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Original Article
- Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
- Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon
- J Prev Med Public Health. 2024;57(3):260-268. Published online May 30, 2024
- DOI: https://doi.org/10.3961/jpmph.24.057
- 758 View
- 28 Download
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Abstract
Summary
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Supplementary Material - Objectives
Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival.
Methods
A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed.
Results
The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91).
Conclusions
Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes. -
SummaryKorean summary
심혈관 관련 수술을 대상으로 지역적 불균형을 분석한 결과, 관상동맥우회술, 경피적 관상동맥중재술, 스텐트 삽입술은 전국적으로 광범위하게 분포되었다. 반면에 대동맥류 절제술은 지역적 불균형이 발생하였고, 사망률 또한 유의한 차이가 있었다. 따라서 의료 격차 해소를 위해 병원 간 협력체계 구축, 지역 균형적 의료자원 확충 등 정책적 노력이 필요하다Key Message
An analysis of regional disparities in cardiovascular surgeries revealed that coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and stent insertion procedures were widely distributed nationwide. However, there was a regional imbalance in aortic aneurysm resection (AAR) surgeries, which also showed significant differences in mortality rates. Therefore, policy efforts are needed to bridge the healthcare gap, such as establishing collaborative systems among hospitals and ensuring a balanced distribution of medical resources across regions.
English Abstract
- The Trend of Risk-adjusted Hospital Mortality Rates of Coronary Artery Bypass Graft Patients from 2001 to 2003.
- Kwang Soo Lee
- J Prev Med Public Health. 2007;40(1):29-35.
- DOI: https://doi.org/10.3961/jpmph.2007.40.1.29
- 2,950 View
- 23 Download
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Abstract
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- OBJECTIVES
To assess whether the risk-adjusted inhospital mortality rates for non-emergent and isolated coronary artery bypass graft surgery (CABG) patients exhibited a consistent trend from 2001 to 2003. METHODS: The data used in this study came from CABG claims that were submitted to a Korean Health Insurance Review Agency (HIRA) in 2001, 2002, and 2003. Study datasets included data from 17 tertiary hospitals, which had at least 25 claims each year over 3 years. The interhospital differences in patients' risk-factors were identified and controlled in the risk-adjustment model. Actual and predicted mortality rates for each hospital were calculated in 2001, 2002, 2003, and 2001+2002, and were then examined to identify consistent rate patterns over time. Kappa analysis was applied to assess the agreements between rates. RESULTS: Hospitals with lower-than-expected inpatient mortality rates showed more consistent rates than those with higher-than-expected mortality rates. The mortality rates that were calculated based on data obtained over multiple years had less variation among hospitals than rates based on single year data. Based on the Kappa score, the highest agreement was found when the rates were compared between the 2-year combined data (2001+2002) and 2003. CONCLUSIONS: Consistent patterns over 3 years were most evident for hospitals which had lower-than expected mortality rates. Policy makers can use this information to identify the degree of outcomes in hospitals and help motivate or channel the behaviors of providers. -
SummaryOriginal Articles
- Severity Measurement Methods and Comparing Hospital Death Rates for Coronary Artery Bypass Graft Surgery.
- Youngdae Kwon, Hyungsik Ahn, Youngsoo Shin
- Korean J Prev Med. 2001;34(3):244-252.
- 1,886 View
- 23 Download
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Abstract
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- OBJECTIVE
Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. METHODS: The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHElll and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. RESULTS: The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and R2 than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. CONCLUSION: These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used. -
Summary
- Severity-Adjusted Mortality Rates: The Case of CABG Surgery.
- Hyeung Keun Park, Hyeongsik Ahn, Young Dae Kwon, You Cheol Shin, Jin Seok Lee, Hae Joon Kim, Moon Jun Sohn
- Korean J Prev Med. 2001;34(1):21-27.
- 1,934 View
- 24 Download
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Abstract
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- OBJECTIVES
To develop a model that will predict the mortality of patients undergoing Coronary Artery Bypass Graft (CABG) and evaluate the performance of hospitals. METHODS: Data from 564 CABGs performed in six general hospitals were collected through medical record abstraction by registered nurses. Variables studied involved risk factors determined by severity measures. Risk modeling was performed through logistic regression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistic, R2, and Hosmer-Lemeshow statistic. Hospital performance was assessed by severity-adjusted mortalities. RESULTS: The developed model included age, sex, BUN, EKG rhythm, Congestive Heart Failure at admission, acute mental change within 24 hours, and previous angina pectoris history. The c-statistic and R2 were 0.791 and 0.101, respectively. Hosmer-Lemeshow statistic was 10.3(p value=0.2415). One hospital had a significantly higher mortality rate than the average mortality rate, while others were not significantly different. CONCLUSION: Comparing the quality of service by severity adjusted mortality rates, there were significant differences in hospital performance. The severity adjusted mortality rate of CABG surgery may be an indicator for evaluating hospital performance in Korea. -
SummaryEnglish Abstract
- Does a Higher Coronary Artery Bypass Graft Surgery Volume Always have a Low In-hospital Mortality Rate in Korea?.
- Kwang Soo Lee, Sang Il Lee
- J Prev Med Public Health. 2006;39(1):13-20.
- 2,093 View
- 30 Download
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Abstract
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- OBJECTIVES
To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. METHODS: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. RESULTS: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test (x2=6.92, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971patients) and 4 high-volume hospitals (1,087patients) were identified. Significantdifferences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. CONCLUSIONS: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship. -
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