Development of Severity-Adjustment Model for Length of Stay in Hospital for Percutaneous Coronary Interventions

관상동맥중재술 환자의 재원일수 중증도 보정 모형 개발

  • 남문희 (가야대학교 간호학과) ;
  • 강성홍 (인제대학교 보건행정학과) ;
  • 임지혜 (동주대학 보건의료행정과)
  • Received : 2011.03.28
  • Accepted : 2011.08.16
  • Published : 2011.09.28


Our study was carried out to develop the severity-adjustment model for length of stay in hospital for percutaneous coronary interventions so that we would analysis the factors on the variation in length of stay(LOS). The subjects were 1,011 percutaneous coronary interventions inpatients of the Korean National Hospital Discharge In-depth Injury Survey 2004-2006 data. The data were analyzed using t-test and ANOVA and the severity-adjustment model was developed using data mining technique. After yielding the standardized value of the difference between crude and expected length of stay, we analysed the variation of length of stay for percutaneous coronary interventions. There was variation of LOS in regional differences, size of sickbed and insurance type. The variation of length of stay controlling the case mix or severity of illness can be explained the factors of provider. This supply factors in LOS variations should be more studied for individual practice style or patient management practices and healthcare resources or environment. We expect that the severity-adjustment model using administrative databases should be more adapted in other diseases in practical.


Percutaneous Coronary Interventions;Length of Stay;Severity-Adjustment;Regional Geographic Vvariation;Data Mining


  1. S Gera, Harsh Wardhan, "Percutaneous Coronary Intervention: A Clinico-angiographic Study," JIACM Vol.5, No.4, pp.322-6, 2004.
  2. R. Doughty, T. Yee, N. Sharpe, and S. McaMahon, "Hospital admissions and deaths due to congestive heart failure in New Zealand 1988-1991," NZ Med J, 1012, vol.108 pp.473-475, 1995.
  3. 통계청, 2009년 사망원인통계결과, 2010.
  4. 김윤아, 정명호, 주신배, 최명자, 김인수, 김남호, 김건형, 이승욱, 조장현, 안영근, 조상기, 조정관, 박종춘, 강정채, "70세 이상 여성 고령환자에서 관상동맥중재술", 대한내과학회지, 제60권, 제5호, pp.456-462, 2001.
  5. C. E. Chambers, G. J. Dehmer, D. A. Cox, R. A. Harrington, J. D. Babb, J. J. Popma, M. A. Turco, B. H. Weiner, and C. L. Tommaso, "Defining the Length of Stay Following Percutaneous Coronary Intervention," An Expert Consensus Document From the Society for Cardiovascular Angiography and Interventions Catheterization and Cardiovascular Interventions, Vol.73, No.7, pp.847-858, 2009.
  6. 조진만, 김종진, 신우승, 조은주, 박철수, 김범준, 이종민, 임상현, 임효영, 장기육, 문건웅, 김용주, 정해억, 김희열, 박지원, 진승원, 전희경, 오용석, 유기동, 전두수, 백상홍, 이길환, 윤호중, 이만영, 정욱성, 박준철, 승기배, 노태호, 김철민, 박인수, 채장성, 김재형, 최규보, 홍순조, "관상동맥 질환 으로 입원한 한국인 환자의 임상양상과 예후인 자", 대한내과학회지, 제73권, 제2호, pp.142-150, 2007.
  7. G. D, Everett, M. D, M. P. Antron, B. K. Jackson, C, Swigert, N, and Uddin, "Comparison of Hospital Cost and Length of Stay Associated With General Internists and Hospitalist Physicians at a Communty Hospital," Am J Manag Care September, Vol.10, No.9, pp.626-630, 2004.
  8. S. P. Wright, D. Verouhis, G. Gamble, K. Swedberg, N. Sharpe, and R. N. Doughty, "Factors influencing the length of hospital stay of patients with heart failure," Eur J Heart Fail, Vol.5, No.2, pp.201-209, 2003.
  9. W. K. Au, M. P. Sun, K. T. Lam, L. C. Cheng, S. W. Chiu, and S. R. Das, "Motality prediction in adult cardiac surgery patient: comparison of two risk stratification model," Hong Kong Med J, Vol.13, No.4, pp.293-297, 2007.
  10. For The Leapfrog Group By The Center for Health Systems Research and Analysis University of Wisconsin - Madison, March 19, 2008. Available from:
  11. E. L. Hannan, C. T. Wu, E. V. Bennett, R. E. Carlson, A. T. Culliford, J. P. Gold, Robert S. D. Higgins, O. Wayne Isom, C. R. Smith, and R. H. Jones, "Risk Stratification of in-Hospital Mortality for Coronary Artery Bypass Graft Surgery," J. Am. Coll. Cardiol, Published online Dec 28, 2005; doi: 10.1016/j.jacc.2005.10.057. Available from
  12. 강성홍, "퇴원환자의 재원일수 변이 분석: 2004-2006년 퇴원손상심층조사 결과 중심으로", 주간 건강과질병, 제2권, 제51호, pp.857-866, 2009.
  13. 질병관리본부, "퇴원손상심층조사 원시자료 이용지침서 2005/2006/2007년", 2010.
  14. Ian H. Witten, and Eibe Frank. "Data Mining, MORGEN KAUFMANN PUBLISHERS," pp.120-122, 2000.
  15. W. S. Weintraub, J. M Craver, C. L. Cohen, E. L. Jones, R. A. Guyton, "Influence of age on results of coronary artery surgery," Circulation 84(Suppl3), pp.226-35, 1991.
  16. C. W. Akins, W. M. Daggett, G. L. Vlahakes, "Cardiac operation in patients 80 years old and olde," Ann Thorac Surg Vol.64, pp.606-615, 1997.
  17. 이재희, 이원재, 정현용, "서울지역으로의 원거리 의료 이용에 대한 영향요인", 한국컨텐츠학회지, 제10권, 제4호, pp.247-256, 2010.
  18. A. Clarke, "Why are we trying to reduce length of stay? evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change," Qual Health Care, Vol.5, No.3, pp.172-179, 1996.
  19. 도영경, "미국의 지역간 의료이용의 변이 연구: 비판적 검토와 함의", 보건행정학회지, 제17권, 제 1호, pp.94-124, 2007.
  20. J. E. Wennberg, "Unwarranted variations in healthcare delivery: Implications for academic medical centres," BMJ, pp.961-964, 2002.
  21. J. Skinner, and J. E. Wennberg, "How much is enough? Efficiency and Medicare spending in the last six months of life," NBER Working Paper No.6513. Cambridge, MA: National Bureau of Economic Research, 1998.
  22. M. R. Chassin, "Health technology case study 24: Variations in hospital length of stay: Their relationship to health outcomes," Washington, D. C.: U.S. Congress, Office of Technology Assessment, OTA-HCS-23, 1983(8).
  23. M. Gornick, "Trends and regional variations in hospital use under medicare," Health Care Financ Re, Vol.3, No.3, pp.41-73, 1982.
  24. J. E. Wennberg, B. A. Barnes, and M. Zubkoff, "Professional uncertainty and the problem of supplier-induced demand," Soc Sci Med, Vol.16, No.7, pp.811-824, 1982.
  25. Clinical Practice Guidelines-Management of Percutaneous Coronary Intervention (PCI), 2009. Available from
  26. J. X. Rolley, Y. Salamonson, C. Wensley, C. R. Dennison, and P. M. Davidson, "Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions," Aust Crit Care, VoL.24, No.1, pp.18-38, 2011.
  27. ACC Clinical Practice Guideline - Percutaneous Coronary Intervention User Reviews. Available from
  28. Update of Korean Guideline of Ischemic Heart Disease. Available from
  29. A. B Flood, W. Ewy, W. R. Scott, F. WH,Jr, and B. BW,Jr, "The relationship between intensity and duration of medical services and outcomes for hospitalized patients," Med Care, Vol.17, No.11, pp.1088-1102, 1979.
  30. G. E. Rosenthal, M. V. Sarrazin, D. L. Harper, and S. M. Fuehrer, "Mortality and length of stay in a veterans affairs hospital and private sector hospitals serving a common market," J Gen Intern Med, Vol.18, No.8, pp.601-608, 2003.
  31. D. P. Chew, F. A. Anderson, Á. Avezum, K. A. Eagle, G. FitzGerald, J. M. Gore, R. Dedrick, and D. Brieger, "InvestigatorsSix-month survival benefits associated with clinical guideline recommendations in acute coronary syndromes," Heart doi:10.1136/hrt.2009.184853
  32. 탁관철, 박현주, 최혜선, 노춘희, 이승혜, 장현옥, 최수영, "Case Management의 임상 적용과 그 효과 분석", 한국의료QA학회 가을학술대회, pp.333-340, 2000.