HIRA

급성기 환자 퇴원지원 시범사업의 의료기관 질 관리 및 수가체계 개발 연구

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Type
Research report
Author(s)
이요셉장준김명화
Issued Date
2022-01
Keyword
HIRAHealth Insurance Review & Assessmentsupport dischargequalitybetween hospitals
Abstract
Background: As medical care and its fields are getting specialized and subdivided, the hospitals have increased in size and have functionally diversified. In order to improving efficiency, the hospitals have differentiated according to this diversity of functions and roles and the patients have moved around the treatment environment accordingly. In these situations, insufficiency of linkage process between hospitals (and communities) is likely to lead some problems such as delayed discharges or overlapping diagnostic tests.
‘A pilot project to support discharge of acute patients and linkage to community’ has been promoted in expectation to solve the problems encouraging hospitals to perform patient-centered integrated assessments and transitions of care with appropriate discharge plans. But this project now has a weakness of not having system of managing quality and rewarding accordingly, although major international organizations emphasize the medical care quality of effectiveness, safety, patient-centeredness and so on.

Objective: This study showed what directions this project should give how to improve quality in transitions of care between hospitals, reviewing domestic and international literature and defining factors of quality assessment. Additionally, it checked improvement requirements for this pilot project by analysis of operational status and advisory conferences with field experts.

Results: The framework for compensation for quality management activities was established, through reviews of the concept and evaluation system of quality specified and used by major international organizations. Based on this, the study made four assessment categories of communication between hospitals, medical staffs empowerment, use of critical pathway and patient satisfaction and it proposed a differential compensation by total acquired score from each category by each hospital. Free-forms was suggested for a while for the way each hospital submits evidence data due to the urgency of the project, however. And then a more precise evaluation would increase reliability through advanced system and actual inspection by HIRA in the future.

Discussion: It maybe somewhat premature, not long after the pilot began, to review the current status and discuss the direction of improving the quality of medical care. But this study is meaningful in that it attempted to consider the direction of compensation for quality management activities without preceding researches, and pointed out improvement requirements based on field experts’ opinions. It is important to increase hospital and patient participation for enough samples analysis, from which we could expect the stability of quality assessment and expand the concept and direction of quality improvement in this pilot project.
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/3038
Alternative Title
A study on the Medical fee Development for Quality management in a Pilot project to Support Discharge of Acute patients
Table Of Contents
제1장 서론 ----------------------------- 1
1. 연구 배경과 목적 ----------------------------- 1
2. 연구 내용과 방법 ----------------------------- 3

제2장 의료기관 간 환자관리에 관한 이론적 배경 ----------------------------- 5
1. 치료 이전(transition of care) ----------------------------- 5
가. 세계보건기구의 치료 이전(transition of care) ----------------------------- 5
나. 미국 사례관리협회 치료 이전의 기준(Transitions of care standards) ----------------------------- 14
다. NCQA의 치료 이전(transition of care) ----------------------------- 21
라. 기타 문헌 고찰 ----------------------------- 23
2. ACO의 의료의 질 관리 평가 체계 ----------------------------- 26

제3장 국내・외 의료기관 간 환자와 질 관리 제도 ----------------------------- 31
1. 개요 ----------------------------- 31
2. 국내 제도와 사례 ----------------------------- 35
가. 재활 의료기관 수가 2단계 시범사업 ----------------------------- 35
나. 협력기관 간 진료의뢰・회송 시범사업 ----------------------------- 41
다. 권역심뇌혈관센터 운영 사업 ----------------------------- 44
라. 공공보건의료 협력체계 구축 사업 ----------------------------- 48
3. 국외 제도와 사례 ----------------------------- 53
가. 일본 ----------------------------- 53
나. 호주 ----------------------------- 65

제4장 시범사업 현황과 의견조회 ----------------------------- 69
1. 시범사업 현황분석 ----------------------------- 69
가. 시범사업 일반현황 ----------------------------- 69
나. 환자의 퇴원ㆍ전원 경로 분석 ----------------------------- 72
다. 의료기관 간 환자관리 자료 내 종합의견 등 기술항목 분석 ----------------------------- 79
2. 의료기관 간 연계와 질 관리 방안 논의 ----------------------------- 85
가. 개요 ----------------------------- 85
나. 의료기관 간 연계 관련 의료의 질 관리 방안 등 ----------------------------- 85
다. 기타 개선 요구 사항 ----------------------------- 85

제5장 의료기관 질 관리 방안과 개선사항 ----------------------------- 89
1. 의료기관 질 관리 방안 ----------------------------- 89
가. 개요 ----------------------------- 89
나. 의료기관 간 질 관리 방안과 보상 체계(안) ----------------------------- 89
2. 시범사업 개선사항 ----------------------------- 96
가. 개요 ----------------------------- 96
나. 시범사업 개선사항 ----------------------------- 96

제6장 결론과 제언 ----------------------------- 99

참고문헌 ----------------------------- 103

부록 ----------------------------- 105
Publisher
건강보험심사평가원
Location
KOR
Citation
이요셉 et al. (202201). 급성기 환자 퇴원지원 시범사업의 의료기관 질 관리 및 수가체계 개발 연구.
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