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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
  • 3,732 View
  • 224 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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
    Sami Khedhiri
    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
  • 8,775 View
  • 190 Download
  • 6 Crossref
AbstractAbstract 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
  • 10,782 View
  • 159 Download
  • 18 Crossref
AbstractAbstract PDFSupplementary 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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    In Gyu Song, You Sun Kim, Min Sun Kim, Ji Weon Lee, Yoon-Min Cho, Youna Lim, Seong Keun Kwon, Dong In Suh, June Dong Park
    BMJ Paediatrics Open.2024; 8(1): e002377.     CrossRef
  • Geographic Distribution of Central Nervous System Rehabilitation Treatment in Korea and Its Associated Factors
    Dong-Gyun Sohn, Jaehong Yoon, Jun-Soo Ro, Ja-Ho Leigh
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Defining Referral Regions for Inpatient Trauma Care: The Utility of a Novel Geographic Definition
    Cheryl K. Zogg, Robert D. Becher, Michael K. Dalton, Sameer A. Hirji, Kimberly A. Davis, Ali Salim, Zara Cooper, Molly P. Jarman
    Journal of Surgical Research.2022; 275: 115.     CrossRef
  • High Level of Unwarranted Clinical Variation in the Use of Lower Extremity Revascularisation Procedures in Hungary (2013–2017)
    Endre Kolossváry, Tamás Ferenci, Tamás Kováts, Péter Sótonyi, Zoltán Szeberin, Balázs Nemes, Edit Dósa, Katalin Farkas, Zoltán Járai
    European Journal of Vascular and Endovascular Surgery.2022; 63(6): 874.     CrossRef
  • Healthcare utilization among children and young people with life-limiting conditions: Exploring palliative care needs using National Health Insurance claims data
    Cho Hee Kim, In Gyu Song, Min Sun Kim, Jin Yong Lee, Nam Gu Lim, Hee Young Shin
    Scientific Reports.2020;[Epub]     CrossRef
  • Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply
    Agnus M. Kim, Sungchan Kang, Jong Heon Park, Yoon Kim
    International Journal of Environmental Research and Public Health.2020; 17(4): 1244.     CrossRef
  • A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea
    Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
    BMC Pulmonary Medicine.2019;[Epub]     CrossRef
  • Regional Differences in Years of Life Lost in Korea from 1997 to 2015
    Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
    Journal of Korean Medical Science.2019;[Epub]     CrossRef
  • Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply
    Agnus M. Kim, Jong Heon Park, Tae Ho Yoon, Yoon Kim
    BMC Health Services Research.2019;[Epub]     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
  • Geographic variation in health insurance benefits in Qianjiang District, China: a cross-sectional study
    Yue Wu, Liang Zhang, Xuejiao Liu, Ting Ye, Yongfei Wang
    International Journal for Equity in Health.2018;[Epub]     CrossRef
  • Epidemiology of pathogens and antimicrobial resistanceof catheter-associated urinary tract infections in intensivecare units: A systematic review and meta-analysis
    Dan Peng, Xuan Li, Pin Liu, Mei Luo, Shuai Chen, Kewen Su, Zhongshuang Zhang, Qiang He, Jingfu Qiu, Yingli Li
    American Journal of Infection Control.2018; 46(12): e81.     CrossRef
  • Regional variation in healthcare spending and mortality among senior high-cost healthcare users in Ontario, Canada: a retrospective matched cohort study
    Sergei Muratov, Justin Lee, Anne Holbrook, Andrew Costa, J. Michael Paterson, Jason R. Guertin, Lawrence Mbuagbaw, Tara Gomes, Wayne Khuu, Jean-Eric Tarride
    BMC Geriatrics.2018;[Epub]     CrossRef
  • Regional Differences in Years of Life Lost in Korea from 1997 to 2015
    Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
    Journal of Korean Medical Science.2018;[Epub]     CrossRef
  • A framework for the identification and classification of homogeneous socioeconomic areas in the analysis of health care variation
    Ludovico Pinzari, Soumya Mazumdar, Federico Girosi
    International Journal of Health Geographics.2018;[Epub]     CrossRef
  • Senior high-cost healthcare users’ resource utilization and outcomes: a protocol of a retrospective matched cohort study in Canada
    Sergei Muratov, Justin Lee, Anne Holbrook, J Michael Paterson, Jason Robert Guertin, Lawrence Mbuagbaw, Tara Gomes, Wayne Khuu, Priscila Pequeno, Andrew P Costa, Jean-Eric Tarride
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JPMPH : Journal of Preventive Medicine and Public Health