Evaluation of the condition of inpatients in acute care hospitals in Japan: A retrospective multicenter descriptive study.

This retrospective, multicenter, descriptive study aimed to evaluate the conditions of inpatients in acute care hospitals using the Severity of a Patient's Condition and Extent of a Patient's Need for Medical/Nursing Care tool. The study included 4 234 253 patients admitted to acute care hospitals in Japan between April 2019 and March 2020. Electrocardiographic monitoring, provision of respiratory care, and administration of antiarrhythmic agent injections and treatment were performed in a sterile room for >20%, >10%, and <1% of patient-days, respectively. More than 40% of inpatients needed support with performing activities of daily living, such as dressing and undressing, turning over, and oral care. The proportion of patients requiring daily medical/nursing care was generally high at the beginning of hospitalization, gradually decreased, and subsequently increased. Patients in acute care hospitals in Japan were not hospitalized unnecessarily early or for inappropriately long periods, and the efficiency of medical care improved over time. The Severity of a Patient's Condition and Extent of a Patient's Need for Medical/Nursing Care tool is useful for evaluating patient conditions in acute care hospitals.

History and Profile of Diagnosis Procedure Combination (DPC): Development of a Real Data Collection System for Acute Inpatient Care in Japan.

DPC, which is an acronym for "Diagnosis Procedure Combination," is a patient classification method developed in Japan for inpatients in the acute phase of illness. It was developed as a measuring tool intended to make acute inpatient care transparent, aiming at standardization of Japanese medical care, as well as evaluation and improvement of its quality. Subsequently, this classification method came to be used in the Japanese medical service reimbursement system for acute inpatient care and appropriate allocation of medical resources. Furthermore, it has recently contributed to the development and maintenance of an appropriate medical care provision system at a regional level, which is accomplished based on DPC data used for patient classification. In this paper, we first provide an overview of DPC. Next, we will look back at over 15 years of DPC history; in particular, we will explore how DPC has been refined to become an appropriate medical service reimbursement system. Finally, we will introduce an outline of DPC-related research, starting with research using DPC data.

Incident reports involving hospital administrative staff: analysis of data from the Japan Council for Quality Health care nationwide database.

BACKGROUND: Task shifting and task sharing in health care are rapidly becoming more common as the shortage of physicians increases. However, research has not yet examined the changing roles of hospital administrative staff. This study clarified: (1) the adverse incidents caused by hospital administrative staff, and the direct and indirect impact of these incidents on patient care; and (2) the incidents that directly involved hospital administrative staff. METHODS: This study used case report data from the Japan Council for Quality Health care collected from April 1, 2010 to March 31, 2019, including a total of 30,823 reports. In April 2020, only the 88 self-reported incidents by hospital administrative staff were downloaded, excluding incidents reported by those in medical and co-medical occupations. Data from three reports implicating pharmacists were rejected and the quantitative and textual data from the remaining 85 case reports were analyzed in terms of whether they impacted patient care directly or indirectly. RESULTS: Thirty-nine reports (45.9%) involved direct impact on patient care, while 46 (54.1%) involved indirect impact on patient care. Most incidents that directly impacted patient care involved administrative staff writing prescriptions on behalf of a doctor (n = 24, 61.5%); followed by errors related to system administration, information, and documentation (n = 7, 17.9%). Most reported errors that indirectly affected patient care were related to system administration, information, and documentation used by administrative staff (n = 22, 47.8%), or to reception (n = 9, 19.6%). Almost all errors occurred during weekdays. Most frequent incidents involved outpatients (n = 23, 27.1%), or occurred next to examination/operation rooms (n = 12, 14.1%). Further, a total of 14 cases (16.5%) involved patient misidentification. CONCLUSIONS: Incidents involving hospital administrative staff, the most common of which are medication errors from incorrect prescriptions, can lead to severe consequences for patients. Given that administrative staff now form a part of medical treatment teams, improvements in patient care may require further submission and review of incident reports involving administrative staff.

The relationship between sedative drug utilization and outcomes in critically ill patients undergoing mechanical ventilation.

OBJECTIVES: The objectives of this study were to describe current sedative drug utilization patterns in critically ill patients undergoing mechanical ventilation (MV) in intensive care units (ICUs) in Japanese hospitals and to elucidate the relationship of these utilization patterns with patient clinical outcomes. METHOD: Analysis of hospital claims data derived from the Quality Indicator/Improvement Project identified 12,395 critically ill adult patients who had undergone MV while hospitalized in the ICUs of 114 Japanese hospitals and had been discharged between April 2008 and March 2010. Descriptive statistics were calculated for the daily utilization of sedative drugs, opioids, and muscle relaxants in this patient sample, and the relationship between drug utilization and patient outcomes using Cox proportional hazards analysis were examined. RESULTS: Of the 12,395 patients included in the analysis, 7300 (58.9 %), 580 (4.7 %), and 671 (5.4 %) received sedative drugs, opioids, and muscle relaxants, respectively, for ≥2 days after intubation. Compared to the other patient groups, there was a higher proportion of males in the group given sedative drugs and the patients were significantly younger (P < 0.001). Propofol was the most frequently used sedative drug, followed by benzodiazepines, barbiturates, and dexmedetomidine. The mortality rate was lower and ventilator weaning was earlier among patients who received only propofol than among those who received only benzodiazepines. Muscle relaxants were associated with increased duration of MV. CONCLUSIONS: This is the first study based on a large-scale analysis in Japan to elucidate sedative drug utilization patterns and their relationship with outcomes in critically ill patients. The most commonly used sedative was propofol, which was associated with favorable patient outcomes. Further prospective research must be conducted to discern effective sedative drug utilization.

Impact of regional clinical pathways on the length of stay in hospital among stroke patients in Japan.

BACKGROUND: Clinical pathways are care plans used by health providers to describe essential steps in the care of patients with specific medical conditions. Clinical implementation of the regional clinical pathways in Japan has spread, and the 2008 fee schedule included a new "regional inter-provider care planning fee" for stroke. However, no evidence regarding the efficacy of the regional clinical pathways for stroke has appeared. OBJECTIVES: We examined the association of regional clinical pathways on the length of in-hospital stay in patients with stroke. We also examined whether a variation in the length of in-hospital stay for stroke patients between hospitals exists, and if so, the impact of regional clinical pathways on this variation. RESEARCH DESIGN: Cross-sectional analysis using the Diagnosis Procedure Combination database for the period April 2011 to March of 2012. SUBJECTS: A total of 117,180 patients with the diagnosis "cerebral infarction," coded as I63 in ICD10. MEASURES: Associations of the use of a regional clinical pathway with the length of in-hospital stay (LOS) were estimated by multilevel regression models using a 2-level structure of individuals nested within the 1011 hospitals. The models added both patient-level factors and hospital-level factors that are potentially associated with LOS. RESULTS: Hospitals administering a regional clinical pathway had a significantly shorter LOS (9.1 d) than hospitals that did not. Approximately 12% of the variation in LOS between hospitals is possibly explained by whether hospitals implement regional clinical pathways. Application of regional clinical pathways at the individual level is associated with a 7.2-day decrease in LOS at the individual level. CONCLUSIONS: These findings suggest that the regional clinical pathways are potentially effective in improving the management of stroke patients and in promoting the consistency of care between hospitals.

Perceptions of Uncertainty in Medical Care Among Non-medical Professionals and Nurses in Japan: A Cross-Sectional Internet-Based Preliminary Survey.

BACKGROUND: Medical care is impacted by uncertainty caused by various factors. The uncertainty that exists in medical care can cause patient distrust and lead to conflict. This study compared the tolerance of uncertainty in medical care between non-medical professionals and nurses. METHODS: We conducted a cross-sectional Internet-based survey. Participants included 2,100 individuals (600 nurses and 1,500 non-medical professionals; aged ≥ 20 years) from different parts of Japan. Of these, we excluded 70 participants who were classified as non-medical professionals but were registered nurses. Finally, we analyzed data from 2,030 participants (600 nurses and 1,430 non-medical professionals). Three registered nurses and nursing researchers developed an original questionnaire on tolerance of uncertainty in medical care. Data regarding participants' characteristics (age, sex, education level, marital status, having children, population size of the residential area, medical care usage, and occupation) were obtained. We performed a one-way analysis of variance (ANOVA) to compare the data between non-medical professionals and nurses. Additionally, we employed a multiple regression model to investigate factors related to tolerance of uncertainty in medical care scores. RESULTS: A significant portion of participants (36.7%) were aged 40-50 years (n = 745). Most were women (n = 1,210, 59.6%), and a considerable percentage were medical care users (n = 1,309, 64.5%). Non-medical professionals were less tolerant of uncertainty than nurses, and uncertainty scores were associated with medical care usage, occupation, and population size of the residential area. CONCLUSIONS: Our findings revealed variations in perceptions of uncertainty in medical care between non-medical professionals and medical care providers. To mitigate conflicts related to medical issues, medical care providers should enhance non-medical professionals' education regarding perceptions of uncertainty in medical care.

Burden of household environmental tobacco smoke on medical expenditure for Japanese women: a population-based cohort study.

BACKGROUND: The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women. METHODS: This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors. RESULTS: We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum. CONCLUSIONS: We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.

[International comparison of the definition of night work - promoting health care of shift workers].

In order to manage occupational exposure, it is necessary to define exposure. In terms of administrative management however, shift work is difficult to define because there is a wide variance of working schedules which do not belong to ordinal day time work. Thus, many countries define night work, which is easier to define based on night working time for administrative management, rather than shift work. On the other hand, the term "night work" has not been so common in medical research compared to the term "shift work". Further, those two words were used in nearly same context among medical researchers in many cases. Given the current situation, for the purpose of promoting occupational health, it is reasonable to treat those two medical and administrative words as synonymous in order to make full use of medical evidence with linkage to the current administrative system.

Factors associated with non-home discharge of patients hospitalized for hip fracture: A nationwide retrospective study using the Japanese diagnostic procedure combination database.

In Japan, the length of stay in acute care hospitals has been shortened, home medical care has been promoted following national policy. However, many issues remain in promoting home medical care. The aim of this study was to clarify the profiles of patients with hip fractures, aged ≥ 65 years, who were hospitalized in acute care institutions at the time of discharge and the influence on nonhome discharge. This study used data from patients who satisfied all the following conditions: Patients aged ≥ 65 years who were hospitalized and discharged between April 2018 and March 2019; Patients with hip fractures, and; Patients who were admitted from home. The patients were classified into the home discharge and nonhome discharge groups. Multivariate analysis was conducted by comparing socio-demographic status, patient background factors, patient status at discharge, and hospital function. This study included 31,752 patients (73.7%) and 11,312 patients (26.3%) in the nonhome discharge group and home discharge group, respectively. Overall, the proportions of males and females were 22.2% and 77.8%, respectively. The average (standard deviation) age of the patients was 84.1 years (7.4) and 81.3 years (8.5) in the nonhome discharge and home discharge groups, respectively (P < .01). The following factors affected nonhome discharge: 75 to 84 years (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.68-1.96), ≥85 years (OR = 2.17, 95% CI = 2.01-2.36), electrocardiography or respiratory treatment "(Factor A3) (OR = 1.44, 95% CI = 1.23-1.68), level of assistance with activities of daily living "(Factor B1)" (OR = 4.56, 95% CI = 4.22-4.92), and hospital where the patient-to-nurse ratio is 7:1 (OR = 2.12, 95% CI = 1.91-2.35). The results suggested that support from activities of daily living caregivers and implementing medical treatments such as respiratory care are required to advance home medical care. This study's method enables analysis focusing on aspiration pneumonia and cerebral infarction, which are common among older adults. Furthermore, specific measures for promoting home medical care for patients who are highly dependent on medical and long-term care may be developed.

On-Campus Nursing Training During COVID-19 in Japan: A Systematic Literature Review.

During the coronavirus disease 2019 (COVID-19) pandemic, nursing education in Japan recommended the implementation of on-campus practical training as a substitute for hospital-based clinical training. This study explores nursing students' experiences with on-campus nursing training as an alternative to clinical practice by clarifying its advantages and disadvantages. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and we included 26 articles in this study. Our findings reveal both the advantages of acquiring nursing knowledge, basic skills, and membership among students. Contrastingly, many students failed to acquire skills related to patient communication and flexible nursing care. Thus, despite some strengths, on-campus training is not a complete replacement for clinical training. Although this method has benefits in emergency situations, it is desirable to consider other educational methods in preparation for future pandemics.

Citation Network Analysis of Nurse Staffing Research from the Past Two Decades: 2000-2022.

Studies have indicated that higher numbers of nurses regarding staffing ensure patient safety and a better practice environment. Using citation analysis, this study visualizes the landscape of nurse staffing research over the last two decades to show the overall publication trends, major contributors, and main research topics. We extracted bibliometric information from PubMed from January 2000 to September 2022. After clustering the network, we analyzed each cluster's characteristics by keyword. A total of 2167 papers were considered for analysis, and 14 clusters were created. The analysis showed that the number of papers published per year has been increasing. Researchers from the US, the UK, Canada, Australia, and Belgium have led this field. As the main clusters in nurse staffing research during the past two decades, the following five research settings were identified: nurse outcome and patient outcome research in acute care hospitals, nurse staffing mandate evaluation research, nursing home research, and school nurse research. The first three clusters accounted for more than 80% of the total number of published papers, and this ratio has not changed in the past 20 years. To further develop nurse staffing research globally, evidence from other geographic areas, such as African and Asian countries, and from long-term care or community settings is necessary.

[Lifetime medical expenditures of smokers and nonsmokers].

OBJECTIVES: The aim of this study was to examine which of the two groups have higher lifetime medical expenditures; male smokers or male nonsmokers. We conducted this investigation using a Japanese single cohort database to calculate long-term medical expenditures and 95% confidence intervals. METHODS: We first constructed life tables for male smokers and male nonsmokers from the age of 40 years after analyzing their mortality rates. Next, we calculated the average annual medical expenditures of each of the two groups, categorized into survivors and deceased. Finally, we calculated long-term medical expenditures and performed sensitivity analyses. RESULTS: The results showed that although smokers had generally higher annual medical expenditures than nonsmokers, the former's lifetime medical expenditure was slightly lower than the latter's because of a shorter life expectancy that resulted from a higher mortality rate. Sensitivity analyses did not reverse the order of the two lifetime medical expenditures. CONCLUSIONS: In conclusion, although smoking may not result in an increase in lifetime medical expenditures, it is associated with diseases, decreased life expectancy, lower quality of life (QOL), and generally higher annual medical expenditures. It is crucial to promote further tobacco control strategically by maximizing the use of available data.

Evidence of the Association between Nurse Staffing Levels and Patient and Nurses' Outcomes in Acute Care Hospitals across Japan: A Scoping Review.

We aimed to summarize the evidence of an association between nurse staffing and nursing sensitivity outcomes in Japanese hospitals. A scoping review was conducted and reported following the PRISMA-SR 2020 statement. The ICHUSHI and CiNii databases were searched for published articles written in Japanese and PubMed and CINAHL for those written in English. Out of the 15 included studies, all observational studies, 3 were written in Japanese and the others in English. The nurse staffing level measures were grouped into three categories: patient-to-nurse ratio, nursing hours per patient day, and nurse-to-bed ratio. The outcome measures were grouped into three categories: patient outcome, nursing care quality reported by nurses, and nurse outcome/nursing care quality. Some studies reported that the nursing staff increasingly favored positive patient outcome. Conversely, the findings regarding failure to rescue, in-hospital fracture, and post-operative complications were inconsistent. Although some studies indicated that more nurse staffing was favored toward better patient and nurse outcomes, due to the sparse accumulation of studies and heterogeneity among the findings, it is difficult to draw robust conclusions between nurse staffing level and outcomes in Japanese acute care hospitals.

Contribution of case-mix classification to profiling hospital characteristics and productivity.

Case-mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case-mix groups at 469 hospitals (1,721,274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case-mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency.

Injury severity score, resource use, and outcome for trauma patients within a Japanese administrative database.

BACKGROUND: Injury Severity Score (ISS) is commonly used in prediction models and risk adjustment for mortality. However, few studies have assessed the relationship of ISS to outcomes such as resource use. To test the utility of ISS for investigation of the quality of trauma care, we evaluated the impact of ISS on resource utilization and mortality. METHODS: Of 1,895,249 cases from a Japanese administrative database in 2006, 13,627 trauma patients with ISS were analyzed. Variables included demographics, ISS, number and locations of injured organs, comorbidities, diagnostic and therapeutic procedures recorded during hospitalization, and hospital type. Dependent variables were length of stay (LOS), total charges (TC), initial 48-hour TC, high outliers of LOS or TC, and mortality. Multivariate analyses were used to measure the impact of ISS. RESULTS: ISS 1 to 9 was most frequent (85.5%) and blunt injury occurred in 93.7% of patients. With increasing ISS, the mortality rate rose to 27.2% at ISS >or=36. LOS was higher at ISS >or=36 whereas TC was higher at 25 to 35. After controlling for study variables, rehabilitation was most strongly associated with LOS, TC, and LOS outliers. ISS 25 to 35 affected initial 48-hour TC most, while ventilation affected mortality most. "Abdomen, pelvic organs" and ISS 25 to 35 or >or=36 were more strongly associated with outcomes. CONCLUSIONS: Specific ISS and injured organs may be used to estimate resource use or mortality for monitoring quality of trauma care. To integrate a more efficient system of trauma care, variations in resource input among hospitals should be investigated.

Clinical phase II and III studies of an AS03-adjuvanted H5N1 influenza vaccine produced in an EB66® cell culture platform.

BACKGROUND: We have developed an AS03-adjuvanted H5N1 influenza vaccine produced in an EB66® cell culture platform (KD-295). OBJECTIVES: In accordance with Japanese guidelines for development of pandemic prototype vaccines, the phase II study was conducted in a double-blind, randomized, parallel-group comparison study and the phase III study was conducted in an open-label, non-randomized, uncontrolled study. METHODS: Healthy adult volunteers aged 20 - 64 years enrolled in the phase II and III studies (N = 248 and N = 369) received KD-295 intramuscularly twice with a 21-day interval. After administration, immune response and adverse events were evaluated. In the phase II study, four different vaccine formulations were compared: MA (3.75 µg hemagglutinin [HA] antigen + AS03 adjuvant system), MB (3.75 µg HA + 1/2AS03), HA (7.5 µg HA + AS03), and HB (7.5 µg HA + 1/2AS03). In the phase III study, the MA formulation was further evaluated. RESULTS: In the phase II study, all four vaccine formulations were well-tolerated and no SAE related to vaccination were observed. The MA formulation was slightly more immunogenic and less reactogenic among the vaccine formulations. Therefore, the MA formulation was selected for the phase III study, and it was well-tolerated and no serious adverse drug reactions were observed. The vaccine fulfilled the three immunogenicity criteria described in the Japanese guidelines. CONCLUSIONS: These data indicate that the MA formulation of KD-295 was well-tolerated and highly immunogenic and it can be considered a useful pandemic and pre-pandemic influenza vaccine.

Influence of verification bias on the assessment of MRI in the diagnosis of meniscal tear.

OBJECTIVE: Previous studies of the sensitivity and specificity of MRI in the diagnosis of meniscal tear have not included correction for verification bias. The purpose of this study was to investigate the extent to which verification bias affected assessment of the utility of MRI in the diagnosis of meniscal tear. MATERIALS AND METHODS: The patients included in the study were outpatients who from April 2006 through July 2008 consecutively visited a single institution for MRI of the meniscus for evaluation of knee pain. For patients who underwent arthroscopy in addition to MRI, the sensitivity and specificity of MRI were calculated. Global sensitivity analysis of data on patients who did not undergo arthroscopy was performed to estimate the influence of verification bias. Global sensitivity analysis is a method for graphically determining whether a particular pair of sensitivity and specificity estimates is compatible with observed data. RESULTS: Eighty-two patients (23%) underwent arthroscopic verification. The sensitivity and specificity of MRI were 85% and 31%. When the possibility of meniscal tears in patients who did not undergo arthroscopy was subjected to global sensitivity analysis, the sensitivity of MRI ranged from 29% to 95% and the specificity ranged from 3% to 92%. All combinations of sensitivity and specificity produced a butterfly-shaped curve, but the base case was not inside the curve. CONCLUSION: Verification bias greatly affected assessment of the utility of MRI in the diagnosis of meniscal tear. Sensitivity and specificity from previous studies may be incompatible with our data owing to verification bias.

Factors associated with system-level activities for patient safety and infection control.

OBJECTIVE: We examined the relationship between hospital structural characteristics and system-level activities for patient safety and infection control, for use in designing an incentive structure to promote patient safety. METHODS: This study utilized a questionnaire to collect institutional data about hospital infrastructure and volume of patient safety activities from all 1039 teaching hospitals in Japan. The patient safety activities were focused on meetings and conferences, internal audits, staff education and training, incident reporting and infection surveillance. Generalized linear modeling was used. RESULTS: Of the 1039 hospitals surveyed, 418 (40.2%) hospitals participated. The amount of activities significantly increased by over 30% in hospitals with dedicated patient safety and infection control full-time staff (P<0.001 and P<0.01, respectively). High profit margins also predicted the increase of patient safety programs (P<0.01). Perceived lack of administrative leadership was associated with reduced volume of activities (P<0.05), and the economic burden of safety programs was found to be disproportionately large for small hospitals (P<0.05). CONCLUSIONS: Hospitals with increased resources had greater spread of patient safety and infection control activities. To promote patient safety programs in hospitals, it is imperative that policy makers require the assignment of dedicated full-time staff to patient safety. Economic support for hospitals will also be required to assure that safety programs are sustainable.

Differences in practice patterns and costs between small cell and non-small cell lung cancer patients in Japan.

Many reports exist regarding the economic evaluation of evolving chemotherapeutic regimens or diagnostic images for lung cancer (LC) patients. However, it is not clear whether clinical information, such as pathological diagnosis or cancer stage, should be considered as a risk adjustment in lung cancer. This study compared the cost and practice patterns between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC) patients. 6,060 LC patients treated at 58 academic hospitals and 14,507 at 257 community hospitals were analyzed. Study variables included demographic variables, comorbid status, cancer stage, use of imaging and surgical procedures, type of adjuvant therapy (chemotherapy, radiation or chemo-radiation), use of ten chemotherapeutic agents, length of stay (LOS), and total charges (TC; US$1 = 100 yen) in SCLC and NSCLC patients. The impact of pathological diagnosis on LOS and TC was investigated using multivariate analysis. We identified 3,571 SCLC and 16,996 NSCLC patients. The proportion of demographic and practice-process variables differed significantly between SCLC and NSCLC patients, including diagnostic imaging, adjuvant therapy and surgical procedures. Median LOS and TC were 20 days and US$6,015 for SCLC and 18 days and US$6,993 for NSCLC patients, respectively (p < 0.001 for each variable). Regression analysis revealed that pathological diagnosis was not correlated with TC. Physicians should acknowledge that pathological diagnosis dose not accounts for any variation in cost of LC patients but that should remain as an indicator of appropriate care like selection of chemotherapeutic agents.