급성기 환자 퇴원지원 시범사업의 의료기관 질 관리 및 수가체계 개발 연구

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.