1,721,126 research outputs found
Song Chong Rye
No full text학위논문(박사)--아주대학교 일반대학원 :간호학과,2011. 2본 연구는 당뇨병성 족부질환자를 대상으로 가정간호서비스 연계군과 비연계군간의 비용-효과비를 비교함으로써 가정간호서비스에 대한 경제적 타당성을 규명하기 위해 시도된 후향적 조사연구이다. 연구 대상자는 2개 상급종합병원에서 당뇨병성 족부질환으로 조기퇴원한 가정간호서비스 연계 대상자 33명, 가정간호서비스 비연계 대상자 27명이며, 2008년에서 2009년 사이 의무기록상 진단코드가 E11.5 또는 E14.5로 등록된 입원환자 중에서 두 그룹간 치유기간과 비용에 대한 영향요인이 유사하게 편의 추출하였다.
자료 수집은 의무기록, 환자 정보시스템 및 진료비 수납자료를 통하여 조사하였다. 타의료기관 진료비는 2009년 당뇨병성 족부질환에 대한 건강보험청구자료, 2008년 건강보험공단의 비급여 환자본인부담률 조사 자료 및 의무기록조사를 통하여 구하였다.
분석관점은 사회적 관점으로, 비용은 당뇨병성 족부질환 치유시까지 환자와 보험자가 부담하는 직접 의료비용으로 하고 당뇨병성 족부질환의 치유기간을 효과로 하여 비용-효과비를 산출하였다. 직접 의료비용은 입원 및 응급진료비, 외래진료비, 가정간호비 및 타의료기관 진료비의 합으로 2009년 건강보험수가 기준으로 하였다. 두 그룹간 동질성 검증은 x2-test, Fisher's Exact Test 및 t-test를 이용하고, 회귀분석을 통하여 비용과 효과에 대한 영향 요인을 확인하였다. 마지막으로 비용-효과비에 영향을 주는 변수에 대하여 연구결과의 변화를 확인하기 위하여 민감도분석을 실시하였다.
본 연구에서 도출한 주요 결과는 다음과 같다.
1. 총 입원일수는 가정간호서비스 연계군은 1인당 평균 25.48±16.31일, 가정간호서비스 비연계군은 1인당 평균 32.41±20.44일로 나타났으며, 그룹간 차이가 통계적으로 유의하지는 않았다(p=.071).
2. 가정간호서비스 연계군의 전체 타의료기관 진료비는 1인당 평균 627,511원, 가정간호비는 1인당 평균 641,854원이었으며, 가정간호서비스 비연계군의 전체 타의료기관 진료비는 2,388,569원으로 전체 타의료기관 진료비에서 그룹간 차이가 통계적으로 유의하였다(p=.002).
3. 직접 의료비용은 가정간호서비스 연계군은 1인당 평균 11,132,586원, 가정간호서비스 비연계군은 16,023,296원으로 나타났으며, 그룹간 차이가 통계적으로 유의하였다(p=.044).
4. 당뇨병성 족부질환 치유기간은 가정간호서비스 연계군은 121.06±72.88일, 가정간호서비스 비연계군은 1인당 평균 145.56± 55.69일로 나타났으며, 두 그룹간 차이가 통계적으로 유의 하였다(p= .036).
5. 비용-효과비 분석결과, 가정간호서비스 연계군은 치유기간 1일당 92,005원, 가정간호서비스 비연계군은 치유기간 1일당 109,749원으로 나타났으며, 가정간호서비스 연계군이 가정간호서비스 비연계군에 비하여 단위당 비용이 적어 비용효과적인 것으로 나타났다.
6. 직접 의료비용을 설명하는 회귀모형은 통계적으로 유의하였으며(F= 13.939, p=<.001), 통계적으로 유의한 영향요인은 혈관중재시술 횟수(t=6.443, p=<.001), 수술 횟수(t=3.107, p=.003), 관리항생제 사용여부(t=2.523, p=.015), 음압치료 여부(t=2.535, p=.014), Silver dressing 사용 여부(t=2.523, p=.015), 가정간호 여부(t=-2.066, p=.044), 시력장애 유무(t=2.248, p=.029)였으며, 각 변수들의 직접 의료비용 설명력은 63.7%(adjusted-R2)였다.
7. 입원일수를 설명하는 회귀모형은 통계적으로 유의하였으며(F=9.119, p=<.001), 통계적으로 유의한 영향요인은 수술횟수(t=2.195, p=.033), 가정간호서비스 여부(t=-2.456, p=.017), 상처중증도(t=2.541, p=.014), 항생제내성 균주 유무(t=2.442, p=.018), 음압 치료 여부(t=3.339, p=.002)였으며, 각 변수들의 직접 의료비용 설명력은 52.4%(adjusted-R2)였다.
8. 민감도 분석 결과, 입원일, 타의료기관 비용 및 치유기간을 달리했을 때 비용-효과비는 가정간호서비스 연계군은 30,594 ~ 399,959원, 가정간호서비스 비연계군은 41,422 ~ 285,562원으로 나타났다.
이상의 연구결과를 통하여 가정간호서비스 연계군은 가정간호서비스 비연계군에 비하여 비용-효과비가 적게 나타나 경제적인 것으로 나타났으며, 가정간호서비스 비연계군의 경우 가정간호서비스 연계군에 비하여 입원일수가 길고 퇴원후 타의료기관 입원 또는 타의료기관 외래진료를 받게 되어 직접 의료비용이 높음을 알 수 있었다. 또한 민감도 분석 결과 당뇨병성 족부질환에 대한 가정간호서비스 연계 효과는 장기간 치료가 이루어질 때 안정적으로 비용효과적임을 알 수 있었다. 따라서 당뇨병성 족부질환에 대한 가정간호서비스의 경제적 타당성을 토대로 관련정책의 수립이나 가정간호제도 확대에 본 연구 결과를 기초 자료로 활용할 것을 제안한다.
_____________
주요어: 당뇨병성 족부질환, 가정간호서비스, 비용-효과 분석, 경제성 평가Ⅰ. 서론 1
A. 연구 필요성 1
B. 연구 목적 3
C. 용어 정의 4
Ⅱ. 문헌고찰 6
A. 당뇨병성 족부질환 6
B. 가정간호서비스의 효과 13
C. 경제성 평가 연구 18
Ⅲ. 연구의 개념적 틀 22
Ⅳ. 연구 방법 25
A. 연구설계 25
B. 연구 대상 28
C. 연구도구 30
D. 자료수집 방법 33
E. 자료분석 방법 35
F. 연구의 제한점 36
Ⅴ. 연구결과 38
A. 연구대상군별 일반적인 특성과 질병 및 치료관련 특성의 동질성 검정 38
B. 연구대상군별 직접 의료비용 분석 50
C. 연구대상군별 비용-효과비 비교 62
D. 연구대상자의 비용-효과에 미치는 영향요인 63
E. 비용-효과비에 대한 민감도 분석 70
Ⅵ. 논의 72
A. 연구방법에 대한 논의 72
B. 연구결과에 대한 논의 75
C. 연구의 의의 80
Ⅶ. 결론 및 제언 82
A. 결론 82
B. 제언 85
참고문헌 86
부록 93
영문초록 99Maste
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Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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