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

BACKGROUND/AIMS: Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals. METHODS: We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013. RESULTS: Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%. CONCLUSIONS: Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.
Administration, Cutaneous ; Anti-Bacterial Agents/*administration & dosage/adverse effects ; Drug Prescriptions ; Drug Resistance, Multiple, Bacterial ; Drug Utilization Review ; *Hospitals, University ; Humans ; Inappropriate Prescribing/*trends ; Methicillin-Resistant Staphylococcus aureus/*drug effects ; Microbial Sensitivity Tests ; Mupirocin/*administration & dosage/adverse effects ; Ointments ; Practice Patterns, Physicians'/*trends ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Staphylococcal Skin Infections/diagnosis/*drug therapy/microbiology ; Time Factors