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국민건강과 환자 안전을 위한 간호 관리 및 수가체계 개선방안 연구

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Type
Research report
Author(s)
신영석조성현배성희신수진나종익이재은옹열여성지영
Issued Date
2023-12
Keyword
입원료간호관리료간호등급제
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/3220
Table Of Contents
제1장 서론 ···································································· 1
1. 연구 배경 및 목적 ················································································ 3
가. 연구 배경 및 필요성 ················································································· 3
나. 연구 목적 ································································································ 5
2. 연구내용 및 방법 ·················································································· 6
가. 연구 내용 ·································································································· 6
나. 연구 방법 ································································································ 7

제2장 간호사 배치현황 및 실태 ···································································· 9
1. 일반병동 간호사 배치수준 ····································································· 11
가. 연구대상 및 자료 분석방법 ········································································ 11
나. 간호등급 산정기준 ···················································································· 13
다. 의료기관 특성 ························································································ 14
라. 상급종합병원 간호사 배치수준 ·································································· 15
마. 종합병원 간호사 배치수준 ········································································ 16
바. 병원 간호사 배치수준 ·············································································· 19
사. 근무조별 간호사 1인당 환자수 추정 ··························································· 23
2. 일반병동 간호사 배치수준과 진료특성과의 관계 ······································· 28
가. 간호등급별 진료특성 ················································································· 28
나. 상관관계분석: 간호사 배치수준과 진료특성과의 관계 ···································· 35
다. 간호사 배치수준과 진료특성에 따른 의료기관 클러스터링 ······························ 38
3. 일반병동과 통합병동 배치수준 비교 ························································ 45
가. 일반병동 간호등급과 통합병동 배치수준 비교 ·············································· 45
나. 일반병동과 통합병동의 근무조별 간호사 1인당 환자수 비교 ·························· 49
다. 통합병동 대비 일반병동 배치수준 ····························································· 53
4. 집중치료실 간호사 배치수준 ·································································· 56
가. 뇌졸중 집중치료실 ·················································································· 56
나. 고위험임산부 집중치료실 ·········································································· 58
5. 중환자실 간호사 배치수준 ····································································· 60
가. 일반 중환자실 ························································································ 60
나. 소아 중환자실 ························································································ 73

제3장 간호관리료 수가 및 인력 검토 ···································································· 79
1. 입원료 및 간호관리료 분석 ·································································· 81
가. 일반병동 입원료 및 간호관리료 분석 ························································ 81
나. 일반 중환자실 입원료 및 간호관리료 분석 ·················································· 93
다. 신생아 중환자실 입원료 및 간호관리료 분석 ················································ 98
2. 간호사 인력 현황 ··············································································· 103
가. 병상유형별 간호사 현황 ··········································································· 103
나. 직책별 간호사 분포 ················································································· 104
다. 근무형태별 간호사 분포 ··········································································· 105
라. 분기 간호사 이직률 ················································································· 107
마. 간호사 근속연수 ····················································································· 110
3. 간호 투입시간 분석 ··········································································· 116
가. RDRG 중증도별 간호행위 시간 차이 분석 ················································ 116
나. 재원일차에 따른 간호행위 시간 분석 ························································ 128

제4장 간호사 배치기준 관련 국내외 사례 및 문헌고찰 ···································································· 131
1. 국외의 간호사 배치수준과 관련된 정책 고찰 ······································ 133
가. 미국의 간호사 배치수준과 관련된 정책 고찰 ·············································· 133
나. 일본의 간호사 배치수준과 관련된 정책 고찰 ·············································· 143
다. 호주의 간호사 배치수준과 관련된 정책 고찰 ·············································· 146
라. 소결 ······································································································ 149
2. 간호사 배치수준과 환자 안전 및 보건의료 질에 대한 실증적 연구 고찰 ··· 151
가. 국내 연구 ······························································································ 153
나. 국외 연구 ······························································································ 158
다. 소결 ······································································································ 164

제5장 간호관리료 차등제 개선방안 ···································································· 167
1. 분석결과 종합 및 논의 ········································································ 169
가. 1등급 배치기준의 상향조정 ······································································ 169
나. 요양기관종별 1등급 기준 통일 ································································· 173
다. 최저등급의 하한선 설정 ········································································· 175
라. 중환자실-집중치료실-통합병동-일반병동의 통합적 배치수준 수립 ················ 177
마. 간호관리료 산정현황 미제출기관에 간호관리료 미지급 ································ 189
바. 배치등급별 간호시간에 비례한 간호관리료 ·············································· 190
사. 배치등급 산정기준 및 산정현황 데이터베이스 관리 ··································· 191
2. 간호관리료 차등제 개선 방향 ······························································· 198
가. 개선의 원칙 ··························································································· 198
나. 고려사항 ································································································ 198
다. 병상유형별 간호사 배치수준 제안 : 중장기적 검토 대안 ····························· 199
3. 간호관리료 개선 모형 ········································································· 203
가. 제도 개선 모형 ······················································································· 203
나. 배치기준 및 가산율 검토 ········································································· 204
다. 필요 인력 검토 ······················································································· 210
라. 재정 검토 ······························································································ 212

◾ 참고 문헌 ··················································································· 214
◾ 부록 ····························································································· 224
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건강보험심사평가원
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Citation
신영석. (2023-12). 국민건강과 환자 안전을 위한 간호 관리 및 수가체계 개선방안 연구.
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