Journal of Preventive Medicine and Public Health

Original Articles

Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea: Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang; J Prev Med Public Health. 2021;54(6):385-394. Published online October 22, 2021; DOI: https://doi.org/10.3961/jpmph.21.329

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to explore the status of regional variations in acute ischemic stroke (AIS) treatment and investigate the association between the presence of a thrombectomy-capable stroke center (TSC) and the case fatality rate (CFR) of AIS within hospital service areas (HSAs).
Methods
This observational cross-sectional study analyzed acute stroke quality assessment program data from 262 hospitals between 2013 and 2016. TSCs were defined according to the criteria of the Joint Commission. In total, 64 HSAs were identified based on the addresses of hospitals. We analyzed the effects of structure factors, process factors, and the presence of a TSC on the CFR of AIS using multivariate logistic regression.
Results
Among 262 hospitals, 31 hospitals met the definition of a TSC. Of the 64 HSAs, only 20 had a TSC. At hospitals, the presence of a stroke unit, the presence of stroke specialists, and the rate of endovascular thrombectomy (EVT) treatment were associated with reductions in the CFR. In HSAs, the rate of EVT treatment (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99) and the presence of a TSC (OR, 0.93; 95% CI, 0.88 to 0.99) significantly reduced the CFR of AIS.
Conclusions
The presence of a TSC within an HSA, corresponding to structure and process factors related to the quality of care, contributed significantly to lowering the CFR of AIS. The CFR also declined as the rate of treatment increased. This study highlights the importance of TSCs in the development of an acute stroke care system in Korea.

Summary

Korean summary
혈관 내 재개통술(endovascular thrombectomy, EVT)는 많은 전문인력과 장비등 상당한 자원을 필요로 하는 특성으로 인해 상대적으로 자원이 부족한 지역에 치료 공백이 발생할 수 있다. EVT 가능 병원(Thrombectomy capable stroke center, TSC)를 "연간 EVT 15회 이상 시행, 뇌졸중 전문치료실 운영 그리고 뇌졸중 관련 전문의(신경과, 신경외과, 재활의학과)가 모두 근무하는 병원으로 정의하고 진료권 단위로 분석한 결과 진료권 내 TSC의 존재는 허혈성 뇌졸중 환자군의 치명률를 유의하게 감소시켰다. 그러므로 급성 허혈성 뇌졸중 치료의 지역 간 변이를 줄이기 위해서 진료권 내 TSC 를 정의하고 설치하는 것의 중요하며, 이러한 결과는 향후 70개 진료권 단위 지역책임의료기관을 구축하는 과정에 중요한 근거자료로 활용될수 있을 것이다.

Citations

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Prioritization of Injury Prevention and Management Programs and Research and Development (R&D) Projects: Survey Using the Delphi Technique and Analytic Hierarchy Process
Won Kyung Lee, Minsu Ock, Ju Ok Park, Changsoo Kim, Beom Sok Seo, Jeehee Pyo, Hyun Jin Park, Ui Jeong Kim, Eun Jeong Choi, Shinyoung Woo, Hyesook Park
Asia Pacific Journal of Public Health.2024; 36(1): 78. CrossRef
Patterns in the number of interventionalists for endovascular treatment of acute ischemic stroke in the US
Ankita Tripathi, Laura K. Stein, Mandip S. Dhamoon
Journal of Stroke and Cerebrovascular Diseases.2023; 32(2): 106943. CrossRef
Thrombectomy-Capable Stroke Centre—A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab
Krzysztof Pawłowski, Artur Dziadkiewicz, Anna Podlasek, Jacek Klaudel, Alicja Mączkowiak, Marek Szołkiewicz
International Journal of Environmental Research and Public Health.2023; 20(3): 2232. CrossRef
COVID-19 case-fatality variations with application to the Middle East countries
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GeoJournal.2022; 88(1): 1127. CrossRef

Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

8,692 View
190 Download
6 Crossref

Abstract PDF

Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Summary

Citations

Citations to this article as recorded by

Development and Evaluation of Rehabilitation Service Areas for the United States
Timothy A. Reistetter, Julianna M. Dean, Allen M. Haas, John D. Prochaska, Daniel C. Jupiter, Karl Eschbach, Yong-Fang Kuo
BMC Health Services Research.2023;[Epub] CrossRef
Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population
Agnus M. Kim, Yoon Kim
Journal of Aging & Social Policy.2023; : 1. CrossRef
Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang
Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef

The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim; J Prev Med Public Health. 2016;49(4):230-239. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.034

10,614 View
159 Download
17 Crossref

Abstract PDF Supplementary Material

Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Summary

Citations

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