The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are established for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The "AUTOGRP System" was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The "Departmental Method" was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying pattern of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among this study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables(i.e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The weighted mean total case cost(TOTC) of the study hospitals for Medicare patients during the study years was $1127.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($745.45). The weighted mean per total cost (DTOC) of the study hospitals for Medicare patients during the study years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the lowest average DTOC($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variable to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of inter-hospital cost variation; 59.1 percent for TOTC and 44.3 percent for DTOC. These results demonstrate that the casemix index is the most important determinant of inter-hospital cost variation. Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix-related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.
Classification ; Connecticut ; Cost Control ; Data Collection ; Dataset ; Diagnosis ; Diagnosis-Related Groups ; Health Facility Size ; Hospital Costs* ; Hospitals, General ; Humans ; Information Systems ; Length of Stay ; Linear Models ; Medicare ; Mortality ; Population Characteristics* ; United States Social Security Administration

No abstract available.
Ultrasonography*

No abstract available.
Aged* ; Humans ; Quality of Life*

School bullying, the most prevalent type of school violence, is known to be related to various behavioral, emotional, and social problems both in victims and perpetrators. The purpose of the present study was to review available reports on school bullying in Korea and other countries, and author's two recently conducted epidemiological studies in a Korean community sample of elementary and middle school students. Among a total of 532 students of 4th to 6th graders of two elementary schools, 44.4% of students experienced school bullying. Children who were involved with school bullying reported impaired quality and satisfaction of friendship. Social immaturity, withdrawal, inattention-passivity, conduct problems, aggression, and male gender were associated with both victims and perpetrators of school bullying. In a 8-month prospective study of two middle schools, the prevalence of school bullying was similar to those in elementary schools (40.9~45.5%). Risks for chronic self-injurious/suicidal behaviors were significantly increased in chronic victims, perpetrators, and victim-perpetrators compared to those who were not involved with school bullying. Additionally, the male gender, first child, and extreme socioeconomic status were identified as environmental risk factors of school bullying. School bullying is very common among Korean elementary and middle school students. Both victims and perpetrators had more significant psychopathology than their counterparts. More active and scientifically tailored intervention and preventive programs are required to decrease school bullying and to provide appropriate assistance for promoting healthy development of Korean students.
Aggression ; Bullying* ; Child ; Epidemiologic Studies ; Friends ; Humans ; Korea ; Male ; Prevalence ; Prospective Studies ; Psychopathology ; Risk Factors ; Social Class ; Social Problems ; Violence

BACKGROUND: In cases of pure mitral stenosis, it is known that the impairment of left ventricular(LV) ejection performance is frequently accompanied, but long term follow up studies on the LV ejection performance after successful percutaneous mitral valvuloplasty are rare on far. METHODS: An prospective investigation was performed on 32 casas of patients, 10 being male and 22 female, who have beem maintained after successful precutaneous mitral valvuloplasty of pure mitral stenosis. The LV ejection preformances have been measured with cardiomechanography and echocardiography before and following the procedure, and the follow-up periods were 24 months in average, in the range of 12 to 35 months. RESULTS: The stroke volume, cardiac output, cardiac index, ejection fraction, mean velocity of circumferential shortening and fractional shortening(FS), which are indices of LV ejection perfomance, all increased in follow-up than before procedure. In addition, LV end-diastolic dimension and LV end-diastolic dimension index, which are indicis of LV preload, increased, and the end-systolic LV wall stress which is an index of afterload, decreased. And the ratio measured FS to expected FS, which in an index of myocardial contractility, increased in follow-up. CONCLUSION: The successful percutaneous mitral valvuloplasty of pure mitral stenosis is found to improve LV ejection performance in long term by increasing preload, decreasing afterload, and increasing myocardial contractility of left venrticle.
Cardiac Output ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve Stenosis* ; Prospective Studies ; Stroke Volume

No abstract available.

No abstract available.
Lymphoma, Non-Hodgkin*

The purposeof this project is offering fundamental and proper informations for the better health control and personnel management of the enlisted men of Marine corps. Korea. Survey has been done under 1,001 marine enlisted men for the purpose of understanding their condition of physique, vital capacity, and bodily strength. 1. Under the subject of physique, 7 items, body weight, chest-girth, relative body weight, relative chest-girth, Vervaeck index, and Roethrer index are listed, and under the subject of vital capacity, BTPS vital capacity and percent predicted vital capacity are listed, and under the subject of bodily strength, 7 items, grasping power, chining-up, throwing a hanp-grenade, forward jumping, sitting-up, 100 meter sprinting, are listed. The total items are 16 and mean score of each one is as follow. 1) physique. a. Height : 168+/-0.15cm. b. Body weight : 62.7+/-0.17kg. c. Chest-grith : 91.4+/-0.16cm. d. Relative body-girth : 37.2+/-0.09. e. Relative Chest-girth : 54.3+/-0.10. f. Vervaeck index : 91.6+/-0.15. g. Roehere index : 1.31+/-0.003. 2) Vital capacity. a. BTPS vital capacity : 4470+/-20cc. b. %Predicted vital capacity : 150+/-5.1% 3) Bodily strength. a. Grasping Power : 41.4+/-0.26kg. b. Chining-up : 5.7+/-0.10. c. Throwing a hand-grenade : 39.7+/-0.20m. d. Forward jumping : 214+/-0.58cm. e. Sitting-up : 19.1+/-0.25. . Pushing-up : 22.1+/-0.18. g. 100 meter sprinting : 16.1+/-0.04sec. 2. Comparative analysis has been done about the conditional classes of marine enlisted men with the results of above mentioned 16 items. 7 classes according to the branches, 3 according to the ranks, 9 according to the length of service are adopted respectively.
Body Weight ; Hand Strength ; Humans ; Korea* ; Male ; Personnel Management ; Vital Capacity

No abstract available.
Animals ; Hepatocytes* ; Organelles* ; Rats*

No abstract available.
Cryptosporidium ; Cyclospora