Review and inspirations of the payment mechanism of Long-Term Care Hospital of Medicare of the United States / 中华医院管理杂志

A type of designated hospitals in Medicare is referred to as Long-Term Care Hospital (LTCH). LTCH is one of Post-Acute Care settings(I. e. Intermediate care)and the only facilities certified by length of stays. This article reviewed the milestones and payment methods of Medicare Long-Term Care Hospital payment system, for perfection of the medical insurance and construction of China′s intermediate care system.

Clinical Nutrition Services of a Long-term Care Hospital in Korea / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to investigate how clinical nutrition services is provided at a long term care hospital in Korea and to investigate job satisfaction levels of the clinical dietitians. METHODS: Survey questionnaire was sent to dietitians working at a long term care hospital in Korea. The participating hospitals (n=240) were randomly selected from 1,180 long- term care hospitals using a stratified sampling method. A total of 134 long term care hospital s and 223 dietitians completed the survey of clinical nutrition service s and job satisfaction questionnaires The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas. RESULTS: The average nutritional screening rate was 17.9% and the rate of computerized nutritional screening system was 9.7% in the participating hospitals. Nutritional intervention rate was only 3.2% of all patients. KOIHA (Korea Institute for Healthcare Accreditation) accreditated hospitals showed only 50% performance rate of nutrition service evaluation area. This shows that after achieving KOIHA accredition, many hospitals do not emphasize the performance of nutritional services. The job satisfaction scores in all four areas ranged from 2/5 to 3/5, implying generally low job satisfaction level in hospital dietitians. Linear regression analysis results showed that the "hospital adequacy grade" type was a significant predictor of job satisfaction level for two areas (working conditions & relationship). CONCLUSIONS: There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service s in long term care hospitals. Therefore, government and local hospitals have to work on implementing nutritional programs and policies for improved service and care.

Long-Term Care Hospital and the Role of Neurologist

Korea health care system and public welfare system have been changed slowly and developed step by step. It makes efforts to promote the welfare of the people, but does not provide good benefits for geriatric patients. In 2008, it was incompletely set up the long term care system in Korea. And the Law on Long-Term Care Insurance for Elderly was officially announced in Nov. 2011 and the law for dementia, Dementia Management Act, was drafted in Feb. 2012. Though there were many laws, the concept of long-term care hospital and geriatric care facility is still obscure. In long-term care hospital, there are big expansion of the number of beds and institutions in Korea. Over a half of the patients in long-term care hospitals are suffered from mixed neurological diseases. Especially, dementia is the comorbid state with other chronic geriatric diseases. In view of the aging population, the role of neurologist will continue to grow. So neurologists need more special training for the needed skills and competencies, and the specific care settings program in long-term care hospital. In this review, the history and current state of long-term care hospital, related laws, and the role of neurologist will be discussed.

Effects on Long-Term Care Hospital Staff Mixing Level after Implementing Differentiated Inpatient Nursing Fees by Staffing Grades / 간호행정학회지

PURPOSE: The purpose of this study was to examine trends in number of nursing staff and skill mix. METHODS: Nursing staff and skill mix were measured using the number of nursing staff including nurse aids and registered nurses per bed. Descriptive and panel data regression analyses were conducted using data on long-term care hospitals which included yearly series data from 2006 to 2010 for 119 hospitals. RESULTS: The number of nursing staff per bed increased significantly but percentage of registered nurses decreased significantly from 2007 to 2010. The regression model explained this variation as much as 35% and 44%. CONCLUSION: The results showed that in long-term care hospitals there were more nurse aids employed instead of registered nurses after the implemention of differentiated inpatient nursing fees. Thus clarifying the job descriptions for nurses and nurse aids is needed and appropriate hospital incentive policies should be implemented.

The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior, dietary behavior, nutrition risk level and nutrient intake

This study was conducted to assess improvements in nutritional status following the application of nutrition education to elderly patients in a long-term care hospital. The study was carried out from January to May 2009, during which a preliminary survey, a pretest, the application of nutrition education, and a post-test were applied in stages. The number of subjects at pretest was 81, and the number of participants included in the final analysis was 61 (18 men, 43 women), all of whom participated in both the nutrition education program and the post-test. The survey consisted of general demographic items, health behaviors, dietary behaviors, the Nutrition Screening Initiative checklist, and nutrient intake assessment (24 hour recall method). The nutrition education program lasted for four weeks. It included a basic education program, provided once a week, and mini-education program, which was offered daily during lunch times. The survey was conducted before and after the education program using the same assessment method, although some items were included only at pretest. When analyzing the changes in elderly patients after the nutritional education program, we found that, among subjective dietary behaviors, self-rated perceptions of health (P < 0.001) and of depression (P < 0.001) improved significantly and that dietary behavior scores also improved significantly (P < 0.001), while nutritional risk levels decreased. In terms of nutrient intake, subjects' intake of energy, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C all increased significantly (P < 0.001). These results indicated that nutritional education is effective in improving the nutritional status of elderly patients. We hope that the results of this study can be used as preliminary data for establishing guidelines for nutrition management tailored to elderly patients in long-term care hospitals.

Importance and Performance of Dietitian's Task at Long Term Care Hospital Foodservice in Busan . Kyungnam Area / 대한지역사회영양학회지

The purpose of this study was to evaluate importance and performance of dietitian's task at long term care hospitals foodservices in the Busan.Kyongnam area. The research was performed through using questionnaires and conducted from June 11 to July 16, 2010 for 186 dietitians at 141 long-term care hospitals. Seventy-two percent of hospitals had two dietitians and 69% of them had a dietitian's office. Fifty-two percent of dietitians has worked for less than 2 years at long term care hospital, and 37.1% of them worked additional tasks. Seventy-three percent of hospitals conducted a therapeutic diet program and the therapeutic diets frequently provided were diabetic diet > tube feeding diet > dysphasia diet > sodium controlled diet. Mean score for the importance (4.36/5.00) and performance (3.91/5.00) of dietitian's tasks were significantly different (p < 0.001). The importance and performance grid showed that the purchase-inspection management and sanitation-safety management were high scores to the importance and performance (doing great area), menu-foodservice management and cooking-working management were low scores to the importance and high scores to the importance (overdone area), and nutrition management was low scores to the importance and performance (low priority). Forty-three percent of dietitians agreed with the needs for role separation between foodservice dietitian and clinical dietitian.

Development of Outcome Indicators of Urinary Incontinence for Quality Evaluation in Long Term Care Hospitals

PURPOSE: To develop outcome indicators of urinary incontinence to measure quality of care in long term care hospitals in Korea. METHODS: The draft indicators of urinary incontinence were developed from a literature review and clinical expert panel. A survey of medical records of 280 patients in 20 hospitals was conducted to test inter-rater reliability. Statistical analysis was done to test risk adjustment criteria, variation between hospitals, and stability of indicators, using assessment data from 77,918 patients in 623 hospitals. RESULTS: The inter-rater reliability of items was high (Kappa range: 0.66-0.92). Severe cognitive impairment (odds ratio [OR]: 3.15, confidence interval [CI]: 3.03-3.26) and total mobility activities of daily living (ADLs) dependency (OR: 4.85, CI: 4.72-4.98) increased the prevalence of urinary incontinence, thus they proved to be significant criteria to stratify high and low risk groups. The prevalence for low risk showed more substantial variation than the high risk group. The indicators were stable over one month. CONCLUSION: This study demonstrated the feasibility of outcome indicators of urinary incontinence. Improving the reliability of the patient assessment tool and refining the indicators through validation study is a must for future study.

Quality Dimension of Long Term Care Hospital

PURPOSE: This is a qualitative study to identify dimensions of long-term care hospital care quality that provide high-level medical services for long-term care patients in Korea. METHODS: Service consumers and providers were interviewed, and collected data were analyzed into thesis, type and dimension. The focus group method was applied to two provider groups and individual interview was applied to two persons who had experienced a long-term care hospital. RESULTS: The results of analyzing the comsumers and providers was integrated into 8 dimensions: physical environment, staff, clinical care and nursing, multiplicity of activity program, atmosphere, interaction with family, nutrition, and quality improvement system. CONCLUSION: The dimensions of long-term care hospital care quality from this study can be used as a basis of quality indicators. Quantitative studies to test these dimensions are required for establishing quality management systems.

Multi-level Analysis of Factors related to Quality of Service in Long-term Care Hospitals

PURPOSE: In this research multi-level analysis was done to identify factors related to quality of services. Patient characteristics and organizational factors were considered. METHODS: The data were collected from the Health Insurance Review and Assessment Service (HIRA) data base. The sample was selected from 17,234 patients who had been admitted between January 2007 and May 2008 to one of 253 long-term care hospitals located in Seoul, six other metropolitan cities or nine provinces The data were analyzed with SAS 9.1 using multi-level analysis. RESULTS: The results indicated that individual level variables related to quality of service were age, cognitive ability, patient classification, and initial quality scores. The organizational level variables related to quality of service were ownership, number of beds, and turnover rate. The explanatory power of variables related to organizational level variances in quality of service was 23.72%. CONCLUSION: The results of this study indicate that differences in the quality of services were related to organizational factors. It is necessary to consider not only individual factors but also higher-level organizational factors such as nurse' welfare and facility standards if quality of service in long term care hospitals is to be improved.