Since nationwide compulsory health insurance started in 1977, shortage of hospital beds has become apparent and this is related in part to the length of hospital stay. To determine the factors which affect the length of stay a total of 1,003 in-patients medical records for appendectomy, cholecystectomy, and Cesarean section discharged in 1965, 1970, 1975 and 1980 from a university hospital were studied. The major findings are as follows; The average length of stay showed a statistically significant difference by year among the cholecystectomy and Cesarean section patients. For the appendectomies no statistically significant difference was found. Complications after surgical operation explained the length of stay mostly in all three procedures; the next factors were age, character of surgery, day of the week of surgery, and multiple diagnoses in this order for appendectomy; day of the week of surgery, age, type of accommodation, route of admission in this order for cholecystectomy; and day of the week of surgery, multiple diagnoses, residential area and type of accommodation in Cesarean section respectively.
Adolescent ; Adult ; Age Factors ; Child ; Hospitals, Teaching/utilization* ; Hospitals, University/utilization* ; Human ; Korea ; Length of Stay* ; Regression Analysis

OBJECTIVES: This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. METHODS: Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. RESULTS: We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. CONCLUSIONS: These new codes will facilitate the use of the drug-drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.
Ambulatory Care ; Decision Support Systems, Clinical ; Drug Interactions ; Drug Utilization Review* ; Drug Utilization* ; Hospitals, Teaching* ; Humans ; Insurance, Health ; Korea* ; Outpatients* ; Prescriptions*

In an attempt to understand the changing pattern of hospital care utilization and costs, a study was made of the medical and administrative records of 7,798 patients, who were discharged from a private, university teaching hospital in the years 1955, 1960, 1965, 1970 and 1974. An analysis of the ages of the patients who utilized the hospital, revealed little change over the study in the age distribution of female patients, but did show increases in the percentages of male patients who were under 5 and over 60 years of age. The overall average length of stay in hospital decreased continuously, from 17.1 days in 1955 to 10.4 days in 1974, and the average length of stay of those who were discharged within 90 days of admission decreased from 14.4 days in 1955 to 8.9 days in 1974. Patients who received surgical treatment remained in hospital for three to four days longer than did those who received non-surgical treatment. Obstetrical cases remained in hospital for 6.9 days in 1955, and 4.8 days in 1974. A large majority of the patients (87 - 96%) were discharged within one month of admission, and virtually all (97.5 - 99.4%) within three months. In respect to the place of residence of the patients, the data revealed that 80% were from Seoul Two-thirds of the patients from Seoul resided in districts immediately surrounding the hospital, showing that despite increasingly effective transportation facilities, hospital utilization continued to be localized to people living in areas near the institution. The study revealed little change in disease patterns over the years: the percentage of obstetrical admissions remained highest with infectious and parasitic diseases, gastrointestinal diseases, injuries, neoplasms and respiratory diseases ranking in descending order. The status of patients at time of discharge showed improvement: the recovery rate increased, and the proportion of patients who died decreased. Total hospital expenses increase 4.4 times and expenses per patient day increased 6.2 times, both results having been determined through the use of constant market prices. It is considered that the latter increase resulted primarily from intensification of medical care and shortening of the hospitalization period. Among the various components of hospital care costs, room (hotel-type) and treatment expenses remained at approximately 40%of the total, while expenses for drugs and injections were approximately 20% in each of the five years of the study. Study of the relative increase of hospital costs by component of care revealed that the highest. increases over the twenty-year period was in the cost of laboratory services, followed by drugs and injections. It would seem that these high increases resulted from rapid technological developments in diagnostic and therapeutic procedures.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Costs and Cost Analysis* ; Female ; Hospitals, Teaching/utilization* ; Hospitals, University/economics ; Hospitals, University/trends ; Hospitals, University/utilization* ; Human ; Korea ; Length of Stay ; Male ; Middle Age