1Health Insurance Research Institute, National Health Insurance Service, Wonju, Korea
2Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
3Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2024 The Korean Society for Preventive Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of Interest
The authors have no conflicts of interest associated with the material presented in this paper.
Funding
None.
Author Contributions
Conceptualization: Choi JW, Yoo A, Lee H. Data curation: Choi JW, Yoo A, Bang H, Park HK, Lee H. Formal analysis: Choi JW, Lee H. Funding acquisition: None. Methodology: Choi JW, Yoo A, Bang H, Park HK, Lee HJ, Lee H. Project administration: Yoo A. Visualization: Choi JW, Lee H. Writing – original draft: Choi JW, Lee H. Writing – review & editing: Choi JW, Yoo A, Bang H, Park HK, Lee HJ, Lee H.
Framework | Establishment of a Public Health-Medical Collaboration System program | Rehabilitation Hospital Discharge Patient Support program |
---|---|---|
Social issue | Gaps in essential health care within regions because of the lack of continuity between medical institutions | Challenges in providing continuous care for patients who need rehabilitation post-discharge |
Agenda setting | Establishing continuous and comprehensive healthcare for patients after discharge | Establishing continuous and comprehensive healthcare for patients who need rehabilitation after discharge |
Problem definition | Fragmented services leading to inefficiencies and poor health outcomes | High readmission rates and lack of resources for discharged patients who need rehabilitation |
Alternative exploration | Introduction of a primary care physician system and establishment of an information-sharing system between hospitals and clinics | Community rehabilitation service, tele-rehabilitation, education |
Policy decision | Providing a comprehensive discharge assessment, planning and post-discharge service | Providing a structured discharge plan with follow-up home-based rehabilitation |
Policy implementation | Conducting pilot programs targeting hospitals with regional responsibility | Conducting pilot programs targeting rehabilitation hospitals |
Policy evaluation | Monitoring health outcomes, patient satisfaction, and system efficiency | Monitoring health outcomes, patient satisfaction, and system efficiency |
Characteristics | Group | n | Profession | Age (y) | Professional experience (y) | Work experience in discharge support programs (y) |
---|---|---|---|---|---|---|
Establishment of a Public Health-Medical Collaboration System program | A | 1 | Doctor | 44 | 21.0 | N/A |
A | 2 | Doctor | 53 | 28.0 | 4.0 | |
A | 3 | Doctor | 42 | 15.0 | N/A | |
B | 4 | Doctor | 37 | 3.0 | 3.0 | |
B | 5 | Doctor | 43 | 3.0 | 3.0 | |
B | 6 | Doctor | 46 | 6.0 | 3.0 | |
C | 7 | Nurse | 40 | 15.0 | 2.0 | |
C | 8 | Nurse | 28 | 5.0 | 2.0 | |
C | 9 | Nurse | 56 | 34.0 | 1.3 | |
C | 10 | Nurse | 57 | 34.0 | 3.0 | |
C | 11 | Nurse | 34 | 12.0 | 4.0 | |
C | 12 | Nurse | 58 | 34.0 | 0.7 | |
D | 13 | Nurse | 28 | 3.0 | 2.0 | |
D | 14 | Nurse | 51 | 30.0 | 3.0 | |
D | 15 | Nurse | 45 | 23.0 | 3.0 | |
D | 16 | Nurse | 44 | 25.0 | 2.0 | |
D | 17 | Nurse | 57 | 21.0 | 3.0 | |
E | 18 | Social worker | 36 | 2.5 | 2.5 | |
E | 19 | Social worker | 30 | 1.8 | 1.8 | |
E | 20 | Social worker | 35 | N/A | 5.0 | |
E | 21 | Social worker | 50 | 2.6 | 2.6 | |
F | 22 | Social worker | 40 | N/A | 2.5 | |
F | 23 | Social worker | 27 | 3.5 | 2.5 | |
F | 24 | Social worker | 37 | N/A | 1.3 | |
F | 25 | Social worker | 36 | 11.0 | 4.0 | |
Rehabilitation Hospital Discharge Patient Support program | A | 1 | Doctor | 33 | 5.0 | 0.5 |
A | 2 | Doctor | 42 | N/A | N/A | |
A | 3 | Doctor | 39 | 8.0 | 4.0 | |
A | 4 | Doctor | 39 | N/A | 1.0 | |
A | 5 | Doctor | 33 | 3.0 | 0.4 | |
B | 6 | Doctor | 41 | 10.0 | 0.4 | |
B | 7 | Doctor | 60 | 45.0 | 0.4 | |
B | 8 | Doctor | 38 | 5.0 | 4.0 | |
B | 9 | Doctor | 47 | 15.0 | 3.0 | |
C | 10 | Nurse | 44 | 20.0 | 3.0 | |
C | 11 | Nurse | 50 | 23.0 | 0.5 | |
C | 12 | Social worker | 25 | 1.4 | 1.4 | |
C | 13 | Social worker | 34 | 9.0 | 6.0 | |
C | 14 | Social worker | 52 | 15.0 | 3.0 | |
D | 15 | Social worker | 40 | 10.0 | 3.0 | |
D | 16 | Social worker | 30 | 9.0 | 1.3 | |
D | 17 | Social worker | 32 | 8.2 | 0.5 | |
D | 18 | Social worker | 24 | 0.4 | 0.4 | |
D | 19 | Social worker | 42 | 5.0 | 5.0 | |
E | 20 | Social worker | 30 | 2.0 | 1.0 | |
E | 21 | Social worker | 28 | 2.0 | N/A | |
E | 22 | Social worker | 32 | 6.0 | 4.0 | |
E | 23 | Social worker | 37 | 3.5 | 3.5 | |
E | 24 | Social worker | 34 | N/A | 2.0 |
Main theme | Sub-theme |
|
---|---|---|
Establishment of a Public Health-Medical Collaboration System program | Rehabilitation Hospital Discharge Patient Support program | |
Perceptions of the discharge support programs | The necessity of the discharge support program | The necessity of the discharge support program |
The efficacy of the discharge support program | The efficacy of the discharge support program | |
Role in the discharge support program | Role in the discharge support program | |
Patients and areas needing discharge support | Patients requiring discharge support programs | Patients requiring discharge support programs |
Essential services to be included in discharge support programs | Essential services to be included in discharge support programs | |
Barriers of discharge support programs | Lack of resources and services | Insufficient reimbursement |
Operational challenges leading to burdens | Operational challenges leading to burdens | |
Low patient and team member participation | Lack of coordination | |
Recommendations to improve discharge support programs | Team restructuring | Standardization |
Improvement of the reimbursement system | Improvement of the reimbursement system | |
Process and awareness improvement | Process and awareness improvement |
Programs | Theme | Doctors | Nurses | Social workers |
---|---|---|---|---|
Establishment of a Public Health-Medical Collaboration System program | Perceptions of the discharge support programs | |||
(1) The necessity of the discharge support program | Necessary for vulnerable groups with weak caregiver support | Necessary as the probability of receiving care at home is higher than hospital admissions | Necessary to reduce caregiver burden and provide appropriate care | |
(2) The efficacy of the discharge support program | Information provision and service linkage are helpful, but unsure if linkage is actually implemented | Only 30-50% are successful due to patient reluctance, strict service eligibility, and changes in service provider conditions | ||
(3) Role in discharge support programs | Final decision on plan for identified subjects and running consultative bodies | Varies by medical institution, identification of subjects, program guidance, initial evaluation, health education, and discharge planning in nursing | Varies by medical institution, program explanation, initial evaluation, medical expense support, and consultative body meetings | |
Patients and areas needing discharge support | ||||
Patients requiring discharge support programs | Patients with diseases like stroke, respiratory diseases, heart diseases, and frail patients | Older patients living alone, older couples who have difficulty managing health or using welfare services after discharge | Patients with social changes such as those who live alone, patients who lack information about community welfare resources or who have lost social connections | |
Essential services to be included in discharge support programs | Necessary in the following order: housekeeping support, housing support, and visiting nursing | Necessary in the following order: housekeeping support, mobility support, and visiting nursing | ||
Barriers of discharge support programs | ||||
Lack of resources and services | Lack of nurses and social workers in charge and insufficient promotion and institutionalization of the program | Unclear and diverse welfare or health resources in the region, making it difficult to establish plans, services cannot be provided if needed based on income level | ||
Operational challenges leading to burdens | Burden of documentation, difficulty in linkage due to a lack of understanding of the program by private hospitals | Suspicions of being insurance company staff and refusal of consultation without prior notice from doctors or ward nurses, difficulty communicating with older patients, lack of privacy during consultations, high workload per person, early patient discharge | ||
Low participation of doctors | Difficult to participate without incentives related to hospital profits and doctors’ willingness to participate | Only specific doctors actively participate, doctors are rarely involved in planning | ||
Recommendations to improve discharge support programs | ||||
Team restructuring | Increase staffing of nurses and social workers | Restructure hospital teams with overlapping roles with discharge support program teams | ||
Improvement of the reimbursement system | Incentives related to hospital profits and doctors’ willingness to participate | Need for health insurance coverage and standardized guidelines | ||
Process improvement | N/A | Coordinate fragmented local services with a focus on municipalities and promote awareness of the program | ||
Rehabilitation Hospital Discharge Patient Support program | Perceptions of the discharge support programs | |||
The necessity of the discharge support program | Necessary to shorten the hospital stay and assist in returning to daily life | Reduces anxiety about returning to the community and helps in discharge preparation | ||
The efficacy of the discharge support program | Participation increases patient motivation for treatment and reduces vague fear of discharge, but limitations exist in actual rehabilitation and linking care resources | Only 20-30% successful due to patient reluctance, service eligibility, and changes in service provider conditions | ||
Role in discharge support programs | Guidance on discharge support program, helpful in treatment and discharge planning | Identify the need for linkage and monitor post-discharge medical management | Identify the welfare needs of the discharged patients and link appropriate welfare resources | |
Patients and areas needing discharge support | ||||
Patients requiring discharge support programs | Patients who are moderately independent but need training for themselves or their caregivers, patients with non-medical discharge difficulties | Need to expand program target, remove or expand inpatient period restrictions, program needed more for patients outside the target | ||
Essential services to be included in discharge support programs | Home rehabilitation or house repair, housekeeping support, or mobility support | Necessary in the following order: housekeeping support, visiting nursing, and home rehabilitation | ||
Barriers of discharge support programs | ||||
Insufficient reimbursement | Low incentives and fees | N/A | ||
Operational challenges leading to burdens | Difficult to focus due to multiple responsibilities of the person in charge, need objective criteria for selecting subjects and guidelines for welfare support, practical difficulties in field visits or home management due to workforce or cost issues | Difficulties due to reduced communication ability and cognitive function of patients, differences in opinions between patients and caregivers, reluctance to disclose sensitive information | ||
Lack of coordination | No control tower for the program | Different criteria and information requirements depending on the municipality or person in charge | ||
Recommendations to improve discharge support programs | ||||
Standardization | N/A | Need to standardize service variations across regions | ||
Improvement of the reimbursement system | Increase fees | N/A | ||
Process improvement | Promote through academic societies and medical associations | Coordinate fragmented local services with a focus on municipalities and promote awareness of the program |
N/A, not available.