Development and Application of a Performance Prediction Model for Home Care Nursing Based on a Balanced Scorecard using the Bayesian Belief Network

PURPOSE: This study was conducted to develop key performance indicators (KPIs) for home care nursing (HCN) based on a balanced scorecard, and to construct a performance prediction model of strategic objectives using the Bayesian Belief Network (BBN). METHODS: This methodological study included four steps: establishment of KPIs, performance prediction modeling, development of a performance prediction model using BBN, and simulation of a suggested nursing management strategy. An HCN expert group and a staff group participated. The content validity index was analyzed using STATA 13.0, and BBN was analyzed using HUGIN 8.0. RESULTS: We generated a list of KPIs composed of 4 perspectives, 10 strategic objectives, and 31 KPIs. In the validity test of the performance prediction model, the factor with the greatest variance for increasing profit was maximum cost reduction of HCN services. The factor with the smallest variance for increasing profit was a minimum image improvement for HCN. During sensitivity analysis, the probability of the expert group did not affect the sensitivity. Furthermore, simulation of a 10% image improvement predicted the most effective way to increase profit. CONCLUSION: KPIs of HCN can estimate financial and non-financial performance. The performance prediction model for HCN will be useful to improve performance.

Current Status of Home-Based Cancer Patients Management in Jeju / 한국호스피스완화의료학회지

PURPOSE: As a part of analysis of home-based cancer patients management of public health centers, regional cancer center, and hospice institution in Jeju, this study was undertaken to establish their role. METHODS: We investigated current status of hospice palliative care, especially home-based cancer patients management and summary demand of public health centers. RESULTS: Services provided through the home-based cancer patients management project included physical, emotional, spiritual and education/informative services, even though there was little difference between them. The result showed that in the view of patients there was little relationship between public health centers, regional cancer center and hospice palliative institution. CONCLUSION: The relationship between home-based cancer patients management and institutions should be reinforced. Patients in acute state and difficulty care of patients should be referred to regional cancer center whereas maintenance state of patients should be referred to public health center.

An Analysis of the Elderly Care and Management in Hospital-Based Home Care Agencies

PURPOSE: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. METHOD: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. RESULT: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. CONCLUSION: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.

El ingreso en el hogar y su costo directo en Cuba / The direct costs of home care in Cuba

OBJETIVOS: Analizar el tiempo de estadía en ingreso en el hogar (IH) y su costo diario y por paciente en Cuba, según el diagnóstico al ingreso y la zona donde se brinda el servicio. MÉTODOS: Se analizó la información de los 837 pacientes en IH entre julio de 2001 y junio de 2002 en un área del municipio Playa, en Ciudad de La Habana (zona urbana metropolitana), una del municipio Cruces, en Cienfuegos (zona urbana no metropolitana), otra del Municipio Unión de Reyes, en Matanzas (zona rural) y una de Fomento, en Sancti Spiritus (zona rural montañosa). Se analizó la mediana del tiempo del IH mediante curvas de supervivencia Kaplan Meier y se evaluó el efecto del diagnóstico al ingreso (afecciones respiratorias, gastrointestinales, ginecobstétricas, egreso hospitalario precoz y otras causas), la zona del IH, el sexo y la edad, sobre la posibilidad de egresar del IH. Para cada municipio se calculó el costo directo del servicio, el costo por paciente y el costo por día de estadía. Se ajustaron modelos de regresión lineal múltiple para identificar el efecto que sobre el costo por paciente tienen el tiempo de estadía, el diagnóstico al ingreso y el área donde se presta el servicio de IH. RESULTADOS: La causa más frecuente de IH en los municipios estudiados fueron las afecciones respiratorias (31,4 por ciento), seguidas del egreso hospitalario precoz (15,5 por ciento), las afecciones ginecobstétricas (10,8 por ciento) y los trastornos gastrointestinales (8,1 por ciento). La mediana del tiempo de estadía fue de 6 días (IC95 por ciento: 5,75 a 6,25). En Fomento los pacientes tuvieron 66 por ciento menos probabilidad de egresar que en Cruces y 30 por ciento menos que en Playa y Unión de Reyes. El costo directo del IH en los municipios estudiados medido en pesos cubanos ($) varió entre $3 983,54 y $9 624,87. El costo por día de estadía fue de $2,57 a $6,88, mientras el costo por paciente fue de $23,04 a $42,78. El tiempo de estadía tuvo un efecto...

OBJECTIVE: To analyze home care services in Cuba and determine how length of stay, per-day cost, and per-patient cost vary by diagnosis and by the area of the country in which the services are rendered. METHODS: Patient information was analyzed for 837 individuals who were enrolled in home care services between July 2001 and June 2002 in the following four municipalities: (1) Playa municipality (a metropolitan urban area) in the province of the City of Havana; Cruces municipality (an urban, but not metropolitan, area) in the province of Cienfuegos; Unión de Reyes municipality (a rural area) in the province of Matanzas; and Fomento municipality (a mountainous rural area) in the province of Sancti Spiritus Analysis of the mean length of stay for home care services was conducted using the Kaplan-Meier survival curve method. The impact of the following criteria on the probability and timing of discharge was also assessed: diagnosis at time of enrollment (respiratory, gastrointestinal, obstetrical/gynecological, hospital discharge follow-up, and other causes), area in which services were rendered, and patient gender and age. The total service, per-patient, and per-day costs were determined for each municipality. Adjusted multilinear regression models were used to determine how length of stay, diagnosis upon enrollment, and service area affected cost. RESULTS: The diagnoses most frequently requiring home care were respiratory illness (31.4 percent), hospital follow-up of acute condition (15.5 percent), obstetrical/ gynecological illness (10.8 percent), and gastrointestinal disorder (8.1 percent). The mean length of stay was 6 days (95 percent confidence interval: 5.75 to 6.25). In Fomento, the probability of patients enrolling in home care was 66 percent lower than in Cruces and 30 percent lower than in Playa and Unión de Reyes. The total direct cost of home care in the municipalities studied ranged, in Cuban pesos, from $3 983.54 to $9 624.87. The...