Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. Methods: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). Results: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. Conclusions: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist’s role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.
Abstract
Background: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. Methods: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). Results: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. Conclusions: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist’s role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.
참고문헌 (27)
- Carmel S, "Variation in intensive care unit outcomes: a search for the evidence on organizational factors", Curr Opin Crit Care, 7, pp.284~296 (2001)
- Nguyen YL, "Angus DC : Critical care : the impact of organization and management on outcomes", Curr Opin Crit Care, 16, pp.487~492 (2010)
- Pronovost PJ, "Physician staffing patterns and clinical outcomes in critically ill patients: a systemic review", JAMA, 288, pp.2151~2162 (2002)
- Tarnow-Mordi WO, "Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit", Lancet, 356, pp.185~189 (2000)
- Kahn JM, "Hospital volume and the outcomes of mechanical ventilation", N Engl J Med, 355, pp.41~50 (2006)
- Leape LL, "Pharmacist participation on physician rounds and adverse drug events in the intensive care unit", JAMA, 282, pp.267~270 (1999)
- Pronovost PJ, "Team care: beyond open and closed intensive care units", Curr Opin Crit Care, 12, pp.604~608 (2006)
- Angus DC, "Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations", Crit Care Med, 34, pp.1016~1024 (2006)
- Gasperino J, "The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review", Health Policy, 102, pp.223~228 (2011)
- Villa RA, "Restructuring for caring and effective education: piecing the puzzle together", pp.93~128 (2000), Brooks
- Kahn JM, "Barriers to implementing the Leapfrog group recommendations for intensivist physician staffing:a survey of intensive care unit directors", J Crit Care, 22, pp.97~103 (2007)
- 고윤석, "How to Enhance Critical Care in Korea: Challenges and Vision", The Korean Journal of Critical Care Medicine, 29(4), pp.246~249 (2014), 대한중환자의학회
- Pronovost PJ, "Intensive care unit physician staffing: financial modeling of the Leapfrog standard", Crit Care Med, 32, pp.1247~1253 (2004)
- 문영전, "병원의 성과급제 운영실태 및 활성화 전략", 보건의료산업학회지, 5(1), pp.31~44 (2011), 보건의료산업학회
- Ward NS, "Intensivist", patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing, 2013, pp.41, 638~645
- Epstein AM, "Public release of performance data: a progress report from the front", JAMA, 283, pp.1884~1886 (2000)
- Millenson ML, "Pay for performance: the best worst choice", Qual Saf Health Care, 13, pp.323~324 (2004)
- Shahian DM, "Variability in the measurement of hospital-wide mortality rates", N Engl J Med, 363, pp.2530~2539 (2010)
- Simon J. Mackenzie, "Measuring Hospital-Wide Mortality—Pitfalls and Potential", Journal for Healthcare Quality, 38(3), pp.187~194 (2016), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Pronovost PJ, "The organization of intensive care unit physician services", Crit Care Med, 35, pp.2256~2261 (2007)
- 조재화, "중환자실 구성이 2009년 인플루엔자 A", H1N1 중증환자의 사망률에 미친 영향, 2012, pp.27(2), 65~69[DOI]
- Kim JH, "Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units", J Crit Care, 27(414), pp.e11~e21 (2012)
- 김길동, "Feasibility and Early Outcomes of Intensivist-Led Critical Care after Major Trauma in the Korean ICU", Yonsei Medical Journal, 54(2), pp.432~436 (2013), 연세대학교의과대학[DOI]
- 박지민, "Impact of a surgical intensivist on the clinical outcomes of patients admitted to a surgical intensive care unit", 대한외과학회지, 86(6), pp.319~324 (2014), 대한외과학회
- "OECD Health Care Quality Review: Korea Assessment and recommendations"[URL]
- Kellerman SE, "Physician response to surveys. A review of the literature", Am J Prev Med, 20, pp.61~67 (2001)
- Garland A, "physicians and alternative staffing models", Chest, 143, pp.214~221 (2013)