취약계층 재가노인의 사례관리 성과와 영향요인에 관한 구조모형 구축

Abstract

It has been predicted that in 2018, the population aged 65 or older in Korea will increase by 14.3% and that Korea will enter into an aged society. The biggest challenges faced by older adults, aged 65 or older, are economic problems and health issues. In particular, chronic illnesses and the breakdown of social support systems for the community-dwelling vulnerable elderly affect their well-being and lead to excessive facility admission and healthcare costs. Accordingly, the case management approach has been applied as an important strategy to improve the functional status of the elderly and the comprehensiveness and continuity of services provided to them. This approach has been recognized as crucial in finding a solution to problems regarding access to services, fragmentation, unnecessary facility admission, and excessive long-term care costs. However, it is not clear from case management research as to which elements of case management systems lead to the most effective outcomes. In addition, many studies do not discuss the process that leads to some levels of outcome in case management. This study aims to develop a structural model of case management outcomes using Donabedians structure-process-outcome model and to verify the model of case management outcomes for the community-dwelling vulnerable elderly. Data were collected from 309 nurses (case managers) and community-dwelling vulnerable elderly (clients) from public health centers, from August 16 to August 31, 2012. For data analysis, descriptive statistics, Pearsons correlation analysis, factor analysis, and covariance structure analysis were performed using SPSS Version 18.0 for Windows and Amos 16.0. The results of this study are as follows. The hypothetical model had acceptable fit: GFI = .970, CFI = .947, RMSEA = .020, SRMR = .051. The factor case managers' singularity had the greatest impact on case management outcomes in this model. In addition, the factor case management practice influenced case management outcomes

however, client characteristics did not. Case managers' singularity affected case management outcomes directly and indirectly, with case management practice mediating the latter effect. These results suggest that the causal relationship between case management outcomes and their influencing factors should be clarified through longitudinal research including a variety of client characteristics. In addition, future studies should analyze the effects of programs to improve manpower quality, such as empowerment programs, and examine the relationships among case management outcomes. It is also necessary to examine the impact on outcome of a collaborative relationship in the point of view of the clients.