의료보장 형태가 혈액투석 서비스 제공에 미치는 영향에 대한 다수준 분석

정진희; 권순만; 김경훈; 이선경; 김동숙

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자료유형: 학술저널

저자정보: 정진희 권순만 김경훈 이선경 김동숙

저널정보: 대한예방의학회 예방의학회지 예방의학회지 제43권 제3호

발행연도: 2010.1

수록면: 245 - 256 (12page)

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Objectives: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. Methods: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time,erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as:hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). Results: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI = 0.43 - 0.99). However, frequency of hemodialysis,hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb≥11 g/dL, blood pressure within the range of 100-140 /60-90 mmHg, calcium × phosphate≤55 g2/dL2 and albumin≥4 g/dL were not significantly different between the groups. Conclusions: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.

#Hemodialysis #Health insurance #Medical aid #Multilevel analysis

참고문헌 (29)

참고문헌 신청

/ / Fistula first national vascular access improvement initiative website / Available

/ / Institute for healthcare improvement : boosting arteriovenous (AV) fistula rates in ESRD patients / Available

Aviva P / 2005 / Statistic at a Glance, 2nd ed / Blackwell Publishing Ltd

Center for Medicare & Medicaid Services / / End stage renal disease(ESRD) quality initiative overview / Available

Charra B / 1992 / Survival as an index of adequacy of dialysis / Kidney Int 41 (5) : 1286 ~ 1291

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