days, and the length of stay varied depending on the type of ischemic heart disease. Third, the age of over 75 years, diabetes, and dyspnea were the factors increasing the length of stay. Therefore, for management of adequate length of stay for ischemic heart disease, it is important to prevent the progression of illness through blood sugar control for ischemic heart disease patients with diabetes. Also, it is necessary to prepare a system where patients can visit hospitals as fast as possible if they have any symptoms.
Due to population aging and westernized lifestyle, ischemic heart diseases are increasing, and Korea has one of the highest lengths of stay for ischemic heart diseases. Since the increase in the length of stay is a major cause of the increase in medical expenses, it is necessary to prepare a plan to manage the length of stay. Accordingly, this study was conducted to identify the factors influencing the length of stay of ischemic heart disease, and provide the elementary resources necessary for the management of the length of stay. The study subjects were 566 ischemic heart disease patients of a tertiary hospital. As the result of the study, first, the number of inpatients with chest pain as the chief complaint was the largest. Second, the average length of stay was 4.89 days, and the length of stay varied depending on the type of ischemic heart disease. Third, the age of over 75 years, diabetes, and dyspnea were the factors increasing the length of stay. Therefore, for management of adequate length of stay for ischemic heart disease, it is important to prevent the progression of illness through blood sugar control for ischemic heart disease patients with diabetes. Also, it is necessary to prepare a system where patients can visit hospitals as fast as possible if they have any symptoms.
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문제 정의
Therefore, this study was conducted to identify the factors influencing the length of stay for ischemic heart disease patients using the clinical data of ischemic heart disease patients of a tertiary hospital, and provide the elementary resources necessary for the management of length of stay of ischemic heart disease patients. The detailed purpose of this study is as follows.
Therefore, for efficient hospital management and national medical expense reduction, the factors increasing the length of stay for ischemic heart disease needs to be identified, based on which the management plan for the length of stay should be prepared. Therefore, this study was conducted in order to identify the factors influencing the length of stay for patients of ischemic heart disease using the clinical data of ischemic heart disease patients at a tertiary hospital and provide elementary data necessary for the management of the length of stay for ischemic heart disease inpatients.
제안 방법
Therefore, it is proposed to conduct a replication study expanded to the national-level study subjects including hospitals and general hospitals. Second, the variables found to be major risk factors of ischemic heart disease in multiple precedent studies such as percutaneous coronary intervention, smoking, obesity, and family history were not included in this study. Therefore, in future, it is thought to be necessary to collect various risk factors through medical record analysis and patient interview and conduct an expansive study including such.
Therefore, for efficient hospital management, it is necessary to identify the increase factor of the length of stay for ischemic heart disease, based on which the management plan for the length of stay should be prepared. Accordingly, this study was conducted to identify the factors influencing the length of stay for ischemic heart disease patients, and provide elementary data necessary for the management of the length of stay for ischemic heart disease inpatients. The study subjects were selected as 566 patients excluding those admitted and discharged on the same day from patients with principal diagnosis of ischemic heart disease among those discharged from cardiology from January 1st to December 31st of 2015 at a tertiary hospital.
대상 데이터
This study selected as study subjects 566 patients excluding those admitted and discharged on the same day from the patients whose principal diagnosis was ischemic heart disease among the discharged inpatients of cardiology from January 1st to December 31st , 2015 in a tertiary hospital. The average age of the study subjects was 65.
Accordingly, this study was conducted to identify the factors influencing the length of stay for ischemic heart disease patients, and provide elementary data necessary for the management of the length of stay for ischemic heart disease inpatients. The study subjects were selected as 566 patients excluding those admitted and discharged on the same day from patients with principal diagnosis of ischemic heart disease among those discharged from cardiology from January 1st to December 31st of 2015 at a tertiary hospital. The data analysis used IBM SPSS ver 23.
데이터처리
3) One-way ANOVA was executed for the difference in the length of stay per type of ischemic heart disease, and Scheffé test was executed for post analysis.
In order to identify the factors influencing the length of stay of patients of ischemic heart disease, the length of stay was set as the independent variable and gender, age, admission path, discharge form, chief complaint, and comorbidity as independent variables and the multiple regression analysis was executed. The tolerance of all independent was found to be 0.
이론/모형
Ischemic heart disease is a coronary artery disease mostly caused by atherosclerosis, being a form of heart disease which causes myocardial ischemia, typical disease being angina pectoris, myocardial infarction[5]. This study defined the case which has the principal diagnosis as I20-I25 code of mid-classification criteria of Korean Standard Classification of Disease-6th as ischemic heart disease.
성능/효과
First, the difference in types of ischemic heart disease according to general characteristics is identified. Second, the difference in the length of stay per type of ischemic heart disease is identified.
First, the difference in types of ischemic heart disease according to general characteristics is identified. Second, the difference in the length of stay per type of ischemic heart disease is identified. Third, the factors influencing the length of stay of ischemic heart disease patients are identified.
2) Cross-analysis and Fisher’s exact test were executed for the types of ischemic heart disease according to general characteristics.
9%). For comorbidity, patients with hypertension, diabetes mellitus, and hyperlipidemia were 32(5.7%), 24(4.2%), and 4(0.7%) respectively, patients with hypertension and diabetes mellitus were 40(7.1%), patients with hypertension and hyperlipidemia were 6(1.1%), and patients with all of hypertension, diabetes mellitus, and hyperlipidemia were 2(0.4%) (Table 1).
The chief complaint for angina pectoris was in the order of chest pain(67.2%), for CAG and PCI(11.8%), others(11.5%), and dyspnea(9.6%), and for acute myocardial infarction, it was in the order of chest pain(76.7%), others(12.1%), dyspnea(6.5%), and for CAG PCI(4.7%), and for chronic ischemic heart disease, it was in the order of chest pain(37.8%), others(32.4%), dyspnea(18.9%), and for CAG and PCI(10.8%), showing a significant difference(χ2=31.590, p=0.000) (Table 2).
As the result of this study, the type of ischemic heart disease was found to be angina pectoris 55.5%, acute myocardial infarction 38.0%, and chronic ischemic heart disease 6.5%. In the study by Choi, Kim, Hong(2015)[1] which used the Korea national hospital discharge injury survey data, it was found to be angina pectoris 55.
0% of early symptom in ischemic heart disease patients showed symptoms including chest pain. Also, while the chief complaint of angina pectoris and acute myocardial infarction was 67.2% and 76.7% respectively, it was relatively low for chronic ischemic heart disease at 37.8%, implying that sudden symptom expression is relatively lower for chronic ischemic heart disease than for angina pectoris and acute myocardial infarction.
5%). As for the type of ischemic heart disease according to the general characteristics, the admission route of ambulatory was more common for angina pectoris and chronic ischemic heart disease each at 51.3% and 67.6%, and emergency was more common for acute myocardial infarction at 58.6%. As for chief complaint, chest paint was most common for angina pectoris and acute myocardial infarction each at 67.
Second, the average length of stay for patients of ischemic heart disease was 4.89 days, showing difference in the length of stay per type of ischemic heart disease. Chronic ischemic heart disease was the highest at 7.
Third, the factors influencing the length of stay for ischemic heart disease patients were found to be age, chief complaint, and comorbidity. For age, those over 75 was found to have a positive influence compared to those under 55, and for comorbidity, those with diabetes were found to have a positive influence compared to those without comorbidity.
As the result of this study, the age over 75, diabetes mellitus, and dyspnea symptoms for admission were found to be factors increasing the length of stay. Based on this, the following is proposed for management of adequate length of stay of ischemic heart disease.
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