퇴원환자를 위한 간호사 주도 전환 프로그램의 내용과 효과에 관한 체계적 문헌고찰
A Systematic Review on Nurse-Led Transitional Care Programs for Discharged Patients from Hospital to Home
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Purpose: 본 연구의 목적은 퇴원환자를 위한 간호사주도 전환 프로그램의 내용과 효과를 체계적 문헌고찰을 통해 파악하기 위함이다. Methods: 본 연구에서는 2005년도에서 2015년까지 Pubmed, Embase, Cochrane Central Register of Controlled Trials, CINAHL 데이터베이스에 게재된 무작위 대조군 연구를 분석에 포함하였다. 자료분석은 Cochrane Review Manager (Revman) software 5.3 프로그램을 이용하여 실시하였다. Results: 총 9편의 연구가 분석에 포함되었다. 분석 결과, 퇴원환자를 위한 간호사주도 전환 프로그램은 크게 퇴원 전 단계, 전환 단계, 퇴원 후 단계의 세 단계로 이루어졌다. 퇴원 전 단계에서는 환자 사정, 교육, 퇴원계획이 이루어졌고, 전환단계에서는 의뢰, 의사소통, 케어플랜수립이 간호사에 의해 이루졌다. 마지막 퇴원 후 단계에서는 가정방문 및 전화방문, 환자 모니터링, 다학제팀의 상담 등의 항목이 포함되었다. 중재 프로그램의 효과를 파악하기 위해 병원 이용(30일 이내 재입원 및 응급실 방문), 삶의 질, 비용 등의 다양한 변수가 측정되었고, 메타분석 결과, 30일 이내 재입원 및 응급실 방문이 통계적으로 유의한 감소를 나타냈다. 그러나 문헌의 질 평가 결과, 7편의 연구에서 연구참여자와 연구자의 눈가림의 비뚤림 위험이 높은 것으로 분석되었다. Conclusion: 본 연구 결과는 간호사주도의 전환 프로그램이 불필요한 병원이용을 감소시키는 데에 효과적임을 의미한다. 그럼에도 불구하고, 분석에 포함된 연구의 수가 적고, 연구참여자와 연구자의 눈가림의 비뚤림 위험이 높은 것으로 분석되었다. 이에, 본 연구결과를 바탕으로, 추후 국내 퇴원환자를 위한 간호사주도 전환 프로그램 개발을 위해서는 체계적으로 설계된 무작위 대조군 연구가 필요함을 제언하는 바이다.
Abstract
Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.
참고문헌 (29)
- "Total discharged patient" (2017)[URL]
- Lee HY, "Development and utilization of domestic readmission evaluation model", Paper presented at Seeking a new paradigm in Korean public health system: Korean Academy of Health Policy and Management Conference (2016), Suwon Ramada hotel
- Lee JH, "A study patient management for both planned and unplanned readmission in a medium-size hospital", Health Service Management Review, 2(1), pp.11~17 (2008)
- 이은환, "서울시 소재 한 대학병원 퇴원환자의 재입원 관련요인", 병원경영학회지, 15(4), pp.125~142 (2010), 한국병원경영학회
- Moon OR, "An analysis on the characteristics high cost patients in the regional medical insurance program", Korean Journal of Health Policy and Administration, 3(1), pp.53~83 (1993)
- "A path to bundled payment around a rehospitalization. Report to the congress: Reforming the delivery system" (2008)[URL]
- Holland DE, "Problems and unmet needs of patients discharged 'home to self-care'", Professional Case Management, 16(5), pp.240~250 (2011)[DOI]
- 조경희, "뇌혈관질환자 가족의 부담감과 가정간호 요구도", 한국간호교육학회지, 12(1), pp.95~103 (2006), 한국간호교육학회
- 박경민, "보건소에서 실시한 당뇨병 환자 방문간호 프로그램의 효과", 한국보건간호학회지, 24(1), pp.71~81 (2010), 한국보건간호학회
- 양순옥, "보건소 맞춤형 방문건강관리사업 관절염 사례관리 효과", 지역사회간호학회지, 22(2), pp.151~161 (2011), 한국지역사회간호학회
- Chow Sk, "A randomized controlled trial of a nurseled case management programme for hospital-discharged older adults with co-morbidities", Journal of Advanced Nursing, 70(10), pp.2257~2271 (2014)[DOI]
- McAlister FA, "Case management reduces global vascular risk after stroke: Secondary results from the preventing recurrent vascular events and neurological worsening through intensive organized case-management randomized controlled trial", American Heart Journal, 168(6), pp.924~930 (2014)[DOI]
- Arts SE, "Liaison nursing for stroke patients: Results of a dutch evaluation study", Journal of Advanced Nursing, 32(2), pp.292~300 (2000)[DOI]
- Hall CJ, "Can post-acute care programmes for older people reduce overall costs in the health system? a case study using the Australian transition care programme", Health and Social Care in the Community, 20(1), pp.97~102 (2011)[DOI]
- Naylor MD, "High-value transitional care: Translation of research into practice", Journal of Evaluation in Clinical Practice, 19(5), pp.727~733 (2013)[DOI]
- "Cochrane handbook for systematic reviews of interventions version 5.1.0" (2011)[URL]
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses: The PRI SMA statement", British Medical Journal, 339, pp.b2535~ (2009)[DOI]
- 김신미, "아로마테라피가 중년여성의 갱년기 증상, 스트레스 및 우울에 미치는 효과: 체계적 문헌고찰", Journal of Korean Academy of Nursing, 46(5), pp.619~629 (2016), 한국간호과학회
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival and Prevalence in 2010", Cancer Research and Treatment, 45(1), pp.1~14 (2013), 대한암학회[DOI]
- "Deaths and death rates by cause (103 item)/by sex/by age (five-year age)" (2015)[URL]
- Paul CL, "Experiences of colorectal cancer patients in the 2-years post-diagnosis and patient factors predicting poor outcome", Support Care Cancer, 24(12), pp.4921~4928 (2016)[DOI]
- "National Priorities Goals" (2008)[URL]
- Weiss ME, "A model for hospital discharge preparation form case management to care transition", The Journal of Nursing Administration, 45(12), pp.606~614 (2015)[DOI]
- Gonçalves-Bradley DC, "Discharge planning from hospital", Cochrane Database of Systematic Reviews, (1) (2016)[DOI]
- Mistiaen P, "Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home", Cochrane Database of Systematic Reviews, (4) (2006)[DOI]
- Halfon P, "Measuring potentially avoidable hospital readmissions", Journal of Clinical Epidemiology, 55(6), pp.573~587 (2002)[DOI]
- Wong FKY, "Effects of a health-social partnership transitional program on hospital readmission:A randomized controlled trial", Social Science and Medicine, 73(7), pp.960~969 (2011)[DOI]
- Jacob L, "Systematic review: Predictors of successful transition to community-based care for adults with chronic care needs", Care Management Journals, 9(4), pp.154~165 (2008)[DOI]
- Latour CH, "Cost-effectiveness of a nurse-led case management intervention in general medical outpatients compared with usual care: An economic evaluation alongside a randomized controlled trial", Journal of Psychosomatic Research, 62(3), pp.363~370 (2007)[DOI]