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.

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.
Fracture Fixation, Intramedullary

A case of syringoma with unusual distribution in a young healthy woman is reported. Physical examination revealed numerous angular or lichenoid papules, varing from skin color to light brown in hue, on the anterior aspect of the neck, upper chest, breast, sternal area, inframammary area and abdomen with grouping tendency. Some papules had fine scales on their surface. The histologic findings were those of charateristic features of syringoma.
Abdomen ; Breast ; Female ; Humans ; Neck ; Physical Examination ; Skin ; Syringoma* ; Thorax ; Weights and Measures

These studies were undertaken to evaluate the morphological development of the epidermis, hair, sebaceous gland, eccrine sweat gland and basement membrane in the skin of the Korean fetuses. Nineteen fetuses, 4 to 28 weeks of age, ranging in size from 4 to 230mm crown-rump length, obtained from healthy Korean mothers, were used in these studies and histological observation was done in the different fetal weeks and in the various parts of .the body such as face, perioral, scalp, axilla, abdomen, palm and sole. The results are as follows: 1) At 4-5 weeks of fetal age, the epidermis consists of a single layer of undifferentiated cells and by the 6th week it becomes two-layered; the periderm and the stratum germinativum. At 12-13 weeks, the germinative layer proliferates in a centrifugal direction to form a stratum intermedium and also proliferates in a centripetal direction, giving rise to clusters of cells that grow into the subjacent dermis, to form prhair germs and eccrine sweat gIand germs. Keratohyaline granules first make an appearance at 20th week and the stratum granulosum appears at 28 weeks of fetal life. From 20th week onward the periderm gradually disappears and is replaced by a stratum corneum at 28 weeks.
Abdomen ; Axilla ; Basement Membrane* ; Crown-Rump Length ; Dermis ; Epidermis* ; Fetus ; Gestational Age ; Hair* ; Humans ; Mothers ; Scalp ; Sebaceous Glands* ; Skin* ; Sweat Glands* ; Sweat*

No abstract available.
Risk Factors*

Clinical and bacteriological studies, including seasitivity tests, of 85 patients in pyodermas such as impetigo contagiosa, pustular acne vulgaris, hair follicle and sweat gland infections, and secondary pyogenic infections superimposed on primary dermatoses were carried out during 4 months period, from June 1970 to Sept.1970, at department of dermatology, schooI of medicine, Seoul national university. The results were as follows; 1) Predominant age group of impetigo was the preschool. ages (87%). 2) Causative agents of impetigo in our 30 cases were coagulase positive staphylococcus aureus only in 27, streptococcus only in 0 and both organisms in 3 (one case wasmixed infection with s. aureus and b-hemolytic streptococcus, and two were mixed infections with s. aureus and a-hemolytic streptococcus). 3) Culturing from l2 cases of pustular acne vulgaris, we found coagulase negative staphylococcus albus in 9, coagulase positive stsphylococcus aureus in 1 and no growth in 2. 4) In 35 cases of hair follicle and sweat gland infections, we isolated coagulase positivestaphylococcus aureus only in 32, coagulase negative staphylococcus albus only in 2, and mixed infection with staphylococcus aureus and b-hemolytic streptococcus in l. 5) Isolated organisms in 8 cases of secondary pyogenic infections superimposed on primary dermatoses were coagulase positive staphylococcus aureus only in 2, coagulase negative staphylococcus albus only in 1, b-hemolytic streptococcus only in 1, a- hemolytic streptococcus only in 1, and mixed infections with various combination in 3. 6) Results of sensitivity tests with isolated organisms in the above diseases groups were as follows; (a) Total 66 strains of coagulase positive staphylococcus aureus showed resistance to ampicillin in 97.0%, penicillin in 78.8%, terramycin in 72.7%, rizynomycin in 71.2%, streptomycin in 24.1%, chloramphenicol in 16.7%, neomycin in 12.1%, kanamycin in 4.5% and leukomycin in 1.5%, (b) Total 8 strains of hemolytic streptococci were sensitive to chloramphenicol, leukomycin and penicillin.
Acne Vulgaris ; Ampicillin ; Chloramphenicol ; Coagulase ; Coinfection ; Dermatology ; Hair Follicle ; Humans ; Impetigo ; Kanamycin ; Neomycin ; Oxytetracycline ; Penicillins ; Pyoderma* ; Seoul ; Skin Diseases ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Streptomycin ; Sweat Glands

No abstract available.
Congenital Abnormalities* ; Neck*

BACKGROUND: Eosinophils are suggested to play a deleterious role in the inflammatory disease of the respiratory mucosa by releasing granule substances such as major basic prorein and eosinophil cationic protein. To investigate the contribution of eosinophils in the pathogenesis of nasal polyps and the mechanism of their accumulation and activation, we observed the eosinophil inhllration and expression of endotjelial and epithelial cell adhesion molecules in the nasal polyp tissues. MATERIALS AND METHODS: Polyp and inferior turbinate mueosal specimens (polyp group) taken out of 20 patients and 10 inferior turbinate mucosa specimens of non-allergic and non-infectious controls (control group) were immunohistochemically stained using EG1, EG2, and mAb for the ICAM-1, VCAM-1 and E-seleetin. The number of EG1 (+) and EG2 (+) cells within lmm2 of tissue and the expression of ICAM-1, VCAM-1 and E-seleetin on the vessels (% of total vessel) and epithelial eelis (area x intensity) were compared among three groups. RESULTS:The inferior turbinate mucosae of nasal polyp patients .were infiltrated by signifieantly higher number of eosinophils (EG1:17, EG2:16/mm2) compared with those of controls (EGi:0, EG2:0/mm2) (p<0.05), and the polyp tissue revealed much more eosinophils (EG1: 213, EG2:154/mm2) than inferior turbinates of same patients and those of controls (p<0.001). ICAM-1 expression in the vessels was frequenly observed both in polyps and in the turbinate mucosae with significant difference (median:85% vs. 67%, p<0.05), and ICAM-1 expression in the epithelial ceils was significantly different between the polyp and turbinate groups (median:9 vs. 2.5, p<0. 01). VCAM-1 was moderately expressed on the vessels of both polyps and turbinate mucosac (median:37%, 14%, respectively) and their expressions were significantly different (p<0.01). E-selectin expression was moderate to low both in the polyps and in the turbinate mucosae (median:18%, 10% respectively) and their expressions were not significantly different (p>0.05). CONCLUSION: Most of the eosinophils infiltrated into nasal tissue as well as nasal polyps were activated forms and they were significantly increased in the nasal polyps compared to the inferior turbinate mueosae of the same patients and control subjects. Significantly increased expression of ICAM-1 and VCAM-1 on the vessels and increased epithelial ICAM-1 expression in the nasal polyps indicate that interactions of eosinophils with ICAM-1 and VCAM-1 participate in the pathogenesis of nasal polyps.
E-Selectin ; Eosinophil Cationic Protein ; Eosinophils* ; Epithelial Cells ; Humans ; Intercellular Adhesion Molecule-1 ; Mucous Membrane ; Nasal Polyps* ; Polyps ; Respiratory Mucosa ; Turbinates ; Vascular Cell Adhesion Molecule-1