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

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

Objective: To investigate the utilization of antibiotics in emergency departments (EDs) of class Ⅲ general hospitals in China. Methods: Data from a national monitoring network for rational use of drugs was used. The data included prescriptions of EDs from 114 class Ⅲ general hospitals in 30 provinces (autonomous regions, municipalities) of China. A total of 10 260 595 prescriptions from October 1, 2014 to December 31, 2016 were extracted. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose (DDD) system was used for the classification of antibiotics and calculation of antibiotic use intensity. An auto-regression model was used to analyze the trend over time and seasonal variation of antibiotic use in EDs. Results: The rate of antibiotic prescriptions was 27.82% in EDs, among the antibiotics prescribed, 25.58% were for the combination therapy with 2 or more antibiotic agents, and injectable antibiotic prescriptions accounted for 60.59%. Besides, the number of DDDs per 100 patient visits was 81.84. Broad-spectrum agents were the most commonly used antibiotics, among which the second and third generation cephalosporins, quinolones and macrolides accounted for 23.83%, 21.68%, 19.17% and 7.89% of all prescribed antibiotics, respectively. The use of antibiotics, including prescription frequency and use intensity, in EDs had a slight but significant increase tendency (P<0.05), and the seasonal variation of antibiotic use in EDs was obvious, characterized by the highest frequency and intensity of antibiotic use in winter, the differences were significant (P<0.05). Conclusion: The antibiotic prescription rate in EDs of classⅢ general hospitals in China was controlled at a low level, but the proportions of broad-spectrum antibiotics and injectable antibiotics were high, and a significant increase trend in antibiotic use in EDs was found.
Anti-Bacterial Agents/therapeutic use* ; China ; Drug Prescriptions ; Drug Utilization ; Emergency Service, Hospital ; Hospitals ; Hospitals, General ; Humans

BACKGROUND: Blood utilization review in medical facilities is necessary for predicting blood demand and maintaining an efficient blood program. We investigated the use of blood components and discard rate of blood components in eight university hospitals in Korea. METHODS: Blood component utilization including autologous blood collection in eight university hospitals on 1999 was analyzed with the co-work of its department of laboratory medicine. RESULTS: 700,686 blood component units were used at eight university hospitals investigated. Among a total of 601,262 units analyzed, the department of internal medicine used 303,843(50.5%) units and ranked first among clinical department for blood use, followed by general surgery 91,450 units, thoracic surgery 45,038 units. The cumulative number of autologous blood collected until 1999 was 6,232 units. Seven hospitals experienced rejection of reimbursement for health insurance payments and the rejection rate ranged from one to 28%. CONCLUSIONS: This survey provides information on blood component usage in eight Korean university hospitals. A successive nationwide survey on blood utilization like this study is required for estimation of blood demand.
Hospitals, University* ; Insurance, Health ; Internal Medicine ; Korea* ; Thoracic Surgery ; Utilization Review

BACKGROUNDAlthough bronchoscopy has been widely performed in China, little has been known about its current state and development. In order to investigate the clinical application of bronchoscopy and make instructions for future education and development, the Chinese Society of Respiratory Diseases conducted postal surveys in both 2008 and 2010 in China.

METHODQuestionnaires were sent to 40 tertiary grade A hospitals in 2008 and 58 tertiary grade A hospitals in 2010 to investigate bronchoscopies performed in 2007 and 2009 respectively.

RESULTSThirty (75%) hospitals returned the completed questionnaires in 2008 and forty-one (71%) hospitals in 2010. All the respondents possessed flexible bronchoscopes. Fifty percent of the respondents had less than five in 2007, while more than 50% of the respondents had 5-9 bronchoscopes in 2009. All the respondents performed a radiograph or CT scan before bronchoscopy. Percentage of general anesthesia and no pre-medication before bronchoscopy increased, while atropine usage decreased in 2009 compared to 2007. During bronchoscopy, pulse oximetry was the most widely used monitoring method. Most respondents used the nasal route to perform routine bronchoscopy. After the procedure, they used sinks to wash and glutaraldehyde to disinfect the bronchoscopes. The total number of flexible bronchoscopies performed during 2007 was 37 874 and the average was 1262. Whereas in 2009, the total number was 60 178 and the average was 1468. Diagnostic bronchoscopy was more widely used than therapeutic bronchoscopy. The mortality rate was 0.076‰ in 2007 and 0.032‰ in 2009.

CONCLUSIONSThe two surveys, to some extent, reflected the current status and development of bronchoscopy in China. The results are worthy of future education and developing of new guidelines. Regular surveys and monitoring of bronchoscopies across China are needed.

Bronchoscopy ; methods ; utilization ; China ; Hospitals ; statistics & numerical data ; Humans ; Surveys and Questionnaires

PURPOSE: This paper reports a study exploring factors related to patient satisfaction and dissatisfaction with inpatient care. METHOD: A cross-sectional study design was used, employing data from the National Health and Nutrition Survey conducted in 2001. Socio-demographic factors, utilization, self-rated health status, and disease characteristics were assessed by employing univariate comparisons and multivariate logistic regression analyses. RESULT: Out of 37,769 respondents, 1,043 aged 20 years and over had been admitted to a hospital or clinic at least once during the past year. About a quarter of the respondents were discharged from tertiary hospitals and 21% from clinics. The majority of patients (58%) were satisfied with inpatient care received, whereas 11% were dissatisfied. Greater satisfaction was found in patients aged 45-64 years and those having formal education, discharge from tertiary hospitals, national health insurance as a payer, medical expenses not being burdensome, good self-rated health status, and neoplasm. Living in non-metropolitan urban areas, shorter length of stay, and musculoskeletal diseases were associated with greater dissatisfaction. CONCLUSION: Different factors were related to patient satisfaction and dissatisfaction with care. Those factors need to be taken into account when evaluating and comparing satisfaction levels between health care institutions.
Socioeconomic Factors ; *Patient Satisfaction ; Middle Aged ; Korea ; Inpatients/*psychology ; Humans ; Hospitals/*utilization ; Female ; Aged ; Adult

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*

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.
Adult ; Delivery, Obstetric/economics/*utilization ; Female ; Hospitals ; Humans ; Pregnancy ; Prenatal Care/economics ; *Program Evaluation ; Republic of Korea ; Rural Population

PURPOSE: The purposes of this study were to develop an educational program to reduce the use of physical restraints for caregivers in geriatric hospitals and to evaluate the effects of the program on cargivers' knowledge, attitude and nursing practice related to the use of physical restraints. METHODS: A quasi experimental study with a non-equivalent control group pretest-posttest design was used. Participants were recruited from two geriatric hospitals. Eighteen caregivers were assigned to the experimental group and 20 to the control group. The data were collected prior to the intervention and at 6 weeks after the intervention through the use of self-administered questionnaires. Descriptive statistics, chi-square test, Fisher's exact probability test, and Mann-Whitney U test were used to analyze the data. RESULTS: After the intervention, knowledge about physical restraints increased significantly in experimental group compared to the control group. However, there were no statistically significant differences between the groups for attitude and nursing practice involving physical restraints. CONCLUSION: Findings indicate that it is necessary to apply knowledge acquired through educational programs to nursing practice to reduce the use of physical restraints. User friendly guidelines for physical restraints, administrative support of institutions, and multidisciplinary approaches are required to achieve this goal.
Adult ; Caregivers/*education/psychology ; Female ; Geriatrics ; Health Knowledge, Attitudes, Practice ; Hospitals ; Humans ; Male ; Program Evaluation ; Questionnaires ; Restraint, Physical/*utilization

OBJECTIVETo investigate the diagnosis,treatment and requirement of epilepsy patients in some urban communities in China, and to provide the evidence of searching for effective treatment and management on epilepsy under the China's context.

METHODSA face-to-face survey were conducted in 3 urban communities in Shanghai, Beijing and Changsha, respectively. The questions in the questionniare were general information, hospital visit, treatment, the level and way of getting on the knowledge of epilepsy, as well as the current obstacles and needs.

RESULTSMost of the patients selected the regular hospitals (90.8%) and the departments (92.3%) for their epielspy diagnosis and treatment. They used AEDs modo dictu (77.4%), and had controlled the seizures quite well (82.6%). A small part of patients still could not deeply understand the basic knowledge on epilepsy (13.5%). They ignored to follow up the drug concentration (45.8%) in blood and the blood biocheminstry indicators (43.9%). Some patients went to private clinics (12.9%) and used lay people remedies (7.7%). Longtime waiting (36.8%), inconvenient traffic (23.2%), and high expenses (22.6%) were the main problems influencing the timely treatment. The main obstacles of the patients were employment (47.2%), marriage (29.9%), psychological conditions (44.4%) and interpersonal relationship (29.9%). The main requirements were the effectiveness (87.0%) and cheap AEDs (40.9%) as well as the convenience of hospital visit (37.0%).

CONCLUSIONIt is very important to emphasize knowledge and publicity/education on epilepsy as well as the psychological treatment according to the requirements of patients.

Anticonvulsants ; therapeutic use ; China ; Data Collection ; Epilepsy ; diagnosis ; therapy ; Health Services Needs and Demand ; Hospitals ; utilization ; Humans ; Patient Compliance ; Urban Health