상급종합병원의 예측 제왕절개분만율과 실제 제왕절개분만율의 격차 관련요인
Factors on the Gap between Predicted Cesarean Section Rate and Real Cesarean Section Rate in Tertiary Hospitals
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: This study was aimed to examine the gap between predicted cesarean section rate and real cesarean section rate and it's determining factors of 44 tertiary hospitals. Method: This study is a cross-sectional analysis using the data of 25,623 deliveries in 2009 drawn from homepage of Health Insurance Review and Assessment Service. Data were analyzed with t-test, F-test, Scheffé test, and logistic regression. Result: There were statistically significant differences in the gap of cesarean section rate (more gap indicates higher quality of delivery) by grade of nurse staffing and delivery cases. Hospitals with nurse staffing grade 1 to 2 had more possibility to be classified into higher grade in quality of delivery (OR 5.67, 95% CI 1.07-30.08). Also hospitals with over 500 delivery cases had more possibility be classified into higher grade in quality of delivery (OR 4.92, 95% CI 1.14-21.23, respectively). Conclusion: The finding suggests that grade of nurse staffing may influence the real cesarean section rate because nurses do a vital role to prevent unnecessary cesarean section. Further study is required to provide evidence that nurse staffing influence on patient outcome and cost-effectiveness in order to obtain adequate number of nursing staffs.
Abstract
Purpose: This study was aimed to examine the gap between predicted cesarean section rate and real cesarean section rate and it's determining factors of 44 tertiary hospitals. Method: This study is a cross-sectional analysis using the data of 25,623 deliveries in 2009 drawn from homepage of Health Insurance Review and Assessment Service. Data were analyzed with t-test, F-test, Scheffé test, and logistic regression. Result: There were statistically significant differences in the gap of cesarean section rate (more gap indicates higher quality of delivery) by grade of nurse staffing and delivery cases. Hospitals with nurse staffing grade 1 to 2 had more possibility to be classified into higher grade in quality of delivery (OR 5.67, 95% CI 1.07-30.08). Also hospitals with over 500 delivery cases had more possibility be classified into higher grade in quality of delivery (OR 4.92, 95% CI 1.14-21.23, respectively). Conclusion: The finding suggests that grade of nurse staffing may influence the real cesarean section rate because nurses do a vital role to prevent unnecessary cesarean section. Further study is required to provide evidence that nurse staffing influence on patient outcome and cost-effectiveness in order to obtain adequate number of nursing staffs.
참고문헌 (30)
- AbouZahr, C., "Maternal mortality at the end of a decade signs of progress?", Bulletin of the World Health Organization, 79, pp.561~568 (2001)
- Aiken, L. H., "Effects of hospital care environments on patientmortality and nurse outcomes", Journal of Nursing Administration, 38, pp.223~229 (2008)
- Almeida, S., "Significant differences in cesarean section rates between a private and a public hospital in Brazil", Cadernos de Saúde Pública, 24, pp.2909~2918 (2008)
- Buchan, J., "A certain ratio? Minimum staffing ratios in nursing : A report for the Royal College of Nursing" (2004), RCN
- Chalmers, B., "WHO principles of perinatal care : The essential antenatal, perinatal, and postpartum care course", Birth, 28, pp.202~207 (2001)
- Chen, C. S., "Urbanization and the likelihood of a cesarean section", European Journal of Obstetrics, Gynecology, and Reproductive Biology, 141, pp.104~110 (2008)
- Childbirth Connection, "Listening to mothers II : Report of the second national U. S. survey of women's childbearing experiences" (2006), Childbirth Connection
- Forster, D. A., "Staffing in postnatal units: Is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia", BioMedCentral Health Services Research, 6, pp.83~ (2006)
- Garcia, F. A., "Effects of academic affiliation and obstetric volume on clinical outcome and cost of childbirth", American Journal of Obstetrics and Gynecologies, 97, pp.567~576 (2001)
- Health Insurance Review and Assessment Service, "Evaluation and follow up report on cesarean section in Korea" (2009), Health Insurance Review and Assessment Service
- "Cesarean section rate evaluation result by hospitals" (2011)[URL]
- "Nurse staffing grade by hospitals" (2009)[URL]
- Health Insurance Review and Assessment Service, "2010 report about appropriateness of cesarean : Preliminary test payment for performance" (2010), Health Insurance Review and Assessment Service
- Hodnett, E. D., "Effect on birth outcomes of a formalized approach to care in hospital labour assessment units: International, randomized controlled trial", British Medical Journal, 337, pp.1021~ (2008)
- Hopkins, K., "Are Brazilian women really choosing to deliver by cesarean?", Social Science and Medicine, 51, pp.725~740 (2000)
- Hugonnet, S., "Nurse staffing level and nosocomial infections : Empirical evaluation of the casecrossover and case-time-control designs", American Journal of Epidemiology, 165, pp.1321~1327 (2007)
- Nursing staffing and quality of patient care, "Kane, R. L.", Agency for Healthcare Quality and Research, ~, pp.AHRQ publication 07-E005 (2007)
- Kim, Y. M., "Factors Determining Cesarean Section Frequency Rates of the OBGY Clinics in Metropolitan Area", Korean Journal of Women Health Nursing, 18, pp.389~401 (2002)
- Kim, Y. M., "A study of the health policy for the cesarean section rate reduction" (2007), Ministry for Health and Welfare
- 김윤미, "의료기관 특성에 따른 간호등급 변화 추이: 2008~2010년", 임상간호연구, 16(3), pp.99~109 (2010), 병원간호사회
- Lee, S. I., "Rising rates, changing relationships: caesarean section and its correlates in South Korea, 1988-2000", International Journal of Obstetrics and Gynecology, 112, pp.810~819 (2005)
- Liberto, J., "Inter-hospital variations in cesarean sections. A risk adjusted comparison in the Valencia public hospitals", Journal of Epidemiology and Community Health, 54, pp.631~636 (2000)
- Lin, H. C., "Doctors' obstetric experience and Caesarean section (CS): Does increasing delivery volume result in lower CS likelihood?", Journal of Evaluation in Clinical Practice, 13, pp.954~957 (2007)
- Ministry for Health and Welfare, "Notification No. 2006-105", ~ (2006)
- Ontario Women's Health Council, "Attaining and maintaining best practices in the use of caesarean sections-An analysis of four Ontario hospitals" (2000), Author
- Organization of Economic Cooperation and Development, "2009 Health data CD", ~ (2009)
- 박정옥, "일개 대학병원의 간호관리료 등급변화에 따른 간호사의 간호활동시간 비교", 임상간호연구, 16(1), pp.95~105 (2010), 병원간호사회
- Wax, J. R., "Patient choice cesarean-the Maine experience", Birth, 32, pp.203~206 (2005)
- West, E., "Nursing resources and patient outcomes in intensivecare : A systematic review of the literature", InternationalJournal of Nursing Studies, 46, pp.993~1011 (2009)
- 윤순길, "병원 간호등급에 따른 간호수행 정도", 병원경영학회지, 15(3), pp.1~16 (2010), 한국병원경영학회