College of Nursing, Dankook University, Chungnam, Republic of Korea.
College of Nursing, Dankook University, Chungnam, Republic of Korea.
Asian Nurs Res (Korean Soc Nurs Sci). 2017 Dec;11(4):283-289. doi: 10.1016/j.anr.2017.11.002. Epub 2017 Nov 28.
The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management.
Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews.
Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected.
The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea.
在其他国家，实施长期住院病例管理已被批准用于控制医疗成本的增长。但是，在韩国引入病例管理时出现了一些问题，阻碍了其有效运作。本定性研究旨在从病例管理者的角度进一步了解医疗补助受益人的长期住院使用管理所面临的问题，并为成功的病例管理提供建议。
采用主题分析法对数据进行分析。从城市、郊区和农村地区招募具有 3 年以上病例管理经验的医疗补助病例管理者。通过深入访谈收集数据：12 名护士病例管理者参加了焦点小组访谈，11 名参加了个人一对一访谈。
出现了四个主要主题：现场障碍阻碍工作进展；背道而驰；病例管理者的模糊立场；与工作相关的情绪。发现了十一个子主题：寻找潜在的候选人；成为敌人；将无处可去的患者出院；以福利为中心的国家政策增加医疗成本；鼓励住院的医疗补助计划；滥用住院；感到受限；在没有权力的情况下工作；履行预期角色；担心社会批评；感到被忽视和不受保护。
研究结果突出了病例管理者所面临问题的复杂性和模糊性。成功管理医疗补助资源需要多个利益相关者的协调努力和合作。为护士病例管理者提供更系统的支持和资源对于在韩国全面实施这一护理创新至关重要。
