The purpose of this study was to assess the current status of utilization of a cost accounting system at medical institutions, as well as to identify factors influencing effective data utilization for implementation of the system.　For this purpose, a mail-in survey was conducted of hospitals using the Diagnosis Procedure Combination/Per-Diem Payment System （DPC/PDPS） （1,580 hospitals） between January and February 2016.

　Of the 1,580 hospitals, responses were obtained from 167 hospitals （response rate:10.6%）;the results revealed that 45.5% of all the responding hospitals utilized the system of cost calculation by department and 23.3% utilized the DPC.　In addition, there was a discrepancy between the degree of expectation in advance and the extent of utilization of the cost accounting system after implementation, and there were large variations in the extent of utilization by the purposes for which the system was utilized.　In addition, the extent of utilization after the implementation was influenced by a sense of purposes for calculation associated with profit and loss analysis, budget control and management awareness, and the founders of the medical institutions.

　Thus, the results of the survey revealed that considerations for development and implementation that suit the purposes are necessary, because the extent of utilization of the cost accounting system was found to be insufficient, and the purposes for which the system was utilized influenced the extent of utilization at medical institutions.

In Japan, the number of patients with pneumonia among the elderly is increasing, and the length of hospital stay of these patients is becoming more and more prolonged.　In elderly patients, changes in the clinical condition, including performance of daily living activities and food intake, in addition to resolution of the disease, may influence the length of hospital stay.　The objective of this study was to describe the patient’s clinical profile for predicting the condition for discharge by classifying the patients into patterns based on multiple variables for determination of the clinical condition and analyzing their transitions over time.

　This study was a cohort study based on a secondary use of electronic medical charts.　A total of 447 patients with pneumonia who had been admitted to A hospital in Tokyo between April 2016 and March 2017 were included for the analysis.　The statuses of “activities of daily living, cognition, food intake, and pneumonia symptoms” were analyzed using the latent class analysis method and its transition probability.

　The results revealed that the length of hospital stay varied even among groups with similar profiles at the time of discharge;it was longer in a group with difficulty in oral intake at the time of discharge.　In addition, the results of the analysis of the transition patterns of a patient’s profile suggested the possibility that a patient’s difficulty in oral intake at the time of discharge might be predictable at 2 weeks after admission, allowing exploration of effective interventions in line with the predicted profile transition.