지방의료원의 재원부적절성에 영향을 미치는 요인: Two-part 모형 분석

Abstract

Objectives: The objective was to ascertain the extent of inappropriate hospitalization days (IHDs) and to identify associated factors in public hospital inpatients. Methods: This cross-sectional study employed concurrent and retrospective medical record reviews to examine patients (n = 800) consecutively discharged from four regional public hospitals’ general care units. Three registered nurses retrospectively reviewed medical records after being trained and assessed in the use of the Korean version of the Appropriateness Evaluation Protocol (K-AEP). A two-part model (TPM) was employed with logistic and multiple regression analyses to identify the predictors of IHDs. Results: Overall, 27.5% (1,466) of the hospital days reviewed were judged to be inappropriate. Factors associated with IHDs included age, LOS, admission route, and clinical department in the first part of the model. A log-linear multiple regression analysis revealed that both LOS and undergoing surgery were significantly associated with a higher IHD rate. Delays in performing diagnostic and therapeutic procedures and stays required to undergo such procedures were the most common causes of IHDs. Conclusions: This study showed that a substantial proportion of hospital stays was inappropriate. The characteristics associated with IHDs should be considered as criteria to promote the appropriate use of regional public hospital beds.