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3 "Quality of healthcare"
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Original Article
Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care
Eun Hye Park, Seung-sik Hwang, Juhwan Oh, Beom-Joon Kim, Hee-Joon Bae, Ki-Hwa Yang, Ah-Rum Choi, Mi-Yeon Kang, S.V. Subramanian
J Prev Med Public Health. 2023;56(2):145-153.   Published online March 31, 2023
DOI: https://doi.org/10.3961/jpmph.22.318
  • 2,102 View
  • 126 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume.
Methods
From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression.
Results
Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96).
Conclusions
The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.
Summary
Korean summary
급성 허혈성 뇌졸중 환자에서 “혈관 내 혈전제거술(endovascular treatment, EVT)”의 치료효과는 여러 연구를 통해 증명되었으나, EVT 후보군에서 EVT를 제공하기 위한 의료서비스 연구는 부족한 실정이다. 5~7차 뇌졸중 적정성 평가 자료를 활용하여 연간 EVT 시행횟수와 EVT후보군의 30일, 1년 후 치명률 간의 연관성을 다수준 분석을 통해 확인하였다. 연간 15회 이상 EVT를 시행하면서 뇌졸중 전문치료실과 뇌줄중 관련 전문분과(신경과, 신경외과, 재활의학과) 전문의가 모두 있는 병원(TCHs)에서 치료받은 환자는 EVT를 시행하지 않는 병원(PSHs-without-EVT)에서 치료받는 환자에 비해 치명률이 감소하는 경향을 보였다. 이는 뇌졸중 치료체계에서 EVT가능병원을 정의할 필요성을 잘 보여주고, “연간 EVT 시행횟수”는 TCHs를 정의하는 중요한 지표로 사용될 수 있을 것이다.

Citations

Citations to this article as recorded by  
  • 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
    Journal of Preventive Medicine and Public Health.2024; 57(3): 260.     CrossRef
  • Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019
    Ji-Sook Choi, Soomin Kim, Choon-Seon Park, Hyejin Lee, Jin Yong Lee, Sun Min Kim
    Yonsei Medical Journal.2024;[Epub]     CrossRef
Research Support, Non-U.S. Gov't
Effect of Repeated Public Releases on Cesarean Section Rates.
Won Mo Jang, Sang Jun Eun, Chae Eun Lee, Yoon Kim
J Prev Med Public Health. 2011;44(1):2-8.
DOI: https://doi.org/10.3961/jpmph.2011.44.1.2
  • 5,380 View
  • 95 Download
  • 13 Crossref
AbstractAbstract PDF
OBJECTIVES
Public release of and feedback (here after public release) on institutional (clinics and hospitals) cesarean section rates has had the effect of reducing cesarean section rates. However, compared to the isolated intervention, there was scant evidence of the effect of repeated public releases (RPR) on cesarean section rates. The objectives of this study were to evaluate the effect of RPR for reducing cesarean section rates. METHODS: From January 2003 to July 2007, the nationwide monthly institutional cesarean section rates data (1 951 303 deliveries at 1194 institutions) were analyzed. We used autoregressive integrated moving average (ARIMA) time-series intervention models to assess the effect of the RPR on cesarean section rates and ordinal logistic regression model to determine the characteristics of the change in cesarean section rates. RESULTS: Among four RPR, we found that only the first one (August 29, 2005) decreased the cesarean section rate (by 0.81 percent) and continued to have an impact period through the last observation in May 2007. Baseline cesarean section rates (OR, 4.7; 95% CI, 3.1 to 7.1) and annual number of deliveries (OR, 2.8; 95% CI, 1.6 to 4.7) of institutions in the upper third of each category at before first intervention had a significant contribution to the decrease of cesarean section rates. CONCLUSIONS: We could not found the evidence that RPR has had the significant effect of reducing cesarean section rates. Institutions with upper baseline cesarean section rates and annual number of deliveries were more responsive to RPR.
Summary

Citations

Citations to this article as recorded by  
  • Changes in cesarean section rate before and after the end of the Korean Value Incentive Program
    YouHyun Park, Jae-hyun Kim, Kwang-soo Lee
    Medicine.2022; 101(33): e29952.     CrossRef
  • Mechanisms and impact of public reporting on physicians and hospitals’ performance: A systematic review (2000–2020)
    Khic-Houy Prang, Roxanne Maritz, Hana Sabanovic, David Dunt, Margaret Kelaher, Lamberto Manzoli
    PLOS ONE.2021; 16(2): e0247297.     CrossRef
  • Ordinal classification of the affectation level of 3D-images in Parkinson diseases
    Antonio M. Durán-Rosal, Julio Camacho-Cañamón, Pedro Antonio Gutiérrez, Maria Victoria Guiote Moreno, Ester Rodríguez-Cáceres, Juan Antonio Vallejo Casas, César Hervás-Martínez
    Scientific Reports.2021;[Epub]     CrossRef
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    Astrid Van Wilder, Luk Bruyneel, Dirk De Ridder, Deborah Seys, Jonas Brouwers, Fien Claessens, Bianca Cox, Kris Vanhaecht
    International Journal for Quality in Health Care.2021;[Epub]     CrossRef
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    David Metcalfe, Arturo J Rios Diaz, Olubode A Olufajo, M. Sofia Massa, Nicole ABM Ketelaar, Signe A. Flottorp, Daniel C Perry
    Cochrane Database of Systematic Reviews.2018;[Epub]     CrossRef
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    Innie Chen, Newton Opiyo, Emma Tavender, Sameh Mortazhejri, Tamara Rader, Jennifer Petkovic, Sharlini Yogasingam, Monica Taljaard, Sugandha Agarwal, Malinee Laopaiboon, Jason Wasiak, Suthit Khunpradit, Pisake Lumbiganon, Russell L Gruen, Ana Pilar Betran
    Cochrane Database of Systematic Reviews.2018;[Epub]     CrossRef
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    Hangsheng Liu, Carolyn T. A. Herzig, Andrew W. Dick, E. Yoko Furuya, Elaine Larson, Julie Reagan, Monika Pogorzelska‐Maziarz, Patricia W. Stone
    Health Services Research.2017; 52(3): 1079.     CrossRef
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    Na Young Ahn, Hye-Ja Park
    Complementary Therapies in Clinical Practice.2017; 28: 101.     CrossRef
  • Ordinal Regression Methods: Survey and Experimental Study
    Pedro Antonio Gutierrez, Maria Perez-Ortiz, Javier Sanchez-Monedero, Francisco Fernandez-Navarro, Cesar Hervas-Martinez
    IEEE Transactions on Knowledge and Data Engineering.2016; 28(1): 127.     CrossRef
  • Exploring the transparency mechanism and evaluating the effect of public reporting on prescription: a protocol for a cluster randomized controlled trial
    Xin Du, Dan Wang, Xuan Wang, Shiru Yang, Xinping Zhang
    BMC Public Health.2015;[Epub]     CrossRef
  • Application of propensity scores to explore the effect of public reporting of medicine use information on rational drug use in China: a quasi-experimental design
    Xiaopeng Zhang, Lijun Wang, Xinping Zhang
    BMC Health Services Research.2014;[Epub]     CrossRef
  • Changes in the Cesarean Section Rate in Korea (1982-2012) and a Review of the Associated Factors
    Sung-Hoon Chung, Hyun-Joo Seol, Yong-Sung Choi, Soo-young Oh, Ahm Kim, Chong-Woo Bae
    Journal of Korean Medical Science.2014; 29(10): 1341.     CrossRef
  • Managing the Primary Cesarean Delivery Rate
    DAVID WARE BRANCH, ROBERT M. SILVER
    Clinical Obstetrics & Gynecology.2012; 55(4): 946.     CrossRef
English Abstract
The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty.
Won Mo Jang, Sang Jun Eun, Pilyoung Sagong, Chae Eun Lee, Moo Kyung Oh, Juhwan Oh, Yoon Kim
J Prev Med Public Health. 2010;43(6):523-534.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.523
  • 5,080 View
  • 46 Download
  • 1 Crossref
AbstractAbstract PDF
OBJECTIVES
We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. METHODS: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume(over 16 operations in a year) and low volume institutions, after performance reporting (december 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. RESULTS: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p=0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25-0.95) and 10% (beta=-0.102 p<0.01) and cost was not changed (beta=-0.01, p<0.27). The high volume institutions were more decreased than low volume in length of stay. CONCLUSIONS: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginal shifted from low volume institutions to high volume institutions.
Summary

Citations

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  • The factors influencing variation by local areas in antibiotics prescription rate according to the public reporting
    Yu-Jin Chun, Chang-Yup Kim
    Health Policy and Management.2012; 22(3): 427.     CrossRef

JPMPH : Journal of Preventive Medicine and Public Health