1.A Study of the Roles, Practice, and Reimbursement of Korean Advanced Practice Nurses, and Proposal for Improving Reimbursement Policies
Su Jung CHOI ; Dong Hyun LEE ; Young Ah KANG ; Cho Sun LEEM ; Mi Kyeong JEON
Journal of Korean Clinical Nursing Research 2024;30(3):178-192
Purpose:
This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice.
Methods:
The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023.
Results:
In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended.
Conclusion
In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.
2.Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong JEON ; Su Jung CHOI ; Ji Eun HAN ; Eun Kyung KWON ; Jeong Hee PARK ; Jeong Hye KIM
Journal of Korean Academy of Nursing 2024;54(4):594-606
Purpose:
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods:
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results:
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.
3.A Study of the Roles, Practice, and Reimbursement of Korean Advanced Practice Nurses, and Proposal for Improving Reimbursement Policies
Su Jung CHOI ; Dong Hyun LEE ; Young Ah KANG ; Cho Sun LEEM ; Mi Kyeong JEON
Journal of Korean Clinical Nursing Research 2024;30(3):178-192
Purpose:
This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice.
Methods:
The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023.
Results:
In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended.
Conclusion
In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.
4.Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong JEON ; Su Jung CHOI ; Ji Eun HAN ; Eun Kyung KWON ; Jeong Hee PARK ; Jeong Hye KIM
Journal of Korean Academy of Nursing 2024;54(4):594-606
Purpose:
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods:
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results:
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.
5.Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong JEON ; Su Jung CHOI ; Ji Eun HAN ; Eun Kyung KWON ; Jeong Hee PARK ; Jeong Hye KIM
Journal of Korean Academy of Nursing 2024;54(4):594-606
Purpose:
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods:
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results:
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.
6.A Study of the Roles, Practice, and Reimbursement of Korean Advanced Practice Nurses, and Proposal for Improving Reimbursement Policies
Su Jung CHOI ; Dong Hyun LEE ; Young Ah KANG ; Cho Sun LEEM ; Mi Kyeong JEON
Journal of Korean Clinical Nursing Research 2024;30(3):178-192
Purpose:
This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice.
Methods:
The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023.
Results:
In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended.
Conclusion
In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.
7.Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong JEON ; Su Jung CHOI ; Ji Eun HAN ; Eun Kyung KWON ; Jeong Hee PARK ; Jeong Hye KIM
Journal of Korean Academy of Nursing 2024;54(4):594-606
Purpose:
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods:
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results:
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.
8.A Study of the Roles, Practice, and Reimbursement of Korean Advanced Practice Nurses, and Proposal for Improving Reimbursement Policies
Su Jung CHOI ; Dong Hyun LEE ; Young Ah KANG ; Cho Sun LEEM ; Mi Kyeong JEON
Journal of Korean Clinical Nursing Research 2024;30(3):178-192
Purpose:
This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice.
Methods:
The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023.
Results:
In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended.
Conclusion
In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.
9.Real-World Eligibility and Cost-Effectiveness Analysis of Empagliflozin for Heart Failure in Korea
Eui-Soon KIM ; Sun-Kyeong PARK ; Jong-Chan YOUN ; Hye Sun LEE ; Hae-Young LEE ; Hyun-Jai CHO ; Jin-Oh CHOI ; Eun-Seok JEON ; Sang Eun LEE ; Min-Seok KIM ; Jae-Joong KIM ; Kyung-Kuk HWANG ; Myeong-Chan CHO ; Shung Chull CHAE ; Seok-Min KANG ; Jin Joo PARK ; Dong-Ju CHOI ; Byung-Su YOO ; Jae Yeong CHO ; Kye Hun KIM ; Byung-Hee OH ; Barry GREENBERG ; Sang Hong BAEK
Journal of Korean Medical Science 2024;39(1):e8-
Background:
The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry.
Methods:
A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY).
Results:
Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY).
Conclusion
There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications.
10.The Effects of a Shift Improvement Pilot Project on Nurses' Shift Adjustment, Work-Life Balance, and Turnover Intention:A Mixed-Methods Study
Su Jung CHOI ; Mi Soon KIM ; Mi-Kyeong JEON ; Jin Ju CHOI ; Sook Yeon SON ; Eun Hye KIM
Journal of Korean Clinical Nursing Research 2023;29(3):223-237
Purpose:
This study aimed to investigate the impact of a nurse shift improvement pilot project on nurses' shift adjustment, work-life balance, and turnover intention, as well as nurses' experiences of participating in the pilot project.
Methods:
An explanatory sequential mixed-methods study was performed. Survey data was collected from a total of 1,051 nurses both in participant and non-participant groups. For the qualitative study, focus group interviews were conducted with 22 nurses who participated in the shift improvement pilot, including 12 staff nurses, 7 nurse managers, and 3 substitute nurses.
Results:
There were significant positive effects on the key variables of nurses’ shift adjustment, work-life balance, and turnover intention in the group that participated in the nurse shift improvement pilot project. Based on the qualitative study, participants in the shift improvement pilot project indicated that it enabled nurses to recover their circadian rhythm, and achieve a better work-life balance, and they wanted to continue working as a nurse, and hoped expanded application of the pilot project.
Conclusion
In order for expanded implementation of the pilot project and continued improvement in the shift system, we recommend establishing compensation standard, systematizing the use of substitute nurses, developing guidelines for shift schedules, and expanding the shift improvement pilot project to other departments such as the emergency room.

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