PURPOSE: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. METHODS: Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. RESULTS: Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. CONCLUSION: The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea.
Case Management* ; Cooperative Behavior ; Focus Groups ; Hospitalization* ; Humans ; Korea* ; Nursing ; Qualitative Research ; Vulnerable Populations

PURPOSE: Medical Aid Beneficiaries were surveyed to identify differences in health behaviors, adherence to drug regimen, and quality of life between those people in the Designated Doctor System and those who are not. METHODS: A total of 1,327 study subjects were separated into three groups: those in the Designated Doctor System for 2 years, those in for 1 year, and those not in the system. RESULTS: After the introduction of the Designated Doctor System, 55.8% and 67.9%, respectively, of the subjects in the Designated Doctor System complained of inconvenience in relation to hospital use and the patient referral process. Also, the rate of emergency room use or hospitalization guided by the Designated Doctor System was only 8.7% and 6.5%, respectively. There were no significant differences in health behaviors and adherence to drug regimens between those in the Designated Doctor System and those who are not. CONCLUSION: This study was carried out early in the introduction of the system. Therefore, it is necessary to monitor the positive and negative effects of the Designated Doctor System for a full reflection of its impact.
Emergencies ; Health Behavior ; Hospitalization ; Humans ; Medicaid ; Medical Staff, Hospital ; Organothiophosphorus Compounds ; Quality of Life ; Referral and Consultation

PURPOSE: The purpose of this phenomenological study was to understand the job experiences of the medical aid client managers METHOD: The data were collected through an in-depth interview from twelve medical aid client managers. It was analyzed using the phenomenological method proposed by Colaizzi (1978). Their feedback was categorized into five items such as 'settlement in the unknown place,' 'exhaustion from work,' 'difficulties in dealing with people,' 'achievement of professionalism and accomplishment,' and 'vision on the new aspect.' CONCLUSION: Medical aid client managers played diverse roles and they had a role conflict due to unstable position amid feeling proud with new vision on their roles. The results of this study suggested that systematic development of job training programs and description on the duty are needed. Moreover, appropriate legal basis for the duty of medical aid client managers is to be established. Finally, based on this research, more acknowledgement from the Korean nursing society is needed for the new emerging professional job.
Qualitative Research ; Societies, Nursing ; Vision, Ocular

PURPOSE: The purpose of this phenomenological study was to understand the job experiences of the medical aid client managers METHOD: The data were collected through an in-depth interview from twelve medical aid client managers. It was analyzed using the phenomenological method proposed by Colaizzi (1978). Their feedback was categorized into five items such as 'settlement in the unknown place,' 'exhaustion from work,' 'difficulties in dealing with people,' 'achievement of professionalism and accomplishment,' and 'vision on the new aspect.' CONCLUSION: Medical aid client managers played diverse roles and they had a role conflict due to unstable position amid feeling proud with new vision on their roles. The results of this study suggested that systematic development of job training programs and description on the duty are needed. Moreover, appropriate legal basis for the duty of medical aid client managers is to be established. Finally, based on this research, more acknowledgement from the Korean nursing society is needed for the new emerging professional job.
Qualitative Research ; Societies, Nursing ; Vision, Ocular

PURPOSE: This study was to compare the effects of individual and group intervention programs on the demented elderly and their families. METHODS: The programs were applied to two groups, one by home visiting and the other by group intervention. The groups were composed of 14 elders and 12 elders, respectively, with their families. The programs were applied twice a week, ninety minutes per session for four weeks. Programs consisted of cognitive therapy, music and art therapy, and massage for the demented elderly, education on dementia, cognitive-behavioral intervention for problematic behavior, methods to lessen stress, and counselling for the families. RESULTS: AER, problematic behavior, QOL of pts and QOL, caregiving burden, and relationship with the pts of caregivers were improved after each program but not significantly except QOL of pts (Z=-3.37, p=.00) in the group intervention. When the two interventions were compared with each other, the group intervention program was more effective than the home visiting program in all variables but not significantly except QOL of pts (U=32.00, p=.00). CONCLUSION: In summary, both the individual and group intervention programs were helpful to both pts and families, and even though tthere was no statistically significant difference between the two intervention programs except in QOL of pts, the group intervention was more effective.
Aged* ; Art Therapy ; Caregivers ; Cognitive Therapy ; Dementia ; Education ; House Calls ; Humans ; Clinical Trial ; Massage ; Music ; Quality of Life

Sleep disturbance is a typical health problem of the elderly. The purpose of this study was to explore the extent of sleep disturbance of Korean elderly, and to identify the influencing and predicting factors. A total of 15216 subjects were interviewed. To measure the quality of sleep, "The Korean Sleep" Scale was used, and as influencing factors on sleep, physical health, emotional and social activity variables were included. In this study, the percentage of a change of sleep pattern was 59.2%, and it was higher in elderly women and in above 80 yrs. But only 10.4% of subjects regarded a change of sleep pattern as a problem, and it was higher in elderly women. Total sleeping time was shorter in female and it was shortest in 65-69yrs. The higher age, the presence of Ds, the longer sickdays, the lower level of ADL and IADL, the more depressive, the more tedious during the daytime, and the less frequent engagement in exercise, the lower quality of sleep measured by KSS. Predicting variables of quality of sleep included depression, boredness during the daytime, sex, the presence of Ds, IADL, the frequency of exercise during a week, and age. These seven variables explained 13% of total quality of sleep. The extent of change of sleep pattern in the elderly is very high. Continuous efforts to increase quality of sleep of the elderly by intervening in factors influencing quality of sleep are needed.
Activities of Daily Living ; Aged* ; Depression ; Female ; Humans ; Korea*

PURPOSE: This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. METHODS: This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. RESULTS: There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). CONCLUSION: Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization.
Adolescent ; Adult ; Aged ; *Case Management ; Case-Control Studies ; Female ; *Health Behavior ; Humans ; Male ; Medication Adherence ; Middle Aged ; National Health Programs/*statistics & numerical data ; Quality of Life ; Questionnaires ; Republic of Korea ; Retrospective Studies ; Self Care ; Young Adult

PURPOSE: This research was carried out to present an ideal cooperative model between the public and private health sectors for the management of community dementia patients. METHOD: In this study a public-private cooperative council was formed, basic data for dementia patients and their families were collected, and a dementia service program was carried out in cooperation between the two sectors. RESULTS: The survey data shows the majority of the registered patients were undergoing a chronic diseases which would make the dementia health service inefficient. The cooperative public-private council adopted the reinforcement of medical service to the public enrolled dementia patients. The intensive medical service program showed effects on the health status of the dementia patients. CONCLUSION: The results of this study pointed out that change of the health insurance program supportive to the private sectors to be made; a referral system for the public health sector to the private sector should be established; and expanding the capacity of the visiting health program in the public health sector is needed.
Aged* ; Chronic Disease ; Community Health Services* ; Dementia ; Disease Management ; Health Services ; Humans ; Insurance, Health ; Private Sector ; Public Health* ; Referral and Consultation

OBJECTIVES: The aim of this study was to develop auditory-verbal and visual-spatial memory tasks using smart devices for children aged 8 to 10 years and examine their validity. METHODS: One-hundred and fourteen school-aged children were recruited through internet advertising. We developed memory tasks assessing auditory-verbal memory, visual-spatial memory, and working memory, and then examined their construct validity by examining the developmental trend of the children's mean scores with age. In order to examine the concurrent validity of the tasks, we conducted correlation analyses between the children's scores on the newly developed auditory-verbal, visual-spatial memory and working memory tasks and their scores on well-known standardized tests of memory and working memory, including the auditory-verbal memory subtests of the Korean Luria-Nebraska Neuropsychological Battery for Children, Korean Rey-Osterrieth Complex Figure Test, digit span and arithmetic subtest of Korean Educational Development Institute Wechsler Intelligence Scale for Children Revised, and Corsi block test. RESULTS: The memory and working memory scores measured by the newly developed tasks tended to increase with age. Further, there were significant correlations between the scores of the four cognitive tasks and the corresponding scores of the standardized assessment tools. CONCLUSION: This study revealed promising evidence for the validity of the memory tasks using smart devices, suggesting their utility for school-aged children in research and clinical settings.
Child* ; Humans ; Intelligence ; Internet ; Luria-Nebraska Neuropsychological Battery ; Memory* ; Memory, Short-Term

OBJECTIVES: The aim of this study was to develop computerized attention tasks using smart devices for preschool aged children for assessment of auditory attention, visual attention, and attention shifting abilities. We then evaluated their construct and concurrent validity of them. METHODS: Sixty-seven 5- to 7-year-old children attending kindergarten were recruited. Newly developed computerized attention tasks and existing standardized attention tests such as Advanced Test of Attention (ATA) and Children's Color Trails Test-2 (CCTT-2) were successively administered. To examine the concurrent validity of these tasks, correlation coefficients between the participants' scores on the newly developed tasks and the scores on well-known measures were calculated for assessment of each component construct. We also examined the construct validity of the tasks using the developmental trend of the auditory attention, visual attention, and attention shifting abilities with age. RESULTS: Significant correlations were observed between the scores of computerized attention tasks using smart devices and corresponding scores of ATA-auditory task, visual task, and CCTT-2. And there were significant linear increasing trends of correct scores with age from 5 to 7 years. CONCLUSION: This study provides promising evidence for the utility of computerized attention tasks using smart devices for preschool-aged children.
Child* ; Humans