일 중소도시 병원중심 가정간호사업 성과 연구

An Outcome Study on the Hospital-Based Home Health Care at a Local City

This study was conducted to evaluate hospital-based home care service according to medical outcome study (=MOS) model. The objects of this study were the hospital at a local city, two home care nurses, and 100 patients who were registered from August, 1999 to March, 2001. The patient charts were analyzed and patient/ family satisfaction were surveyed from 57 patients who were visited four or more occasions. The findings were summarized as follows: 1. Structure: In the system characteristics, the goals of home health care were to provide more accessible, convenient service to the people, and to improve the image of hospital in the community. The major clinical departments of hospital were internal medicine, obstetetric/gynecology and pediatric departments, and the home health care center was under direct control of the hospital director and the center office shared with nursing department. In the provider characteristics, one was 31 years old home health nurse specialist with BS degree-director of the center, and the other was 39 years old general nurse with diploma who was under home health nurse training. ln the patient characteristics, a majority of the patients were over 70 years of age, and came from urban and rural areas, and 16.0% of them were the group of Medical Aid. Diagnosis of the patients were malignant tumor (33.0%), cardiovascular (16.0%), and cerebrovascular (10.0%) conditions in order. 2. Process: The average number of visiting frequency was 10.7 per patient and service hour 38.8 minutes per visit. Patients registered from ward (52.0%), OPD (37.0%) and from other hospitals (11.0%); and were referred from other patients or their families (49.0%) and physicians (48.0%). Registration period was for 42.9 days in average and 38.0% of them received home care for 15 days or less, and 31.0% for 46 days and more. Visiting interval was 4.6 days in average, and 24.0% of patients received it daily basis. Home care services were mainly physical assessment, vital sign check, injection, medication, and patient consultation. 3. Outcome: The reasons for service end point were death (40.0%), resolution of the problem (32.0%) and patient or family request (9.0%). At starting period, 67.0% were in level Ⅱ and 32.0% in m, at closing point; on the other hand, 12.0% were in Ⅱ and 21.0% in Ⅲ. The average score of patient satisfaction was 3.5 out of 4 points. 4. In the relationship between patient satisfaction and home care service, the group who had received home visit more frequently and longer period were more significant satisfied with hospital-based home care services. The patients who recovered their conditions or received hospice care also more satisfied. According to the above findings, the authors concluded as follows: 1. Contents of medium•siæd hospital-based home care service at local city were not different from those of general or university hospital-based at large city. 2. Further study is needed concerng the relationships among system and provider characteristics, process and outcomes, as well as the effects of interpersonal style (interpersonal manner, patient participation, counseling, communication level) which was not included in this study. 3. For evaluation on hospital-based home care service, MOS model can be recommended as a tool at the beginning stage of home care plan.