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지역사회 통합 케어서비스 방안 마련을 위한 시립병원 입원환자의 동반질환 분포와 재원일수 및 진료비와의 관련성

Relationship between the Distribution of Comorbidity and Length of Stay and Medical Cost for Planning Integrated Community Care Services among Inpatients at a Seoul Municipal Hospital

보건행정학회지 2019년 29권 4호 p.445 ~ 453
김재현 ( Kim Jae-Hyun ) - 단국대학교 보건과학대학 보건행정학과

노진원 ( Noh Jin-Won ) - 단국대학교 보건과학대학 보건행정학과
이윤환 ( Lee Yun-Hwan ) - 아주대학교 의과대학 예방의학교실
소예경 ( So Ye-Kyoung ) - 서울특별시 공공보건의료재단
홍현석 ( Hong Hyun-Suk ) - 서울특별시 공공보건의료재단

Abstract


Background: This study is to investigate the association between the distribution of multimorbidity and length of stay and medical expenses among inpatients in a municipal hospital to achieve an integrated care setting.

Methods: We used the exploratory factor analysis and the generalized estimating equation model to analyze the data from patients living in the northeast region of Seoul, who were hospitalized from January 2017 to December 2017 in a municipal hospital.

Results: As a result of the factor analysis, seven types of multiple chronic diseases were classified. Among the elderly patients admitted to municipal hospitals, the burden of medical expenses was mainly influenced by the length of stay (B=310,719, p-value <0.0001), not the type of disease (all not significant). Length of stay were mainly due to psychiatric illness (factor 1: B=4.323, p-value <0.0001) related to the brain and metabolic diseases (factor 2: B=2.364, p-value=0.003).

Conclusion: This study showed that the medical expenses of the elderly patients were largely due to prolonged hospitalization, not multimorbidity. Therefore, it is necessary to develop an integrated care paradigm strategy cope with the multimorbidity of the elderly in the community and to alleviate the socio-economic burden.

키워드

Elderly; Integrated care; Comprehensive care; Length of stay; Expenses
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