This study aimed to develop a web-based cost management program for visiting nursing centers (CMP-VNC), using time-driven activity-based costing (TD-ABC), and to analyze effects of the program.

The CMP-VNC was developed using the combined prototyping approach and system developing life cycle method following four stages: need analysis with comprehensive literature reviews and focus group interviews, design and development of program algorithm, evaluation of the developed program validity using experts and users group, and application and effects analysis. The non-equivalent control group pretest-posttest design was used to analyze the effects of the program. The program demonstration was conducted for four weeks with 60 visiting nurses in 35 visiting centers.

The web-based program was developed. It has five interfaces with basic and special functions using TD-ABC, namely, input, visiting nursing activity, visiting nursing activity cost, cost efficiency, and cost calculation report. The experimental group showed significantly higher cost perception and cost confidence than control group.

We found that the CMP-VNC can be an effective tool to increase visiting nurses’ competency of costing and enhance efficiencies of visiting nursing centers.

The purpose of this study was to determine the subjects' health status according to the needs of visiting health and the function of the family in home care nursing.

The data collection period was from 07/01/04 to 10/31/04 and the subjects were 488 of those above 60 years of age staying at home or living alone who registered at a visiting health service of public health center at an urban area in Korea. This survey was carried out by visiting health nurses and participation was agreed on by the elderly people.

The extent of the subjects' total health status to the general characteristics had differences according to the age, sex, monthly income, perceived health status, known functional disorder, and yes-or-no for disease. At all health status domains, visiting health need care in the group I was very lower than one in II, III, or IV groups. Also the severe dysfunctional family was lower than lightly dysfunctional family and normal functional family in all health status domains.

Nurses must provide their characteristics considered nursing intervention for the elderly who have high visiting health needs and severe dysfunctional family with vulnerable health care.

Previous evaluation studies of the visiting nursing program explained an average change of the participants' health status, without considering socio-ecological characteristics and their impacts. However, these factors must affect individual health problems and lifestyles. For effective and appropriate community based programs, the Geographical Information System(GIS) can be utilized. GIS is a computer-based tool for mapping and analyzing things that happen on earth, and integrates statistical analysis with unique visualization. The purpose of this study was to evaluate visiting nursing care and to advocate the usefulness of planning and evaluating visiting nursing programs using Exploratory Spatial Data Analysis(ESDA) with GIS technology.

One hundred eighty-four elderly participants with cerebrovascular risk factors who lived in 13 areas of one community received visiting nursing care. The data analyzed characteristics of pre-post change and autocorrelation by ESDA using GIS technology.

Visiting nursing care showed an improvement in the participants' lifestyle habits, and family management ability and stress level, while the improvements were different depending on the regions. The change of family management ability and stress level correlated with neighborhoods (Morgan's I= 0.1841, 0.1675).

Community health providers need to consider the individual participant's health status as well as socio-ecological factors. Analysis using GIS technology will contribute to the effective monitoring, evaluation and design of a visiting nursing program.

The purpose of this research was to address the working conditions of home health nurses through a nationwide home health agency survey conducted at hospitals.

The mail surveys were sent to 303 home health nurses nation wide and returned with a response rate of 71.8%.

(a) Seventy-five percent of home health agencies were established within the past5 years and half of home health nurses are over 40 years old. (b) Working conditions were considered as follows: Seventy-one percent of respondents were full-time employees, sixty-sixpercent of home health nurses had unscheduled visits on a regular day of duty and forty-eight percent were on vacation. Fifty-one percent of home health nurses have experienced traffic accidents and paid penalties (65.9%). Self-reported monthly income level per year was an average of 28,364,000 won. (c) Rates were significantly higher for shoulder pain (61.5%), lower back pain (54.1%), knee pain (39.4%), and gastrointestinal problems (33.0%).

These baseline results show the importance of improving home health nursing working conditions, a comprehensive prevention system and safeguards from physical discomfort.

The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S.

The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG).

The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) < ‘ Low (C1) < ‘ Moderate (C2) < ‘ High (C3), according to dependency in daily activities was in order of Minimum (F0) < ‘ High (F3) < ”Medium (F2) < ”Low (F1) < ”Maximum (F4). Resource utilization by HHRGs was the highest 564,735 won in group C0F0S2 (clinical severity minimum, dependency in daily activity minimum, service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter.

Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.

This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses.

The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied.

The HHC activities were classified into 70 activities. In resource, the labor cost was 245\per minute, operating cost was 9,570\ per visit and traffic expense was an average of 12,750\. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741\ and the cost ranged from 55,560\ to 74,016\.

The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

The purpose of this study was to develop a tool for nutritional assessment, so that home care nurses can make early assessment of patients' nutritional status.

The study was done in two partsfirst a tool was developed to assess nutrition, and second the content validity and clinical validity of the categories and indices were verified.

The results of this study are summarized in two ways. First,the nutritional assessment tool was classified into 3 areas, physical measurement, nutritional survey and clinical survey, and into 11 categories with 22 indices. Second, when 5 of the 11 categories were positive, nutritional status was considered to be poor.

By developing a clinically useful nutritional assessment tool for patients receiving home care, which was developed in this study, the quality of life for these patients will improve and contribution to the development of a more effective clinical home nursing practice will occur.

This study was to develop a client health status outcome evaluation instrument, and examine content validity, reliability, construct validity, and the acceptability of this instrument.

A preliminary list was made of such key information as standards, criteria, indicators and measures, by means of a broad review of literature within the field. After determining the preliminary instruments, the study sought to obtain examination, consensus, and modification of two groups of experts in the home-care field. Finally, the instrument examined content validity, reliability, construct validity, and the acceptability of this instrument.

The tool was considered of 13 criteria, 48 indicators, and 167 detail measures. The content validity index of the tool was above 0.8 according to the expert group. Regarding the reliability of the evaluators of standards 1 and 2, the degree of agreement between evaluators was high(96.4% through 98.2%). Construct validity in this study, the difference in the mean score between the baseline point and the follow up point of each of standards 1 and 2 was significant, and the mean score of the follow up point was more than that of the baseline point. After examining the acceptability of this instrument with practice managers and home care nurses in home care institutions, a positive opinion was given of this instrument, and it was indicated that to be useful and applicable in home care practice.

The results of evaluating client outcome will contribute to overall outcome-based quality improvement and service marketing in home care by providing a constant gauge of home care effectiveness.

The purpose of this study was to measure the functional status of stroke patients cared for in different long-term care settings.

We assessed all stroke patients in two home health care agencies, four nursing homes and one geriatric hospital in Korea (n=171) using the Resident Assessment Instrument (RAI), which comprises Activity of Daily Living (ADL), urine incontinence, bowel incontinence, a Cognitive Performance Scale (CPS),and being understood and understanding others. Data was collected by face-to-face surveys with patients.

The mean ADL score, urine incontinence score, bowel incontinence score, CPS, and being understood score and understanding others score were lowest for the patients receiving home health care, and highest for the patients in nursing homes. Low scores described poor and high scores good functional status. The results showed significant differences in physical and cognitive function scores between the three groups of patients.

This study suggests that there may be large differences between the patients in these three types of long-term care settings. These findings can be used to help develop and implement efficient long-term care programs.

This study was designed to compare direct cost and indirect cost between home care and hospital care according to subject's characteristics.

The subjects of this study were patients with cerebrovascular disease. They were 50 patients in six university hospitals and 49 in four home care centers. Data were collected by using two type of questionnaires and reviewing medical records, home care service records and medical-fee claims from April 4th to September 13th, 2001.

The results were as follows; First, there was a statistically significant difference of direct cost between home care and hospital care, however, there was not a statistically significant difference of indirect cost. Second, according to subject's characteristics, six variables had statistically significant differences; sex, age, marital status, economy, job and diagnosis.

It was found that cost-saving effect of home care was affected by subject's characteristic factors. More study needs to be done to develop a more detailed selection criteria for home care subjects.

This study was intended to integrate the evidence of home care service intervention for mothers and children in vulnerable groups through an integrative literature review.

We searched the MEDLINE (PubMED), EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, DBpia databases. The quality of the articles was assessed by one doctoral researcher and verified by one professor of community health nursing who had participated in the systematic review of literature. A framework was developed to identify the intervention patterns in the selected papers and categorize various elements. The extracted intervention elements were grouped into potential themes, which were verified by assessors on whether they clearly reflected the interventions in the papers.

Among 878 searched papers, we selected 16 papers after excluding literature that does not satisfy the selection criteria and quality evaluation. The intervention elements of 16 selected papers were categorized into six themes. The extracted intervention elements were divided into the themes of Patient-specific/Situation-specific care planning and intervention, Emphasis on self care competency, Intense home visit by developmental milestone, Reinforcing and modeling mother-child attachment, Communication and interaction across the intervention, Linkage with community resource and multidisciplinary approach.

As a result of the analysis of proper interventions of home care services for mothers and children in vulnerable groups, it was found that it is necessary to consider indispensable intervention elements that can standardize the quality of home care services, and conduct studies on developing intervention programs based on the elements.

The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress.

A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3.

Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult.

The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

In this study the costs and benefits of a home health care program were examined to evaluate the economic feasibility of the program.

The study participants included 349 patients in the community who had been registered at a home health care center for 5 years. The costs and benefits of the program were analyzed using performance data and health data. The benefits were classified as the effects of pressure ulcer care, skin wound care and catheters management. The program effect was evaluated on the change of progress using transition probability. Benefits were divided into direct benefit such as the savings in medical costs and transportation costs, and indirect benefits which included saving in productivity loss and lost future income.

Participants had an average of 1.82 health problems. The input cost was KRW 36.8~153.3 million, the benefit was KRW 95.4~279.7 million. Direct benefits accounted for 53.4%~81.2%, and was higher than indirect benefits. The net benefit was greater than 0 from 2006 to 2009, and then dropped below 0 in 2010.

The average net benefit during 5 years was over 0 and the benefit cost ratoi was over 1.00, indicating that the home health care program si economical.

The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services.

A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program.

Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling.

The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

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).

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.

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.

KPIs of HCN can estimate financial and non-financial performance. The performance prediction model for HCN will be useful to improve performance.

This study was done to evaluate effectiveness of home healthcare services (HHCS) specialized for elders who received spinal surgeries.

A non-equivalent control group pre-post test quasi-experimental study was performed. HHCS was developed based on the Rice model of dynamic self-determination for self-care. For data collection, a control group (n=23) and an experimental group (n=23) were selected by matching age, BMI, pain, general characteristics and type of spine surgery. Measurement tools to evaluate uncertainty and knowledge were developed by the authors. The Numeric Rating Scale (NRS) and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were used to evaluate pain levels. Muscular strength in the legs was measured using a digital muscle tester and tape ruler. Questionnaires were used to evaluate disability in performing ADL and psychological distress levels.

The experimental group showed significant decrease in uncertainty (p=.028), increased knowledge (p=.038), and partially decreased pain (p=.003-.331). Partial muscle strength increased significantly (p=.021-.644). Disability in performing ADL and psychological distress in the experimental group decreased significantly compared to control group (p=.002, p=.004).

Results indicate HHCS is an efficient home care nursing program for these elders. Further experimental studies with larger samples are required to confirm effects of HHCS.

The purpose of this study was to help families decrease and alleviate the burden on family care-givers taking care of elderly patients.

Data was collected by a questionnaire from 100 family members who were registered in the department of home health care nursing at 4 hospitals of H University Medical Center from September 20 to October 25, 2005. The collected data was analyzed using Mean and Standard Deviation, Pearson Correlation Coefficient, t-test and One-Way ANOVA with the Duncan's test, and Stepwise multiple regression.

The average burden on family care-givers of elderly patients with chronic diseases was 3.31. The social burden was the highest(M=3.68), the lowest was the emotional burden (M=2.95). In ADL of elderly patients with chronic diseases, all 10 questions showed an average point above 2.50. The dependency level of going up and down the stairs was the highest (M=2.88).

This research is necessary for the application of a plan in the social support system in order to reduce the burden on family care-givers who are taking care of elderly patients with a chronic disease.

It is important to understand the nature of the identity through the live experiences of Home Care Nurse Practitioner(HCNP) because the role identity of a professional is constructed by continuous social interactions, This study aims to understand the construction of the role identity of HCNP.

Data was collected from 12 hospital based HCNPs. This study involved two focus group discussion sand four in-depth individual interviews. The main question was “what is the role of HCNP?” The debriefing notes and field notes were analyzed using consistent comparative data analysis method.

First, Home care (HC) is a small clinic. HCNP brings it to home to provide various services. Second, HC is the real nursing and HCNP is the ‘genuine’ nurse who actualizes the essence of nursing in practice. Third, HC is empowering activity to promote self-care ability of the patients and their caregivers. Forth, HC is like the dish-spinning required high-level mastery and HCNP is an expert who provides the most appropriate services to the patients.

HCNPs have the role identity as a highly qualified professional who delivers services from hospital to home, actualizes the essence of nursing in practice, empowers the patients and their caregivers to have self-efficacy to recover, and offers the most appropriate nursing care.