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가치기반 지역사회중심 일차의료 건강관리 모델 효과분석 연구용역

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제1장 서론 1
1. 연구 배경 및 필요성 ··············································································· 3
가. 국내 인구 고령화 및 건강수준 및 의료자원의 지역격차 ·································· 3
나. 지역사회 중심의 건강관리 모형 구축 필요 ···················································· 5
다. 예방 중심의 질환관리 전환 필요 ·································································· 6
라. 가치 기반 지불제(fee-for-value)로의 전환 요구 ··········································· 7
마. 안성의료사협의 지역사회 중심 건강관리 사업 추진 ········································ 8
2. 연구 목적 ······························································································ 9
가. 궁극적 목적 ······························································································· 9
나. 구체적 목적 ······························································································· 9

제2장 연구방법 11
1. 지역사회 중심 일차의료 건강관리 모형 시범운영 ····································· 13
가. 2021년 진행 경과 ···················································································· 13
나. 2022년 추진 사항 ···················································································· 13
다. 기타 고려사항 ························································································ 16
2. 지역사회 중심 일차의료 건강관리 모형 시범운영 효과성 평가 ··················· 18
가. 사후 설문조사 실시 ·················································································· 18
나. 자료 수집 및 정리 ···················································································· 19
다. 지역사회 중심 일차의료 건강관리 모형 시범운영에 대한 효과성 평가 ··········· 20
3. 지역사회 중심 일차의료 건강관리 해외사례 검토 ·································· 21
가. 일차의료 건강관리 서비스 국외 사례 검토 ·················································· 21
나. 성과평가 지표 사례 검토 ··········································································· 21
4. 지역사회 중심 일차의료 건강관리 모형 제안 ··········································· 22
가. 지역사회 중심 일차의료 건강관리 모형 ······················································· 22
나. 성과 평가 및 지불보상 방안 ······································································ 22
다. 성과관리 및 평가를 위한 자료 연계 방안 ···················································· 22
라. 지역사회 중심 일차의료 건강관리 모형 운영을 위한 기타 준비사항 ················ 22
마. 정책적 제언 ····························································································· 22

제3장 지역사회 중심 일차의료 건강관리 모형 시범운영 23
1. 안성의료복지사회적협동조합(이하 안성의료사협) 개요 ······························· 25
가. 안성의료사협의 조직도 ·············································································· 25
나. 안성의료사협의 의료사업 운영현황 ······························································ 25
다. 안성의료사협의 의료기관 특징 ···································································· 26
라. 안성의료사협의 평생건강관리 ····································································· 29
2. 등록자 모집 현황 및 특성 ····································································· 32
가. 대상자 등록 현황 ·················································································· 32
나. 등록자 일반적 특성 ················································································· 32
3. 지역사회 중심 일차의료 건강관리 모형 ················································· 33
가. 등록자 유형 분류 ····················································································· 33
나. 등록자 유형별 서비스 제공 ········································································ 40
4. 건강관리 서비스 제공 ··········································································· 47
가. 대상자 등록 ····························································································· 48
나. 초기검사 ·································································································· 50
다. 포괄평가 및 건강관리종합계획 수립 ···························································· 53
라. 서비스 제공 ····························································································· 66
5. 서비스 제공 현황 ················································································· 86
가. 초기검사 ································································································ 86
나. 포괄평가 및 건강생활실천 계획 수립 ·························································· 87
다. 일차의료 서비스 제공 현황: 코디네이터 제공 서비스 중심으로 ······················ 87
라. 지역사회 중심 활동 참여 현황 ································································· 90
6. 등록자 유형별 서비스 제공 주요 사례 ···················································· 91
가. 위험집단1 ································································································ 91
나. 위험집단2 ································································································ 93
다. 위험집단3 ································································································ 95
라. 위험집단4 ································································································ 98
7. 시범 운영 결과 지역사회 중심 일차의료 건강관리 모형 개선의견 ········· 104
가. 등록 ······································································································ 104
나. 초기검사 ······························································································ 106
다. 포괄평가 및 계획 수립 ············································································ 107
라. 서비스 제공 ··························································································· 107

제4장 지역사회 중심 일차의료 건강관리 모형 시범운영 효과성 평가 109
1. 건강행태 변화 조사 ··········································································· 111
가. 사후 설문지 조사 수행 결과 ·································································· 111
나. 생활습관 ································································································ 112
다. 주관적 건강과 정신 건강(우울감 점수) ······················································ 118
2. 서비스 이용 만족도 조사 ····································································· 121
가. 조사 개요 ······························································································ 121
나. 의사 진료에 대한 만족도 ········································································· 121
다. 코디네이터 서비스에 대한 만족도 ····························································· 123
라. 전반적인 만족도 ····················································································· 124
마. 서비스 경험 만족도에 영향을 미친 요인 ·················································· 126
3. 검사수치 변화 분석 ············································································ 129
가. 개요······································································································ 129
나. 고혈압 관련 수치 ···················································································· 130
다. 당뇨병 관련 수치 ·················································································· 134
라. 이상지질혈증 관련 수치 ········································································· 137

제5장 지역사회 중심 일차의료 건강관리 모형 국내외 사례 141
1. 지역사회 중심 일차의료 건강관리 해외사례 ········································· 143
가. 미국······································································································ 143
나. 영국 ···································································································· 175
다. 호주······································································································ 189
라. 해외사례 시사점 ····················································································· 203
2. 일차의료 평가지표 사례 ····································································· 206
가. 해외 평가지표 사례 ················································································· 206
나. 국내 의료서비스 성과 평가지표 사례 ························································ 235

제6장 지역사회 중심 일차의료 건강관리 모형 제안 241
1. 일차의료의 특성 ················································································· 243
가. 일차의료의 속성 ····················································································· 243
나. 일차의료의 일반적인 이점 ········································································ 244
2. 지역사회 중심 일차의료 건강관리 모형 ·············································· 245
가. 대상자 ······························································································· 245
나. 등록자 유형별 서비스 제공 ······································································ 252
다. 코디네이터의 역할 ·················································································· 260
라. 주요 참여인력의 업무량 분석 ··································································· 262
3. 성과평가 및 지불보상방안 ··································································· 265
가. 성과평가 ································································································ 265
나. 지불보상방안 ·························································································· 270
4. 성과관리 및 평가를 위한 자료 연계 방안 ·············································· 278
가. 자료 연계 및 활용을 위한 고려사항 ·························································· 278
나. 자료 유형 및 수집방안 ············································································ 280
다. 자료 연계 방안 ······················································································· 281
5. 지역사회 중심 일차의료 건강관리 모형 운영을 위한 기타 준비사항 ········ 284
가. 관련 교육과정 개발 및 운영 ···································································· 284
나. 공간, 관련 교육 자료, 전산기자재 등 확보 ················································ 285
다. 서비스 제공시간 및 횟수, 기타 자원사용량에 대한 계량적 측정 ················· 285
라. 지역사회 기반 통합적 접근을 위한 지역별 일차의료지원센터 마련 ·············· 286
6. 정책적 제언 ······················································································· 287
가. 가치기반 의료의 필요성 ··········································································· 287
나. 안성의료사협모형 시범운영의 교훈 ···························································· 287
다. 가치기반 지역사회 중심 건강관리 모형 확산을 위한 제언··························· 288

참고 문헌 ··················································································· 291
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건강보험심사평가원
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Citation
임종한. (2022-12). 가치기반 지역사회중심 일차의료 건강관리 모델 효과분석 연구용역.
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